Panes bed to your | MRCS Part A: | Paper 1 SBAs | in Applied Basic Tei (= al ex~) | Second EditionMRCS Part A: Paper 1 SBAs in Applied Basic Science Second Edition Shahzad G Raja BSc, MBBS, MRCS, FRCS(CTh) Specialist Registrar in Cardiothoracic Surgery Department of Paediatric Cardiothoracic Surgery Great Ormond Street Hospital London© 2010 PASTEST LTD Egerton Court Parkgate Estate Knutsford Cheshire WAI6 8DX Telephone: 01565 752000 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior permission of the copyright owner. First Published 2006, Second Edition Published 2010 ISBN: 1905635 648 978 1905635 641 A percentage of questions were previously published in intercollegiate MRCS: 300 Single Best Answer Questions in Applied Basic Sciences (ISBN 9781905635061). A catalogue record for this book is available from the British Library. The information contained within this book was obtained by the author from reliable sources. However, while every effort has been made to ensure its accuracy, no responsibility for loss, damage or injury occasioned to any person acting or refraining from action as a result of information contained herein can be accepted by the publishers or author. PasTest Revision Books and Intensive Courses PasTest has been established in the field of undergraduate and postgraduate medical education since 1972, providing revision books and intensive study courses for doctors preparing for their professional examinations. Books and courses are available for: Medical undergraduates, MRCGP, MRCP Parts 1 and 2, MRCPCH Parts 1 and 2, MRCS, MRCOG Parts 1 and 2, DRCOG, DCH, FRCA, Dentistry. For further details contact: PasTest, Freepost, Knutsford, Cheshire WA16 7BR Tel: 01565 752000 Fax: 01565 650264 www.pastest.co.uk enquires@pastest.co.uk Text prepared by Carnegie Book Production, Lancaster Printed and bound in the UK by CPI Antony Rowe, Chippenham, WiltshireContents Dedication Introduction. Useful Addresses vi The Intercollegiate MRCS Examination vii Abbreviation: ‘ii Questions Anatomy 3 Physiology 45 Pathology 97 Answers Anatomy 149 Physiology 203 Pathology 289 IndexDedication To my parents who made me what | am today and taught me the difference between good intentions and good deeds. To my wife for her patience and unwavering support in all my endeavours. To my sons, Roheen and Sameer, who provide me with limitless pleasure and give me my purpose in life.Introduction This revised and updated second edition of Intercollegiate MRCS: 300 Single Best Answer Questions in Applied Basic Sciences not only has a new title but also includes 60 new questions that conform to the current IMRCS examination format. The revised edition has been updated to remain current with the syllabus and with the subtle changes in the examination philosophy. There are many single best answer guides available for the IMRCS candidates. However, MRCS Part A Paper 1: Single Best Answer Questions in Applied Basic Sciences is the only title that provides ‘real’-type practice questions at the appropriate level for candidates, similar to the exam. The 360 questions in this book are divided into three major sections, namely Anatomy, Physiology, and Pathology; each section has 120 questions with answers and detailed teaching notes. The questions in the book are designed to enable candidates to master large amounts of information in a limited amount of time as well as review important topics quickly and easily. There is a natural tendency to avoid the harder and more confusing topics, but rather than avoiding these, | have deliberately included them so that the candidates can use these to their advantage; everyone will get the easy questions right, but the students who enter the examination having done the more difficult questions should not just pass, but pass well. | am hopeful that this revised edition will prove more useful for the IMRCS candidates as it has been prepared in direct response to the feedback from the candidates who have sat the IMRCS examination. It is expected that | will be guided by constructive criticism and useful suggestions in the future as well. Last but not the least, | take this opportunity to acknowledge the numerous sources and resources which have been used in the preparation of this revised edition. Shahzad G RajaUseful Addresses The Royal College of Surgeons of England 35-43 Lincoln’s Inn Fields London WC2A 3PE Tel: 0207 869 6281 (+ 44 20 7 405 3474) www.rcseng.ac.uk The Royal College of Surgeons of Edinburgh Information Section Adamson Centre 3 Hill Place Edinburgh EH8 9DS Tel: 0131 668 9222 (+ 44 131 668 9222) www.rcsed.ac.uk The Royal College of Physicians and Surgeons of Glasgow 232-242 Vincent Street Glasgow G2 5R} Tel: 0141 221 6072 (+ 44 141 2216072) www.rcpsg.ac.uk The Royal College of Surgeons in Ireland 123 St Stephens Green Dublin 2, Ireland Tel: +353 1402 2223 (+ 353 1402 2100) wwwicsiieThe Intercollegiate MRCS Examination From September 2008, the Intercollegiate MRCS examination has altered in order to reflect the new pattern of surgical training introduced in the UK in 2007. All new candidates in the UK must take this new exam. The exam consists of two parts: Part A - written component This is made up of two papers of multiple choice Single Best Answer Questions (SBAs) and Extended Matching Questions (EMQs). Paper 1 SBAs focuses on Applied Basic Science and Paper 2 EMQs on Principles of Surgery-in-General. Each paper lasts 2 hours and both are taken on the same day. Part B - OSCE (objective structured clinical examination) This replaces the previously separate viva and clinical components and has been introduced in order for the MRCS to conform to PMETB (Postgraduate Medical Education Training Board) requirements. To be eligible for part B, you must have passed part A. Candidates are currently allowed four attempts in which to pass the Part B OSCE. For full and up-to-date information, visit www.intercollegiatemrcs. org.uk.Abbreviations ASE ACE ADH AFP AIDS A\CC ARDS ARF ATN AV cAMP CCK CEA CN CNS co corpD COx-2 cPK RP CSF ct cvp DHT Dico 2,3-DPG DPL DVT ECF EDV EF ESD ESR accident and emergency department angiotensin-converting enzyme antidiuretic hormone a-fetoprotein acquired immune deficiency syndrome American Joint Committee on Cancer acute respiratory distress syndrome acute renal failure acute tubular necrosis atrioventricular cyclic adenosine monophosphate cholecystokinin carcinoembryonic antigen cranial nerve central nervous system cardiac output chronic obstructive pulmonary disease cyclo-oxygenase-2 creatine kinase C-reactive protein cerebrospinal fluid computed tomography central venous pressure 58-dihydrotestosterone carbon monoxide diffusing capacity 2,3-diphosphoglycerate diagnostic peritoneal lavage/tap deep venous thrombosis extracellular fluid end-diastolic volume ejection fraction end-systolic volume erythrocyte sedimentation rateFEV, FGF FNA FRC FVC GFR GH GM-CSF GORD GVHD HBV B-hCG HDL HIV HLA HR Icu IP Ivc IGA \vP LAP LDH LDL LMW MAC MAP MCH MCHC MCV MEN MIP MPAP MRI MRSA MSSA Abbreviations forced expiratory volume in 1s fibroblast growth factor fine-needle aspiration functional residual capacity forced vital capacity glomerular filtration rate growth hormone granulocyte—macrophage colony-stimulating factor gastro-oesophageal reflux disease graft-versus-host disease hepatitis B virus B-human chorionic gonadotrophin high-density lipoprotein human immunodeficiency virus human leukocyte antigen heart rate intensive care unit inositol triphosphate inferior vena cava juxtaglomerular apparatus jugular venous pulse (pressure) left atrial pressure lactate dehydrogenase low-density lipoprotein low-molecular-weight membrane attack complex mean arterial pressure mean corpuscular haemoglobin mean corpuscular haemoglobin concentration mean corpuscular volume multiple endocrine neoplasia macrophage inflammatory protein mean pulmonary artery pressure magnetic resonance imaging methicillin-resistant Staphylococcus aureus methicillin-sensitive Staphylococcus aureusMRCS Part A: Paper 1 SBA NK NSAID NSGCT PAF PAH PAWP PE PNS Pog RBCs RF RPF RV SA SAA SIADH SLE SV SvO, SVR Ts TB TGF Th1 TLC TNM tPA TPN TRH TSH uicc UTI VC VIP natural killer non-steroidal anti-inflammatory drug non-seminomatous germ-cell tumour platelet-activating factor p-aminohippuric acid pulmonary artery wedge pressure partial pressure of carbon dioxide pulmonary embolism parasympathetic nervous system partial pressure of oxygen red blood cells rheumatic fever renal plasma flow residual volume sinoatrial serum amyloid A syndrome of inappropriate ADH secretion systemic lupus erythematosus stroke volume mixed venous oxygen saturation systemic vascular resistance triiodothyronine thyroxine tuberculosis transforming growth factor T-helper cell total lung capacity tumour, node, metastases tissue plasminogen activator total parenteral nutrition thyroid-releasing hormone thyroid-stimulating hormone Union Internationale Contre le Cancer urinary tract infection vital capacity vasoactive poplypeptideQuestionspt gin ange apa taleSection 1: Anatomy Questions For each question given below choose the SINGLE BEST option. 1.1. Following ton: lectomy, a patient noted loss of general sensation and taste from the posterior one-third of the tongue. It could be assumed that the nerve that was injured was a branch of the: A 00000 N Facial nerve Glossopharyngeal nerve Hypoglossal nerve Lingual nerve Vagus nerve Which one of the following arteries can be felt pulsating at the lower border of the mandible just anterior to the masseter muscle? A O000®8 Facial artery Lingual artery Maxillary artery Superficial temporal artery Transverse facial artery anatomyAwio}eue MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior 1.3 O00@O *& O0@O0O moO 8 wu O000® moo Which one of the following structures lies parallel and immediately deep to the carotid sheath in the neck? A Internal jugular vein Superior ramus of the ansa cervicalis Sympathetic trunk Trachea mgae Vagus nerve While mobilising the second part of the duodenum a vital structure got injured. Which one of the following structures is it most likely to be? A Gallbladder Hilum of the right kidney Left lobe of the liver Superior mesenteric artery Transverse colon Injury to which one of the following nerves will result in an inability to dorsiflex and evert the foot? A Common peroneal nerve Deep peroneal nerve Femoral nerve Superficial peroneal nerve Tibial nerve& 00000 & O000@8 & @®0000 moO ® Questions Which one of the following is the most superficial structure encountered while performing dissection in the popliteal fossa? A Popliteal artery Popliteal vein Posterior tibial artery Profunda femoris artery Tibial nerve mQO8 anatomy A 43-year-old woman was diagnosed as having a meningioma that was compressing the neural contents within the right jugular foramen. Which one of the following clinical features is most likely to be seen in this patient? A Inability to elevate soft palate B_ Inability to protrude tongue C_ Inability to turn chin upwards and to the left D_ Loss of pain from the anterior two-thirds of the tongue E Sensory loss from skin overlying the zygomatic bone A 56-year-old man was found to have enlarged submental lymph nodes. Enlargement of the submental lymph nodes is suggestive of pathology of which one of the following structures? A Hard palate Maxillary incisors Palatine tonsils Soft palate Tip of the tongueAwio}eue MRCS Part 19 O@000 = 3 O000®@ "970 8 O@000 = ™O0 8 A 26-year-old motorcyclist was brought to the Emergency Department with a fractured right humeral shaft. Which one of the following nerves is most likely to be injured in a fracture of the humeral shaft? A Axillary nerve Median nerve Musculocutaneous nerve Radial nerve ™O0 8 Ulnar nerve A 36-year-old builder falls from the ladder resulting in the entire greater tubercle of the left humerus being torn away. Which one of the following movements of the humerus would be affected as a result of this injury? A Abduction and lateral rotation Extension and medial rotation Flexion and medial rotation Flexion, abduction and adduction Flexion and abduction Clinical examination of a 56-year-old man reveals absent vibratory sensation in the toes. Absent vibratory sensation in the toes may indicate a lesion in the: A Anterior nerve roots Anterior spinothalamic tract Lateral columns of the spinal cord Posterior white columns of the spinal cord Spinotectal tractQuestions 112 A 67-year-old patient with atrial fibrillation has an embolic stroke. A computed tomography (CT) scan reveals extensive infarction of the medial surface of the frontal, parietal and limbic lobes. Embolic occlusion of which one of the following arteries affect the blood supply to the medial surface of the frontal, parietal and limbic lobes? A Anterior cerebral artery Anterior choroidal artery Anterior communicating artery Middle cerebral artery Posterior cerebral artery O000®@ a .13 Which one of the following structures is most likely to be damaged if a lesion in the caudal medulla resulted in ipsilateral loss of perception of pain over much of the face? > Dorsal trigeminothalamic tract Lateral spinothalamic tract Medial lemniscus Spinal trigeminal tract O@000 Ventral trigeminothalamic tract 2 & Which one of the following pairs of nerves supplies the biceps femoris muscle? A Femoral and common peroneal nerves Femoral and obturator nerves Obturator and tibial nerves Tibial and common peroneal nerves mga Tibial and femoral nerves O©000 anatomyAwio}eue MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior 115 O000e@ OCO0C@O =z m™m™oOaQ 8 ™O9 8B g O00@O0 Patients with myocardial infarction usually experience excruciating pain running down the left upper extremity. This referred pain is relayed by the: A Left intercostobrachial nerve Left musculocutaneous nerve Left phrenic nerve Left recurrent laryngeal nerve Left vagus nerve Which one of the following structures forms the lateral boundary of the superior mediastinum? A Lateral border of the sternum Mediastinal pleura Roots of the lungs Sternal angle TI-T4 vertebrae Which one of the following parts of the heart will be damaged as a result of occlusion of the circumflex branch of the left coronary artery? > Apex of the heart Left atrium and left ventricle Left ventricle and interventricular septum Right atrium and left ventricle Right and left ventricles moo1.18 @0000 o |. § 00008 00000 Questions An FY doctor, while performing a posterolateral thoracotomy injures the posterior intercostal artery in the fifth intercostal space on the left side. The posterior intercostal artery in the fifth intercostal space arises from the: A moa8 Costocervical trunk Internal thoracic artery Musculophrenic artery Subclavian artery anatomy Thoracic aorta The site of the cloacal membrane (which is also the point of demarcation between the endodermal and ectodermal epithelium) is represented in the adult anal canal by the: A mOn@ Anal valves (pectinate/denate line) External anal sphincter Rectal columns ‘Transition zone White line A newborn baby is diagnosed as having a vitelline duct anomaly. Which one of the following is a vitelline duct anomaly? > moO ® Duodenal stenosis Gastroschisis Omphalocele Umbilical fistula Umbilical herniaAwio}eue c00d80 ™O0 8 MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior 1.21 .22 © OO 00 A 22-year-old man is stabbed in the axilla. There is profuse bleeding from the axillary artery. Which of the following statements about the axillary artery is true? A It originates from the arch of the aorta It gives origin to the thoracoacromial artery It has the lateral thoracic artery as its first branch It divides into radial and ulnar arteries in the cubital fossa It provides no blood supply to the humerus A man stabbed in a bar fight suffers a penetrating wound through the anterior axillary fold, with resulting damage to one of the main terminal branches of the brachial plexus. Clinical examination in the Emergency Department revealed a significant weakening of flexion of the elbow. The other effect to be expected is: A Loss of cutaneous sensation on the tips of several fingers B Loss of cutaneous sensation just on the anterolateral surface of the forearm Just weakening of flexion at the shoulder D_ Weakening of flexion at the shoulder and loss of cutaneous sensation on the anterolateral surface of the arm E Weakening of flexion at the shoulder and loss of cutaneous sensation on the anterolateral surface of the forearm23, O0008 moO ® Nv ES O0@00 mone N a @0000 Questions After a road traffic accident a young man is noticed to have suffered injury to the lower subscapular nerve. Injury to the lower subscapular nerve will affect the function of: A. Teres major muscle Teres minor muscle Deltoid muscle Supraspinatus muscle Infraspinatus muscle anatomy A 62-year-old woman has a loop of bowel herniating into the femoral canal. Which of the following statements best describes the femoral canal? A_ It is superficial to the inguinal ligament It transmits the obturator nerve It is the medial compartment of the femoral sheath It transmits the femoral artery It is lateral to the femoral nerve Clinical examination of a patient with a diabetic ulcer in the anterior midline of the ankle region elicited loss of cutaneous sensation on the dorsal surface of the foot. Which nerve was most probably damaged? A Femoral B Lateral sural cutaneous C Saphenous D_ Sural E Superficial peronealAwio}eue MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior 1.26 A 20-year-old man presents to the Emergency Department with features suggestive of common peroneal nerve injury. The common peroneal nerve is most commonly injured: A Where it emerges below the piriformis muscle B_ At the site where it divides into the superficial and deep peroneal nerves Where it leaves the sciatic nerve in the popliteal fossa D_ As it branches into the head of the biceps femoris E Just behind the head of the fibula @00 OO = .27 A 2-year-old baby developed chylothorax as a result of iatrogenic injury to the thoracic duct at the time of surgery to correct a congenital cardiac defect. Which of the following statements about the thoracic duct is true? A It returns lymph from the convex surface of the liver B_ It extends from the fifth lumbar vertebra to the root of the neck It enters the thorax through the aortic hiatus of the diaphragm D_ It ends by opening into the angle of junction of the right subclavian vein with the right internal jugular vein E It has no valves to ensure smooth flow of lymph OO © 00 N o A patient with acute anal fissure has severe pain. The pain sensations in this condition are transmitted by: A The superior rectal nerve The inferior rectal nerve The pelvic splanchnic nerve The perineal nerve The posterior scrotal nerve O0O000 mone 2image not availableAwio}eue MRCS Part A: Paper 1 SB) Applied Basic Scienc Editior 1.32 A patient with an ulcerative carcinoma of the posterior third of the tongue presented to the Emergency Department with arterial bleeding from the lesion. Which of the following arteries was involved? A Deep lingual Dorsal lingual Facial Sublingual ™O0 8 Tonsillar OO0000 = w w After a myocardial infarction a patient underwent coronary angiography, which showed a blockade in the left coronary artery. Which of the following statements about the left coronary artery is true? A. Itis smaller than the right coronary artery B_ It gives off a large marginal branch C_ It continues to the apex of the heart as the posterior descending branch D_ It supplies both ventricles E It supplies the whole of the conducting system of the heart OO 000 w & A 40-year-old man with dysphagia underwent oesophagoscopy, which revealed an exophytic growth in the abdominal part of the oesophagus. Which of the following statements about the abdominal portion of the oesophagus is true? A It lies in the oesophageal groove on the posterior surface of the right lobe of the liver B_ It is about 3.5cm in length It is supplied by the left gastric branch of the coeliac artery D_ It is completely intraperitoneal 00 00 O E It is mainly innervated by the left phrenic nerveimage not availableimage not availableimage not availableAwio}eue MRCS Part A: Paper 1 SB) Applied Basic Science, Second Editior 1.44 A patient presents to the Emergency Department with a bullet wound that has severed the musculocutaneous nerve at its origin. On clinical examination which of the following will be elicited? A Action of supinator Action of brachialis Action of coracobrachialis Action of biceps brachii Sensations over lower two-thirds of the dorsolateral surface of the forearm OO0000 ™O0 8 FS 45 During cranial nerve examination, the integrity of the right trochlear nerve can be tested by asking the patient to look: A Towards the nose in a horizontal plane Inwards, towards the nose and downwards Laterally in a horizontal plane Outwards, away from the nose and downwards Inwards, towards the nose and upwards O0O000 moO 8 FS 6 Clinical examination of a patient complaining of frequent episodes of aspiration of fluid into her lungs after subtotal thyroidectomy revealed that the area of the piriform recess above the vocal fold of the larynx was numb. This is the result of intraoperative injury to: A The lingual nerve The recurrent laryngeal nerve The external branch of the superior pharyngeal nerve The hypoglossal nerve O0000 ™9A8 The internal branch of the superior laryngeal nerveimage not availableimage not availableimage not availableAwio}eue MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior 1.56 OO000 u N O 00 OO wu o 00000 After a right-sided mastectomy a woman complains of winging of the scapula. The most likely nerve to be injured in this operation is: A. The long thoracic nerve The accessory nerve The lateral pectoral nerve The phrenic nerve The vagus nerve mgae A patient with aortic dissection suffered infarction of the lower spinal cord as a result of extension of the dissection into the artery of Adamkiewicz. Which of the following statements best describes this artery? A It is also known as the artery of lumbar enlargement B_ It is aradicular artery in the lower thoracic or upper lumbar region C_ It is most frequently found on the right side D_ It has extensive anastomoses on the surface of the sacral spinal cord E It passes through foramina in the bodies of the vertebrae to reach the cord A super I cut on the ulnar side of forearm is most likely to damage: A The basilic vein The cephalic vein The median cubital vein The median antebrachial vein "9908 The ulnar veinimage not availableimage not availableimage not availableAwio}eue MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior a O0000 a 9 O0000 moO 8 N ° OO0000 moo Compared with the ileum, the jejunum: A Is narrow Is thinner Is less vascular Has larger villi Has more numerous Peyer’s patches moO 8 While performing exploratory laparotomy, which of the following features will help you to distinguish the ileum from the jejunum? A It possesses numerous circular folds It chiefly occupies the umbilical and left iliac regions It has larger and more numerous aggregated lymph nodes It is more vascular It is retroperitoneal A 62-year-old with chronic alcohol problems developed obstructive jaundice as a result of a carcinoma in the head of the pancreas. Which of the following statements about the head of the pancreas is true? A. It is lodged within the curve of the jejunum It is posteriorly related to the superior mesenteric vessels It is posteriorly related to the root of the mesentery It is posteriorly related to the common bile duct It is anteriorly related to the right crus of diaphragmimage not availableimage not availableimage not availableAwio}eue MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior OO O 00 O0000 mone Which of the following statements best describes the transpyloric plane? A. It lies midway between the nipples and the pubic symphysis B It lies roughly a hand’s breadth below the xiphisternal joint C It passes anteriorly through the tip of the tenth costal cartilage D It passes posteriorly through the body of the second lumbar vertebra near its lower border E It cuts through the body of the stomach A 25-year-old man arrived in the Emergency Department with a firearm injury to the right popliteal fossa that had severed his popliteal artery. Which of the following statements about the popliteal artery is true? A It is the continuation of the profunda femoral artery B_ It divides at the lower border of adductor magnus into its terminal branches C Inthe middle part of its course, it is crossed from the lateral to the medial side by the tibial nerve and the popliteal vein D_ It is related laterally to semimembranosus E It is related medially to biceps femoris An acoustic neuroma (tumour of the eighth cranial nerve) is also likely to involve: A The glossopharyngeal nerve The abducent nerve The trigeminal nerve The facial nerve The vagus nerveimage not availableimage not availableimage not availableAwio}eue MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior 00000 § © 2 00000 moae O0000 ™9V0O 8 The cremasteric muscle is an extension of: A The external abdominal oblique muscle The internal oblique muscle The rectus abdominis muscle The pyramidalis muscle The dartos muscle moO 8 Which of the following structures corresponds to the T8 vertebral level? A The manubriosternal junction The inferior angle of scapula The medial end of spine of scapula The vena caval opening in diaphragm The suprasternal notch While mobilising structures in the pelvis to perform abdominoperineal resection, the surgeon accidentally injures a branch of the posterior division of the internal iliac artery. Which of the following is most likely to be injured? A Superior vesical artery Superior gluteal artery Obturator artery Internal pudendal artery Middle rectal arteryimage not availableimage not availableimage not availableAwio}eue MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior 1.103 The masseter is an important muscle of O000 O ™O0 8 mastication. Which of the following statements about the masseter is true? A It extends almost horizontally between the infratemporal fossa and the condyle of the mandible It consists of superficial and deep portions It arises by two heads It assists in opening the mouth It is supplied by the seventh cranial nerve 1.104 During a carotid endarterectomy, the spinal O0000 accessory nerve (cranial nerve XI) is damaged with resultant weakness and atrophy of: A Rhomboid major Teres minor ‘Trapezius Levator scapulae moa 8 Splenius capitis 1.105 During cholecystectomy, which of the following O O 000 38 gross features of the gallbladder is noticed? A. The fundus is completely retroperitoneal B_ The neck is wide and dilated C_ The body is in relation, via its undersurface, with the start of the jejunum D_ The cystic duct of the gallbladder courses independently to the duodenum — The fundus of the gallbladder usually lies at the tip of the ninth costal cartilage, in the midclavicular lineimage not availableimage not availableimage not availableAwio}eue MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior 1115 O000 O 1.116 O00 00 1.117 00 0 00 Jugular foramen tumours are rare skull-base lesions that present diagnostic and complex management problems, Which of the following statements about the jugular foramen is true? A It is situated behind the carotid canal on the base of the skull It is divided into two compartments It transmits the mandibular nerve It transmits the transverse sinus ™O0 8 It transmits the hypoglossal nerve Which of the following features help to identify the clavicle? A It is a short bone B_ It has a facet for articulation with the coracoid process of the scapula C_ Its medial two-thirds are flattened from above downwards D_ The anterior border of the lateral third gives attachment to the deltoid E The posterior border of the lateral third gives attachment to the sternocleidomastoid The lumbrical muscles of the hand are vital for pianists and typists. Which of the following statements about the lumbrical muscles of the hand is true? A There are five in number B_ They are associated with the tendons of flexor digitorum superficialis C_ They are inserted into the distal interphalangeal joint of the corresponding finger D_ They are all innervated by the ulnar nerve E They assist in extension of the middle and distal phalangesimage not availableimage not availableimage not availableABojoisAyd MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior 2.3 O0000 O0000) & O0O00O g mon ® ™O0 8 A 22-year-old athlete is running the London marathon. Which one of the following mechanisms is the most important for maintaining increased blood flow to this athlete’s skeletal muscles? A Anincrease in aortic pressure An increase in a-adrenergic impulses An increase in B-adrenergic impulses Vasoconstriction in the splanchnic and renal areas Vasodilation secondary to the effects of local metabolites A patient with chronic obstructive pulmonary disease undergoes measurement of his lung volumes and capacities prior to undergoing major abdominal surgery. The volume of gas in his lungs at the end of a normal expiration is referred to as the: A Expiratory reserve volume Functional residual capacity Inspiratory reserve volume Residual volume ™Og9n0 8 Total lung capacity Following extubation, arterial blood gas analysis of a patient showed raised Paco, levels. Hypercapnia affects respiration primarily by stimulating the: A Arterial baroreceptors Carotid and aortic bodies Central (medullary) chemoreceptors Hypoglossal nerve J receptorsimage not availableimage not availableimage not availableAbojoiskyd MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior 2.14 A semicomatose 17-year-old girl is brought to the Emergency Department with dry skin, hyperventilation, and a rapid pulse rate. The following blood results were obtained: pH = 7.14 pCO, = 30mmHg Na* = 140mEq/L K+ = 4.5mEq/L Cl = 82mEq/L HCO,” = TimEg/L glucose = 180mg/dL What is the most likely diagnosis based on the above clinical presentation and laboratory data? A Hypoglycaemia Metabolic acidosis Metabolic alkalosis Respiratory acidosis QO0000 "908 Respiratory alkalosis N = a A 56-year-old patient is taking spironolactone (an aldosterone antagonist). What will be the effects of this drug on Na* and K* excretion? A Nat = decreased; K* = decreased Nat = decreased K* = increased Na* = increased K* = decreased Nat = increased K* = increased Nat = increased K* = unchanged QO0000 moneimage not availableimage not availableimage not availableABojoiskyd MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Edition O000CO & N N 22 00000 N N 23 O0000 ™9V0O 8 Insulin is produced by the f cells of the islets of Langerhans in the pancreas. Insulin secretion from endocrine pancreas is inhibited by: A Glucagon a,-Adrenergic agonists B,-Adrenergic agonists Cholecystokinin Muscarinic agonists mgae Vasopressin is released from the posterior pituitary gland when there is a decrease in plasma: > Potassium concentration Sodium concentration pH Volume moaA@ Calcium concentration The second heart sound is produced by the closure of the aortic and pulmonic valves. Closure of the aortic valve occurs at the onset of: A The rapid ejection phase of the cardiac cycle The isovolumetric contraction phase of the cardiac cycle The protodiastole The rapid filling phase of the cardiac cycle The isovolumetric relaxation phase of the cardiac cycleimage not availableimage not availableimage not availableABojoiskyd MRCS Part A: Paper 1 SBA 2.32 Oo O000 N w 3 O0000 When air enters the intrapleural space (pneumothorax), the most likely response is for: A The lung to expand outwards and the chest wall to spring inwards B_ The lung to expand outwards and the chest wall to spring outwards C_ The lung to collapse inwards and the chest wall to collapse inwards D_ The lung to collapse inwards and the chest wall to spring outwards E The lung volume to be unaffected and chest wall to spring outwards Haemodynamic changes in response to obstruction of venous return to the right side of heart include: A Cardiac output will fall and systemic arterial blood pressure will fall B Cardiac output will rise and systemic arterial blood pressure will rise C Cardiac output will fall and systemic arterial blood pressure will rise D_ Cardiac output will fall and systemic arterial blood pressure will remain unchanged —£ Cardiac output will remain unchanged and systemic arterial blood pressure will fallimage not availableimage not availableimage not availableAbojoiskyd MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior 2.42 O0000 ™O0 8 N FS 43 O0000 A patient on the surgical ward is noted to have metabolic alkalosis with a urine CI" concentration of <15mmol/L. Which of the following conditions is most likely to be associated with this abnormality? A Nasogastric suctioning Mineralocorticoid excess Alkali loading Concurrent diuretic administration Severe hypokalaemia The ejection fraction is a measurement of the heart's efficiency and can be used to estimate the function of the left ventricle, which pumps blood to the rest of the body. In a resting healthy individual the ejection fraction is: A 20% 30% 45% 260% 90% moO 8image not availableimage not availableimage not availableABojoiskyd MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior 2.50 A 23-year-old man arrived in the Emergency Department in shock with profuse bleeding from his femoral vessels after a gun shot injury to his right groin. Which of the following changes is most likely to be anticipated in this patient? > Decreased release of thromboxane A, at the site of injury Increased baseline vagal tone Dilatation of veins and venous reservoirs Increased renin secretion from the juxtaglomerular apparatus Decreased level of circulating ADH O O000 mm 9A N a A 16-year-old girl is admitted with mitral stenosis caused by rheumatic heart disease. A rise in which of the following parameters is consistent with this patient's valvular lesion? A Aortic pressure Cardiac output Left atrial pressure Left ventricular end-systolic volume cvP QO0000 mon @ Ni w 2 You are looking at an ECG strip that shows sinus bradycardia. Which of the following conditions is most likely to be associated with this ECG finding? OQ A Hypovolaemia O 8B Hypothermia OQ C Vasodilator therapy QD Irjection of atropine O E Feverimage not availableimage not availableimage not availableABojoiskyd MRCS Part A: Paper 1 SB) plied Basic Science, Second Editior 2.59 A 46-year-old man with a mechanical mitral valve and atrial fibrillation developed mesenteric ischaemia as a result of thromboembolism from the valve. Upon exploratory laparotomy the whole of the jejunum was noticed to be gangrenous and resected. Absorption of which of the following substances is likely to be affected in this patient? A Vitamin By, Water Electrolytes Bile salts Fat-soluble vitamins ™O0 8 O0000 N a .60 After a total hip replacement a 78-year-old woman developed a pulmonary embolism that caused obstruction of a branch of the pulmonary artery. Which of the following is likely to increase in this patient? A Ventilation/perfusion ratio Lung volume Arterial CO, Arterial O, Alveolar O, saturation QO0000 mone N: a a A woman pulled from a fire is markedly hypoxic. Respiration in this patient will be rapidly influenced by hypoxia through its stimulatory effect: A. Directly on the medullary respiratory neurons Directly on the pulmonary mechanoreceptors On the central chemoreceptors On the carotid and aortic chemoreceptors Directly on the Hb—-O, dissociation curve O0O000 moneimage not availableimage not availableimage not availableABojoiskyd MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior 2.66 A 26-year-old man falls from a ladder and sustains injury to the back of his neck. Computed tomography (CT) reveals a bony fragment that penetrated the lateral portion of the dorsal columns. Which of the following functions is most likely to be affected by this lesion? Vibratory sensations from the ipsilateral arm Fine motor control of the ipsilateral fingers Motor control of the contralateral foot Sweating of the ipsilateral face Proprioception from the ipsilateral leg QQ0000 ™OIO8 > N a .67 A 55-year-old man is admitted to an ICU with acute respiratory distress syndrome. Which of the following variables is most likely to be lower than normal in this patient? A Oncotic pressure of alveolar fluid Work of breathing Lung compliance Alveolar—arterial pressure difference Surface tension of alveolar fluid QO0000 mon @ N a 8 A 43-year-old man has a parathyroid adenoma producing elevated levels of parathyroid hormone. Which of the following statements about parathyroid hormone is true? A Increased ionised calcium levels are essential for its release B_ It causes increased deposition of calcium in bones It stimulates production of the active form of vitamin D in the small intestine D_ It stimulates loss of phosphate ions in the urine E It stimulates excretion of calcium in the urine OO 00 Oimage not availableimage not availableimage not availableAbojoiskyd MRCS Pa 2.77 O000 0 N N 00000 When a patient has a lower than normal haemoglobin, it is important to determine whether RBCs are of normal size and whether they have a normal concentration of Hb. These measurements, known as erythrocyte or RBC indices, provide important information about various types of anaemia. Which of the following is correct? A Mean corpuscular volume (MCV) = Haematocrit x Total RBC count B MCV = Hb x Total RBC count Mean corpuscular haemoglobin (MCH) = Haemoglobin x [Total RBC count/100] D MCH concentration (MCHC) = [Haemoglobin/Haematocrit] x 100 E MCHC = Haemoglobin/Total RBC count A 22-year-old woman with paroxysmal hypertension, tachycardia, diaphoresis, tachypnoea, flushing, cold and clammy skin, severe headache, angina and palpitation is diagnosed with a phaeochromocytoma. The urine levels of which of the following substances will be high in this patient? A Dehydroepiandrosterone Pregnanetriol Cortisol Homovanillic acid ™9O0 8 5-Hydroxyindoleacetic acidimage not availableimage not availableimage not availableAbojoiskyd MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior 2.86 Potassium affects the way the cell membranes work and governs the action of the heart and the pathways between the brain and the muscles. Which of the following statements about potassium metabolism is true? A 98% of potassium is extracellular B_ Total body potassium stores are approximately 100 mmol/kg (7000 mmol in a 70kg person) The liver determines potassium homeostasis D_ Early changes of hyperkalaemia include inverted T waves and a prolonged Q-T interval O 00 OO E Acidosis results in hyperkalaemia N 2 .87 A phospholipase is an enzyme that converts phospholipids into fatty acids and other lipophilic substances. There are four major classes, termed A, B, C and D. Phospholipase C acts as a secondary messenger. Which of the following statements about phospholipase C is true? A It frees a fatty acid bound in an ester linkage to carbon-2 of glycerol B Its activity is stimulated by hormone-receptor interactions coupled to a Gp protein It initiates a cascade, resulting in the activation of protein kinase A D_ It initiates a cascade, resulting in the activation of guanylyl! kinase E It initiates a cascade, resulting in the activation of tyrosine kinase 00000image not availableimage not availableimage not availableAbojoiskyd MRCS Part A: 2.95 After coronary artery bypass surgery a 56-year-old man develops atelectasis of both lung bases. The physiotherapist advises him that deep inspiration followed by gradual expiration will be good for him. Which of the following events takes place during deep inspiration? A 0000 O ™O0 8 N ‘o The pressure gradient between the peripheral veins and the right atrium decreases Pulmonary blood volume decreases Cardiac output of the right ventricle increases Cardiac output of the left ventricle increases Venous return to the left atrium increases .96 A patient with low systemic vascular resistance after cardiac surgery is started on an infusion of a vasoconstrictor agent. Which of the following effects is likely to be produced by the vasoconstrictor agent in this patient? A QO0000 mone Increased end-diastolic volume Decreased preload Decreased stroke volume Increased end-diastolic reserve volume Decreased work of the heartimage not availableimage not availableimage not availableAbojoiskyd MRCS Part A: 2.104 A marathon runner was disquali ‘ied from the Athens Olympics because he was found to have used erythropoietin to enhance endurance. Which of the following features is a marker of erythropoietin-stimulated bone marrow? A OO000 ™O0 8 Low reticulocyte count Decreased radioactive plasma iron turnover Decreased serum ferritin Increased myeloid:erythroid ratio Shift cells in the peripheral blood film 2.105 The blood clotting system or coagulation pathway, similar to the complement system, is a proteolytic cascade. Which of the following statements about the coagulation pathway is true? A 00 0 0 0 The Hagemann factor (factor XII), factor XI, prekallikrein and high-molecular-weight kininogen are involved in the extrinsic pathway of coagulation The intrinsic pathway provides a very rapid response to tissue injury, generating activated factor X almost instantaneously The intrinsic and extrinsic systems converge at factor X to a single common pathway, which is ultimately responsible for the production of thrombin (factor Ila) The end result of the clotting pathway is the production of fibrin for the conversion of prothrombin to thrombin The coagulation pathway acts independently of other plasma enzyme systemsimage not availableimage not available2.112 00 00 O Question: A 26-year-old motorcyclist arrived in the Emergency Department after an accident. He was conscious and haemodynamically stable. The only Significant finding was leakage of clear fluid from the nose. To confirm the diagnosis of cerebrospinal fluid (CSF) rhinorrhoea a sample of the fluid was sent for immunoelectrophoresis. Which of the following statements about CSF is true? A The normal circulating volume of CSF is 500ml B_ Circulating CSF is absorbed into the lymphatic circulation through the cranial arachnoid granulations and spinal arachnoid villi C Normal CSF pressure is 100-200 mmHg D_ The normal CSF protein content is 20—-45mg/L E The normal CSF glucose range is 50-100 mg/dl A 45-year-old woman developed position-sensitive vertigo accompanied by nausea, vo ig and malaise after a recent viral illness. She was told that she had an inflammation or dysfunction of the vestibular labyrinth, which would resolve after a few days. Which of the following statements about the vestibular labyrinth is true? A The vestibular labyrinth consists of the cochlea and otolith organs The utricle senses motion in the horizontal plane o C_ The semicircular canals are sensitive to motion in the sagittal plane D_ The sensory portion of the otolith organs is the ampulla E The structure of the utricle and saccule is similar to that of the semicircular canals physiologyAbojoiskyd MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Edition 2.114 The neurological examination of a 63-year-old patient with diabetes reveals a lesion involving the right anterior spinothalamic tract at the level of the sixth cervical vertebra. The patient will have: A Contralateral loss of crude touch and pressure sensation below the level of the lesion B Contralateral loss of pain and temperature sensation below the level of the lesion Ipsilateral loss of crude touch and pressure sensation below the level of the lesion D Ipsilateral loss of pain and temperature sensation below the level of the lesion E Loss of the ability consciously to perceive the position and movements of the ipsilateral limb below the level of the lesion O0000 2.115 The liver receives a dual blood supply. Which of the following statements about hepatic circulation is true? A. The portal area can hold about three-quarters of the total blood volume B_ The average minute blood flow in the hepatic circulation is about 300ml/100q of liver tissue Oo Oo QC The hepatic artery supplies 50% of the total hepatic blood flow Oo Oo D_ Pressure in the portal vein is about 8-10 mmHg E Hepatic blood flow increases during moderate exerciseQuestions 2.116 A 65-year-old man had an embolic stroke that affected his dominant Broca’s area. This patient will have: Sensory aphasia Anomic aphasia Receptive aphasia Global aphasia Motor aphasia O0000 2.117 A 78-year-old man with urinary hesitancy and orthostatic hypotension is seen in the Emergency Department. On clinical examination he had pill- rolling movements of his right hand, bradykinesia and rest tremor. The patient most probably has a lesion involving: A_ The motor cortex The neostriatum The substantia nigra The hypothalamus The red nucleus 00000 2.118 A weightlifter was banned from competing in international events after unusually high levels of testosterone were detected in his blood during random dope testing at the Commonwealth Games. Which of the following statements about testosterone is true? A_ It binds to the cell surface receptor B_ It is reduced to dehydroepiandrosterone by the cytoplasmic enzyme Sareductase C_ It decreases bone density D_ It stimulates bone marrow E It has no effect on the larynx O00 OO physiologyAbojoiskyd MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior 2.119 Immunoglobulins are glycoproteins in the immunoglobulin superfamily that function as antibodies. They are grouped into five classes or isotypes: IgG, IgA, IgM, IgD and IgE. Which of the following statements about lg isotypes is true? A IgG is the most abundant immunoglobulin IgA is the only isotype that can pass through placenta IgM has the smallest molecular mass IgD mainly acts as opsonin OO000 ™O0 8 IgE is a polymeric immunoglobulin 2.120 Serial lactate determinations may be helpful in patients resuscitated from shock to assess the adequacy of therapies. Which of the following statements about lactate is true? A The normal blood lactate concentration in unstressed patients is 2.5—3.5mmol/L B_ The Cori cycle deals with conversion of glucose to lactate and vice versa Lactate turnover in healthy resting humans is approximately 130 mmol every 24 hours D Lactate producers are the liver, kidneys and heart E Lactate is a by-product of glycogenolysis 00 000Section 3: Pathology Questions For each question given below choose the SINGLE BEST option. " = Which one of the following cell changes associated with injury is most likely to be accompanied by disruption of the cell membrane? A Apoptosis Cloudy swelling Coagulative necrosis Hydropic change Pyknosis moae 00000 “ N The full blood count report of a 38-year-old man shows low haemoglobin. Further investigations reveal it to be due to iron deficiency anaemia. Which one of the following disorders is the most common cause of iron deficiency anaemia in males? pathology A Cardiomyopathy Pancreatitis Peptic ulcer Renal failure QO0000 mone Severe liver diseaseAbojoyyed MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior OOO00O0 i we b 00000 mone A histology report mentions epithelioid cells in a tuberculous granuloma. Which cells are transformed into epithelioid cells? A Eosinophils Epithelial cells Lymphocytes Macrophages Neutrophils mgae A Ghon focus is a primary lesion caused by infection with Mycobacterium tuberculosis, and which develops in the lung of a previously uninfected individual. The Ghon focus is located in which part of the lung? A The apex The diaphragmatic surface of the lung The hilum The lower part of the upper lobes The pleural surface 3.5 A 16-year-old woman with blood in stool is diagnosed 000 OO 98 with familial polyposis coli. Which one of the following is characteristic of familial polyposis coli? An association with fibromatosis and multiple osteomas B_ An association with tumours of the central nervous system C Autosomal recessive pattern of inheritance D_ Multiple hamartomatous polyps throughout the colon E 100% risk of carcinoma within 30 years of diagnosisO0000 moO e ~ N 00000 mon @ a & O0000 Question: A 52-year-old man complaining of severe chest pain is brought to the Emergency Department. Preliminary investigations are suggestive of type A aortic dissection. Which one of the following pathological conditions is most commonly associated with aortic dissection? A Atherosclerosis Cystic medial necrosis Mycobacterial aortitis Streptococcal endocarditis with aortitis Syphilitic aortitis Which one of the following conditions on immunofluorescence is characterized by a linear pattern of immunoglobulin deposi glomerular basement membrane? A Diabetic glomerulopathy Goldblatt’s kidney Goodpasture’s syndrome Lupus nephritis Renal vein thrombosis pathology Paget's disease, otherwise known as osteitis deformans, is a chronic disorder that typically results in enlarged and deformed bones. Which one of the following tumours is associated with Paget’s disease of bone? A Ewing's sarcoma Giant cell tumour Osteosarcoma Metastatic duct carcinoma of the breast ™90 8 Multiple enchondromasAbojoyyed MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior 3.9 O00 OO “ ° O0000 "970 8 w 1 = O0000 ™O0 8 100 A 58-year-old man was anticoagulated with warfarin following an embolic stroke. Which one of the following statements regarding arterial emboli is false? A Arterial emboli rarely embolise to the lower extremities B_ Emboli from infective endocarditis can cause septic infarcts C_ Embolisation to the middle cerebral artery can be fatal D_ Most arterial emboli arise from cardiac thrombi E Most arterial emboli cause infarction A biopsy of an excised lump shows what appears to be an abnormal amount and arrangement of normal tissue that is appropriate or normal for the area in which the tissue arises. This is best described as: A Carcinosarcoma Embryonal tumour Hamartoma Mixed tumour Teratoma Which one of the following disease states is characterised by a kidney Psy specimen that shows subendothelial granular electron-dense deposits? A Goodpasture’s syndrome Membranous glomerulonephritis Rapidly progressive glomerulonephritis Post-streptococcal glomerulonephritis Systemic lupus erythematosusO0000 sh = a QO0000 w = & O0000 Questions Macrophages phagocytose cellular debris and pathogens either as stationary or mobile cells. Which of the following cells are the precursors of macrophages? A Basophils B_ Eosinophils C_ Lymphocytes D Monocytes —E Neutrophils A 41-year-old unconscious woman was brought to the Emergency Department. In view of history of severe headache prior to becoming unconscious a CT scan was requested, which was suggestive of subarachnoid haemorrhage. Which one of the following is the most common cause of spontaneous subarachnoid haemorrhage? A Arteriovenous malformation Blood dyscrasia Intracranial congenital aneurysm. pathology Primary brain tumour ™908 Tumour metastatic to the brain An icteric 6-weeks-old baby was found to have cholestatic jaundice. Which one of the following conditions is the most common cause of neonatal cholestasis? A Budd—Chiari syndrome Choledochal cyst Extrahepatic biliary atresia Intrahepatic biliary atresia ™90 8 Primary biliary cirrhosisAbojoyyed MRCS Part A: Paper 1 SBAs in Applied Basic Scienc 3.15 ¥ 00000 # O0000 moa O0000 "O08 The first symptom of thyroid cancer most commonly is a nodule in the thyroid region of the neck. Which one of the following is the most common primary malignant tumour of the thyroid gland? A Anaplastic carcinoma Follicular carcinoma Large cell carcinoma Medullary carcinoma ™O0 8 Papillary carcinoma Which one of the following features is absent in primary biliary cirrhosis, an autoimmune disease of the liver 7 A Bile duct destruction Cholestasis Irregular regenerative nodules Large lymphoid aggregates in the portal tracts Prominent plasma cell infiltrate Which cell types are most commonly seen in tissues with chronic inflammation? A Eosinophil leucocytes Lymphocytes Mast cells Platelets Polymorphonuclear leucocytesw = o QQ0000 3 O0000 = N 0 O0000 mone Questions Granulation tissue is characterised by: A Giant cells and fibroblasts Giant cells and lymphocytes Giant cells, plasma cells and lymphocytes Neutrophils and necrotic tissue Proliferation of new capillaries with fibroblasts and new collagen formation mone Which one of the following is the most common benign bone tumours that affects individuals under the age of 21 years? A Aneurysmal bone cyst Chondromyxoid fibroma Giant cell tumour Osteochondroma moOaA@ Osteogenic sarcoma pathology Which one of the following is the most frequently encountered colorectal lesion of epithelial derivation? A Adenocarcinoma Adenomatous polyp Metaplastic polyp Mixed adenomatous and villous polyp Villous polypAbojoyyed MRCS Part A: Paper 1 SB) plied Basic Science, Second Editior 3.21 Bronchial biopsy of a 58-year-old man who is a chronic smoker showed squamous metaplasia. Which of the following statements best describes metaplasia? A It is an irreversible change It is an adaptive response It occurs only in epithelium It is characterised by cloudy swelling of cells O0000 mon ® It results from a change in the phenotype of a differentiated cell type o nN N A 60-year-old woman with a long history of poorly controlled type 2 diabetes mellitus has had extensive black discoloration of the skin and soft tissue of her right foot and calf, with areas of yellowish exudate, for the past month. A mixed growth of aerobes and anaerobes is cultured from this exudate. A below-knee amputation is performed. The amputation specimen sent to the histopathology laboratory is most likely to demonstrate which of the following pathological abnormalities? O A Neoplasia QO BB Coagulopathy OQ C Haemosiderosis QD Caseation necrosis QE. Gangrenous necrosis3.23 O0000 mone = N 4 O0000 mone Question: A 22-year-old man who is a motorcyclist is involved in a high-impact road traffic accident on the motorway which results in multiple blunt trauma and lacerations to his lower extremities. The left femoral artery is lacerated, and he incurs extensive blood loss and remains hypotensive for hours during transport to the Emergency Department. On admission, his haematocrit is 15%. Which of the following tissues is most likely to sustain the least damage as a result of prolonged hypotension? A Small intestinal epithelium Skeletal muscle Retina Myocardium Hippocampus A histopathology report mentioned the term ‘fat necrosis’. Fat necrosis is a feature of: A Brain injury Muscle injury Trauma to the bowel Acute pancreatitis Trauma to the uterus pathologyAbojoyyed MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Editior 3.25 A fair-skinned child develops sunburn within 24 hours of exposure to sun. This is caused by: A. Free radical injury Ischaemic injury Direct endothelial injury Chemical injury O0000 "908 Hypoxic injury ow NN 6 Report of a biopsy specimen sent to the histopathology laboratory came back claiming ‘no granuloma seen’. The patient is most likely to have which of the following conditions? A Lepromatous leprosy Tuberculosis (TB) Coccidioidomycosis Syphilis Trypanosomiasis 00000 moO 8 “ N 7 A patient with an inflammatory condition was told by the consultant that he has features consistent with a type II hypersensitivity reaction. This patient is most likely to have which of the following disorders? A. Polyarteritis nodosa Reactive arthritis Serum sickness Graves’ disease "998 OO000 Arthus reaction 1063.28 O0000 w 29 00000 Question: On receiving intravenous penicillin, a child develops urticaria, dyspnoea and generalised oedema immediately as a result of: A Type I hypersensitivity Type Il hypersensitivity Type Ill hypersensitivity Type IV hypersensitivity Systemic immune complex disease mgae A 50-year-old marketing executive has complained of mild burning epigastric pain after meals for the past 3 years. Upper gastrointestinal (GI) endoscopy is performed and biopsies are taken of an erythematous area of the lower oesophageal mucosa 3cm above the gastro-oesophageal junction. There is no mass lesion, no ulceration and no haemorrhage noted. The biopsies demonstrate the presence of columnar epithelium with goblet cells. Which of the following mucosal alterations is most probably represented by these findings? A Metaplasia B_ Dysplasia C Hyperplasia D = Carcinoma E Ischaemia pathologyAbojoyyed MRCS Part A: Paper 1 SB) Applied Basic Science, Second Editior 3.30 A serum electrolyte analysis suggests hypernatraemia. Which of the following conditions is most likely to be associated with hypernatraemia? A Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Oedematous conditions Patients on diuretic therapy Patients on osmotic cathartics Cases of water intoxication O000 O ™O0 8 w w a While playing football a 25-year-old man is kicked on the thigh by a player from the opposite team. The skin is not broken. Within 48 hours he notices a 6 x 8cm purple patch at the site of injury. Which of the following substances most likely has to accumulate at the site of injury to produce a yellow-brown colour 2 weeks after the injury? A Lipofuscin Bilirubin Haemosiderin Melanin QO0000 mone Glycogen 108O0000 w w w 00000 mon @ Questions Which of the following statements about special total parenteral nutrition (TPN) solutions is contrary to the available scientific evidence? A For patients in cardiac failure the TPN solution must be more concentrated B Patients in renal failure who cannot be dialysed should be given a TPN solution without amino acids C_ Patients in hepatic encephalopathy should receive branched-chain amino acids D_ Hepatic failure patients should receive major calories in the form of intravenous glucose infusions E Patients with respiratory failure may benefit from the replacement of some glucose energy intake with fat For which of the following conditions is morphine the analgesic of choice? A Head injuries Acute myocardial infarction pathology Chronic obstructive pulmonary disease (COPD) Addison’s disease Liver diseaseimage not availableimage not availableAbojoyyed MRCS Part A: Paper 1 SBA 3.39 O 00 OO w 40 0000 0 m2 Which of the following changes is most likely to be seen after major trauma? A There is profound insulin hypersensitivity B_ Marked vasoconstriction occurs in vessels that perfuse injured areas during the hyperdynamic phase C_ Peripheral resistance increases D_ Control of wound circulation is different to other critical tissues E The liver is the origin of the nitrogen loss in the urine Which of the following statements correctly describes the approach to a patient with trauma to the neck? A Aradiograph of the neck is a particularly useful diagnostic tool for suspected laryngeal fracture or penetrating laryngeal injury B Zone | or thoracic inlet injuries must be investigated with panendoscopy and early arteriography C Zone Il injuries are injuries to the upper neck D> Zone Ill injuries must be immediately explored without any preliminary investigations E Zone Ill extends from the clavicular heads to the angles of the jaw