2015

Recalls

2015 recalls
MRCS I.V.
 MRCS I.V. Course

2015 recalls
1. A patient is found drowsy with low SVR, high Cardiac Output and tachycardia. What may be the
cause?
A. septic shock
B. neurogenic shock
C. cardiogenic shock
D. hemorrhagic shock
E. obstructive shock

2. Which is false about SA node?

A. Pacemaker of the heart
B. It is present in the wall of right atrium beside SVC
C. Has somatic nerve supply
D. Has vagal nerve supply
E. Has sympathetic nerve supply

3. Which of the following is Lignocaine commonest side effect?

A. Cardiotoxicity
B. Hepatotoxicity
C. Malignant hyperthermia
D. Renal toxicity
E. Urticaria

4. Which of the following is considered a depolarizing agent for anesthesia?

A. Succinyl choline
B. Vecuronium
C. Atracium
D. Propofol
E. Halothane

5. A patient sustained a bee sting, presented with HR 120, BP 60/40. What is the first line of
treatment?
A. IV antihistamine
B. IV fluid
C. IV steroid
D. Local antihistamine
E. IM adrenaline

6. A patient presented with fatiguability, ptosis. Which of the following tumors can cause
myasthenia like symptoms?
A. Thymus
B. Adrenals
C. Lung
D. Liver
E. Kidney

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7. A 5 years old male was admitted for chest infection. 5 days later, he developed a cystic
fluctuating neck swelling, anterior to sternomastoid border. What is the underlying cause?
A. Thyroglossal cyst
B. cystic hygroma
C. Branchial cyst
D. congenital epidermoid
E. acquired epidermoid

8. An 8 weeks old infant is brought to clinic with history of 18 days of jaundice. The mother is
breast feeding. He was a full term baby with no family history of liver disease. What is the most
appropriate next step?
A. Ultrasound liver
B. Unconjugated bilirubin measurement
C. Conjugated bilirubin measurement
D. ERCP
E. Reassurance and discharge

9. Posterior bed of kidney includes all the following except?

A. Iliacus
B. Psoas muscle
C. Transversus abdominus
D. Quadratus lumborum
E. None of the above

10. What is most relevant anterior relation of right suprarenal gland?

A. IVC
B. SVC
C. SMA
D. IMA
E. All of the above

11. Which of the following statements is true regarding cardiac muscle?

A. Contraction does not involve release of Ca by the sarcoplasmic reticulum
B. Contraction is triggered by an influx of Ca through the sarcolemma
C. Excitation is passed from one cardiac cell to another through desmosomes
D. Hypertrophy is brought about by division of existing cardiac cells
E. There is capacity for regeneration

12. Epistaxis is caused mainly by bleeding from which of the following vessels?
A. External palatine artery
B. Greater palatine artery
C. Anterior ethmoidal artery
D. Posterior ethmoidal artery
E. Sphenopalatine artery

MRCS IV recalls 2 MRCS I.V. Course

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13. Which of the following is false regarding cavernous sinus thrombosis?

A. painful swelling of the eye
B. Ophthalmoplegia
C. Gradual loss of vision
D. It passes through valveless facial vein to cavernous sinus
E. reach to it by mastoid abscess

14. A 69-year-old man has been admitted to the high dependency unit following an anterior
resection under general anesthesia. He was given 2 mg of intrathecal morphine. On
examination, he looks pale and drowsy. Arterial blood gasses results are:
PH 7.28 7.35-7.45
pCo2 8.1 kPA 4.7-6.0
pO2 10.2 kPa 11.9-13.3
Base Excess -2.1 -2 to +2
Glucose 21 mmol/L 4-7
Lactate 4.0mmol/L 0.5
Which of the following is the most likely diagnosis?
A. Diabetic ketoacidosis
B. Metabolic acidosis
C. Metabolic alkalosis
D. Respiratory acidosis
E. Respiratory Alkalosis

15. A boy presents with his mother after a history of cyanosis. A diagnosis of tetralogy of Fallot was
taken. Which of the following is characteristic to this condition?
A. Pulmonary stenosis
B. Patent foramen ovale
C. Left ventricular hypertrophy
D. Patent ductus arteriosus
E. All of the above

16. Which of the following is not inactivated by antithrombin III?

A. Factor VIIIa
B. Factor Xa
C. Factor XIIa
D. FactorXIa
E. FactorIXa

17. Which of the following neurotransmitters is associated with reduced gastrointestinal motility?
A. Dopamine
B. Acetylcholine
C. Noradrenaline
D. Dobutamine
E. None of the above

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18. A 70 years old man attended a respiratory clinic due to complaint of longstanding
breathlessness. His spirometry revealed an FEV1 of 1.8L and FVC of 2.1L. Which of the following is
the most likely cause?
A. Fibrosing alveolitis
B. Asthma
C. Bronchiectasis
D. COPD
E. Pneumonia

19. A young man took a maximal inspiration after exhaling maximally. This is measured by
spirometry. What does this represent?
A. Vital capacity
B. Functional residual capacity
C. Total lung capacity
D. Inspiratory reserve volume
E. None of the above

20. A 25 years old patient was involved in an accident during which he had a left hemi section of his
spinal cord at the level of T4. Which of the following are the findings on examination?
A. Left leg weakness and right sided loss of light touch (two-point discrimination)
B. Left leg weakness and left sided loss of light touch (two-point discrimination)
C. Right leg weakness and left sided loss of light touch (two-point discrimination)
D. Right leg weakness and left sided loss of pain sensation
E. None of the above

21. A 22-year-old man arrives to the Emergency Department with sudden breathlessness due to a
large pneumothorax. A chest drain is inserted into the fifth left intercostal space in 5th mid-
axillary line. There is blood into the drainage bottle. Which of the following structures is the
most likely cause of this acute hemorrhage?
A. Intercostal artery
B. Pericardiophrenic artery
C. Ventricular artery
D. Intercostal vein
E. None of the above

22. A farmer had an injury to the middle phalanx of his right index finger. On examination he was
able to flex his PIP joint but unable to flex his DIP joint. What tendon is the most likely to be
injured?
A. Flexor digitorum profundus
B. Flexor digitorum superficialis
C. Flexor carpi ulnaris
D. Flexor pollicis longus
E. Flexor pollicis brevis

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23. A 39 years old lady presents with a painful shoulder for 6 months. On examination she is tender
between 60ᵒ to 120ᵒ. Which of the following muscles are likely to be implicated?
A. Supraspinatus muscle
B. Infraspinatus muscle
C. Subscapularis muscle
D. Teres minor muscle
E. Teres major muscle

24. A patient had an intramuscular injection to his right buttock for a medication. Subsequently, he
was unable to dorsiflex his right foot. Which of the following nerve is injured?
A. Common peroneal nerve
B. Posterior tibial nerve
C. Superior gluteal nerve
D. Inferior gluteal nerve
E. Saphenous nerve

25. A 26 years old patient had a lateral malleolar fracture in a car accident. Which of the following
structures are likely to be injured?
A. Tibial nerve
B. Peroneus longus tendon
C. Tibialis posterior muscle
D. Saphenous nerve
E. All of the above

26. A patient fell on an outstretched hand. Initial x-ray did not show any fracture. 4 weeks later, he
came back with a pain in the anatomical snuffbox. X-ray showed scaphoid fracture. Which of
the following describe the blood flow to this bone?
A. Distal
B. Proximal
C. Medial
D. Lateral
E. None of the above

27. A 24 years old man had a groin injury during a sport match. He presented with swelling of the
testicle with a mildly tender lump in the right testicle and enlarged left supraclavicular LN. What
is the likely diagnosis?
A. Seminoma
B. Teratoma
C. Lymphoma
D. Choriocarcinoma
E. None of the above

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28. A 60 years old man presents with pain, weakness and tingling in the legs. He has a calf
claudication, but he is able to cycle hundreds of meters without any pain. What is the likely
cause?
A. Spinal canal stenosis
B. Intermittent claudication
C. Chronic ischemia
D. Syringomyelia
E. Spondylolisthesis

29. A patient had a cut wound passing midline between the base of the little finger and the wrist.
On examination, he has loss of thumb adduction. what is the nerve being injured?
A. Superficial ulnar nerve
B. Deep ulnar nerve
C. Median nerve
D. Radial nerve
E. Posterior interosseus nerve

30. After the varicose vein surgery, a patient noticed loss of sensation at the dorsal aspect of the
foot with lost ability of dorsiflexion. What is the nerve being injured?
A. Common peroneal nerve
B. Superficial peroneal nerve
C. Deep peroneal nerve
D. Sciatic nerve
E. Tibial nerve

31. A 45 years old patient underwent an inguinal hernia repair. After 5 days. He developed an
abscess discharging pus at the site of the wound. What is the most likely causative organism?
A. Staphylococcus aureus
B. Clostridium perfringens
C. Streptococcus pyogenes
D. Staphylococcus epidermides
E. None of the above

32. A patient had a gangrene affecting perineum with discoloration which is rapidly progressive. He
has elevated body temperature and systemic illness. What is the most likely causative
organism?
A. Staphylococcus aureus
B. Clostridium perfringens
C. Bacteroides
D. Staphylococcus epidermides
E. None of the above

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33. A 72 years old female undergoes a total hip replacement. Postoperatively, the surgeon noticed
that she walks with Trendelenburg gait. Which structure is likely to be damaged?
A. Sciatic nerve
B. Obturator nerve
C. Femoral nerve
D. Superior gluteal nerve
E. Gluteus maximus muscle

34. A patient suffered a deep injury just above the olecranon process. On examination, there’s lost
elbow and wrist extension with some cutaneous sensory loss. Which structure is likely to be
damaged?
A. Triceps tendon
B. Radial nerve
C. Median nerve
D. Ulnar nerve
E. Posterior interosseus nerve

35. A 53 years old female presented with history of back pain especially with walking. She reported
loss of the sensation over the surface of the knee. Where would you expect the level of cord
lesion?
A. L5
B. S1
C. L3
D. L4
E. L2

36. A man had a direct stab to his popliteal fossa during a fight. The surgeon decided to explore the
wound to exclude vascular injury. The first structure being exposed after incision is:
A. Popliteal vein
B. Femoral nerve
C. Tibial nerve
D. Popliteus muscle
E. Common peroneal nerve

37. A 23 years old athlete suffered a knee injury during a football game. Xray showed multiple tibial
and fibular fractures. An intramedullary nail was inserted. 6 hours later, the patient was found
in severe pain at leg with intact distal pulsations. What is the most likely cause?
A. DVT
B. Compartment syndrome
C. Limb ischemia
D. Compression due to tourniquet
E. None of the above

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38. A 2-day old baby presents with increasing respiratory distress. He was born at term by normal
vaginal delivery. On examination he has cyanosis of the lower limbs and marked respiratory in
drawing of the chest. His femoral pulses are absent bilaterally and he has been anuric for the
last 2 hours. Pulse rate is 140 beats/minute, regular, and his blood pressure is 60/30 mmHg in
both upper limbs. What is the most likely diagnosis?
A. Hypoplastic left heart syndrome
B. Interrupted aortic arch
C. Pulmonary atresia and ventricular septal defect
D. Transposition of the great arteries
E. None of the above

39. A 70 years old man was found in severely hypothermic. His temperature on arrival was 32ᵒC.
What would be seen in his ECG?
A. J wave with prolonged PR and ORS interval
B. Atrial flutter
C. Narrow complex QRS
D. U wave
E. Long QT interval

40. A patient was diagnosed with pulmonary embolism. What would be seen in the ECG?
A. Inverted T wave in lead V1-V3
B. Left axis deviation
C. Left bundle branch block
D. Left ventricular strain pattern
E. ST elevation in lead V1-V3

41. A patient was given adrenaline and developed tachycardia. Which of the following receptors
are implicated?
A. β2
B. β1
C. α1
D. α2
E. All of the above

42. A patient underwent a surgery for hyperhidrosis. Unfortunately, the anterior nerve above
which the surgery took place was inadvertently injured. Which of the following would develop?
A. Horner’s syndrome
B. Oculomotor nerve injury
C. Weakness of the muscle of the upper limb
D. Phrenic nerve injury
E. Vagus nerve injury

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43. At which level does the aorta pierces the diaphragm?

A. T12
B. T10
C. T8
D. L1
E. T11

44. A patient presents with a serum osmolality of 275 mosm, and her serum Na level was 125. His
urinary osmolality was 1000 mosm. What is your management?
A. Loop diuretics
B. Mannitol
C. Thiazide diuretics
D. K sparing diuretic
E. fluid restriction

45. A patient presented with a vesicular rash between T8 to T10. What anatomical location is this
associated with?
A. Costal margins
B. Nipple
C. Suprapubic
D. Inguinal region
E. All of the above

46. A patient had a rectal carcinoma; he had a surgery. The inferior mesenteric vein drains to which
of the following?
A. Portal vein
B. Splenic vein
C. Superior mesenteric vein
D. IVC
E. None of the above

47. What is the electrolyte imbalance in a case of rectal adenoma?

A. Hypokalemia
B. Hypocalcemia
C. Hyponatremia
D. Hyperkalemia
E. None of the above

48. A patient had a shrapnel injury lateral to the rectus abdominis muscle on the right side just
below his costochondral margin. The shrapnel penetrates into the abdomen at this level
towards his back. What structure is likely to be injured?
A. Aorta
B. Inferior vena cava
C. Gallbladder fundus
D. Hilum of kidney
E. Stomach antrum

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49. A patient had a velvety red lesion in the mouth. Biopsy revealed keratin. What is the cause?
A. SCC
B. adenocarcinoma
C. Basal cell carcinoma
D. Keratoacanthoma
E. None of the above

50. Which of the following stimulate the production of hydrochloric acid in the stomach?
A. Somatostatin
B. Fat in the stomach
C. Secretin
D. Histamine
E. CCK

51. A patient had atrophic gastritis associated with pernicious anemia, now the patient presents
with weakness and low hemoglobin. what is the type of his anemia?
A. Macrocytic
B. Microcytic
A. Normocytic
B. Spherocytic
C. None of the above

52. A mother presented to the clinic complaining of facial abnormality in her baby. Which of the
following nerve arise from second branchial arch?
A. Trigeminal nerve
B. Facial nerve
C. Glossopharyngeal nerve
D. Vagus nerve
E. None of the above

53. The first non-invasive test done in chronic pancreatitis is:

A. Fecal elastase
B. Chymotrypsin
C. Lipase
D. Amylase
E. Gastrin

54. Counter current multiplier mechanism that leads to the concentration of urine in the Loop of
Henle is mediated by:
A. Active transport of solute out of thin section ascending limb
B. Impermeability to water in thick ascending limb
C. Permeability to solute in descending limb
D. Permeability to solute in thick ascending limb
E. Permeability to water of thin section ascending limb

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55. A patient complained from homonymous hemianopia, what is the site in brain to be affected?
A. Optic nerve entry in foramen
B. Optic chiasma
C. Optic tract
D. Temporal lobe
E. Parietal lobe

56. A man suffered 60% burn with bilateral leg edema. Most common Cause of edema is:
A. Hypoalbuminemia
B. Sepsis
C. Heart failure
D. DVT
E. Compartmental syndrome

57. A 53 years old man with profuse lower GIT bleeding. Contrast accumulate at the left iliac fossa.
For vessel embolization, which level is appropriate?
A. T12
B. L1
C. L3
D. L4
E. L5

58. A knife penetrates the midline of the sternal angle mostly will lead to injury to:
A. trachea
B. esophagus
C. SVC
D. azygos vein
E. None of the above

59. IN surgical ICU, a patient developed metabolic alkalosis. What is the most likely cause?
A. Vomiting
B. Nasogastric aspiration
C. Peritonitis
D. COPD
E. None of the above

60. A patient with a history of MI and atrial fibrillation was admitted to ICU due to symptoms of
abdominal pain, PR bleeding and abdominal distension. He had a blood picture consistent with
metabolic acidosis. Which of the following best describe lactate?
A. Produced due to anaerobic fermentation of glucose to pyruvate
B. Production of only 2 ATP, while spending 4 ATP in Cori cycle
C. Produced due to reduced tissue perfusion
D. Produced due to aerobic respiration
E. None of the above

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61. A male infant is born at 28 weeks gestation by emergency cesarean section. He is taken to
theatre for a colostomy. Due to an imperforate anus. He initially seems to be progressing well.
However, he begins to develop decerebrate posturing and is becoming increasingly drowsy.
What is your diagnosis?
A. Intraventricular hemorrhage
B. Chronic sub Dural bleed
C. Acute sub Dural bleed
D. Extra Dural hemorrhage
E. Sub arachnoid hemorrhage

62. A previously fit 21-year-old man collapses while running a Marathon. Resuscitation was
unsuccessful. A pos-mortem examination shows an intracranial hemorrhage. What is the most
likely site of the hemorrhage?
A. Intraventricular hemorrhage
B. Chronic sub Dural bleed
C. Acute sub Dural bleed
D. Extra Dural hemorrhage
E. Sub arachnoid hemorrhage

63. Female patient has mediastinal mass. Biopsy taken from the mass showed Hassall corpuscles
What the most probably diagnosis?
A. Lymphoma
B. Follicular carcinoma
C. Schwannoma
D. Thymoma
E. none of the above

64. A 45 years old white smoker female came to your clinic with recurrent attack of inflammation in
her right breast. During her self-examination, she noticed a creamy greenish discharge from her
nipple. What is your provisional diagnosis?
A. Duct Papilloma
B. Lobular carcinoma in situ
C. Sclerosing adenosis
D. Duct ectasia
E. Invasive duct carcinoma

65. An 18-year-old female presented with a mobile breast lump in her right breast. What is your
possible diagnosis?
A. Phyllode tumor
B. Traumatic fat necrosis
C. Breast cyst
D. Intra ducat papilloma
E. Fibroadenoma

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66. A 50-year-old patient came to ER after head trauma. Assessment of consciousness level was
done He can localize pain, open his eyes to pain with only sounds. What is the GCS ?
A. 9
B. 7
C. 11
D. 12
E. 8

67. In a 9-year-old child with cellulitis of the hand, which chronological sequence of
immunoglobulin production is correct?
A. IgD precedes IgE production
B. IgG precedes IgA production
C. IgG precedes IgE production
D. IgM precedes IgA production
E. IgM precedes IgG production

68. A patient presents with lymph node swelling in the neck. She was later diagnosed with thyroid
cancer. Which of the following is the most likely type?
A. Papillary carcinoma
B. Follicular carcinoma
C. Medullary carcinoma
D. Lymphoma
E. None of the above

69. A patient with achondroplasia attended your clinic for an advice regarding inheritance. What
mode of inheritance would you describe to him?
A. Autosomal recessive
B. X linked recessive
C. X linked dominant
D. Autosomal dominant
E. None of the above

70. A 20 years old lady presented to the breast clinic complaining of a bloody discharge from a
nipple. What is the most likely diagnosis?
A. Ductal papilloma
B. Duct ectasia
C. Carcinoma of the breast
D. Paget’s disease of the breast
E. Fibro adenosis
71. A patient had a breast cancer. On gene analysis she had a gene mutation affecting DNA
replication. Which phase of cell cycle is affected?
A. G1 phase
B. G2 phase
C. S phase
D. M phase
E. None of the above

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72. A woman of Asian origin presents with shortness of breath and hemoptysis. She is noted to
have supraclavicular lymphadenopathy. Chest Xray revealed lesions in the lung. A biopsy of the
lymph node is likely to show which of the following?
A. Macrophage invasion
B. Lymphocytic infiltration
C. Neutrophils infiltration
D. Tumor cell invasion
E. None of the above

73. A patient underwent an inguinal hernia repair. 4 days following the procedure, he developed
fever and an abscess in the groin area. Which of the following best describe the process of
inflammation?
A. Infiltration of the tissue by neutrophils causing edema
B. Increased vascular permeability causing edema and fluid accumulation then cell
infiltration
C. Release of cytokines causing inflammation
D. Hypoalbuminemia cause edema
E. None of the above

74. A 20 years old man presented with an acute abdominal pain following a rugby sport. On
examination his abdomen was tender especially in the left upper quadrant and he becomes
hypotensive on arrival. Which of the following organism is likely to have caused the
presentation?
A. Epstein-Barr virus
B. Cytomegalovirus
C. Mumps
D. Herpes simplex virus
E. Hepatitis B virus

75. A patient had a head injury. Initial GCS was 15, after a few hours the GCS dropped to 7 and he
developed dilated pupil in the left side. What is the likely cause?
A. Subarachnoid hemorrhage
B. Subdural hemorrhage
C. Intracerebral hemorrhage
D. Brain herniation
E. None of the above

76. A patient had a renal transplant. Immediately after the anastomosis, the kidney appeared
reduced perfusion and became ischemic. What is the likely underlying pathology?
A. Cytotoxic T-cells in the recipient against the graft
B. ABO and HLA incompatibility
C. anaphylactic shock
D. Immune complex theory
E. None of the above

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77. A patient had a prostate enlargement. A biopsy showed increased number of cells. What is the
pathology process described?
A. Hyperplasia
B. Hypertrophy
C. metaplasia
D. Dysplasia
E. Neoplasia
78. A patient had a serum sodium of 120mEq/L. Chest Xray showed lung cancer, what is the most
likely type of cancer?
A. squamous cell carcinoma
B. Large cell lung carcinoma
C. Adenocarcinoma
D. Small cell lung carcinoma
E. None of the above

79. A 20-year-old woman presents acutely with abdominal pain, imaging reveals a right ovarian
cystic lesion which is excised. Histological examination shows a cyst lined by keratinizing
stratified squamous epithelium. Areas of fat, muscle, thyroid and neural tissue are seen in the
wall. What is the appropriate pathological designation for this lesion?
A. Adenocarcinoma
B. Cystadenoma
C. Dysgerminoma
D. Squamous cell carcinoma
E. Teratoma

80. A patient sustained trauma to the chest, CXR shown widening of the mediastinum. what of the
structure being rupture?
A. Ascending aorta
B. Descending aorta
C. Aortic arch
D. Thoracic duct
E. Subclavian artery

81. A 40 years old female underwent radical mastectomy. What type of drain will you use?
A. Wallace drain
B. Redivac system
C. Chest tube 16Fr
D. Nelaton catheter
E. Corrugated drain
82. Primary sclerosing cholangitis is usually associated with?
A. Ulcerative colitis
B. Chron's disease
C. Cancer colon
D. Diverticulosis
E. IBS

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83. A patient was recently diagnosed with colonic cancer and underwent a surgery. The pathology
report came back as Duke’s B. What is the 5 years survival in this patient?
A. 90%
B. 40%
C. 30%
D. 70%
E. 5%

84. A 60-year-old lady presented with acute severe headache. She was diagnosed as subarachnoid
hemorrhage. What is the pathology of saccular aneurysm?
A. Congenital wall weakness
B. Mycotic aneurysm (fungal)
C. Hypertensive
D. atherosclerosis
E. None of the Above

85. A young pregnant lady presents with a third episode of DVT. All blood investigations are
normal. What is the likely cause?
A. Anti-phospholipid syndrome
B. Antiendometrial syndrome
C. Factor 5 leydin
D. Factor VIII deficiency
E. None of the above

86. A patient presents with intermittent claudication after 100m he begins to complain of calf pain.
What artery is likely affected?
A. Superficial femoral artery
B. Popliteal artery
C. Iliac artery
D. Anterior Tibial artery
E. Posterior Tibial artery

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Notes

MRCS IV recalls 17 MRCS I.V. Course