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Questions and Answers

What neurological condition is characterized by loss of motor function on the same side of the injury and loss of pain and temperature sensation on the opposite side?

  • Posterior cord syndrome
  • Brown-Séquard syndrome (correct)
  • Complete spinal cord transection
  • Anterior cord syndrome

    • In Brown-Séquard syndrome, which tract is responsible for the ipsilateral loss of motor function?

  • Lateral spinothalamic tract
  • Anterior spinothalamic tract
  • Corticospinal tract (correct)
  • Dorsal columns

    • Which of the following symptoms would NOT be expected in a case of Brown-Séquard syndrome?

  • Ipsilateral loss of proprioception
  • Contralateral loss of pain sensation
  • Ipsilateral loss of vibratory sense
  • Loss of all sensory and motor functions below the injury (correct)

    • What is the primary reason Anterior cord syndrome is not the correct diagnosis for the patient's presentation?

    <p>It typically spares proprioception and vibratory sensation</p> Signup and view all the answers

    In the scenario described, what would likely happen if damage were to occur to the dorsal columns?

    <p>Ipsilateral loss of proprioception and vibratory sense</p> Signup and view all the answers

    Which area does the lateral spinothalamic tract primarily affect in the context of spinal cord injuries?

    <p>Pain and temperature sensation</p> Signup and view all the answers

    What is a hallmark feature of Brown-Séquard syndrome compared to complete spinal cord transection?

    <p>Contralateral loss of pain and temperature sensation</p> Signup and view all the answers

    Which of the following is a potential complication of hemisection injuries like Brown-Séquard syndrome?

    <p>Increased muscle tone on the ipsilateral side</p> Signup and view all the answers

    What is the most indicative symptom group for a diagnosis of tuberculosis (TB)?

    <p>Night sweats, hemoptysis, and lymph node enlargement</p> Signup and view all the answers

    Which of the following is NOT typically associated with tuberculosis (TB)?

    <p>Immediate hyperreflexia</p> Signup and view all the answers

    What characterizes the acute phase of spinal shock following a C5 spinal cord injury?

    <p>Flaccid paralysis below the level of injury</p> Signup and view all the answers

    Which symptom is less likely to be observed with lymphoma compared to tuberculosis?

    <p>Hemoptysis</p> Signup and view all the answers

    In a patient with a C5 spinal cord lesion, which reflex finding is expected during spinal shock?

    <p>Absent reflexes below the level of injury</p> Signup and view all the answers

    What distinguishes pneumonia from tuberculosis when considering symptoms?

    <p>Pneumonia typically presents with a more acute onset</p> Signup and view all the answers

    Which complication of spinal cord injury is most likely to develop after the initial spinal shock phase?

    <p>Hyperreflexia and spasticity</p> Signup and view all the answers

    Which of these conditions can lead to systemic symptoms such as night sweats and lymph node enlargement?

    <p>Tuberculosis</p> Signup and view all the answers

    What is the primary function of the corticospinal tract?

    <p>Motor control, especially voluntary movement</p> Signup and view all the answers

    What type of sensory loss occurs on the same side as the lesion in Brown-Séquard Syndrome?

    <p>Ipsilateral loss of vibration sense</p> Signup and view all the answers

    How does a lesion in the spinal cord affect pain sensation in Brown-Séquard Syndrome?

    <p>Pain sensation is lost contralaterally starting below the lesion</p> Signup and view all the answers

    Which tract is primarily responsible for transmitting proprioception and vibration sense?

    <p>Dorsal columns (medial lemniscus pathway)</p> Signup and view all the answers

    What is the consequence of a lesion in the dorsal columns in terms of sensory perception?

    <p>Ipsilateral loss of vibration, fine touch, and proprioception</p> Signup and view all the answers

    What happens to light touch sensation in Brown-Séquard Syndrome?

    <p>It is not distinctly patterned and less commonly referenced</p> Signup and view all the answers

    In terms of Brown-Séquard Syndrome, which of the following statements is true?

    <p>Motor dysfunction occurs ipsilaterally while pain and temperature loss occurs contralaterally</p> Signup and view all the answers

    Which statement correctly describes the effects of a lesion in the lateral spinothalamic tract?

    <p>Loss of pain and temperature sensation on the contralateral side below the lesion</p> Signup and view all the answers

    Study Notes

    MRCS Illustrated Recall January 2024

    • Dr. Shahriar's Surgical Handicrafts, ATLAS MED publication
    • The book is a set of illustrated recall questions for the MRCS exam.
    • The author expresses gratitude to contributors, reviewers, and those who provided feedback for their effort to ensure accuracy and comprehensiveness of the content..
    • This version is a sample and may not be comprehensive.
    • This is not a reference material.
    • The document contains recall questions.

    Acknowledgements

    • The author thanks Dr. Waqas for their invaluable contribution to the book's recall in January 2024
    • The author thanks reviewers for their dedication and expertise, which ensured the accuracy and comprehensiveness of the content.
    • Any errors or oversights are appreciated for feedback in future editions.

    Support Our Academic Initiative

    • The author intends to elevate surgical academic pursuits and aid in exam preparation through their MRCS Surgery books.
    • Financial and feedback contributions are welcome
    • Own notes and insights of colleagues are encouraged, as are active contributions to the community.

    Payment Options

    • Detailed payment options (bKash) are offered
    • The contact information for payments is given

    References

    • The document lists affiliations of institutions such as NICE, NHS England, CK, ditki, TeachMeSurgery, AAMBOSS, KEN HUB, Pastest and OSMOSIS for the reference source for the MRCS recall questions.

    Special Acknowledgements

    • A list of various notes collections for MRCS exam preparation is provided.

    Question 1: Thyroid Disorder

    • A 45-year-old woman presents with a thyroid swelling.
    • Blood tests show normal thyroid profile but atypical CD20+ lymphocytes.
    • The most likely diagnosis is Hodgkin Lymphoma.

    Question 2: Renal Physiology

    • A 35-year-old patient presents with severe right arm pain and swelling after self-injecting Diazepam.
    • The most likely elevated substance in the patient's urine is myoglobin.

    Question 3: Paediatrics

    • A 7-year-old boy presents with intermittent, painless rectal bleeding.
    • CT scan shows a well-circumscribed, contrast-filled outpouching in the ileum.
    • The most likely diagnosis is Meckel's Diverticulum.

    Question 4: Congenital

    • A 10-year-old presents with intermittent, painless rectal bleeding.
    • The most appropriate initial investigation to confirm the diagnosis of Meckel's diverticulum is the Technetium-99m pertechnetate scan (Meckel's scan).

    Question 5: Real Physiology

    • A 54-year-old woman with hypertension and diuretic medication presents with decreased blood volume.
    • The first activated component of the RAAS is renin.

    Question 6: Renal Physiology

    • In the regulation of glomerular filtration rate (GFR), which substance is primarily responsible for causing vasoconstriction of the efferent arterioles, thus influencing renal blood flow and filtration pressure?
    • The most likely answer is Angiotensin II.

    Question 7: Perioperative

    • A 58-year-old man with angina, poorly controlled diabetes, and an ejection fraction (EF) of 40% is scheduled for elective surgery.
    • The most appropriate ASA physical status classification is ASA 4.

    Question 8: Shock

    • A 55-year-old man with chronic liver disease presents with hypotension, fever, and confusion, and is in refractory septic shock.
    • The most appropriate next vasopressor to administer is norepinephrine.

    Question 9: Neuroanatomy

    • A 32-year-old man with a penetrating neck injury presents with weakness on one side and loss of pain and temperature on the opposite side below the injury.
    • The most likely diagnosis is Brown-Séquard syndrome.

    Question 10: Burn

    • A patient with burns and a history of smoke inhalation presents with hoarseness and stridor.
    • The most immediate indication for endotracheal intubation is hoarseness and stridor.

    Question 11: Amyloid

    • A 60-year-old with multiple myeloma presents with kidney dysfunction and cardiac arrhythmias.
    • The most likely type of amyloid fibrils is AL amyloid.

    Question 12: Lung Cancer

    • A 68-year-old male with a history of construction work presents with worsening shortness of breath and chest pain.
    • Chest X-ray shows pleural thickening and biopsy shows malignant cells.
    • The most likely diagnosis is mesothelioma.

    Question 13: Sepsis

    • In the assessment of adults with suspected infection outside of the ICU, the qSOFA score is used to identify patients at greater risk of a poor outcome.
    • The correct combination of criteria for the qSOFA score is Respiratory rate ≥ 22/min, Systolic blood pressure < 90 mmHg, Altered mental status.

    Question 14: Perioperative

    • A 50-year-old male with mild hypothermia is scheduled for elective hernia repair.
    • The most effective intervention to manage the hypothermia is to warm the patient using a Bair Hugger device.

    Question 15: Stress in Surgery

    • A patient undergoing major abdominal surgery develops hyperglycemia.
    • The most likely physiological mechanism is decreased insulin sensitivity.

    Question 16: Renal Physiology

    • A 40-year-old female presents with dizziness and fatigue and dehydration.
    • The most likely hormonal changes in response to hypovolemia is an increase in renin, increase in aldosterone, increase in ADH.

    Question 17: Endocrine

    • A 40-year-old female presents with weight loss, palpitations, and exophthalmos with elevated thyroid hormones.
    • The most appropriate medication to initiate is Carbimazole.

    Question 18: Orthopaedics

    • A patient with tibial and fibular fracture reports severe pain in the operated limb. The most appropriate next step is measuring intracompartmental pressure.

    Question 19: Head Injury

    • A 45-year-old male with a history of alcohol use presents with head trauma and unsure about loss of consciousness.
    • The most appropriate management is admission for 24-hour observation.

    Question 20: Breast

    • A 55-year-old female presents with unilateral breast pain, not related to the menstrual cycle.
    • The most appropriate next step in management is a mammogram.

    Question 21: Breast Cancer

    • A patient with breast cancer presents with sternum pain, suggestive of metastatic bone involvement.
    • The most appropriate approach is bisphosphonates or denosumab

    Question 22: Breast

    • A 43-year-old female presents with 10-day history of breast pain, diffuse tenderness without a mass.
    • The most appropriate next step is a breast ultrasound.

    Question 23: Tongue

    • A patient with a tongue piercing presents with infection concern.
    • The tip of the tongue primarily drains into the submental lymph nodes.

    Question 24: Perioperative

    • The primary aim of implementing ERAS protocols in surgical patients is to reduce overall postoperative complications and hospital stay.

    Question 25: Orthopaedics

    • A patient presents with reduced mouth opening, misalignment of jaws, inability to bite properly, and preauricular tenderness after falling onto their chin.
    • The most likely fractured part of the mandible is the condylar.

    Question 26: Neurosurgery

    • A 29-year-old man with a history of motor vehicle collision presents with specific eye opening, verbal response, and motor responses of pain.
    • The GCS score is 8, which indicates severe head injury.

    Question 27: GIT

    • A patient with gastric bypass presents with weakness, sweating, and palpitations 2 hours after eating.
    • The most likely diagnosis is late dumping syndrome.

    Question 28: Neurosurgery

    • A patient with head trauma and a GCS of 14, with a single episode of vomiting, presents with additional physical findings; what finding most urgently necessitates a CT scan of the head?
    • Retroauricular bruising or Battle's sign.

    Question 29: Microbiology

    • A patient with hemoptysis, cervical lymphadenopathy, mediastinal lymph node enlargement, and night sweats.
    • The most likely diagnosis is Tuberculosis (TB).

    Question 30: Neuroanatomy

    • A patient with a C5 spinal cord lesion in spinal shock is assessed for recovery.
    • The finding indicative of transitioning out of spinal shock and beginning neurological recovery is a delayed plantar reflex.

    Question 31: Orthopaedics

    • A pediatric patient with a supracondylar humerus fracture presents with an absent radial pulse.
    • The most appropriate next step in management is urgent vascular consultation, internal fixation, and rechecking of the pulse.

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