MRCS Recalls Mock 1 4-18 first 40Q Flashcards

1
Q

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

A

Medullary Carcinoma

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2
Q

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?

A

Neointimal hyperplasia

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3
Q

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

A

Osteomalacia

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4
Q

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?

A

Ischaemic colitis

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5
Q

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?

A

B-adrenoceptor blockers and thionamides

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6
Q

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?

A

It improves nitrogen balance and insulin resistance

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7
Q

It improves nitrogen balance and insulin resistance

A

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

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8
Q

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?

A

Keratoacanthoma

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9
Q

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?

A

Increase steroids on day of surgery and for three days postoperatively

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10
Q

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 ?

A

B. Cardiac tamponade

VS

E. Left ventricular failure

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11
Q

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

A

B. Nerve block

vs

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

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12
Q

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?

A

Acute thrombosis of femoro-distal graft

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13
Q

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

A

Adrenocorticotrophic hormone (ACTH)

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14
Q

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?

A

Total parenteral nutrition

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15
Q

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 :

A

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

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16
Q

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 ?

A

Normocalcaemia

17
Q

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?

A

Pulmonary oedema secondary to heart Failure

18
Q

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?

A

Juvenile rectal polyp

19
Q

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?

A

Surgical excision of affected ducts

20
Q

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 ?

A

Barette = adenocarcinoma

if achalasia = squamous

21
Q

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 ?

A

AIDS

22
Q

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 ?

A

Acute gastric dilatation