MRCS Recalls Mock 1 4-18 first 40Q

Question 1

53 year old woman who complains of paroxysmal headaches associated with palpitation and sweating. is found to have a mass in the right lobe of her thyroid . she has family history of thyroid cancer. which of the following is the most likely diagnosis

Answer 1

Medullary Carcinoma

Question 2

62-year-old man presents with a painful, pale right lower limb. He underwent right femoro popliteal(below knee) bypass 18 months ago using in-situ vein. On duplex examination the graft isblocked. What is the most likely histological feature of the graft?

Answer 2

Neointimal hyperplasia

Question 3

A 24-year-old man with a history of Crohn disease presents with generalised bone pains and tenderness in his thighs. He also has increasing muscle weakness, increasing difficulty in walking and a change of gait. Serum calcium and phosphate levels are low but alkaline phosphatase and parathyroid hormone levels are elevated. A bone biopsy shows increase in non-mineralised osteoid What is the most likely diagnosis

Answer 3

Osteomalacia

Question 4

67-year-old man is admitted with history of rectal bleeding, preceded by left-sided abdominal pain on two occasions in the past 36 h. The blood was both bright red and dark plum coloured mixed with a loose motion he is on atenolol for hypertension. Examination shows frankblood per rectum. There is slight abdominal tenderness in the left iliac fossa. He is normotensive with hemoglobin of 106 g/L. Which of the following is the most likely diagnosis?

Answer 4

Ischaemic colitis

Question 5

32-year-old woman, with a recent diagnosis of Graves disease, underwent incision and drainage of a breast abscess three hours ago. She has become agitated, confused and is noted to be jaundiced and sweaty. Her 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?

Answer 5

B-adrenoceptor blockers and thionamides

Question 6

75-year-old man is scheduled for abdominal resection for a rectal carcinoma. As part of the enhanced recovery programme, he was given carbohydrate drink the night before surgery. How does preoperative carbohydrate loading help to improve the outcome of surgery?

Answer 6

It improves nitrogen balance and insulin resistance

Question 7

It improves nitrogen balance and insulin resistance

Answer 7

This is Malunion unless he mentions any skin manifestations ** = Cprs

Question 8

65-year-old farm worker presented with a six-week history of a rapidly growing tumour on his face. On examination, the tumour is 2 cm in diameter, with a large central keratin plug. What is the most likely diagnosis?

Answer 8

Keratoacanthoma

Question 9

A 23-year-old asthmatic man is admitted with a bilateral fracture of fibula and tibia following a road traffic accident. He is on 15 mg of prednisolone daily and is to undergo surgery the following day Which of the following steroid regimes should be implemented?

Answer 9

Increase steroids on day of surgery and for three days postoperatively

Question 10

24 hours after a routine aortic valve replacement for heavily calcified valve the patient’s heart rate abruptly falls to 40 Beats/min . the systolic pressure which was 140 mmhg is now 110 mmhg and the right atrial pressure which was 7 mmhg is now averaging 15 mmhg which of the following is the most likely diagnosis ?

Answer 10

B. Cardiac tamponade

VS

E. Left ventricular failure

Question 11

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

Answer 11

B. Nerve block

vs

C. Non-steroidal anti-inflammatory drugs (NSAIDs)(if only on paracetamol)

Question 12

A 75 year old woman with ischemic heart disease and atrial fibrillation is admitted with a 5 day history of discoloration of her right leg. she has a non healing ulcer on the medial malleolus . A femoro-distal bypass graft was performed a month ago . on examination , her heart rate is 85 beats / minute . there is a palpable femoral pulse but the distal pulses are absent . the entire leg is warm and swollen . Hand-held Doppler shows a monophasic signal at the dorsalis pedis artery . what is the most likely diagnosis?

Answer 12

Acute thrombosis of femoro-distal graft

Question 13

A 48 year old woman presents with a history of anorexia , followed by nausea , vomiting and abdominal pain . her pulse is 130 beats/min and blood pressure 85/50 mmhg blood tests show the table below. A CT scan of her abdomen does not demonstrate any gastrointestinal pathology. Analysis of which of the following hormones is most likely to be helpful in establishing the dianosis ?
Hyperkalaemic, hyponatraemic and hypoglycaemic

Answer 13

Adrenocorticotrophic hormone (ACTH)

Question 14

40-year-old man develops a high output fistula following multiple jejunal stricturoplasties and an ileal resection for Crohn disease. Which of the following is the most appropriate of nutritional support?

Answer 14

Total parenteral nutrition

Question 15

Three days after an isolated head injury from a fall a 76-year-o|d* woman,is admitted for drowsiness and confusion. There are no localising signs. A CT scan is most likely to show :

Answer 15

cerebral atrophy with a subdural collection on the left side i.e. chronic subdural

Question 16

75 year old woman presents with acute back pain after a minor fall. Radiological examination reveals an osteoporotic crush fracture. which of the following is the most likely electrolyte finding ?

Answer 16

Normocalcaemia

Question 17

A 56-year-old woman ventilated in intensive care has increasing oxygen requirements one day after elective aortic aneurysm repair. Her pulmonary capillary wedge pressure (PCWP) is 20 mmHg (normal range 8-12 mmHg) and she has obvious bilateral diffuse opacities on chest X-ray. Which of the following is the most likely diagnosis?

Answer 17

Pulmonary oedema secondary to heart Failure

Question 18

An otherwise healthy 5-year-old boy presents with a six-week history of minor, painless, intermittent,bright red rectal bleeding with no associated disturbance of bowel habit. Which of the following is the most likely diagnosis?

Answer 18

Juvenile rectal polyp

Question 19

A 68-year-old woman presents with a two-month history of intermittent, bloodstained nipple discharge from her right breast. There is no significant past history. Clinical examination confirm spresence of a bloodstained nipple discharge but shows no palpable abnormality. A mammogram and ultrasound scan are normal. What is the most appropriate next step in management?

Answer 19

Surgical excision of affected ducts

Question 20

A 78-year-old man, who is a smoker with a long history of Barrett oesophagus presents with progressive dysphagia and weight loss. endoscopy confirms the presence of a malignant stricture which of the following is the most likely histopathological diagnosis ?

Answer 20

Barette = adenocarcinoma

if achalasia = squamous

Question 21

A 38 year Old man complain of a cough weight loss , lethargy and oral discomfort . Examination reveals bilateral cervical lymph node enlargement and a white hairy patvh on the lateral border of the tongue . which of the following is the most likely underlying diagnosis ?

Answer 21

AIDS

Question 22

A 39 year old woman is making a slow but adequate recovery after sustaining a 40 % surface area burn injury . On the sixth postoperative day she becomes unwell she vomits intermittently , has painless abdominal distension and starts to hiccup . what is the most likely cause of these symptoms ?

Answer 22

Acute gastric dilatation