EMQs for the MRCS Part A This page intentionally left blank EMQs for the MRCS Part A Mr Sri G. Thrumurthy MBChB(Hons), MRCS Core Trainee in General Surgery London Deanery, UK Miss Tania S. de Silva MBChB, MRCS(Ed) Specialty Registrar in General Surgery Sheffi eld Teaching Hospitals NHS Trust Sheffi eld, UK Mr Zia M. Moinuddin MBBS, MRCS Specialty Registrar in General Surgery Central Manchester University Hospitals NHS Foundation Trust Manchester, UK Professor Stuart Enoch MBBS, MRCS(Ed), PGCert (Med Sci), MRCS(Eng), PhD Clinical Director, Centre for Study of Wound Care and Burns Visiting Professor, Department of Biomedical Research Noorul Islam University, India Director of Education and Research, Doctors Academy, Cardiff , UK 1 3 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. 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Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding. Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work. DEDICATION To my father and my greatest role model, Thrumurthy; to my loving mother, Sobanah; to my wonderful wife, Ayishwarriyah; and to my baby sister, Sasha, for their unconditional love and endless support. To Mr Muntzer Mughal, for his relentless inspiration. SGT To my parents for their love and tireless support. To Amit, for his endless patience and support over the years. To Aiya, with love. TSdS To my parents, wife, and brothers for their constant encouragement and support. ZMM To Sri Thrumurthy, the lead author of this project, whose focus, passion and enthusiasm helped us compile this resource; this endeavour would not have materialised without his great commitment and motivation. SE This page intentionally left blank FOREWORD As is well known, the I-MRCS Examination (the Intercollegiate Membership Examination of the Surgical Royal Colleges of Great Britain and in Ireland), comprises two parts: Part A—Multiple Choice Questions (Written) Part B—Objective Structured Clinical Examination (OSCE). Part A is further subdivided into two papers: Paper 1, which is a test of knowledge in the Applied Basic Sciences, and Paper 2, which is an assessment of knowledge and competence in the Principles of Surgery-in-General. As things stand, Paper 2 of the I-MRCS is made up exclusively of Extended Matching Questions (EMQs).This variety of multiple choice question is now recognized as an adequately validated, critically-evaluated, and well-established assessment tool, and regarded by educationalists as a reliable and discriminating method of assessing an examinee’s command of applied knowledge. Conducted appropriately, the EMQ has the potential, also, to test higher order thinking. The EMQ format has for a number of years been embraced enthusiastically by the United States Licensing Examinations system and by the American Board examinations in various surgical and non-surgical specialties. The EMQ format is now being increasingly adopted and used in several postgraduate medical and surgical diploma examinations in the UK. EMQs for the MRCS Part A by Thrumurthy, de Silva, Moinuddin, and Enoch is a very timely and worthy addition to every pre-MRCS surgical trainee’s book shelf. Having taken on what can only be described as a herculean challenge, the authors have acquitted themselves with much credit. A great deal of thought, patience, diligence, and eff ort has gone into composing a most impressive collection of diverse EMQs. The EMQs have been classifi ed into four chapters, with 20 to 25 EMQ units in each chapter. Throughout, the questions are worded unambiguously and in simple prose. Collectively the hundred or so well-constructed EMQs sample an impressive breadth of the I-MRCS syllabus. To complement the rich range of EMQs in each chapter, are the detailed answers to the EMQs which make up the latter half of each chapter. All the answers are comprehensive, well-researched, and refl ective of contemporary practice. Very evidently, Mr Thrumurthy and colleagues have expended much time and eff ort to ensure the accuracy of the information they have provided in the book. I have no doubt at all that the Foundation and Core trainees intending to sit the MRCS examina- tion, and for whom this book is primarily intended, will fi nd in this little gem of a book a most useful guide, resource, and friend! I congratulate Mr Thrumurthy and colleagues warmly on their splendid eff ort and I commend this book with unreserved enthusiasm to all surgical trainees preparing for the MRCS examination. Professor Vishy Mahadevan MBBS PhD FRCS Barbers’ Company Professor of Anatomy The Royal College of Surgeons of England, London This page intentionally left blank PREFACE Major reform within the United Kingdom’s postgraduate medical education system has necessitated a shift from the traditional true/false multiple questions of the old MRCS Part 1 examination to the ‘single best answer’ (SBA) and ‘extended matching question’ (EMQ) format used in the new intercollegiate MRCS Part A examination. Although a thorough understanding of the essential principles of surgery should be obtained from core textbooks and clinical experience, it is vital for candidates to actively recall, apply, and thereby reinforce their knowledge by attempting sample questions in the lead-up to the examination. SBA MCQs for the MRCS Part A and EMQs for the MRCS Part A have been written to provide MRCS candidates with a series of questions preparing them for this new format. As the new format of the Part A paper de-emphasizes the traditional basic science disciplines and accentuates an integrated approach, these books will contain a substantial number of patient-based questions or clinical vignettes that will enable prospective candidates to test their ability to integrate key basic science concepts with relevant clinical problems. Despite our attempt to comprehensively span the syllabus of the MRCS examination, it needs to be acknowledged that encompassing the full breadth and depth of all curricular topics is beyond the scope of this series. It is hence suggested that these books are used in conjunction with time- honoured surgical textbooks and used as a complementary resource rather than to supplement the reading material recommended by the Royal Colleges of Surgeons. The detailed approach that these books undertake will not only serve MRCS candidates but will also be an appropriate revision aide for higher surgical trainees preparing for their intercollegiate speciality exit examinations. In addition, although the depth and breadth of this series’ content surpasses that of typical undergraduate surgical curricula, these books will nevertheless be an ideal tool for the fervent medical student pursuing an ‘honours’ or ‘distinction’ grade in his or her surgical fi nals. We sincerely wish all readers the very best of success in their surgical examinations and careers. SGT TDS ZM SE