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