Genesis Sif 16

12/19/23, 10:27 AM GENESIS : SIF
GENESIS
(Post Graduation Medical orientation Centre)
Exam : MRCS Sub Final Pathology (Surgical) Jan-24
Course: OUTLIER Discipline: Surgery Faculty: Surgery
Batch: MRCS P-A Exam Batch Jan-24
Year: 2023 Session: July (July-Jan)
(1 of 100 )
Which of the following features are not typical of Crohns disease
a) Complex fistula in ano
b) Small bowel strictures
c) Skip lesions
d) Rose thorn ulcers' on barium studies
Correct
e) Pseudopolyps on colonoscopy
Ans
(2 of 100 )
A 30 year old male presents with gynaecomastia. Clinically, he is noted to have a nodule in the
left testis. What is the most likely diagnosis?
a) Oestrogen abuse
b) Seminoma with syncytiotrophoblast giant cells
c) Teratoma
d) Sarcoma
Correct
e) Leydig cell tumour
Ans
(3 of 100 )
https://genesisedu.info/question-answer-list/10014901/10922 1/41
12/19/23, 10:27 AM GENESIS : SIF
A 55 year old man undergoes a colonoscopy and a colonic polyp is identified. It has a lobular
appearance and is located on a stalk in the sigmoid colon. Which of the processes below best
accounts for this finding?
a) Apoptosis
b) Metaplasia
Correct
c) Dysplasia
Ans
d) Calcification
e) Degeneration
(4 of 100 )
Which of the following is associated with poor wound healing?
Correct
a) Jaundice
Ans
b) Patients taking carbamazepine
c) General anaesthesia using thiopentone
d) General anaesthesia using ketamine
e) Multiple sclerosis
(5 of 100 )
A 34 year old man is diagnosed with an aggressive caecal adenocarcinoma. His sister died from
the same disease at 38 years of age. His mother died from endometrial cancer at the age of 41.
What is the most likely underlying abnormality?
a) Familial adenopolypomatosis coli
b) Gardeners syndrome
12/19/23, 10:27 AM GENESIS : SIF
Correct
c) Mutation of mismatch repair genes
Ans
d) Deletion of chromosome 6
e) MYH gene mutation
(6 of 100 )
Features which are evaluated for the grading of breast cancer include all the following, except:
a) Tubule formation
b) Mitoses
c) Nuclear pleomorphism
Correct
d) Tumour necrosis
Ans
e) Coarse chromatin
(7 of 100 )
You review a 42-year-old woman 8 months following a renal transplant for focal segmental
glomerulosclerosis. She is on a combination of tacrolimus, mycophenolate, and prednisolone.
She has now presented with a five day history of feeling generally unwell with jaundice, fatigue
and arthralgia. On examination she has jaundice, widespread lymphadenopathy and
hepatomegaly. What is the most likely diagnosis?
a) Hepatitis C
Correct
b) Epstein-Barr virus
Ans
c) HIV
d) Hepatitis B
e) Cytomegalovirus
12/19/23, 10:27 AM GENESIS : SIF
(8 of 100 )
Which of the following statements relating to chronic inflammation is true?
a) Chronic inflammation is mainly secondary to acute inflammation
b) Neutrophils are the predominant cells involved
c) Growth factors are not involved in the process
d) Appendicitis is mainly a form of chronic inflammation
Correct
e) Fibrosis is a macroscopic feature
Ans
(9 of 100 )
A 16 year-old boy presents to his GP with loss of weight, pain and fever. On examination, a mass
is palpable over the mid-thigh region. What is the most likely diagnosis?
a) Fibrosarcoma
b) Osteosarcoma
Correct
c) Ewing sarcoma
Ans
d) Osteoid osteoma
e) Synovial sarcoma
(10 of 100 )
A 63 year old man has a history of claudication that has been present for many years. He is
recently evaluated in the clinic and a duplex scan shows that he has an 85% stenosis of the
superficial femoral artery. Two weeks later he presents with a 1 hour history of severe pain in his
leg. On examination, he has absent pulses in the affected limb and it is much cooler than the
contra-lateral limb. Which process best accounts for this presentation?
Correct
a) Thrombosis
Ans
12/19/23, 10:27 AM GENESIS : SIF
b) Embolus
c) Atheroma growth
d) Sub intimal dissection
e) Anaemia
(11 of 100 )
A 55 year old man has suffered from reflux oesophagitis for many years. During a recent
endoscopy a biopsy is taken from the distal oesophagus. The histopathology report indicates
that cells are identified with features of coarse chromatin and abnormal mitoses. The cells are
confined to the superficial epithelial layer only. Which of the following accounts for this process
a) Metaplasia
b) Apoptosis
c) Autoimmune oesophagitis
Correct
d) Dysplasia
Ans
e) Infection with Helicobacter pylori
(12 of 100 )
A 56 year old man with Wilsons disease presents with right upper quadrant discomfort. An
ultrasound scan is performed and this demonstrates a mass lesion in the right lobe of the
liver.What is the most appropriate method of establishing the underlying diagnosis?
a) PET CT scan
b) Ultrasound guided biopsy
Correct
c) Measurement of serum alpha feto protein
Ans
d) MRI scan of the liver
e) CT scan of the liver
(13 of 100 )
12/19/23, 10:27 AM GENESIS : SIF
A 22year old man is reviewed on the ward 10 days following a laparotomy. The wound is
inspected and is healing well. Which of the following processes is least likely to be occurring in
the wound at this stage?
a) Angiogenesis
b) Synthesis of collagen
Correct
c) Necrosis of fibroblasts
Ans
d) Secretion of matrix metalloproteinases by fibroblasts
e) Proliferation of fibroblasts
(14 of 100 )
A 23 year old man fractures his right tibia in a sporting accident. At which point in the healing
process is fracture callus first visible radiologically?
a) 1 day
b) 7 days
c) 8 weeks
d) 6 weeks
Correct
e) 3 weeks
Ans
(15 of 100 )
A 5 year old boy is found to have a Meckels diverticulum at an appendicectomy and it looks to
be non inflamed. What type of epithelium is most likely to be found in the diverticulum?
a) Gastric mucosa
b) Non stratified squamous epithelium
12/19/23, 10:27 AM GENESIS : SIF
Correct
c) Ileal mucosa
Ans
d) Stratified squamous epithelium
e) Jejunal mucosa
(16 of 100 )
A 30 year old man presents with abdominal distension, a laparotomy is performed, at operation
the abdomen is filled with a large amount of gelatinous fluid. What is the most likely underlying
diagnosis?
a) Infection with entamoeba histolytica
Correct
b) Pseudomxyoma peritonei
Ans
c) Metastatic colonic cancer
d) Chylous ascites
e) None of the above
(17 of 100 )
A pregnant women suddenly develops bilateral leg swelling. Her mother and aunt were troubled
by the same problem. What is the most likely underlying abnormality?
a) Anti endomysial antibodies
b) Anti nuclear antibodies
Correct
c) Anti cardiolipin antibodies
Ans
d) Anti thyroid antibodies
e) Anti mitochondrial antibodies
(18 of 100 )
12/19/23, 10:27 AM GENESIS : SIF
A 73-year-old man undergoes an emergency amputation for severe lower limb sepsis and
gangrene. Post operatively he develops disseminated intravascular coagulation. Which of the
following clotting factors will be most rapidly consumed in this process?
Correct
a) Factor V and VIII
Ans
b) Factor I
c) Factor I and III
d) Factor III and VII
e) Factor VI and VIII
(19 of 100 )
A 23 year old man presents with weight loss fatigue and lymphadenopathy. He is diagnosed with
tuberculosis. Which of the following processes most closely matches the underlying
pathological process?
a) Type 1 hypersensitivity reaction
b) Type 2 hypersensitivity reaction
c) Type 3 hypersensitivity reaction
Correct
d) Type 4 hypersensitivity reaction
Ans
(20 of 100 )
A 68 year old man presents with an ulcerated lesion on his right cheek. It is excised and on
histological assessment a squamous cell carcinoma is diagnosed. It measures 25mm in
diameter and is 4mm deep. Which of the following statements relating to this condition is false?
a) In this particular case margins of at least 6mm are required
12/19/23, 10:27 AM GENESIS : SIF
b) Use of cryosurgery to treat this patients lesion would have been unsafe
Correct
c) Use of radiotherapy to treat this lesion would have been unsafe
Ans
d) This patients local recurrence rate may approach 15%
e) The disease usually spreads via lymphatics
(21 of 100 )
Which of the following is not included in Multiple Endocrine Neoplasia Type 2b?
a) Phaeochromocytoma
b) Visceral ganglioneuromas
c) Thyroid medullary carcinoma
Correct
d) Zollinger Ellison syndrome
Ans
e) Marfanoid features
(22 of 100 )
A 4 year old presents with sudden onset of dysphagia. He undergoes an upper GI endoscopy
and a large bolus of food is identified in the mid oesophagus. He has no significant history,
other than a tracheo-oesophageal fistula repair soon after birth. What is the most likely
diagnosis?
a) Barretts oesophagus
Correct
b) Benign oesophageal stricture
Ans
c) Squamous cell carcinoma of the oesophagus
d) Oesophageal adenocarcinoma
12/19/23, 10:27 AM GENESIS : SIF
e) Achalasia
(23 of 100 )
A 40 year old female is diagnosed as having Dercums disease. Which of the lesions listed
below are most likely to be identified on physical examination?
Correct
a) Lipomas
Ans
b) Neuromas
c) Hamartomas
d) Arteriovenous malformations
e) Histiocytomas
(24 of 100 )
A 40 year old man presents with symptoms of dysphagia that have been present for many
months. His investigations demonstrate lack of relaxation of the lower oesophageal sphincter
during swallowing. What is the most likely diagnosis?
a) Benign stricture
b) Leiomyoma
c) Adenocarcinoma
d) Barretts oesophagus
Correct
e) Achalasia
Ans
(25 of 100 )
A 22 year old man is admitted to hospital with a lower respiratory chest infection. He had a
splenectomy after being involved in a car accident. What is the most likely infective organism?
Correct
a) Haemophilus influenzae
Ans
b) Staphylococcus aureus
c) Rhinovirus
12/19/23, 10:27 AM GENESIS : SIF
d) Mycobacterium tuberculosis
e) Moraxella catarrhalis
(26 of 100 )
A 43 year old woman undergoes a sigmoid colectomy for carcinoma. The histology report
shows pT3, pN1, systemic staging is M0. She is otherwise well. What is the most appropriate
course of action?
a) Active surveillance with CT scans at 6 and 12 months and monthly CEA measurement
Correct
b) Referral for chemotherapy
Ans
c) Radiotherapy to the resection site
e) Active surveillance with colonoscopy at 12 months and CT scan at 6 months and 3

monthly CEA measurement
d) Discharge
(27 of 100 )
A 73 year old lady falls and sustains a distal radius fracture that is immobilized in a cast. What
pathological process is most likely to have affected the immobilized muscles?
a) Agenesis
b) Hypoplasia
c) Apoptosis
Correct
d) Atrophy
Ans
e) Coagulative necrosis
(28 of 100 )
12/19/23, 10:27 AM GENESIS : SIF
Which of the metastatic bone tumours described below is at the greatest risk of pathological
fracture?
a) Proximal humeral lesion from a prostate cancer
b) Vertebral body lesions from a prostate cancer
Correct
c) Peritrochanteric lesion from a carcinoma of the breast
Ans
d) Proximal humeral lesion from a carcinoma of the breast
e) Peritrochanteric lesion from a prostate cancer
(29 of 100 )
A 45 year old man with long standing ulcerative colitis and rectal dysplasia presents with a
DALM lesion in the rectum. What is the most appropriate management option?
a) Snare polypectomy
b) Repeat endoscopy in 2 years

c) Discharge
d) Anterior resection
Correct
e) Panproctocolectomy
Ans
(30 of 100 )
A 59 year old man presents with recurrent episodes of urinary sepsis. In his history he mentions
that he has suffered from recurrent attacks of left iliac fossa pain over the past few months. He
has also notices bubbles in his urine. He undergoes a CT scan which shows a large
inflammatory mass in the left iliac fossa. No other abnormality is detected. The most likely
diagnosis is:
a) Ulcerative colitis
b) Crohns disease
c) Mesenteric ischaemia
Correct
d) Diverticular disease
Ans
e) Rectal cancer
(31 of 100 )
12/19/23, 10:27 AM GENESIS : SIF
A 63 year old man finds that he has to stop walking after 100 yards due to bilateral calf pain. He
finds that bending forwards and walking up hill helps. He is able to ride a bike without any pain.
What is the most likely underlying cause?
Correct
a) Lumbar canal stenosis
Ans
b) Diabetic neuropathy
c) Aorto-iliac occlusion
d) Occlusion of the superficial femoral artery
e) Pelvic rheumatoid arthritis
(32 of 100 )
A 34 year old woman presents with recurrent peptic ulceration. She is on proton pump inhibitors
and previously received Helicobacter pylori eradication therapy three months ago. Which of the
following is likely to be raised on venous blood testing?
a) Secretin
b) Cholecystokinin
Correct
c) Gastrin
Ans
d) Amylase
e) Histamine
(33 of 100 )
A 72 year old man has been unwell for many years and following his death a post mortem is
performed. Tissue is submitted for microscopic evaluation. Evaluation of sections of the
myocardium demonstrates evidence of apple green birefringence with polarised light. What is
the most likely diagnosis?
Correct
a) Amyloidosis
Ans
b) SLE
c) Tuberculosis
d) Disseminated B cell lymphoma
12/19/23, 10:27 AM GENESIS : SIF
e) Systemic sclerosis
(34 of 100 )
Which of the following hepatobiliary disorders are most classically associated with ulcerative
colitis?
a) Gallstones
Correct
b) Primary sclerosing cholangitis
Ans
c) Bile duct stones
d) Liver hamartomas
e) Hepatocellular carcinoma
(35 of 100 )
A patient is diagnosed with a Klatskin tumour which of the structures listed below is affected by
this disease process?
a) Kidney
b) Stomach
c) Colon
Correct
d) Bile duct
Ans
e) Spleen
(36 of 100 )
An 18 year old rock climber falls onto his left arm and sustains a large haematoma of the left
upper arm. Unfortunately the wound associated with the injury is neglected and it becomes
infected. Which of these changes is least likely to occur?
12/19/23, 10:27 AM GENESIS : SIF
a) Axillary lymphadenopathy
Correct
b) Leucopenia
Ans
c) Tenderness
d) Mild pyrexia
e) Local formation of yellow pus
(37 of 100 )
A 20 year old girl presents with a thyroid cancer, she is otherwise well with no significant family
history. On examination, she has a nodule in the left lobe of the thyroid, with a small discrete
mass separate from the gland itself. Which of the following is the most likely cause
a) Follicular carcinoma
b) Anaplastic carcinoma
c) Medullary carcinoma
Correct
d) Papillary carcinoma
Ans
e) B Cell Lymphoma
(38 of 100 )
A 25 year old man from the far east presents with a fever and right upper quadrant pain. As part
of his investigations a CT scan shows an ill defined lesion in the right lobe of the liver. What is
the most probable cause?
a) Hydatid cyst
Correct
b) Amoebic abscess
Ans
c) Hepatocellular carcinoma
12/19/23, 10:27 AM GENESIS : SIF
d) Simple liver cyst
e) Liver cell adenoma
(39 of 100 )
A patient is diagnosed with a Klatskintumour which of the structures listed below is affected by
this disease process?
a) Kidney
b) Stomach
c) Colon
Correct
d) Bile duct
Ans
e) Spleen
(40 of 100 )
An 18year old rock climber falls onto his left arm and sustains a large haematoma of the left
upper arm. Unfortunately, the wound associated with the injury is neglected and it becomes
infected. Which of the following changes is least likely to occur?
Correct
b) Leucopenia
Ans
c) Tenderness
d) Mild pyrexia
(41 of 100 )
A 20 year old girl presents with a thyroid cancer, she is otherwise well with no significant family
history. On examination, she has a nodule in the left lobe of the thyroid, with a small discrete
mass separate from the gland itself. Which of the following is the most likely cause?
a) Follicular carcinoma
12/19/23, 10:27 AM GENESIS : SIF
b) Anaplastic carcinoma
c) Medullary carcinoma
Correct
d) Papillary carcinoma
Ans
e) B Cell Lymphoma
(42 of 100 )
A 28 year old lady has a malignant melanoma removed from her calf. Which of thefollowing
pathological criteria carries the greatest prognostic weighting?
a) Vascular invasion
b) Abnormal mitosis
Correct
c) Breslow thickness
Ans
d) Perineural invasion
e) Lymphocytic infiltrates
(43 of 100 )
A 60 year old man is found to have a 2 cm diameter mass in the upper lobe of his left lung.The
lesion is excised and it is found that the lesion includes connective tissue, mature cartilage and
ciliated epithelium. What is the most likely diagnosis?
a) Sarcoma
b) Adenocarcinoma
c) Squamous cell carcinoma
Correct
d) Hamartoma
Ans
12/19/23, 10:27 AM GENESIS : SIF
e) Chondroma
(44 of 100 )
Which of the following features are not typically seen in a venous stasis ulcer?
a) Located above the medial malleolus
b) Haemosiderin deposits
c) Variable scarring
Correct
d) Exophytic granulation tissue
Ans
e) Varicose veins
(45 of 100 )
A 4year old girl presents with symptoms of right sided loin pain, lethargy and haematuria. On
examination she is pyrexial and has a large mass in the right upper quadrant. The most likely
underlying diagnosis is:
a) Perinephric abscess
Correct
b) Nephroblastoma
Ans
c) Renal cortical adenoma
d) Grawitz tumour
e) Squamous cell carcinoma of the kidney
(46 of 100 )
A 20 year old man is involved in a road traffic accident. Following the incident he is unable to
extend his wrist. However, this improves over the following weeks. Which type of injury is he
most likely to have sustained?
12/19/23, 10:27 AM GENESIS : SIF
a) Radial nerve neurotmesis
Correct
b) Radial nerve neuropraxia
Ans
c) Axillary nerve axonotmesis
d) Ulnar nerve neuropraxia
e) Ulnar nerve axonotmesis
(47 of 100 )
A 22 year old man is kicked in the head during a rugby match. He is temporarily concussed, but
then regains consciousness. Half an hour later he develops slurred speech, ataxia and loses
consciousnesses. On arrival in hospital he is intubated and ventilated. A CT Scan is performed
which shows an extradural haematoma. What is the most likely cause?
a) Basilar artery laceration
Correct
b) Middle meningeal artery laceration
Ans
c) Laceration of the sigmoid sinus
d) Laceration of the anterior cerebral artery
e) Laceration of the middle cerebral artery
(48 of 100 )
A 35 year old male presents with haematuria. He is found to have bilateral masses in the flanks.
He has a history of epilepsy and learning disability. Which of the lesions below is most likely?
Correct
a) Angiomyolipoma
Ans
b) Renal cortical cysts
c) Transitional cell cancer
12/19/23, 10:27 AM GENESIS : SIF
d) Nephroblastomas
e) Staghorn calculi
(49 of 100 )
What is the most common cause of osteolytic bone metastasis in children?
a) Osteosarcoma
Correct
b) Neuroblastoma
Ans
c) Leukaemia
d) Rhabdomyosarcoma
e) Nephroblastoma
(50 of 100 )
A 56 year old lady has just undergone a colonoscopy and a 1.5cm lesion was identified in the
caecum. The histology report states that biopsies have been taken from a sessile serrated polyp
with traditional features. What is the best management option?
a) Perform a right hemicolectomy
Correct
b) List the patient for colonoscopic polypectomy
Ans
c) Discharge the patient
d) Re scope the patient in 6 months
e) Re scope the patient at 3 years
(51 of 100 )
Which of the disorders listed below is characterized by a PTEN mutation and intestinal
hamartomas?
12/19/23, 10:27 AM GENESIS : SIF
a) Familial adenomatous polyposis coli
b) MYH associated polyposis
c) Peutz-Jeghers syndrome
Correct
d) Cowden disease
Ans
e) Lynch syndrome
(52 of 100 )
Which of the following processes facilitates phagocytosis?
a) Apoptosis
Correct
b) Opsonisation
Ans
c) Proteolysis
d) Angiogenesis
e) Necrosis
(53 of 100 )
A 32 year old lady undergoes a thyroidectomy for a mild goitre. The resected specimen shows
an intense lymphocytic infiltrate with acinar destruction and fibrosis. What is the underlying
lesion?
a) Anaplastic carcinoma
b) Rhadomyosarcoma
c) Lymphoma
12/19/23, 10:27 AM GENESIS : SIF
Correct
d) Hashimotos thyroiditis
Ans
e) Graves disease
(54 of 100 )
A 16 year-old boy presents to his GP with loss of weight, pain and fever. On examination, a mass
is palpable over the mid-thigh region. What is the most likely diagnosis?
a) Fibrosarcoma
b) Osteosarcoma
Correct
c) Ewing sarcoma
Ans
d) Osteoid osteoma
e) Synovial sarcoma
(55 of 100 )
During a difficult femoro-popliteal bypass operation the surgeon inadvertently places a clamp
across the femoral nerve. It remains there for most of the procedure. At the end of the operation
the nerve is inspected, it is in continuity but has evidence of being crushed. Which of the
following is most likely to occur over the following weeks
Correct
a) Wallerian degeneration
Ans
b) Rapid restoration of neuronal function because the axon itself is intact
c) Normal but delayed neuronal transmission due to disruption of the myelin
d) Absence of neuroma formation
12/19/23, 10:27 AM GENESIS : SIF
(56 of 100 )
Which one of the following confers the least risk of developing osteoporosis?
Correct
a) Obesity
Ans
b) Long term unfractionated heparin therapy
c) Gastrectomy
d) Osteogenesis imperfecta
e) Diabetes
(57 of 100 )
A 56-year-old man with Wilsons’s disease presents with right upper quadrant discomfort. An
ultrasound scan is performed and this demonstrates a mass lesion in the right lobe of the liver.
What is the most appropriate method of establishing the underlying diagnosis?
a) PET CT scan
b) Ultrasound guided biopsy
Correct
c) Measurement of serum alpha feto protein
Ans
d) MRI scan of the liver
e) CT scan of the liver
(58 of 100 )
A 48 year old lady is admitted with abdominal distension. On examination, she is cachectic and
has ascites. Her CA19-9 returns highly elevated. What is the most likely cause?
a) Metastatic ovarian cancer
Correct
b) Metastatic pancreatic cancer
Ans
12/19/23, 10:27 AM GENESIS : SIF
c) Metastatic gastric cancer
d) Metastatic colonic cancer
e) Pseudomyxoma peritoneii
(59 of 100 )
Beta-naphthalamine is associated with which of the following malignancies?
a) Lung cancer
b) Bowel cancer
Correct
c) Bladder cancer
Ans
d) Liver cancer
e) Renal cancer
(60 of 100 )
A 45 year old woman is identified as having a gastric gastro-intestinal stromal tumour. What is
the usual cell of origin of these lesions?
a) Brunners glands
Correct
b) Interstitial cells of Cajal
Ans
c) Primitive stem cells of the gut wall
d) Fundic glands
e) Antral goblet cells
(61 of 100 )
12/19/23, 10:27 AM GENESIS : SIF
A 30 year old man is suspected of having appendicitis. At operation an inflamed Meckels

diverticulum is found. Which of the following vessels is responsible for the blood supply to a
Meckels diverticulum?
a) Right colic artery
Correct
b) Vitelline artery
Ans
c) Appendicular artery
d) Internal iliac artery
e) External iliac artery
(62 of 100 )
A pregnant women suddenly develops bilateral leg swelling. Her mother and aunt were troubled
by the same problem. What is the most likely underlying abnormality?
a) Anti endomysial antibodies

b) Anti nuclear antibodies
Correct
c) Anti cardiolipin antibodies
Ans
d) Anti thyroid antibodies
e) Anti mitochondrial antibodies
(63 of 100 )
Which of the following does not occur as a pathological response to extensive burns?
a) Plasma leakage into interstitial space
Correct
b) Absolute polycythaemia
Ans
c) Increased haematocrit
d) Keratinocyte migration during healing
e) Cardiac output reduction by 50% in first 30 minutes
12/19/23, 10:27 AM GENESIS : SIF
(64 of 100 )
A 69 year old man presents with a purple lesion on his forearm. It is excised and an a 3 cm
Merkel cell tumour is diagnosed. Which of the following statements relating to this diagnosis is
false?
a) He should undergo a sentinel lymph node biopsy.
b) Lymphovascular invasion is typically seen histologically
c) They are more common in immunosupressed patients
Correct
d) Histologically they may resemble pyogenic granuloma
Ans
e) They are associated with visceral metastasis
(65 of 100 )
A 40 year old woman is being investigated for haematuria. She was living with her sister who
has just died from a sub arachnoid haemorrhage. The haematuria is painless and she has mild
renal impairment. What is the most likely cause?
a) Adenocarcinoma of the bladder
b) Bladder stones
Correct
c) Polycystic kidney disease
Ans
d) Renal cancer
e) Pyelonephritis
(66 of 100 )
A 22 year old lady presents with symptoms and signs of hyperthyroidism. Her diagnostic work
up results in a diagnosis of Graves disease. Which of the following best describes the
pathophysiology of the condition?
Correct
a) Formation of IgG antibodies to the TSH receptors on the thyroid gland
Ans
12/19/23, 10:27 AM GENESIS : SIF
b) Formation of IgG antibodies to the TRH receptors on the anterior pituitary
c) Formation of IgM antibodies to the TSH receptors on the thyroid gland
d) Formation of IgA antibodies to the TSH receptors on the thyroid gland
e) Formation of IgM antibodies to the TRH receptors on the anterior pituitary
(67 of 100 )
A 53 year old man presents with dyspepsia. An upper GI endoscopy is performed and
Helicobacter pylori is identified. A duodenal ulcer is present in the first part of the duodenum.
Duodenal biopsies are taken and demonstrate epithelium that resembles cells of the gastric
antrum. Which of the following is the most likely explanation for this process?
a) Hyperplasia of the crypts of Lieberkuhn
Correct
b) Duodenal metaplasia
Ans
c) Duodenal dysplasia
d) Duodenal carcinoma
e) Hyptertrophy of Brunners glands
(68 of 100 )
A 45 year old woman complains of painful tingling in her fingers. The pain is relieved by hanging
the arm over the side of the bed. She has a positive Tinel's sign at the wrist. Which of the
following is most likely to contribute to her diagnosis?
a) Methotrexate use
b) Crohn's disease
c) Hyperthyroidism
12/19/23, 10:27 AM GENESIS : SIF
d) Tuberculosis
Correct
e) Rheumatoid arthritis
Ans
(69 of 100 )
What is the most likely electrolyte abnormality in a patient with diarrhoea and a soft mass felt on
digital rectal examination?
a) Hyperkalaemia
Correct
b) Hypokalaemia
Ans
c) Hyponatraemia
d) Hypernatraemia
e) Hypocalcaemia
(70 of 100 )
A 22 year old man presents with symptoms of lethargy and bilateral facial nerve palsy. On
examination he has bilateral parotid gland enlargement. What is the most likely cause?
a) Pleomorphic adenoma
b) Cerebrovascular accident
Correct
c) Sarcoidosis
Ans
d) Warthins tumour
e) Adenoid cystic carcinoma
(71 of 100 )
Which of the following is not found on a blood film post splenectomy
12/19/23, 10:27 AM GENESIS : SIF
a) Pappenheimer bodies
Correct
b) Stipple cells
Ans
c) Erythrocyte containing siderotic granules
d) Howell-Jolly bodies
e) Target cells
(72 of 100 )
Which of the following cellular types or features is not seen in sarcoidosis?
Correct
a) Reed Sternberg Cells
Ans
b) T lymphocytes
c) Macrophages
d) Asteroid bodies
e) B lymphocytes
(73 of 100 )
A keen surgical trainee is about to embark on her first hemi arthroplasty for a fractured neck of
femur. In the anaesthetic room the patient is given 1.2g intravenous co-amoxiclav. There is a
possible history of penicillin allergy but the patient is demented and the history is not checked.
The patient then develops severe respiratory compromise and haemodynamic collapse. Which
of the following pathological processes accounts for this event?
a) Binding of the drug to circulating IgG class antibodies
Correct
b) Recognition of the drug by IgE receptors on mast cells
Ans
c) Drug initiated formation of hapten-protein complexes
12/19/23, 10:27 AM GENESIS : SIF
d) Binding of the drug to circulating IgM class antibodies
(74 of 100 )
A 28 year old lady has a malignant melanoma removed from her calf. Which of the following
pathological criteria carries the greatest prognostic weighting?
a) Vascular invasion
b) Abnormal mitoses
Correct
c) Breslow thickness
Ans
d) Perineural invasion
e) Lymphocytic infiltrates
(75 of 100 )
A 24 year old lady from Western India presents with symptoms of lethargy and dizziness, worse
on turning her head. On examination her systolic blood pressure is 176/128. Her pulses are
impalpable at all peripheral sites. Auscultation of her chest reveals a systolic heart murmur.
What is the most likely diagnosis?
a) Subclavian steal syndrome
b) Aortic coarctation
c) Patent ductus arteriosus
d) Aortic dissection
Correct
e) Takayasu's arteritis
Ans
(76 of 100 )
12/19/23, 10:27 AM GENESIS : SIF
A 43year old lady with hypertension is suspected of having a phaeochromocytoma. Which of the
following investigations is most likely to be beneficial in this situation?
a) Dexamethasone suppression test
b) Urinary 5-Hydroxyindoleacetic Acid (5-HIAA)
c) Histamine provocation test
d) Tyramine provocation test
Correct
e) Urinary vanillymandelic acid measurements
Ans
(77 of 100 )
A 35 year old man is found to have carcinoid syndrome. Which of the following hormones is
released by carcinoids?
Correct
a) Serotonin
Ans
b) Dopamine
c) Nor adrenaline
d) Adrenaline
e) Aldosterone
(78 of 100 )
A 53year old man from Hong Kong presents with symptoms of fatigue, weight loss and recurrent
epistaxis. Clinical examination reveals left sided cervical lymphadenopathy and oropharyngeal
examination reveals an ulcerated mass in the nasopharynx. Which of the following viral agents
is most commonly implicated in the development of this condition?
a) Cytomegalovirus
Correct
b) Epstein Barr virus
Ans
12/19/23, 10:27 AM GENESIS : SIF
c) Coxsackie virus
d) Herpes simplex virus
(79 of 100 )
A 5 year old boy presents with recurrent episodes of sinusitis. The casualty staff are surprised
to find his liver lying in the left upper quadrant of the abdomen. What is the underlying
diagnosis?
a) Von Recklinghausen's disease
b) Li Fraumeni syndrome
c) Pierre Robin syndrome
Correct
d) Kartagener's syndrome
Ans
e) MEN I
(80 of 100 )
A 38year old lady presents with a recent episode of renal colic. As part of her investigations the
following results are obtained: Corrected Calcium: 3.84 mmol/l; PTH: 88pg/ml (increased). Her
serum urea and electrolytes are normal. What is the most likely diagnosis?
a) Carcinoma of the bronchus
b) Secondary hyperparathyroidism
Correct
c) Primary hyperparathyroidism
Ans
d) Tertiary hyperparathyroidism
e) Carcinoma of the breast
12/19/23, 10:27 AM GENESIS : SIF
(81 of 100 )
A 78 year old lady presents 6 years following a successfully treated squamous cell carcinoma of
the oesophagus. She has a long history of dysphagia but it is not progressive. What is the most
likely diagnosis?
a) Recurrent malignancy
b) Oesophageal candidiasis
Correct
c) Radiation stricture
Ans
d) Globus
e) Pharyngeal pouch
(82 of 100 )
A 26 year old man who smokes heavily develops aching, crampy pains in his legs. On
examination, distal limb pulses are diminished. What is the most likely cause?
Correct
a) Vasculitis
Ans
b) Steal syndrome
c) Clot embolus
d) Vasospasm
e) Arterial injury
(83 of 100 )
A 22year old man is referred to the surgical clinic. He has been complaining of varicose veins
for many years. On examination he has extensive varicosities of the right leg, there are areas of
marked port wine staining. The saphenofemoral junction is competent on doppler assessment.
The most likely underlying diagnosis is:
a) Deep vein thrombosis
12/19/23, 10:27 AM GENESIS : SIF
Correct
b) Klippel-Trenaunay syndrome
Ans
c) Varicose veins due to sapheno-popliteal junction incompetence
d) Sturge - Weber syndrome
e) Angiosarcoma
(84 of 100 )
A 55 year old man with dyspepsia undergoes an upper GI endoscopy. An irregular erythematous
area is seen to protrude proximally from the gastro-oesophageal junction. Apart from
specialised intestinal metaplasia, which of the following cell types should also be present for a
diagnosis of Barretts oesophagus to be made?
Correct
a) Goblet cell
Ans
b) Neutrophil
c) Lymphocytes
d) Epithelial cells
e) Macrophages
(85 of 100 )
A 24 year old lady from Western India presents with symptoms of lethargy and dizziness, worse
on turning her head. On examination her systolic blood pressure is 176/128. Her pulses are
impalpable at all peripheral sites. Auscultation of her chest reveals a systolic heart murmur.
What is the most likely diagnosis?
a)Subclavian steal syndrome
b) Aortic coarctation
c) Patent ductus arteriosus
d) Aortic dissection
Correct
e) Takayasu's arteritis
Ans
(86 of 100 )
12/19/23, 10:27 AM GENESIS : SIF
What is the commonest malignant tumour of the anal canal?
a) Lymphoma
b) Melanoma
Correct
c) Squamous cell carcinoma
Ans
d) Adenocarcinoma
e) Sarcoma
(87 of 100 )
A 73 year old man presents with haemoptysis and is suspected of suffering from lung cancer.
On examination he has an enlarged supraclavicular lymph node. Which of the following features
is most likely to be present on histological examination?
Correct
a) Increased mitoses
Ans
b) Apoptosis
c) Barr Bodies
d) Multinucleate giant cells
e) Granuloma
(88 of 100 )
A 25 year old woman presents with a slowly enlarging mass on the side of the face. Clinical
examination demonstrates that the mass is located in the tail of the parotid gland. There is no
evidence of facial nerve involvement. What is the most likely cause?
a) Sialolithiasis
b) Adenocarcinoma
12/19/23, 10:27 AM GENESIS : SIF
c) Warthins tumour
d) Oncocytoma
Correct
e) Pleomorphic adenoma
Ans
(89 of 100 )
A 30 year old man presents with abdominal distension, laparotomy is performed, at operation,
abdomen is filled with large amount of gelatinous fluid. What is the most likely diagnosis?
a) Entamoeba histolytica infection
Correct
b) Pseudomyxoma peritonei
Ans
c) Metastatic colonic cancer
d) Chylous ascites
e) None of above
(90 of 100 )
A 52 year old lady is referred to the breast clinic with symptoms of nipple discharge. The
discharge is usually thick and green. Which of the following statements relating to the most
likely underlying diagnosis is untrue?
a) The majority of patients will be smokers
Correct
b) Typically produces blood stained nipple discharge
Ans
c) It is not associated with increased risk of breast cancer
d) May result in development of mammary duct fistula
e) May require total duct excision (Hadfields operation) if it fails to resolve
(91 of 100 )
12/19/23, 10:27 AM GENESIS : SIF
A 75 year Old man is admitted with large bowel Obstruction and on investigation is found to
have a significant sigmoid diverticular stricture as the underlying cause. What is the most
appropriate treatment?
a) Colonosscopy and pneumatic dilatation Of the Stricture
Correct
b) Laparotomy and Hartmanns procedure
Ans
c) Colonoscopy and insertion of self expanding metallic stent
d) Loop ileostomy
e) Laparotomy, sigmoid colectomy and colorectal anastomosis
(92 of 100 )
A 19 year old male presents with bright red rectal bleeding that occurs post defecation onto the
paper and into the pan. Apart from constipation his bowel habit is normal. Digital rectal
examination is normal. What is the most likely cause?
Correct
a) Haemorrhoidal disease
Ans
b) Fissure in ano
c) Solitary rectal ulcer
d) Rectal cancer
e) Crohns disease
(93 of 100 )
A 62 year old man is identified as having a rectal cancer. Following diagnostic work up no
metastatic disease is identified. The tumour is 2cm from the anal verge. On MRI, lesion is T2,
NO. Which of the following represents the correct course of action?
Correct
a) Proceed to abdomino-perineal excision of the colon and rectum (ELAPE)
Ans
12/19/23, 10:27 AM GENESIS : SIF
b) Undertake a low anterior resection and loop ileostomy
c) Undertake a Hartmanns procedure
d) Offer radical extern I beam radiotherapy followed by abdomino-perineal excision of the

colon and rectum (ELAPE)
e) Offer radical radiotherapy followed by low anterior resection and loop ileostomy
(94 of 100 )
A 4 year old girl presents with symptoms of right sided loin pain, lethargy and haematuria. On
examination she is pyrexial and has a large mass in the right upper quadrant. The most likely
underlying diagnosis is:
a) Perinephric abscess
Correct
b) Nephroblastoma
Ans
c) Renal cortical adenoma
d) Grawitz tumour
e) Squamous cell carcinoma of the kidney
(95 of 100 )
A 45 year old women with a thyroid carcinoma undergoes a total thyroidectomy. The post
operative histology report shows a final diagnosis of medullary type thyroid cancer. Which of
the tests below is most likely to be of clinical use in screening for disease recurrence?
a) Serum CA 19-9 Levels
b) Serum thyroglobulin levels
c) Serum PTH levels
12/19/23, 10:27 AM GENESIS : SIF
Correct
d) Serum calcitonin levels
Ans
e) Serum TSH levels
(96 of 100 )
A 73 year old man presents with haemoptysis and is suspected of suffering from lung cancer.
On examination he has an enlarged supraclavicular lymph node. Which of the following features
is most likely to be present on histological examination?
Correct
a) Increased mitoses
Ans
b) Apoptosis
c) Barr Bodies
d) Multinucleate giant cells
e) Granuloma
(97 of 100 )
A 34 year old lady undergoes an elective cholecystectomy for attacks of recurrent cholecystitis
due to gallstones. Microscopic assessment of the gallbladder is most likely to show which of
the following?
a) Dysplasia of the fundus
b) Widespread necrosis
Correct
c) Aschoff-Rokitansky sinuses
Ans
d) Metaplasia of the fundus
(98 of 100 )
12/19/23, 10:27 AM GENESIS : SIF
An 18 year old rock climber falls onto his left arm and sustains a large haematoma of the left
upper arm. Unfortunately, the wound associated with the injury is neglected and it becomes
infected. Which of the following changes is least likely to occur?
Correct
b) Leucopenia
Ans
c) Tenderness
d) Mild pyrexia
(99 of 100 )
Which of the following is true regarding natural killer (NK) T cells?
a) NK T cells can commence cell destruction with the presence of both an activation signal
and an inhibitory signal on the target cell surface.
b) NK T cells can commence cell destruction with the absence of both an inhibitory signal
and an activation signal on the target cell surface.
c) NK T cells can only commence cell destruction when the target cell surface has both the Correct
presence of an activation signal and the absence of an inhibitory signal. Ans
d) IL-12 inhibits activation of NK T cells.
e) NK T cells require activation by lymphocytes
(100 of 100 )
A 22 year old lady presents with an episode of renal colic and following investigation is
suspected of suffering from MEN IIa. Which of the following abnormalities of the parathyroid
glands are most often found in this condition?
a) Hypertrophy
12/19/23, 10:27 AM GENESIS : SIF
Correct
b) Hyperplasia
Ans
c) Adenoma
d) Carcinoma
e) Metaplasia

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Genesis Sif 16

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12/19/23, 10:27 AM GENESIS : SIF

Course: OUTLIER Discipline: Surgery Faculty: Surgery

Batch: MRCS P-A Exam Batch Jan-24

Year: 2023 Session: July (July-Jan)

Which of the following features are not typical of Crohns disease

a) Complex fistula in ano

b) Small bowel strictures

d) Rose thorn ulcers' on barium studies

b) Seminoma with syncytiotrophoblast giant cells

Which of the following is associated with poor wound healing?

b) Patients taking carbamazepine

c) General anaesthesia using thiopentone

d) General anaesthesia using ketamine

a) Familial adenopolypomatosis coli

e) MYH gene mutation

Which of the following statements relating to chronic inflammation is true?

a) Chronic inflammation is mainly secondary to acute inflammation

b) Neutrophils are the predominant cells involved

c) Growth factors are not involved in the process

d) Appendicitis is mainly a form of chronic inflammation

d) Sub intimal dissection

e) Infection with Helicobacter pylori

d) Secretion of matrix metalloproteinases by fibroblasts

b) Non stratified squamous epithelium

d) Stratified squamous epithelium

a) Infection with entamoeba histolytica

c) Metastatic colonic cancer

e) None of the above

a) Anti endomysial antibodies

b) Anti nuclear antibodies

d) Anti thyroid antibodies

e) Anti mitochondrial antibodies

c) Factor I and III

d) Factor III and VII

e) Factor VI and VIII

a) Type 1 hypersensitivity reaction

b) Type 2 hypersensitivity reaction

c) Type 3 hypersensitivity reaction

e) None of the above

a) In this particular case margins of at least 6mm are required

d) This patients local recurrence rate may approach 15%

e) The disease usually spreads via lymphatics

c) Thyroid medullary carcinoma

c) Squamous cell carcinoma of the oesophagus

c) Radiotherapy to the resection site

e) Active surveillance with colonoscopy at 12 months and CT scan at 6 months and 3

a) Proximal humeral lesion from a prostate cancer

b) Vertebral body lesions from a prostate cancer

d) Proximal humeral lesion from a carcinoma of the breast

e) Peritrochanteric lesion from a prostate cancer

b) Repeat endoscopy in 2 years

d) Disseminated B cell lymphoma

c) Bile duct stones

e) Local formation of yellow pus

d) Simple liver cyst

e) Liver cell adenoma

e) Local formation of yellow pus

c) Squamous cell carcinoma

a) Located above the medial malleolus

c) Renal cortical adenoma

e) Squamous cell carcinoma of the kidney

a) Radial nerve neurotmesis

c) Axillary nerve axonotmesis