MRCS HIGH YIELD EXAM 2025 WITH WELL
REVIEWED ANSWERS
What is the treatment of palliative colon cancer? - CORRECT -Stents
Bypass surgery
Diversion stomas
What is the treatment of right colon cancer? - CORRECT -Right hemicolectomy with ileo-colic
anastomosis
<5% leak rate
What is the treatment transverse colon cancer? - CORRECT -Extended right hemicolectomy
with ileo-colic anastomosis
<5% leak rate
What is the treatment of splenic flexure colon cancer? - CORRECT -Extended right
hemicolectomy with ileo-colic anastomosis
<5% leak rate (better than left hemicolectomy w/ colo-colic: 2-5%)
What is the treatment of left colon cancer? - CORRECT -Left hemicolectomy with colo-colon
anastomosis
2-5% leak rate
What is the treatment of sigmoid colon cancer? - CORRECT -High anterior resection with colo-
rectal anastomosis
,5% leak rate
What is the treatment of upper rectal cancer? - CORRECT -Anterior resection with total
mesorectal excision and Colo-rectal anastomosis
Likely radiotherapy
5% leak rate
What is the treatment of low rectal cancer? - CORRECT -Anterior resection with TME and
colo-rectal anastomsis (+/- defunctioning stoma)
Likely radiotherapy
10% leak rate
What is the treatment of anal verge rectal cancer? - CORRECT -Abdomino-perineal excision of
colon and rectum
Likely radiotherapy
What is Hartmans procedure? - CORRECT -Resection of sigmoid colon with end colostomy
How do you manage patients with large bowel obstruction resulting from carcinoma above the
peritoneal reflection? - CORRECT -Resection
Stenting
Defunctioning
,How do you manage patients with large bowel obstruction from rectal cancer? - CORRECT -
*Defunctioning loop colostomy*
Then staging
What is the level of the inferior phrenic branches? - CORRECT -T12 (paired, parietal)
What is the level of the coeliac trunk? - CORRECT -T12 (unpaired, visceral)
What is the level of the SMA? - CORRECT -L1 (unpaired visceral)
What is the level of the middle suprarenal arteries? - CORRECT -L1 (paired visceral)
What is the level of the renal arteries? - CORRECT -L1/L2 (paired visceral)
What is the level of the gonadal arteries? - CORRECT -L2 (paired visceral)
What is the level of the lumbar arteries? - CORRECT -L1-L4 (paired parietal)
What is the level of the IMA? - CORRECT -L3 (unpaired visceral)
What is the level of the median sacral artery? - CORRECT -L4 (unpaired parietal)
What is the level of the common iliac artery? - CORRECT -L4 (paired terminal)
What vessel may be divided to improve access to aneurysm neck in juxtarenal AAA?
, What branch of aorta overlies this? - CORRECT -Left renal vein (anterior relation of AA)
SMA overlies left renal vein
When do you offer surgery for AAA? - CORRECT -Aneurysm 5.5-6cm (asymptomatic)
Symptomatic aneurysms
Rupture
How many layers of abdominal wall are found in AAAs? - CORRECT -All 3 layers
What are the risks of AAA rupture depending on size? - CORRECT -5-5.9cm = 25% 5yr
6-6.9cm = 35%
7cm+ = 75%
What is the most appropriate fluid regime in rAAA? - CORRECT -1 litre Hartmanns over 4hours
(avoid high volume infusion)
Mnemonic for decending abdominal aorta branches? - CORRECT -Prostitutes cause sagging
swollen red testicles (in men) living in sin
What vessels are the commonest cause of back bleeding during aortic surgery? - CORRECT -
Lumbar arteries L1-4 are not cross clamped
Definition of abdominal compartment syndrome?
REVIEWED ANSWERS
What is the treatment of palliative colon cancer? - CORRECT -Stents
Bypass surgery
Diversion stomas
What is the treatment of right colon cancer? - CORRECT -Right hemicolectomy with ileo-colic
anastomosis
<5% leak rate
What is the treatment transverse colon cancer? - CORRECT -Extended right hemicolectomy
with ileo-colic anastomosis
<5% leak rate
What is the treatment of splenic flexure colon cancer? - CORRECT -Extended right
hemicolectomy with ileo-colic anastomosis
<5% leak rate (better than left hemicolectomy w/ colo-colic: 2-5%)
What is the treatment of left colon cancer? - CORRECT -Left hemicolectomy with colo-colon
anastomosis
2-5% leak rate
What is the treatment of sigmoid colon cancer? - CORRECT -High anterior resection with colo-
rectal anastomosis
,5% leak rate
What is the treatment of upper rectal cancer? - CORRECT -Anterior resection with total
mesorectal excision and Colo-rectal anastomosis
Likely radiotherapy
5% leak rate
What is the treatment of low rectal cancer? - CORRECT -Anterior resection with TME and
colo-rectal anastomsis (+/- defunctioning stoma)
Likely radiotherapy
10% leak rate
What is the treatment of anal verge rectal cancer? - CORRECT -Abdomino-perineal excision of
colon and rectum
Likely radiotherapy
What is Hartmans procedure? - CORRECT -Resection of sigmoid colon with end colostomy
How do you manage patients with large bowel obstruction resulting from carcinoma above the
peritoneal reflection? - CORRECT -Resection
Stenting
Defunctioning
,How do you manage patients with large bowel obstruction from rectal cancer? - CORRECT -
*Defunctioning loop colostomy*
Then staging
What is the level of the inferior phrenic branches? - CORRECT -T12 (paired, parietal)
What is the level of the coeliac trunk? - CORRECT -T12 (unpaired, visceral)
What is the level of the SMA? - CORRECT -L1 (unpaired visceral)
What is the level of the middle suprarenal arteries? - CORRECT -L1 (paired visceral)
What is the level of the renal arteries? - CORRECT -L1/L2 (paired visceral)
What is the level of the gonadal arteries? - CORRECT -L2 (paired visceral)
What is the level of the lumbar arteries? - CORRECT -L1-L4 (paired parietal)
What is the level of the IMA? - CORRECT -L3 (unpaired visceral)
What is the level of the median sacral artery? - CORRECT -L4 (unpaired parietal)
What is the level of the common iliac artery? - CORRECT -L4 (paired terminal)
What vessel may be divided to improve access to aneurysm neck in juxtarenal AAA?
, What branch of aorta overlies this? - CORRECT -Left renal vein (anterior relation of AA)
SMA overlies left renal vein
When do you offer surgery for AAA? - CORRECT -Aneurysm 5.5-6cm (asymptomatic)
Symptomatic aneurysms
Rupture
How many layers of abdominal wall are found in AAAs? - CORRECT -All 3 layers
What are the risks of AAA rupture depending on size? - CORRECT -5-5.9cm = 25% 5yr
6-6.9cm = 35%
7cm+ = 75%
What is the most appropriate fluid regime in rAAA? - CORRECT -1 litre Hartmanns over 4hours
(avoid high volume infusion)
Mnemonic for decending abdominal aorta branches? - CORRECT -Prostitutes cause sagging
swollen red testicles (in men) living in sin
What vessels are the commonest cause of back bleeding during aortic surgery? - CORRECT -
Lumbar arteries L1-4 are not cross clamped
Definition of abdominal compartment syndrome?
