Part A

candidate guidance notes partA.pdf

MRCS part A is a written examination formed of extended-matching questions (EMQ) and single best answer questions (SBA).

Here you will find free questions similar to those found in the MRCS Part A exam.

Sample Questions

1. A 36-year-old female teacher presents with a left sided neck mass. Examination reveals a 3 cm diameter thyroid nodule on the left side and a 1cm nodule on the right side. Histology from fine needle aspiration shows Orphan Annie eye nuclear inclusions. Relevant blood tests are shown:

TSH                                        2.0

T4                                           16

Thyroglobulin                       210 (0.5-55.0 ng/ml)


1.1: What is the likely diagnosis?

A.    Follicular thyroid cancer

B.    Anaplastic thyroid cancer

C.   Toxic multinodular goitre

D.   Graves disease

E.    Papillary thyroid cancer

1.2: Which investigation is most indicated next?

A.    Ultrasound of the thyroid

B.    CT scan of the head, neck and chest

C.   MRI scan of the head, neck and chest

D.   MIBI scan

E.    Chest X-ray

1.3: After investigations and further imaging there is a low suspicion of metastatic disease.Which management plan is most appropriate?

A.    External radiotherapy

B.    Hemi-thyroidectomy and central compartment lymph node removal with radioiodine therapy

C.   Total thyroidectomy and central compartment lymph node removal with radioiodine therapy

D.   Total thyroidectomy and central compartment lymph node removal

E.    Cisplatin chemotherapy

1. Answers

2. A 46 year-old Egyptian farmer, on holiday in the UK, presents with frank haematuria and recent weight loss. He reports a long history of dysuria and lower abdominal discomfort.

Which one of the following is the most likely diagnosis?

A.    Transition cell carcinoma

B.    Interstitial cystitis

C.   Squamous cell carcinoma

D.   Adenocarcinoma

E.    Cystitis cystica

2. Answer

3. A 46-year-old stockbroker presents to A&E with acute onset severe epigastric pain radiating into his back. He also complains of severe vomiting. His vital signs are: HR116, BP 96/42, Sa02 96%, T36.2, RR 22. 

Relevant investigations are shown below:

Blood gas:    Pa02 12kpa PaC02 5kpa PH  7.36

Hb       12.6    K         4.0      ALP     180     Bili      18

WCC   15.2    Ca       2.3      AST     210     Alb      35

Plt       312     Creat   88       ALT     78       Amy 1200

Na       135     Urea    9         LDH    458     Glu      8


3.1: Which of the following is the most likely diagnosis?

A.    Pancreatitis

B.    Alcoholic hepatitis

C.   Ruptured abdominal aortic aneurysm

D.   Cholangitis

E.    Gastroenteritis

3.2: Using the Modified Glasgow criteria what is this patient’s score?

A.    0

B.    1

C.   2

D.   3

E.    4

3.3: Which of the following eponymous triads best characterises cholangitis?

A.    Charcot’s triad

B.    Saint’s triad

C.   Virchow’s triad

D.   Beck’s triad

E.    Bergmann’s triad

3. Answers

4. A young man of unknown age arrives in resus after being shot in the abdomen. On primary survey he appears agitated, his heart rate is 116, blood pressure 126/90 and capillary refill time is 2 seconds peripherally.

Which one of the following stages of shock is this patient in?

A.             Stage I

B.             Stage II

C.            Stage III

D.            Stage IV

E.             Stage V

4. Answer

5.Which one of the following is NOT a branch of the external carotid?

A.             Superior thyroid artery

B.             Ascending pharyngeal artery

C.            Facial artery

D.            Lingual artery

E.             Mandibular artery

5. Answer

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