FRCS general surgery viva topics and revision notes

160 Pages·2016·1.54 MB·English

by  Brennan

FRCS General Surgery
Viva Topics and Revision Notes

FRCS General Surgery
Viva Topics and
Revision Notes
STEPHEN BRENNAN
MBChB BSc (Pharm) MRCS (Ed) FRCSEd (Gen Surg)
Specialist Registrar in General Surgery
Raigmore Hospital, Inverness
Radcliffe Publishing
London (cid:129) New York
Radcliffe Publishing Ltd
33–41 Dallington Street
London
EC1V 0BB
United Kingdom
www.radcliffepublishing.com
Electronic catalogue and worldwide online ordering facility.
© 2011 Stephen Brennan
Stephen Brennan has asserted his right under the Copyright, Designs and Patents Act 1998
to be identifi ed as the author of this work.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval sys-
tem or transmitted, in any form or by any means, electronic, mechanical, photocopying,
recording or otherwise, without the prior permission of the copyright owner.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
ISBN- 13: 978 184619 498 6
Typeset by Pindar NZ, Auckland, New Zealand
Contents
About the author vi
Preface vii
Acknowledgements ix
Part One
Vascular 3
Hepatobiliary 13
Colorectal 40
Upper GI 59
Breast and endocrine 70
General surgery of childhood 76
Critical care and emergency surgery 82
Part Two
MCQs and SBAs 119
References 144
Index 146
About the author
Stephen Brennan initially graduated in pharmacology and then studied
medicine at the University of Aberdeen. He is currently a specialist registrar
in general surgery with a particular interest in upper GI and laparoscopic sur-
gery, and also trauma and the general surgery of childhood. In addition, he
is involved with both undergraduate and postgraduate surgical training and
is a tutor for the Royal College of Surgeons of Edinburgh and MRCS revision
courses. He is an instructor in Advanced Trauma Life Support (ATLS) and has
completed a postgraduate qualifi cation in medical education.
vi
Preface
FRCS General Surgery Viva Topics and Revision Notes is neither intended to be a
textbook of surgery nor is it a guide for managing the surgical take. It is simply
a collection of topics that tend to come up with regular frequency in the exam.
As a surgical registrar who has recently passed the FRCS, my aim is to provide
future candidates with a selection of ideas, exam tips, hints and suggestions,
and advice that I received from my surgical trainers while preparing for this
exam. The exit FRCS should be a once-i n-a -lifetime experience and may
well be the most stressful time in your life. These are my suggestions along
the way.
My advice is to plan when you are going to sit the exam and just write
the cheque. I sat the exam in year 5, but you should be at a stage where you
could take out a colon, a gallbladder, or a spleen by yourself. Any sooner and
you probably will not have seen or done enough to be confi dent to cover the
scenarios they will give you in the viva with ease.
Part One is separated into chapters covering conditions that are common
in the exam. I claim no expertise in any of them. This book is designed to be
used in conjunction with some key textbooks that I feel are essential reading
in order to pass this exam. First, I believe that the companion series should
be the bible for the exam. You will need an up-t o- date set and would be well
advised to read them all cover to cover. The second book I believe is essential
for the exam is Emergency Abdominal Surgery, edited by Jones, Krukowski and
Youngson (3rd ed.; 1998). Unfortunately, it is out of print but contains the
secrets of three surgical masters and will provide answers to situations that
no other textbook will. Bailey and Love should be read cover to cover as all
the examiners will have read it too.
Part Two of the book contains 120 multiple choice questions (MCQs),
which are as close to the real thing as possible. They are based on actual ques-
tions from the exam that candidates recalled immediately thereafter. The
remainder are designed de novo.
A further piece of advice is to do a preparatory or revision course. There are
a few around and likely more to follow. It will cost you around £1500 for the
week, so that with the exam fee itself, the books, travel and accommodation
vii
viii PREFACE
will leave you little change from £5K at the end of the day. That should be
enough motivation to pass the fi rst time!
A revision course is helpful, as it will not only test you on topics you poss-
ibly never thought about, it will also give you the necessary confi dence to
defend your answers under scrutiny. Remember this is a consultant’s exam,
and it is not suffi cient to give a range of options. You must tell the examiner
what you as a consultant are going to do.
The single most useful method of revision is simply going to work every
day. Seeing patients in clinic and on-c all is essential. This exam tests clinical
management, not basic science. The EWTD and MMC do little to help the
exam candidate here. Read your ATLS manual. Read the diathermy section of
the basic surgical skills course.
Coming up to the exam, go to a variety of other specialty clinics. This
means plastics, urology, orthopaedics, vascular and paediatric surgery. If you
have declared general surgery for the exam, then you are fair game for mela-
nomas, varicocoeles, hydatid of Morgagni, carpal tunnel syndrome, hernias
and ingrown toenails. They are regularly examined. You must know the SIGN
and NICE guidelines for everything.
The critical care viva needs an ITU anaesthetist to get you up to speed with
inotropes and ventilators. Surgeons, if they are honest, know very little about
these areas. You just need the basics for the exam. In the exam you need to be
safe and will be expected to discuss the topics covered in this book.
The academic viva can be tackled by attending (or creating) a journal club
each week for a couple of months prior to the exam. I would recommend
reading the British Journal of Surgery for at least six months prior to the exam
and ideally during the previous year. There is a high probability that at least
one of the papers will be taken from there.
This book is divided into areas of general surgery that are common exam
topics and not frequently studied. The suggested answers given here are by no
means meant to be comprehensive but a guide to the key discussion points
you should be prepared to discuss.
Stephen Brennan
April 2011
Acknowledgements
I wish to express my sincere gratitude to all my surgical trainers over the years.
A few have stood out. Mr Norman Binnie for supporting me through thick
and thin, Professor Ron Keenan for teaching me how to fi x a hernia, Mr Keith
Buchan for teaching me how to open a chest, M r John Duncan for teaching
me how to take out a gallbladder and, fi nally, to Mr Iain Gunn and Mr John
Logie for inspiring me to become a surgeon in the fi rst place.
ix