MRCS Part A Exam
Where is the main source of bleeding in epistaxis - ANS Littles area
What is the main source of arterial supply to Littles area - ANS Sphenopalatine and greater Palatine
arteries
What is the most common parotid neoplasm - ANS Benign Pleomorphic Adenoma or Benign Mixed
tumour
What is the most common bilateral benign neoplasm of the parotid - ANS Warthins tumour (Papillary
cystadenoma)
What the most common parotid tumour in children less than 1 year of age - ANS Haemangioma
What is Swirl Sign on CT - ANS Areas of fresh blood and clots together, seen in intracranial
haemorrhages
When are you most likely to see an intraventricular haemorrhage - ANS Neonates in the first 72 hours
What are the 5 levels of evidence - ANS I - Evidence gained from systematic review of all RCTs
II - Evidence gained form at least 1 properly performed RCT
III - Evidence gained from well desienged pseudo RCT or historical controls
IV - Evidence derived from case series or reports
V - Panel or expert opinion
What is suitable management of scalp bleeding - ANS Mattress sutures
,What is is suitable management of bleeding from raw surfaces - ANS Spray diathermy and argon plasma
coagulation
How do wounds heal in primary closure - ANS Primary intention
What is a major risk of incorrect vacuum assisted closure involving bowel - ANS Fistulation
Where are Latex tube drains mainly used - ANS Where fibrosis is ideal EG T tube following exploration of
common bile duct
What are good sutures to use that will break down after 6-12 weeks - ANS Polydiaxone (PDS) and
Polyglycolic acid (Vicryl)
What is a good suture to use thats permanent for vascular anastomoses? - ANS Polypropylene (prolene)
What is a good suture to use thats permanent for laparoscopic surgery? - ANS Polyester (ethibond)
What is the waveform of the cutting function in electrosurgery - ANS Sinusoidal and non-modulated
What is the waveform of the coagulation function in electrosurgery - ANS Modulated current with
intermittent dampened sine waves of high peak voltage
What electrosurgery setting leads to loss of cellular water but not protein damage - ANS Desication
Which electrosurgery setting leads to a spray effect with local, superficial tissue destruction - ANS
Fulguration
,What type of transplant is allograft - ANS Transplant of tissue from genetically non identical donor from
the same species
What type of transplant is isograft - ANS Graft between two individuals with genetically identical
material
What type of transplant is autograft - ANS Transplanation of organs or tissues from one part of the body
to another in the same individual
What type of transplant is xenograft - ANS Tissue transplanted from another species
What is the commonest cause of acute limb ischaemia - ANS Thrombosis of a pre-existing site of
atherosclerosis
What are the clinical signs of limb ischaemia by their ABPI - ANS 1.2+ - Usually due to vessel calcification
1.0-1.2 - Normal
0.8-1.0 - Minor stenotic lesion (risk factor management)
0.5-0.8 - Consider duplex, if mixed ulcers present then avoid compressive bandages
0.3-0.5 - Likely significant stenosis, duplex, no compression bandages
<0.3 - Critical ischaemia
What is Klippel-Trenaunay Syndrome - ANS Affects a single extremity, most commonly the leg
Birth defect
Combination of:
- One or more distinctive port wine stains with sharp border
- Varicose veins
, - Hypertrophy of bony and soft tissues that may lead to local gigantism
- Improper developed lymphatics system
Why do venous ulcers form - ANS Capilliary fibrin cuff and leucocyte sequestration
What is a Marjolins ulcer - ANS - Squamous cell carcinoma occuring at sites of chronic inflammation
What are primary causes of lymphoedema - ANS Congenital-1 year:
- Milroys
1-35 years:
- Meiges
What are the operative options from lymphoedema - ANS Homans operation
Charles operation (more agrresive)
Lymphvenous anastamosis
Where do the majority of upper limb emboli lodge - ANS Brachial Artery
What is the treatment for Raynauds disease - ANS Calcium antagonists
Where does the fibrous band originate from that is the cervical rib - ANS C7
What is the follow up plan for colonic polyps - ANS Colorectal cancer
- Colonoscopy 1 year post resection
Where is the main source of bleeding in epistaxis - ANS Littles area
What is the main source of arterial supply to Littles area - ANS Sphenopalatine and greater Palatine
arteries
What is the most common parotid neoplasm - ANS Benign Pleomorphic Adenoma or Benign Mixed
tumour
What is the most common bilateral benign neoplasm of the parotid - ANS Warthins tumour (Papillary
cystadenoma)
What the most common parotid tumour in children less than 1 year of age - ANS Haemangioma
What is Swirl Sign on CT - ANS Areas of fresh blood and clots together, seen in intracranial
haemorrhages
When are you most likely to see an intraventricular haemorrhage - ANS Neonates in the first 72 hours
What are the 5 levels of evidence - ANS I - Evidence gained from systematic review of all RCTs
II - Evidence gained form at least 1 properly performed RCT
III - Evidence gained from well desienged pseudo RCT or historical controls
IV - Evidence derived from case series or reports
V - Panel or expert opinion
What is suitable management of scalp bleeding - ANS Mattress sutures
,What is is suitable management of bleeding from raw surfaces - ANS Spray diathermy and argon plasma
coagulation
How do wounds heal in primary closure - ANS Primary intention
What is a major risk of incorrect vacuum assisted closure involving bowel - ANS Fistulation
Where are Latex tube drains mainly used - ANS Where fibrosis is ideal EG T tube following exploration of
common bile duct
What are good sutures to use that will break down after 6-12 weeks - ANS Polydiaxone (PDS) and
Polyglycolic acid (Vicryl)
What is a good suture to use thats permanent for vascular anastomoses? - ANS Polypropylene (prolene)
What is a good suture to use thats permanent for laparoscopic surgery? - ANS Polyester (ethibond)
What is the waveform of the cutting function in electrosurgery - ANS Sinusoidal and non-modulated
What is the waveform of the coagulation function in electrosurgery - ANS Modulated current with
intermittent dampened sine waves of high peak voltage
What electrosurgery setting leads to loss of cellular water but not protein damage - ANS Desication
Which electrosurgery setting leads to a spray effect with local, superficial tissue destruction - ANS
Fulguration
,What type of transplant is allograft - ANS Transplant of tissue from genetically non identical donor from
the same species
What type of transplant is isograft - ANS Graft between two individuals with genetically identical
material
What type of transplant is autograft - ANS Transplanation of organs or tissues from one part of the body
to another in the same individual
What type of transplant is xenograft - ANS Tissue transplanted from another species
What is the commonest cause of acute limb ischaemia - ANS Thrombosis of a pre-existing site of
atherosclerosis
What are the clinical signs of limb ischaemia by their ABPI - ANS 1.2+ - Usually due to vessel calcification
1.0-1.2 - Normal
0.8-1.0 - Minor stenotic lesion (risk factor management)
0.5-0.8 - Consider duplex, if mixed ulcers present then avoid compressive bandages
0.3-0.5 - Likely significant stenosis, duplex, no compression bandages
<0.3 - Critical ischaemia
What is Klippel-Trenaunay Syndrome - ANS Affects a single extremity, most commonly the leg
Birth defect
Combination of:
- One or more distinctive port wine stains with sharp border
- Varicose veins
, - Hypertrophy of bony and soft tissues that may lead to local gigantism
- Improper developed lymphatics system
Why do venous ulcers form - ANS Capilliary fibrin cuff and leucocyte sequestration
What is a Marjolins ulcer - ANS - Squamous cell carcinoma occuring at sites of chronic inflammation
What are primary causes of lymphoedema - ANS Congenital-1 year:
- Milroys
1-35 years:
- Meiges
What are the operative options from lymphoedema - ANS Homans operation
Charles operation (more agrresive)
Lymphvenous anastamosis
Where do the majority of upper limb emboli lodge - ANS Brachial Artery
What is the treatment for Raynauds disease - ANS Calcium antagonists
Where does the fibrous band originate from that is the cervical rib - ANS C7
What is the follow up plan for colonic polyps - ANS Colorectal cancer
- Colonoscopy 1 year post resection
