Get Through MRCS Part A

SBAs

Nikhil Pawa, Paul Cathcart, Howard Tribe, Nikhil Pawa, Paul Cathcart, Howard Tribe

• Publisher: CRC Press
• Year: 2016
• ISBN:
  9781138032132
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Success in any exam requires careful preparation, background reading and, importantly, prior self-assessment. Containing 1000 Single Best Answer (SBA) questions for the MRCS Part A, this book offers surgical trainees a wealth of exam practice, written and edited by expert authors with recent experience of the MRCS syllabus. Get Through MRCS Part A:

PART I
APPLIED SURGICAL ANATOMY

CHAPTER 1 APPLIED SURGICAL ANATOMY

Questions

THORAX

1. 1. The lung pleurae meet in the midline and then separate to allow space for the heart. At the level of which costal cartilage does the pleura of the left lung separate from the pleura of the right lung?
   1. 1st
   2. 2nd
   3. 4th
   4. 6th
   5. 8th
2. 2. At which costochondral joint do the oblique fissures of the lung finish?
   1. 4th
   2. 5th
   3. 6th
   4. 7th
   5. 8th
3. 3. When examining a fit young patient you would anticipate to find the apex beat of the heart in the mid-clavicular line of which intercostal space?
   1. 2nd
   2. 3rd
   3. 4th
   4. 5th
   5. 6th
4. 4. At which vertebral level does the aorta pass through the diaphragm?
   1. T9
   2. T10
   3. T11
   4. T12
   5. L1
5. 5. A 52-year-old man with oesophageal carcinoma undergoes an Ivor Lewis oesophagectomy. Two days postoperatively you notice a thick, creamy liquid in the chest drain effluent. It was thought his thoracic duct may have been iatrogenically injured during the procedure. The internal thoracic duct lies laterally to which of the following anatomical structures?
   1. Thoracic aorta
   2. Oesophagus
   3. Left brachiocephalic vein
   4. Vertebral bodies
   5. Azygous vein
6. 6. A 60-year-old woman is seen in the preoperative clinic awaiting a para-umbilical hernia repair. Her past medical history includes rheumatic fever as a child. Clinical examination reveals a rumbling diastolic murmur. Which of the following is the correct anatomical location of the affected cardiac valve?
   1. 2nd intercostal space
   2. 5th costal cartilage
   3. 3rd costal cartilage
   4. 4th intercostal space
   5. 4th costal cartilage
7. 7. A patient with chest pain is found to have an occlusion of his left coronary artery (LCA) on angiogram. Which of the following statements regarding the LCA is false?
   1. The LCA supplies the majority of the left ventricle.
   2. The LCA supplies the left atrium.
   3. The LCA supplies the sinoatrial (SA) node in 40% of hearts.
   4. The LCA supplies the atrioventricular (AV) node in most cases.
   5. The LCA supplies part of the right ventricle.
8. 8. A young man is admitted as an emergency following a road traffic accident suffering injury to his sternum. Reviewing the computed tomography (CT) scan of his chest, which of the following statements regarding the anatomy of the level of the sternal angle is true?
   1. It demonstrates the bifurcation of the brachiocephalic artery.
   2. It demonstrates the bifurcation of the trachea.
   3. It gives a clear section through the left ventricle.
   4. It shows the commencement of the aortic arch.
   5. It demonstrates the T4 vertebral body.
9. 9. Which of the following statements regarding the movements of inspiration is false?
   1. It involves descent of the diaphragm.
   2. It involves an increase in the anteroposterior dimension of the chest.
   3. It involves an upward/forward movement of the first rib.
   4. It involves contraction of the intercostal muscles.
   5. It involves the long thoracic nerve of Bell.
10. 10. Which of the following statements regarding paralysis of the left hemidiaphragm is true?
    1. It may be caused by the transection of the cord below C6.
    2. It may be caused by the section of the left phrenic nerve alone.
    3. It causes flattening of the diaphragm during inspiration.
    4. It increases intrathoracic pressure on the left.
    5. It does not cause paradoxical chest movement.
11. 11. An elderly patient suffers a myocardial infarction after a routine elective anterior resection for rectal cancer. Which of the following statements regarding blood supply to the heart is false?
    1. The right coronary artery has a marginal and posterior branch.
    2. The left coronary artery has a circumflex branch.
    3. The right and left coronaries arise from immediately inferior to the aortic valve.
    4. The anterior interventricular branch supplies the ventricular septum.
    5. Venous drainage of the heart opens into the right atrium via the coronary sinus.
12. 12. Which of the following statements about the anatomy of the diaphragm is correct?
    1. The central portion obtains its sensory supply from the lower six intercostal nerves.
    2. The oesophageal hiatus opens at T12.
    3. The left phrenic nerve pierces the central tendon.
    4. The inferior vena cava opening is at T10.
    5. The sympathetic chain passes through the median arcuate ligament.
13. 13. Concerning the arterial supply and venous drainage, which of the following statements is correct?
    1. The arterial supply to the upper third is derived from the superior thyroid artery.
    2. The arterial supply to the lower third is derived from the left gastric artery.
    3. The thoracic oesophagus drains into the hemiazygous vein.
    4. The abdominal oesophagus drains via the splenic vein.
    5. The arterial supply to the middle third is derived from the inferior thyroid artery.
14. 14. Which of these structures passes through the opening in the diaphragm at the level of T10?
    1. Thoracic duct
    2. Right phrenic nerve
    3. Azygous vein
    4. Inferior vena cava
    5. Left gastric artery
15. 15. Which of the following veins does not drain into the coronary sinus of the heart?
    1. Small cardiac vein
    2. Oblique cardiac vein
    3. Great cardiac vein
    4. Anterior cardiac vein
    5. Middle cardiac vein
16. 16. During embryological development, there are a series of six paired aortic arches. Which of the following statements about the paired aortic arches is true?
    1. The 1st and 3rd arches disappear.
    2. The 2nd arches become the carotid arteries.
    3. The 4th arch on the left side becomes the definitive aortic arch.
    4. The 5th arch forms the right and left pulmonary arteries.
    5. On the left side the recurrent laryngeal nerve hooks around the 4th arch.
17. 17. Which of the following are the correct relations of the thoracic trachea?
    1. Anterior – left recurrent laryngeal nerve
    2. Posterior – left common carotid artery
    3. Left – left brachiocephalic vein
    4. Right – azygous vein
    5. Posterior – thymus
18. 18. Which of the following statements regarding the thoracic duct is correct?
    1. It commences at the level of T10.
    2. It passes upwards between the vena cava and azygous vein.
    3. It drains into the confluence of the right internal jugular and subclavian veins.
    4. The right lower limb is drained by the right lymphatic trunk.
    5. In adults the thoracic duct transports up to 4 L of lymph per day.
19. 19. Which of the following is the most common site of Bochdalek (diaphragmatic) hernias?
    1. Left anterior
    2. Right posterior
    3. Right anterior
    4. Left posterior
    5. None of the above
20. 20. A 35-year-old man is brought in with severe breathlessness following a road traffic collision. The chest X-ray shows a rib fracture with haemothorax and you are required to insert a chest drain. Which one of the following anatomical landmarks is least useful to you?
    1. Anterior border of latissimus dorsi
    2. The mid-clavicular line
    3. The nipple
    4. The mid-axillary line
    5. Inferolateral border of pectoralis major
21. 21. A 5-year-old boy is about to undergo bronchoscopy for a suspected inhaled peanut. Which of the following is the most likely ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Acknowledgements
• Introduction
• Editors
• Contributors
• Part I Applied surgical anatomy
• Part II Physiology
• Part III Pathology
• Part IV System-specific pathology
• Part V Practice paper
• Index