MRCS Questions and Answers
MRCS Questions from the years gone by. These help you to get an insight of what might be expected in actual exams
Q6.) A 42 year old lady undergoes exploration for a retro peritoneum mass. In OT it is suspected that this is a liposarcoma. Which of the following is not true about liposarcoma?
a) Liposarcoma is the most common variant of sarcomas
b) They have a pseudocapsule
c) They can grow quite large before producing symptoms
d) They are locally invasive and do not metastatize
Q7 ) A 40 year old male undergoes reversal of loop ileostomy. Surgery was uneventful with minimum adhesiolysis. He is discharged on 7th POD but comes back on 12th POD with features of colicky pain abdomen, vomiting , obstipation. On examination he is anxious, HR is 106/min, BP is 120/70 and he has tenderness and swelling at the previous colostomy site.
The probable diagnosis is
a) Adhesive intestinal obstruction
b) Anastomotic leak
c) Incisional hernia obstruction
Q8) A 45 year old male with carcinoma head of pancreas, complains of stickiness of stools and difficulty in digestion. Which of the following enzyme deficiency does he have?
MRCS questions from 2013.
Q9) A 45 year old man who has been drinking regularly for the past 15 years vomits after a large meal and complains of severe chest pain. Cardiac cause is ruled out and boerhavve's syndrome is suspected. Which of the following is not true about this condition
a) Gastrograffin tests will confirm the diagnosis
b) Perforation is most common in the left lower end
c) Exploration and full thickness suturing of perforation should be done
d) This condition has a high morbidity and mortality if not diagnosed at time
MRCS Questions from 2012
10) A 70 year-old man undergoes cystectomy for urinary bladder cancer. To safeguard the ureters they have to be identified. On which region of the bladder do the ureters pierce the bladder wall?
A. Anterior surface
C Lateral surfaces
D Posterior surface
Ans 6) d
Retroperitoneal Sarcoma constitue 1-2% of all solid tumors and 10-20% of all sarcomas are retroperitoneal.
The most common type of sarcomas are different in different series. Bailey says liposarcoma is most common where as some series say MFH (Malignant fibrous histiocytoma). These lesions tend to have a pseudocapsule and that should be completely removed. These tumors can achieve a large size in retroperitoneum before producing symptoms.
Pain and fullness in abdomen are common symptoms
Surgery is the mainstay of treatment.Cell type has no implications on prognosis and survival
They frequently have pulmonary metastasis
Ref Bailey 986
From the question it is clear that this is a case of intestinal obstruction.Tender swelling at the previous site gives hint that this is an obstructed hernia at the site of previous ileostomy.
It could have been adhesive but the tell tale sign is at the site of previous colostomy
It is not an anastomotic leak because that would manifest early and not after 10th day
Ileus does not have pain
This patient has steatorrhoea (pale sticky bulky stools) which is due to the deficiency of lipase. Lipase is responsible for breakdown of fats into fatty acids and triglycerides and its deficiency leads to foul smelling bulky stools.
Boerhavve's syndrome is a full thickness perforation of esophagus at the left lower end usually after a heavy meal. It is a spontaneous perforation and often misdiagnosed as a cardiac event.
Binge alcohol drinking with vomiting and retching leads to increased intraluminal pressure
Mortality is 20-30% if not treated at time.
Perforation is most commonly at the left lower end and not confined to the defect which is seen. It can extend either way under the muscularis and requires myotomy to see the full longitudinal extent. Layered cloure with intercostal muscle flap should be done
Ureters join the posterior surface of urinary bladder. The apex of the bladder is connected to the umbilicus by the median umbilical ligament, which is a remnant of the urachus.