Mrcs Paper 2 (Omar’s sheet)

A 60-year-oldi Australian woman has multiple flat, brown skin lesions that are rough on the surface and
well defined the most likely histological finding?

A Dermatofibroma (histiocytoma)

B Keratoacanthoma

с Malignant melanoma

D Neurofibroma

E Seborrheic keratosis

A 45-year-old man has surgery for a fistula-in-Ano. This is slow to heal and four months later he develops
diarrhea w of 3 kg in two weeks. Abdominal examination reveals minimal tenderness in the left iliac fossa.
Which of the follows

A Crohn colitis

B Diverticular disease

с Left colon cancer

D Right colon cancer

E Ulcerative colitis

A 75-year-old man presents with a 45' flexion deformity at the metacarpophalangeal joints of the ring and
little finger fully into the palm Which of the following is the most appropriate treatment?

A An extension splint

B Division of the flexor retinaculum

с Fasciectomy

D Physiotherapy

E Release of trigger finger

1
Mrcs Paper 2 (Omar’s sheet)

A 75-year-old woman presents with acute back pain after a minor fall Radiological examination reveals an
osteoporosis the most likely electrolyte finding?

А Hypercalcemia

B Hyperphosphatasemia

с Hypocalcemia

D Hyponatremia

E Normokalaemia

A 50-year-old woman sustains a closed fracture of the distal radius that is manipulated and treated in plaster
CO complains of burning pain in the hand. She does not respond to treatment with simple analgetic. The
hand is swollen Which of the following is the most likely diagnosis?

А Carpal tunnel syndrome

B Complex regional pain syndrome Type 1 (reflex sympathetic dystrophy)

с Radial nerve compression

D Tendon adhesion

E Ulnar nerve compression

A 50-year-old woman sustains a closed fracture of the distal radius that is manipulated and treated in a
plaster carton complains of burning pain in the hand. She does not respond to treatment with simple
analgesics. The hand is swollen Which of the following is the most likely diagnosis?

A Carpal tunnel syndrome

B Complex regional pain syndrome Type 1 (reflex sympathetic dystrophy)

с Radial nerve compression

D Tendon adhesion

E Ulnar nerve compression

2
Mrcs Paper 2 (Omar’s sheet)

A 75-year-old man sustains an open fracture of the tibias which requires external fixation

Three days later he develops pus. What is the most likely infective cause?

А Clostridium perfringens

B Proteus vulgaris

с Pseudomonas aeruginosa

D Staphylococcus aureus vs E

E Staphylococcus epidermidis

A 40-year-old woman with a history of kidney stones is diagnosed with primary hyperparathyroidism What
is the best in parathyroid adenoma?

А CT scan

B MRI scan

C Parathyroid venous sampling

D Technetium sestamibi imaging

E Ultrasound Following a thoracotomy

Following a thoracotomy, a patient complains of numbness and loss of fine control of the left hand. On
examination its more on the ulnar border of the hand and involves the little finger and both sides of the ring
finger. The hand is weak including both dorsal interosseous muscles Which of the following is the mostly

A Lower trunk of the brachial plexus

B Median nerve

с Middle trunk of the brachial plexus

D Radial nerve

E Upper trunk of the brachial plexus

3
Mrcs Paper 2 (Omar’s sheet)

A 6-month-old baby presents with a 24-hour history of screaming episodes, irritability and vomiting. On
examination distension and rectal examination releases a small quantity of dark red blood which of the
following is the most likely cause

А Anal fissure

B Gastroenteritis

С Intussusception

D Juvenile rectal polyp

E Meckel diverticulum

Which of the following is the most likely set of test results for medullary thyroid carcinoma?

A 52-year-old woman with a 20-year history of systemic lupus erythematosus (SLE) presents to the
Emergency department with displaced sub capital femoral neck fracture with an area of linear subchondral
lucency in the femoral head the patient underwent hemiarthroplasty. Which of the following medications for
SLE is the most likely cause of her presentation?

A Azathioprine

B Hydroxychloroquine

с Methotrexate

D Prednisolone

E Rituximab

4
Mrcs Paper 2 (Omar’s sheet)

A 32-year-old man who weighs 90 kg, with circumferential burns to the whole left lower limb and perineum
region, most appropriate volume of crystalloid fluid that should be used for resuscitation over the first 24
hours?

A 2-31

B 3-5

с 7-9 L

D 10-13L

E 14-16L

A 65-year-old man with no other significant comorbidities undergoes a sigmoid colectomy for diverticular
disease which one of the following options is NOT RECOMMENDED as part of his enhanced recovery

A Early mobilization

B Nasogastric tube placement

с Regular antiemetics

D Restriction of IV fluids

E Thromboembolic deterrent (TED) stockings

A 60-year-old man is diagnosed with squamous cell carcinoma of the lung which of the following
investigations is most useful in assessing local respectability

Answers A-E

A Bone scans

B Bronchial biopsy

С CT scan

D Mediastinoscopy

E PET scan

5
Mrcs Paper 2 (Omar’s sheet)

A 25-year-old man is playing football when he complains of posterior thigh pain whilst sprinting on
examination, he has tenderness in the lower lateral posterior thigh he is unable to fully extend to fully to
pain. What is the most likely injury?

A Biceps femoris tear

B Gastrocnemius tear

с Gracilis tear

D Semimembranosus tear

E Semitendinosus tear r

A 22-year-old woman is admitted as an emergency with right lower quadrant abdominal pain, nausea
vomiting. Her temperature is 38.5°C, heart rate 80 beats/minute and blood pressure 80150 mm tests show a
white cell count of 15 x 10°/L, sodium 125 mmol/L and potassium 60 mmol/l. She pregnant. She takes
prednisolone 10 mg twice a day for rheumatoid arthritis and salbutamol for Which of the following is the
most appropriate management? Answers A-E

A 4 mg ondansetron orally

B. 100 mg IV hydrocortisone

с 1.2 g IV co-amoxiclav

D 250 ml IV colloid fluid and reassess

E Calcium resonium per rectum

A 72-year-old patient is admitted to the intensive care un after report ruptured abdominal aneurysm. His
heart rate is 100 beats/minute, his blood pressure is 90/60 mmHg and his hem 9 g/L Readings from his
pulmonary artery catheter are cardiac index 1.9 mm (normal 2 wedge pressure 19 mmHg (normal <15
mmHg), stroke volume 40 ml (normal 60-80 ml). He intensivist, who is most likely to prescribe which of the
following options?

A Administer 250 ml of Gelofusin

B Administer 1 unit of red cells

с Commence epinephrine (adrenaline)

D Commence norepinephrine (noradrenaline)

E Commence vasopressin

6
Mrcs Paper 2 (Omar’s sheet)

A patient's preoperative ECO shows widened QRS complex flattened t wave and heart block?

A Hypercalcemia

B Hyperkalemia

с Hypocalcemia

D Hypokalemia

E Hyponatremia

A policeman is shot during an armed robbery in the Emergency Department his general condition in of the
left thigh and an X-ray reveals a bullet adjacent to his ischial tuberosity unable to move his …... nerve
lesion?

A S7 root lesion

B L5 root lesion

C Deep peroneal nerve palsy

D Sciatic nerve palsy

Tibial nerve palsy

A 35-year-old building worker is hit on the head by a tube of scaffolding. He was not wearing a helmet to
hospital by his foreman Skull X-rays suggested a depressed skull fracture Which of the following is

A Admit for observation

B Allow home with head injury instructions and accompanied

с Arrange an immediate [within 1 hour) CT scan of head

D Arrange an urgent (within 8 hours) CT scan of head

E Transfer to neurosurgical unit

7
Mrcs Paper 2 (Omar’s sheet)

A 63-year-old man presents with painless hematuria of 5 days duration. Which of the following is correct?

A Acute bacterial urinary tract infection

B Benign prostatic hyperplasia

с Carcinoma of the prostate

D Oncocytoma of the kidney

E Transitional cell carcinoma of the bladder

A 17-year-old man is brought in to the Emergency Department with an obvious open fracture of his right
forearm following a motorcycle accident. He is fully cons and alert but in remarkable pain. On examination
he is found to have no active right elbow flexion and absent sensation on the lateral right arm Which of the
following is the most likely diagnosis? Answers A-E

A Anterior dislocation of the shoulder

. Brachial plexus injury

с Dislocated elbow with ulnar nerve damage

D Fracture of the surgical neck of the humerus

E Supracondylar fracture of the humerus with median nerve damage

A 45-year-old woman underwent a day case laparoscopic cholecystectomy 4 days ago. she now presents to
the Emergency Department with an acute abdomen Her pulse is 96 mmHg, temperature 36 0°C, and
respiratory rate 22 breaths minute Her wbcs 3.9 hemoglobin 10 g/L. Which investigation would be most
helpful in the management of this patient?

A Coeliac axis angiogram

B CT pulmonary angiogram

с CT scan of abdomen

D Echocardiogram

E Ultrasound of abdomen

8
Mrcs Paper 2 (Omar’s sheet)

A 35-year-old man presents with a single fresh 200 mt hematemesis following an acute alcohol (binge) and
a prolonged bout of vomiting Which of the follow the mostly likely diagnosis

A Candida esophagitis

B Carcinoma of the esophagus

с Mallory-Weiss tear

D Esophageal varices

E Peptic esophagitis

An adult patient has been given 3 L of 5% dextrose solution intravenously in the 24 hours after an elective
splenectomy initial observation?

A Low blood pressure

B Oliguria

с Raised jugular venous pressure

D Urine of high osmolality

E Urine of low osmolality *

A 25-year-old man is stabbed in the foot with a garden fork on examination there is an indurated swelling
around the wound Which of the following is the most appropriate management

А Delayed primary closure

B Primary suture with drain

с Simple suture

D Wound excision and allow to heal by secondary intention

E Wound excision and suture

9
Mrcs Paper 2 (Omar’s sheet)

A pale 65-year-old man collapsed at home. He is a known hypertensive. On examination his blood pressure
beats/minute. A pulsatile mass is noted in his epigastrium. Which of the following is the most appropriate?

А 2 liters of 0.9% saline

B 2 liters of Ringer lactate

с 2 units of group O negative red cells *

D 6 packs of platelets

E Prothrombin complex concentrate (Octaplex or Beriplex)

A 45-year-old woman is to undergo cholecystectomy for multiple gallstones Which of the following effects
is mostly to

A Decreased bile reflux in the stomach

B Decreased cholesterol metabolism

С Decreased common bile duct capacity

D Decreased entero hepatic circulation of bile salts

E Decreased maximal bile flow after large meals

A 45-year-old man is involved in a car accident on admission he is in hypovolemic shock, and radiographs
show an examination, the prostate gland cannot be felt in its usual position. Which of the following is the
most likely diagnosis?

A The bladder is ruptured

B The bulbar part of the urethra is ruptured

С the external urethral sphincter is ruptured

D The membranous urethra is ruptured

E The prostatic urethra is ruptured

10
Mrcs Paper 2 (Omar’s sheet)

An elderly man presents with urinary retention and is found to have a carcinoma of the prostate.

A Deep inguinal node

B Medial group of superficial inguinal nodes

с Nodes along the external iliac vessels

D Nodes along the internal iliac vessels

E Para-aortic lymph nodes

A 70-year-old woman, who suffers from multiple metastatic bony lesions, sustains metastatic lesion in her
humerus after her dog pulls on the lead. Which of the following fracture?

A Greenstick

B. Multi-fragmented

с Oblique

D Spiral

E Transverse

A girl is born with abdominal distension and on the second day of life she passes a mucus plug per marked
abdominal distension and there are palpable loops of bowel on the right. Her cousin has cy diagnosis?

А Duodenal atresia

B Hirschsprung disease

с Intussusception

D Meconium ileus

E Necrotizing enterocolitis

11
Mrcs Paper 2 (Omar’s sheet)

A 30-year-old man presents with a six-week history of a lump on the anterior aspect of the right thigh. The
lump measures 15 cm x 9 cm and is clinically deep to the deep fascia What procedure should be used
diagnosis at the regional center?

А Core biopsy

B Fine needle aspiration cytology

с Local excision

D Open biopsy

E Wide excision

A 60-year-old man is brought to the Emergency Department following a road traffic accident. His blood
pressure is 80/50 mmHg and heart rate 115 beats/minute. He is bleeding from his right thigh. The major
hemorrhage protocol is activated and the pack contains four units of red blood cell concentrate and to units
of fresh frozen plasma (FFP). Which one of the following is true regarding FFP?

A Fibrinogen content of four units of FFP is 29

B FFP contains all clotting factors except factors V and VIII

C FFP is leucodepleted plasma

D Once out of the fridge and thawed, FFP can be refrozen

E Once out of the fridge. FFP should be used within 24 hours

A premature infant has bloody stools on the 10th day of life. The abdomen is tender and distended and
nasogastric aspirates are bile-stained Which of the following is the most likely diagnosis

A Duodenal atresia

B Hirschsprung disease

с Intussusception

D Meconium ileus

E Necrotizing enterocolitis

12
Mrcs Paper 2 (Omar’s sheet)

A 50-year-old man presents with a 5% burn on his anterior abdominal wall that occurred 24 hours ag burn is
painless, dry, and crusted Which of the following is the most appropriate treatment?

A Fasciotomy

B Full thickness skin graft

с Leave the wound uncovered

D Occlusive dressings

E Split skin graft e

A 50-year-old man presents with a 5% bum on his anterior abdominal wall that occurred 24 hours ago. The
burn is painless, dry, and crusted. Which of the following is the most appropriate treatment?

А Fasciotomy

B Full thickness skin graft

с Leave the wound uncovered

D Occlusive dressings

E Split skin graft

A 45-year-old man, from whom consent is being taken for a partial colectomy for Crohn disease, asks for an
explanation of the advantages of the enhanced recovery program. Which one of the following should not be
included in the list?

A Decreased risk of developing chronic pain after surgery

B Decreased risk of perioperative complications

С Quick return to normal activity

D Reduced length of stay in the hospital following surgery

E Reduction in physiological stress response to surgery

13
Mrcs Paper 2 (Omar’s sheet)

Which of the following anesthetic agents should be used to perform a Bier block intravenous regional
anesthetic?

A 0.5% levobupivacaine with epinephrine (adrenaline) 1 in 200,000

B 0.5% prilocaine

с 1% lidocaine

D 1% lidocaine with epinephrine (adrenaline) 1 in 200,000

E 4% amethocaine

A 70-year-old man presents to his family doctor with back pain that has been worsening over the last weeks.
On examination there is restricted back movement Plan X-rays of the back show multiple sclerotic lesions.
What is the most likely diagnosis?

А Ankylosing spondylitis

B Multiple myeloma

с Osteoarthritis

D Prostate carcinoma

E Spinal tuberculosis

A 20-year-old man becomes oliguric following an emergency appendicectomy after a two- abdominal pain,
nausea and vomiting. What is the appropriate action to take?

A Infuse 60 mmol of potassium chloride over 24 hours

B Infuse 500 ml of Hartmann solution over 30 minutes and monitor urine output

с Infuse 2 L of 5% dextrose over 8 hours

D Infuse 2 L of Hartmann solution rapidly

E Infuse 3 L of normal saline over the following 24 hours

14
Mrcs Paper 2 (Omar’s sheet)

A 22-year-old man was involved in a fight and received a stab wound to the right chest admitted to the
Emergency Department where a diagnosis of tension pneumothorax is made. Which following is the most
likely clinical feature to be present?

A Chest auscultation reveals a pleural rub

B Hypotension is present

с Increased chest expansion is present on the left side of the chest

D The apex beat is deviated to the right

A 40-year-old man is involved in a road traffic accident. Radiographs reveal a minimally displaced
suboccipital by following is the most appropriate treatment? Answers A-E

A External fixation

B Hemi-arthroplasty

с Internal fixation

D Primary total hip replacement

E Traction

A fit 63-year-old man has undergone a radical three-stage esophagectomy for carcinoma 1 cm in length. The
operation is expected to be curative but he lost months prior to surgery. Which of the following is the most
appropriate treatment?

A Intraoperative feeding jejunostomy

B Naso-enteric fine bore tube feeding

с Nasogastric tube

D Parenteral nutrition

15
Mrcs Paper 2 (Omar’s sheet)

A 47-year-old woman notices a swelling in her right groin that is disappears with gentle pressure, and
reappears immediately on release. There is a cough impulse of the following is the most likely diagnosis?

А Femoral aneurysm

B Femoral hernia

с Lipoma

D Lymph node

E Saphina varix

A 34-year-old woman presents with examination she has obvious sphincter (incomplete question)

A Anorectal manometry

B Barium enema

с Endo-anal ultrasonography

D Pelvic floor electromyograph (EMG)

E Proctometrogram

A 62-year-old man complains of tingling and numbness in and forearm. He has recently noticed that he is
dropping this tingling. Which of the following is the most appropriate define (incomplete question)

A An extension splint

B Division of the flexor retinaculum

с Fasciectomy

D Physiotherapy

E Reassurance

16
Mrcs Paper 2 (Omar’s sheet)

A 75-year-old man with known carcinoma of the prostate, presents with a pain in a solitary bony metastasis
Which of the following is the appropriate method of management?

A Carbamazepine

B Chemotherapy

с Further investigations

D Morphine elixir

E Radiotherapy

A 25-year-old man gives a history of several bouts of backache and low back pain after has resolved
spontaneously after one week off work. This time there is pain radiating foot. There is complete loss of
lumbar lordosis. Which of the following is the most likely?

А Acute spasm of erector spinae muscle

B Central prolapse of lumbar intervertebral disc

C Posterolateral prolapse of lumbar intervertebral disc

D Spondylolisthesis of L4 on L5 vertebra

A 65-year-old male smoker presents with cervical lymphadenopathy, biopsy of which contains squam
carcinoma. Endoscopic examination of the upper aerodigestive tract is unremarkable. Imaging of the with
which modality is most likely to demonstrate the primary tumor site?

A Barium swallows

B CT scan

с FDG PET-CT scan

D MRI scan

E Water-soluble swallow

17
Mrcs Paper 2 (Omar’s sheet)

During scrotal examination of a 3-year-old, a unilateral scrotal swelling is found that does not present all the
time. Which of the following is the most likely diagnosis?

A Benign adenomatoid tumor of the epididymis

B. Epididymal cyst

с Hydrocoele

D Idiopathic scrotal oedema

E Torsion of the hydatid of Morgagni

A 25-year-old sportsman complains of the stiffness and persistent backache he is noted to have restriction in
movements in all directions and his chest expansion is 5 cm what is the most likely dx?

A Ankylosing spondylitis

В Intervertebral disc degeneration and prolapse

с Multiple myeloma

D Spina bifida occulta

E Spondylolisthesis

On the seventh day following an anterior resection 62-year-old man develops a tachycardia hypotension and
severe lower abdominal pain. Which of the following is the most likely answer?

А Intra-abdominal hemorrhage

B. Intra-abdominal sepsis

с Pulmonary atelectasis

D Pulmonary embolus

E Urinary tract infection

18
Mrcs Paper 2 (Omar’s sheet)

After an intraoperative cardiac arrest, a 67-year-old man opens his eyes to pain makes incomprhensral
sounds and extends his limbs to pain Which of the following is his Glasgow Coma Score (GCS Answers A-
E

A3

B5

C6

D8

E 12

A patient is deteriorating on the ward. As part of the assessment, this any electrocardiogram (ECG)
technician VI Month AVE while What do the abnormal findings stand for?

Pulmonary embolism

A 25-year-old woman with a strong family history of breast cancer, presents with ad breast. She has bilateral
breast implants. Which of the following is the most appropriate?

A Core biopsy

B Mammography

C MRI scanning

D Ultrasound

19
Mrcs Paper 2 (Omar’s sheet)

A 70-year-old man underwent femoral popliteal bypass three days and has fresh blood since operation. in
surgery he received 5000 of het Aspirin 75 mg and Clopidogrel 75 mg until the day before surgery
hemoglobin and platelets are 255 x 10°/L (normal 150-400 x 109/L) What is the most likely cause of
bleeding

A Abnormal sensitivity to heparin

B Disruption of the proximal anastomoses

с Disseminated intravascular coagulation

D Drug induced platelet dysfunction

A 12-year-old girl presents with knee pain. There are no local signs but the les flexion of the hip. Which of
the following is the most likely diagnosis? Answers A – E

А Congenital dislocation of the hip

B Osgood Schlatter apophysitis of knee

с Perthes disease

D Septic arthritis of the hip joint

E Slipped upper femoral epiphysis

An 80-year-old man presents with severe abdominal pain due to perforated diverticulitis the affected bowel
is resected but 48 hours later the patient, who has been catheter Which of the following is the most likely
diagnosis?

A Acute tubular necrosis

B Bilateral renal papillary necrosis

с Nephrocalcinosis

D Rapidly progressive crescentic glomerulonephritis

20
Mrcs Paper 2 (Omar’s sheet)

A 13-year-old girl presents to her family doctor with a history of intermittent right upper quadrant food
intolerance. She is under the care of a hematologist for hereditary spherocytosis. She has spleen. Which of
the following is the most likely diagnosis?

A Acute cholecystitis

B Ascending cholangitis

С Biliary colic

D Gilbert syndrome

E Hepatitis B

Twenty-four hours after a routine aortic valve replacement for a heavily calcified abruptly falls to 40
beats/minute. The systolic pressure, which was 140 mmHg. right atrial pressure, which was 7 mmHg, is now
averaging 15 mmHg. Which of diagnosis?

А Atrial fibrillation

B Cardiac tamponade

C Digoxin toxicity

D Heart block

A 25-year-old man, who has noticed mild intermittent jaundice for the past six ye during a chest infection.
There is a moderate unconjugated hyperbilirubinemia function tests and hepatic histology. Which of the
following is the most likely diagnosis?

A Acute alcoholic hepatitis

B Ascending cholangitis

с Common bile duct stone

D Gilbert syndrome

21
Mrcs Paper 2 (Omar’s sheet)

A 45-year-old woman presents with a cough and weight loss over three months. She also complains of
recent onset polyuria. On examination her pulse rate is 90 beats/minute and her blood pressure is 100185
mm supine. Her body mass index (BMI) is 21 and she has reduced breath sounds in the right upper zone.
Her chest X-ray shows an irregular mass lesion in the right upper lobe. Her corrected serum calcium is 3.52
mm (normal < 2.70 mmol/L). Which of the following blood assays would be the most informative?

А 1,25 dihydroxycholecalciferol

B 25 hydroxycholecalciferol

С Glucose

D Parathyroid hormone (PTH)

E Parathyroid hormone-related peptide (PTHrP)

A 28-year-old man is involved in a road traffic collision and is in shock. During his first hour of resuscitate
receives 6 L of normal saline. Which of the following is the most likely biochemical change he will exe?

A Hyperchloremic acidosis

B Hyperkalemic acidosis

C Hypernatremia alkalosis

D Hypochloremia alkalosis

E Hypokalemic acidosis

A patient presents with loss of extension of the thumb and fingers and some loss of wrist extension
cutaneous sensory loss. Which of the following is the most likely diagnosis?

A C5-6 intervertebral disc prolapse

B Injury to the lateral cord of the brachial plexus

C Posterior interosseous nerve injury

D Radial nerve injury at mid-humeral level

E Ulnar nerve injury at the wrist

22
Mrcs Paper 2 (Omar’s sheet)

A 50-year-old man is scheduled to have a small bowel resection for Crohn disease. Which of the
intraoperative measures will form part of the enhanced recovery program me?

A Large volume of intravenous fluids

B. Midline abdominal incision

с Minimally invasive surgical technique

d Routine use of nasogastric tube

E Use of intravenous opioids

A 3-year-old boy presents with malnutrition, respiratory tract infection, dry scaly skin and cloudiness to be
deficient?

A Folic acid

B Vitamin A

С Vitamin B2 (riboflavin)

D Vitamin C

E Vitamin D

What is the most commonly divided structure in the upper abdominal midline incision?

a Arcuate line

B External oblique aponeurosis

с Linea alba

D Rectus abdominis muscle

E Rectus sheath

23
Mrcs Paper 2 (Omar’s sheet)

A 51-year-old woman with known breast carcinoma with multiple skeletal metastases clinic with increasing
drowsiness and lethargy Examination reveals her to be generally weak w hypotonia. Which the following is
the most likely biochemical result in this patient?

A Hypercalcemia

B Hyperphosphatasemia

С Hypocalcemia

D Hypokalemia

E Hyponatremia

A 50-year-old man sustains a bimalleolar ankle fracture that is treated with open reduction, internal fixation
and six-week below knee cast immobilization. When the cast is removed, he exhibits foot drop What is the
most likely cause?

А Common peroneal (fibular) nerve neurapraxia

B Compartment syndrome

с iatrogenic injury of tendons anterior to the ankles

D Rupture of tibialis anterior tendon

E Tibial nerve neuropraxia

What is the most commonly divided structure in the inguinal herniorrhaphy incision?

A Conjoint tendon

B External oblique aponeurosis

с Internal oblique muscle

D Rectus sheath

E Transversus abdominis muscle

24
Mrcs Paper 2 (Omar’s sheet)

A 78-year-old man attends the chest clinic with an apical mass in the night lung, which is diagnosed as a
bronchial carcinoma. He has wasting of the small muscles of the hand and some numbness on the medial
aspect of the upper arm. Which of the following nerve lesions is he most likely to have?

А Axillary nerve

B Median nerve

с T1 lesion

D Ulnar nerve

E Upper trunk of the brachial plexus

A 25-year-old man presents with sudden onset of severe right loin pain which is colicky in nature. He
apyrexial. Routine observations are normal. Urine analysis shows blood only Radiological imaging
demonstrates a 3 mm calculus at the vesical-ureteric junction on the night with slight dilation of the pain
settles after treatment with diclofenac, which of the following is the most appropriate treatment

A Conservative management

B Intravenous rehydration and oral sodium bicarbonate

C Percutaneous nephrolithotomy with insertion of JJ stent

D Shock wave lithotripsy

E Ureteroscopy lithotripsy

A 30-year-old man is rescued from a house fire. He has no burns which of the following is an indication for
ventilation?

А A respiratory rate above 35 breaths/minute

B Arterial carbon dioxide level of 5 kPa

с Exhaustion, sweating and confusion

D Oxygen saturation of 96%

E pH of 7.25

25
Mrcs Paper 2 (Omar’s sheet)

A 30-year-old man injures his right knee, with immediate swelling. Radiographs show no bony injury. He
has difficulty walking downhill. On examination, when viewed from the side, the upper part of the right tibia
is seen to be posteriorly displaced compared with the left tibia. Which of the following is the most likely
structure to have been damaged?

А Anterior cruciate ligament

B Lateral collateral ligament

с Lateral meniscus

D Medial meniscus

E Posterior cruciate ligament Question

Over a period of a year a 52-year-old man has had difficulty in doing his job as a painter on account
shoulder pain. One day he experiences severe pain in the same shoulder while at work and is un complete
the task he is engaged in. When examined he is found to be unable to actively abduct and shrugs his
shoulder on attempting this movement. When his arm is passively abducted at angle, he is able to maintain
that position. Which of the following is the most likely diagnosis?

А Acute calcific tendinitis of shoulder

B 'Frozen' shoulder

с Rupture of long head of biceps

D Subacromial impingement syndrome

E Supraspinatus tendon tear

An 8-year-old boy is admitted with a 24-hour history of abdominal pain. He has vomited twice on
examination he has a pulse rate of 80 beats/minute and a low-grade fever. There is diffuse abdominal
tenderness within muscle guarding. Rectal examination is unremarkable Urine microscopy is normal Which
of the following the most likely diagnosis?

А Acute non-specific abdominal pain

B Appendix abscess

с Constipation

D Urinary tract infection

E Volvulus

26
Mrcs Paper 2 (Omar’s sheet)

A 25-year-old woman presents with Graves' disease. She is eight weeks pregnant. Which of the following is
the most appropriate treatment?

А Carbimazole

B Propranolol

с Propyl thiouracil

D Thyroxine

E Total thyroidectomy

An 84-year-old man is noted to have a sodium of 124 mmol/L (normal 137-144) following a transurethral
resection of his prostate. Which of the following is most likely to occur as a consequence of the
hyponatremia?

A Central pontine myelinolysis

B. Confusion

с Hematuria

D Lower abdominal pain

E Thirst

A patient with locally advanced pancreatic cancer has persistent back pain Which of the following is the
appropriate treatment?

A Corticosteroids

B Nerve block

с Non-steroidal anti-inflammatory drugs (NSAIDs)

D Paracetamol

E Transcutaneous electric nerve stimulation

27
Mrcs Paper 2 (Omar’s sheet)

A 40-year-old man presents with a thyroid swelling, sweating, palpitations and headache His blood pressure
200/120 mmHg. Which of the following is the most likely diagnosis?

A Conn syndrome

B Cushing syndrome

с Essential hypertension

D Hyperparathyroidism

E Phaeochromocytoma

A 50-year old man presents to the Emergency Department with multiple injuries following a road traffic
accident. He undergoes intramedullary nail fixation of a fracture of the right tibia Twelve hours later,
intensive care, his lower right leg is found to be tense and swollen. Which of the following is the most
appropriate next step of management?

A Compartment fasciotomy

B Embolectomy

с Heparinization

D Leg elevation

E Re-exploration of the wound

A 77-year-old man who is a smoker, collapses 12 days following an esophagectomy. Prior to his collapse he
complained of a sudden onset of chest pain and dyspnea on examination is blood pressure is 90/60 mmHg.
His ECG shows right heart strain Which of the following is the most likely diagnosis Answers A-E

An Atelectasis

B Myocardial infarction

C Pulmonary embolism

D Simple pneumothorax

E Tension pneumothorax

28
Mrcs Paper 2 (Omar’s sheet)

A 75-year-old man with a history of ischemic heart disease and bilateral peripheral vascular disease has a
mid-thigh amputation. What is the appropriate anti-thromboembolic precaution to take? Answers A-E

А Aspirin therapy

B Intermittent pneumatic calf compression

с Intravenous heparin pump delivering 1000 units hourly

D Low molecular weight heparin

E Low molecular weight heparin and graduated compression stockings

Which of the following is the most likely set of test results for a patient on T3 replacement, following total
thyroidectomy for differentiated thyroid carcinoma, without suspected tumor recurrence?

AA

BB

CС

DD

A previously healthy 32-year-old man is admitted with a fractured shaft of the femur following a road traffic
accident. Twelve hours after admission his blood pressure drops from 120/75 mmHg to 85/50 mmHg and
his pulse rises from 75 beats/minute to 120 beats/minute. On examination he has central cyanosis,
tachypnoea, confusion and complains of vague chest pain. He is also noted to have a rash on his chest. His
ECG shows T wave inversion in leads V1 to V4. Arterial blood gases on air are:

What is the most likely diagnosis?

A Cardiac tamponade

B Fat embolus

C Hypovolemia

D Myocardial infarction

29
Mrcs Paper 2 (Omar’s sheet)

A 65-year-old man with a primary lung cancer develops persistent headache from cerebral secondaries of
the following is the most appropriate treatment?

А Corticosteroids

B. Non-steroidal anti-inflammatory drugs (NSAIDs)

с Paracetamol

D Radiotherapy

E Slow-release morphine

A 32-year-old woman, with a recent diagnosis of Graves' disease, underwent incision and drainage of an
abscess three hours ago. She has become agitated, confused and is noted to be jaundiced and sweetness
temperature is 39°C, pulse 152 beats/minute and blood pressure 95/60 mmHg. An ECG shows an irregular
ventricular rate with absent p waves. After resuscitation, what is the most appropriate next step in
management?

А B-adrenoceptor blockers and iodides

B. B-adrenoceptor blockers and thioamides

с Bile acid sequestrants and glucocorticoids

D iodides and bile acid sequestrants

E Thioamides and thyroidectomy

30