MRCS Questions

MRCS Questions
Q1. A 40  year old executive presents with severe sudden epigastric pain radiating to the back associated with vomiting. On examination he is anxious with a pulse  rate of 110/min and BP 100/80. His RR is 24/min and he has abdominal distension with tenderness in epigastrium. Bowel sounds are sluggish.  What is the most likely diagnosis
a) Duodenal ulcer perforation
b) Acute pancreatitis
c) Acute gastritis
d)Ruptured Aortic aneurysm

e) Acute appendicitis


Q2. A 56 year old lady presents with weakness and jaundice. Here Serum Bilirubin is 10 mg%. She is investigated and found to have cirrhosis of liver with a 3 cm mass in segment II of liver. of Her Alpha feto protein is 120 ng/ml and FNAC of the mass shows Hepatocellular carcinoma (HCC) Which viral infection is most likely to cause HCC?

a) Human Papilloma Virus (HPV)
b) Herpes virus
c) Hepatitis A virus
d) Hepatitis B virus

e) Cytomegalovirus (CMV)

 Q3 A 48 year old hypertensive man presents with sudden onset pain in chest  which radiates to the back. Over a period to 3 hours pain moves down to the epigastric region. What is the likely diagnosis in this case?
a) Aortic Stenosis
b) Aortic dissection
c) Myocardial Infarction
d) Ruptured aortic aneurysm

e) Severe Esophagitis

 Q4) An elderly gentleman is evaluated for persistent progressive difficulty in swallowing. A barium swallow investigation is done which reveals compression of  anterior wall of esophagus in the mid segment. Which of the following structures is most likely to cause this compression ?
a) Right Atrium
b) Left Atrium
c) Pulmonary trunk
d) Left Ventricle

e) Left atrium

Q5) A 30 year old male is brought to the emergency room forty minutes after sustaining a gun shot wound to the abdomen. Patient is conscious but drowsy. His pulse rate is 110/min, BP is 84/56. Respiratory rate is 30/min. Quick exmaination reveals decreased breath sounds on the left. There is an enterance wound in the left upper quadrant just below the mid clavicular line and exit wound on the left at the side of 5th rib. Which of the following should be done next?
a) Urgent x ray chest
b) CT Chest and Abdomen
c) Intubation
d) Wait and watch

e) Left tube Thoracostomy


All the choices are for acute abdomen but an executive with pain radiating to the back most likely has acute pancreatitis. Duodenal ulcer perforation is mostly anterior and chances of pain in the back are less. Also with the advent of effective drugs the incidence of gastric and duodenal ulcers has decreased. Acute gastritis will also not present with pain going to the back. Acute appendicitis has shifting pain to Right iliac fossa and aortic aneurysm is the disease in the 6th or 7th decade
The diagnosis of Acute pancreatitis is confirmed by amylase, lipase and CT findings.
In Pancreatitis also read about
  • Etiology of pancreatitis
  • Modified glascow criteria
  • Local Complications of Pancreatitis
  • Systemic Complications of Pancreatitis

2. d

Hepatits B virus

Hepatitis B virus is the leading cause of cirrhosis and subsequently HCC formation .

Hepatitis A and e virus cause viral hepatitis and sometimes acute liver failure

CMV causes viral hepatitis

3. Looking for answer

this is not Aortic stenosis - characterised by Syncope, angina, dyspnea

 this is  not Ruptured aortic aneurysm as it  presents with sudden severe pain in the abdomen which radiates to the back. There is sudden hypotension associated with it

4 b Left atrium

Structural (Mechanical) Disorders
Intrinsic Encroachment
 — Mucosal rings and webs: Schatzki, Plummer-Vinson, or multi ringed esophagus (eosinophilic esophagitis)
 — Strictures (inflammatory or fibrotic): peptic, caustic, pill, or radiation-induced
 — Esophageal tumors: adenocarcinoma, squamous cell carcinoma, metastatic (breast or melanoma), leiomyoma, lymphoma, or granular cell tumor
 — Systemic diseases: scleroderma (multifactorial), pemphigus/pemphigoid, lichen planus, or Crohn’s disease
 — Miscellaneous: postsurgery (laryngeal, esophageal, or gastric cancers), acute esophageal infections, esophageal diverticulae, or foreign bodies
Extrinsic Compression
 — Mediastinal masses: lung cancer, lymphoma, lymph node, or thyromegaly
 — Vascular compression: dysphagia lusoria (aberrant right subclavian artery), dysphagia aortica (right-sided aorta), or cardio-megaly (enlarged left atrium)
 — Miscellaneous: cervical spine osteophytes/spondylosis or fundoplication
Motor Disorders
 — Primary: achalasia, diffuse esophageal spasm, hypertensive lower esophageal sphincter, ineffective esophageal motility disorder, or nutcracker esophagus
 — Secondary: connective tissue diseases, scleroderma, CREST syndrome, diabetes, Chagas disease, or para neoplastic syndrome

5. e

This is tension pneumothorax and requires urgent chest tube insertion to save patient's life. Penetrating injury has produced a one way valve, air enters the pleural space but can not leave

Mechanical compression of IVC gives rise to hypotension

Treatment involves immediate decompression with a large-bore cannula inserted
into the second intercostal space on the midclavicular line on the side of tension
pneumothorax before a definitive chest drain is provided.