MRCS-B: Topics

• ANATOMY:
  1. Head–
     • Brain, Skull, sinuses, meninges etc…++
  2. Neck–
     • Cervical Spine
     • Thyroid…+++
     • Anterior neck
     • Infrahyoid muscles…+
     • Oesophagus, Carina, Salivary glands, Facial vessels & Nerve
  3. Thorax/Chest–
     • Heart, Lung, Diaphragm,
  4. Abdomen & Pelvis–
     • Abdomen at transpyloric plane…++
     • Pancreas, its relations & development
     • Stomach
     • Muscles of Abdominal Wall & nerve roots; Appendicectomy- nerve injury/at risk.
     • Liver- lobes, vessels, relations
     • Abdominal aorta
  5. Upper Limb–
     • Shoulder- Rotator cuff, Brachial Plexus, Erb’s Palsy
     • Bones of upper limbs (humerus, scapula, clavicle); Rotator cuff Muscles with nerve supply…++
     • Ulnar & Radial Nerve Injury
     • Brachial Plexus injury
     • Extensor compartment- forearm & hand
  6. Lower Limb–
     • Osteology, Muscles- origin & insertion
     • Glutei muscles, Trendelenburg sign; Sciatic nerve; Hamstring muscles; Popliteal fossa
     • 
       
  7. Spine–
     • Cauda Equina
     • Lumbar Spine
     • 
       
       
• SURGICAL PATHLOGY:
  1. Gangrene, Necrosis, Apoptosis
  2. Knee pain
  3. Thyroid: Hypothyroidism…++
  4. Neck Lump- TB/Lymphoma…++
  5. Testicular Tumours (also Lymphoma, Non-germ cell tumour, SCC)…++
  6. Blood transfusion & transfusion reactions; Bone-fracture healing
  7. Crohn’s disease on immunosupressive therapy with hip pain
  8. Tuberculosis
  9. Polycystic Kidney disease & General pathology of Inflammation
  10. Undescended testes
  11. Polytrauma & transfusion
• APPLIED SURGICAL SCIENCE & CRITICAL CARE:
  1. Perforated Viscus with Septicaemia & Atrial Fibrillation
  2. Burn
  3. Epidural/Extradural Haematoma (RTA pt.) & its management (also ICP & CPP)…+++
  4. Diabetes: perioperative management & others…++
  5. Cholestatic Jaundice ( about bile & enterohepatic circulation)
  6. Billiary colic/ Gall stones
  7. Post-Op Pulmonary embolism
  8. Pregnant lady- splenectomy in Reverse Trendelenberg Positon- causing hypotension
  9. Upper GI bleeding
  10. Cervical spine injury
  11. Thyroid-
      • Hypothyroidism…++
  12. Polytrauma patient (Pneumothorax, Liver injury etc)
  13. Bloody diarrhoea
• HISTORY:
  1. Pain- abdomen
  2. Pre-Op assessment (breathlessness, wheezing){?Anxiety/Asthma}…+++
  3. Assessment of Capacity of a confused patient for elective THR.
  4. Obstructive LUT (lower urinary tract), e.g. BPH …++
  5. Post-op (THR) ?Pleuritic Chest pain
  6. Knee Pain
  7. PR Bleeding
  8. Seizure history
  9. Tonsil swelling
• Clinical & Procedural Skills-
  • EXAMINATIONS:
    1. Abdomen..++++
       • Epigastric pain
       • RIF pain
       • Left Iliac region pain(CCrISP)
       • Rt Hypochondriac pain
    2. Chest
    3. Submandibular Gland…++
    4. Knee joint
    5. Cranial Nerve for Bitemporal hemianopia & others…+++
    6. Inguinal Hernia (B/L)
    7. Hand Exam (Dupuytren’s contractures, scar over rt elbow)
    8. Examination of leg post-phlebectomy numbness/clumsiness
    9. Neurological Examination of Lower Limb
       • Post-op(vein strapping) foot drop
    10. Respiratory Examination
        • Pt. with PE
        • Pre-op assessment for shortness of breathing
    11. Ankle examination for ankle injury
    12. Lipoma
    13. Neck swelling (Thyroid swelling)
    14. Varicose vein
  • PROCEDURES:
    1. OT List Order…+++
    2. ATLS on a Manikin– Airway Management
    3. Sutures, Hand tie & surgical Knot/Knot tying/Tying at depth/Underrun ulcer with figure of 8/Z-suture to stop a bleeding vessel…+++
    4. IV Cannula insertion (also fluid management, venous cut down etc)
    5. Wound suturing
    6. I&D of anterior Thigh abscess…++
    7. Excision biopsy of Naevus
    8. Foley’s catheter
• COMMUNICATION SKILLS:
  1. Call to ICU Registrar for peri-op advice & book post-op bed (SBAR)…++++
  2. Splenic Haematoma pt- self discharge…+++
  3. Anxious mother of a child with splenic injury under divorced father’s care.
  4. Discuss with consultant about a post-op pt with low urine output
  5. Discuss to angry patient about repeated cancellation of procedure
  6. SBAR TO CONSULTANT OVER PHONE.
  7. OGD counselling to patient.