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Free MRCS Sample Questions (SBAs)

Six original MRCS-style single best answer questions. Choose an option, then open the answer to see the explanation. These are practice questions written for revision, not real exam items.

Question 1

A 25-year-old man falls and fractures the surgical neck of his humerus. Which nerve is most at risk?

  1. Radial nerve
  2. Axillary nerve
  3. Musculocutaneous nerve
  4. Ulnar nerve
  5. Median nerve
Show answer and explanation

Answer: B. Axillary nerve

The axillary nerve winds around the surgical neck of the humerus with the posterior circumflex humeral artery. Injury causes deltoid weakness and loss of sensation over the regimental badge area. The radial nerve is at risk in mid-shaft fractures.

Question 2

Which nerve passes through the foramen ovale?

  1. Maxillary nerve
  2. Ophthalmic nerve
  3. Mandibular nerve
  4. Facial nerve
  5. Glossopharyngeal nerve
Show answer and explanation

Answer: C. Mandibular nerve

The mandibular division of the trigeminal nerve (V3) leaves the skull through the foramen ovale. The maxillary nerve passes through foramen rotundum, and the ophthalmic nerve through the superior orbital fissure.

Question 3

During a Pringle manoeuvre the free edge of the lesser omentum is compressed. Which set of structures does this control?

  1. Hepatic artery, portal vein and common bile duct
  2. Left gastric artery, splenic artery and portal vein
  3. Hepatic veins and inferior vena cava
  4. Gastroduodenal artery and cystic duct only
  5. Coeliac trunk and superior mesenteric artery
Show answer and explanation

Answer: A. Hepatic artery, portal vein and common bile duct

The free edge of the lesser omentum (hepatoduodenal ligament) contains the portal triad: hepatic artery proper, portal vein and common bile duct. Clamping it reduces inflow to the liver in haemorrhage. It does not control hepatic venous bleeding.

Question 4

A thyroid nodule is excised. Histology shows nuclei with an optically clear, ground-glass appearance and psammoma bodies. What is the most likely diagnosis?

  1. Follicular carcinoma
  2. Medullary carcinoma
  3. Anaplastic carcinoma
  4. Papillary carcinoma
  5. Hashimoto thyroiditis
Show answer and explanation

Answer: D. Papillary carcinoma

Papillary thyroid carcinoma is the most common thyroid cancer and shows clear "Orphan Annie eye" nuclei, nuclear grooves and psammoma bodies. It spreads mainly via lymphatics to cervical nodes.

Question 5

A trauma patient has a heart rate of 125/min, a blood pressure of 85/50 mmHg and a reduced pulse pressure. Using ATLS classification, what percentage of blood volume has most likely been lost?

  1. Up to 15%
  2. 15 to 30%
  3. 30 to 40%
  4. More than 40% only
  5. No significant loss
Show answer and explanation

Answer: C. 30 to 40%

Class III haemorrhage (about 30 to 40% blood volume loss, roughly 1500 to 2000 mL in an adult) typically presents with marked tachycardia, hypotension, reduced pulse pressure and confusion. These patients usually need blood product resuscitation and haemorrhage control.

Question 6

A patient on warfarin has a life-threatening gastrointestinal bleed with a markedly raised INR. Which is the most appropriate reversal?

  1. Oral vitamin K alone
  2. Fresh frozen plasma alone after 24 hours
  3. Prothrombin complex concentrate with intravenous vitamin K
  4. Protamine sulfate
  5. Tranexamic acid alone
Show answer and explanation

Answer: C. Prothrombin complex concentrate with intravenous vitamin K

For life-threatening bleeding on warfarin, give prothrombin complex concentrate for immediate factor replacement together with IV vitamin K for sustained effect. Protamine reverses heparin, not warfarin. Always follow your local protocol.

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