Basic Science for the MRCS: A Revision Guide for Surgical Trainees

538 Pages·2017·12.61 MB·English

by  Andrew T. Raftery

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2015v1.0
BASIC SCIENCE

MRCS
FOR THE

A revision guide for surgical trainees
This page intentionally left blank
BASIC SCIENCE

MRCS
FOR THE

A revision guide for surgical trainees
THIRD EDITION
Andrew T. Raftery BSc MBChB(Hons) MD FRCS(Eng) FRCS(Ed)
Clinical Anatomist.
Formerly Consultant Surgeon, Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS
Foundation Trust, Northern General Hospital, Sheffield; Formerly Member (formerly Chairman),
Court of Examiners, Royal College of Surgeons of England; Formerly Member of Panel of
Examiners, Intercollegiate Speciality Board in General Surgery; Formerly Member of Council,
Royal College of Surgeons of England; Formerly Honorary Clinical Senior Lecturer in Surgery,
University of Sheffield, UK
Michael S. Delbridge MBChB(Hons) MD FRCS(Vascular)
Consultant Vascular and Endovascular Surgeon, Norfolk and Norwich Hospital, UK
Helen E. Douglas MBChB MSc MD FRCS(Plast)
Specialist Trainee in Plastic and Reconstructive Surgery, Yorkshire and Humber Deanery, UK
For additional online content visit StudentConsult.com
EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO 2018
© 2018, Elsevier Limited. All rights reserved.
First edition 2006
Second edition 2012
Third edition 2018
The right of Andrew T. Raftery, Michael S. Delbridge and Helen E. Douglas to be identified as authors of this work has
been asserted by him in accordance with the Copyright, Designs and Patents Act 1988.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical,
including photocopying, recording, or any information storage and retrieval system, without permission in writing from
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This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as
may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any
information, methods, compounds, or experiments described herein. In using such information or methods they should be
mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current
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the recommended dose or formula, the method and duration of administration, and contraindications. It is the
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determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.
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use or operation of any methods, products, instructions, or ideas contained in the material herein.
ISBN: 978-0-7020-6909-3
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Content Strategist: Laurence Hunter
Content Development Specialist: Fiona Conn
Project Manager: Joanna Souch
Design: Paula Catalano
Illustration Manager: Teresa McBryan
Marketing Manager: Deborah Watkins
The
publisher’s
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Contents
 I  ANATOMY
1 The thorax 3
2 The abdomen, pelvis and perineum 22
3 The upper limb and breast 66
4 The lower limb 84
5 The head, neck and spine 112
6 The nervous system 153
 II  PHYSIOLOGY
7 General physiology 181
8 Respiratory system 196
9 Cardiovascular system 215
10 Gastrointestinal system 226
11 Urinary system 245
12 Endocrine system 253
13 Nervous and locomotor systems 272
 III  PATHOLOGY
14 Cellular injury 293
15 Disorders of growth, morphogenesis and differentiation 311
16 Inflammation 320
17 Thrombosis, embolism and infarction 326
18 Neoplasia 332
19 Immunology 345
20 Haemopoietic and lymphoreticular system 357
21 Basic microbiology 375
22 System-specific pathology 402
 IV  APPENDIX
OSCE scenario answers 449
Index 491
 
Online contents
Single Best Answer questions for the following chapters can be found in the StudentConsult ebook at https://
studentconsult.inkling.com/ See inside cover for registration details
 I  ANATOMY
1 The thorax
2 The abdomen, pelvis and perineum
3 The upper limb and breast
4 The lower limb
5 The head, neck and spine
6 The nervous system
 II  PHYSIOLOGY
7 General physiology
8 Respiratory system
9 Cardiovascular system
10 Gastrointestinal system
11 Urinary system
12 Endocrine system
13 Nervous and locomotor systems
 III  PATHOLOGY
14 Cellular injury
15 Disorders of growth, morphogenesis and differentiation
16 Inflammation
17 Thrombosis, embolism and infarction
18 Neoplasia
19 Immunology
20 Haemopoietic and lymphoreticular system
21 Basic microbiology
22 System-specific pathology
 IV  APPENDIX
OSCE scenario answers
 
Preface
The authors are grateful to the publishers, Elsevier, questions at the end with sample answers provided
for the invitation to produce a third edition of Basic in an appendix at the back of the book. More than 20
Science for the MRCS. new OSCE scenarios have been added to this edition.
The book is a concise revision guide to the core In addition, to accompany this edition there is an online
basic sciences which comprise the essential knowledge question bank within the Student Consult ebook
for those entering surgical training. It is a basic require- comprising over 200 Single Best Answer questions
ment that every surgical trainee has a thorough (SBAs) based on each chapter in the book. The reader
understanding of the basic principles of anatomy, can access the section from the Table of Contents or
physiology and pathology irrespective of which speciality from the relevant chapter in the ebook.
within surgery they intend to pursue as a career. It is No book of this length could hope to be compre-
equally important that they understand the clinical hensive and we have therefore concentrated on the
application of the basic sciences. This revision guide topics that tend to be recurring examination themes.
has been written with this in mind, using a bullet-point As with previous editions, this book has been written
style which we hope will make it easier for the reader primarily as a means of rapid revision for the surgical
to revise the essential facts. trainee. However, it should also prove useful for those
Much has changed both in the undergraduate in higher surgical training, as well as for the surgically
curriculum and in the post-graduate examination system inclined, well-motivated medical student. We hope that
since the first edition was published 11 years ago. In this third edition will provide a simple and straightfor-
this third edition, the chapters have been updated where ward approach to the basic science that underpins
appropriate and sections expanded to cover topics surgical training.
which are particularly relevant to examinations. As Andrew T. Raftery
most examinations are Objective Structured Clinical Michael S. Delbridge
Examinations (OSCEs), each chapter has OSCE scenario Helen E. Douglas
 
Acknowledgements
We are extremely grateful to the publishers, Elsevier Figs 8.1, 8.12B, 8.12C, 10.3, 10.4, 10.5, 10.6,
Limited, and in particular to Laurence Hunter, Executive 10.7, 11.1, 11.3, 13.1, 13.5 and 13.6 from McGeown
Content Strategist and Fiona Conn, Content Develop- 2002 Physiology, 2nd edn. Churchill Livingstone,
ment Specialist, for their support and help with this Edinburgh
project. We are also grateful to the following colleagues Figs 8.3 and 8.4 from Pocock & Richards 2004
at the Sheffield Teaching Hospitals NHS Foundation Human Physiology: The Basis of Medicine, 2nd edn.
Trust who provided help, advice and criticism: Dr Paul Oxford University Press, Oxford
Zadik, Consultant Microbiologist; Dr TC Darton, NIHR Figs 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 1.11,
Academic Clinical Research Fellow, Infectious Diseases 1.13, 1.14, 2.1, 2.2, 2.3, 2.4, 2.7, 2.8, 2.9, 2.10,
and Medical Microbiology; Mr BM Shrestha, Consultant 2.12, 2.13, 2.14, 2.17, 2.18, 2.19, 2.20, 2.21, 2.22,
General and Transplant Surgeon. We would also like 2.23, 2.24, 2.25, 2.27, 2.28, 2.29, 2.30, 2.31, 2.32,
to thank our consultant radiologist colleagues, who 5.1, 5.2, 5.7, 5.8, 5.16, 5.17, 6.1, 6.2, 6.3, 6.4, 6.7,
provided images: Dr Matthew Bull, Dr Peter Brown, 6.8, 6.9, 6.10, 6.11, 6.12, 6.13, 6.15, 8.2, 8.6, 8.10,
Dr James Hampton, Dr Robert Cooper and Dr Rebecca 8.12A, 9.2, 9.4, 9.6, 11.4, 12.1, 12.4, 13.8, 19.2,
Denoronha. Mr Raftery would like to thank his secretary, 20.1, 20.2, 20.3, 21.1, 22.1, 22.2 and 22.3 from Raft-
Mrs Denise Smith, for the long hours and hard work ery (ed) 2000 Applied Basic Science for Basic Surgical
she has put in typing and re-typing the manuscript, Training. Churchill Livingstone, Edinburgh
and Anne Raftery for collating and organizing the whole Fig. 17.2 and A.3 (Q&A) from Pretorius & Solo-
manuscript into its final format. The task could not mon 2011 Radiology Secrets Plus, 3rd edn. Elsevier,
have been completed without them. Philadelphia
The figures in this book come from a variety of Figs 5.35, 6.14, 22.2 & A.5 (Q&A), 22.3 & A.6
sources, and many are reproduced from other publica- (Q&A) and 22.5 & A.7 (Q&A) from Raftery, Delbridge
tions, with permission, as follows: & Wagstaff 2011 Pocketbook of Surgery, 4th edn.
Fig. 3.9 from the University of Michigan Medical Churchill Livingstone, Edinburgh
School, with kind permission of Thomas R Gest, PhD Figs 1.10, 3.1, 3.2, 3.3, 3.4, 3.8, 3.12, 4.1, 4.2,
Figs 13.10A, 13.10B and 13.11 from Crossman & 4.3, 4.4, 4.6, 4.7, 4.8, 4.9, 4.11, 4.12, 4.13, 4.15,
Neary 2000 Neuroanatomy: An Illustrated Colour Text, 4.16, 5.3, 5.4, 5.5, 5.9, 5.10, 5.11, 5.13, 5.14,
2nd edn. Churchill Livingstone, Edinburgh 5.21, 5.22, 5.24, 5.26, 5.27, 5.28, 5.29, 5.30, 5.31
Figs 3.11 and 4.14, and Tables 6.1 and 6.3 from and 6.16 from Rogers 1992 Textbook of Anatomy.
Easterbrook 1999 Basic Medical Sciences for MRCP Churchill Livingstone, Edinburgh
Part 1, 2nd edn. Churchill Livingstone, Edinburgh Fig. 13.4 from Stevens & Lowe 2000 Pathology,
Fig. 9.1 from Hoffman & Cranefield 1960 Electro- 2nd edn. Mosby, Edinburgh
physiology of the Heart. McGraw-Hill, New York (now Figs 15.1 and 15.2, and Boxes 15.1 and 15.2
public domain) from Underwood (ed) 2004 General and Systematic
Figs 4.20, 4.24, 5.25, 6.5 and 6.6 from Jacob Patholo gy, 4th edn. Churchill Livingstone, Edinburgh
2002 Atlas of Human Anatomy. Churchill Livingstone,
Edin burgh