MRCS Applied Basic Science and Clinical Topics

422 Pages·2012·28.51 MB·English

by  Steve Parker

MRCS
Applied Basic Science
and Clinical Topics
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MRCS
Applied Basic Science
and Clinical Topics
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Stephen Parker BSc DipMedEd MS FRCS (Gen)
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Consultant Geneeral Surgeon
University Hospitapls of Coventry and
Warwick.shire NHS Trust
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Coventry, UK
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London • St Louis • Panama City • New Delhi
© 2013 JP Medical Ltd.
Published by JP Medical Ltd
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ISBN: 978-1-9t07816-43-7
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British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
JP Medical Ltd is a subsidiary of Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India
Publisher: Richard Furn
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Preface
MRCS Applied Basic Science and Clinical Topics has been written as a resource for candidates who are
preparing for postgraduate surgical examinations, in particular Parts A and B of the Intercollegiate
MRCS Examination. It has its foundation in my experience as a general surgical consultant with a
strong interest in medical education. The content has evolved over time, shaped by feedback from
previous candidates who have identified what they would have wanted when preparing for their
examinations. /
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The book aims to fill the gap between large surgical textbooks and smaller revision aids. This
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has necessitated a selective approach to the topics included and the depth in whic.h they are
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discussed: the basic science topics have been chosen for their direct bearing on clinical practice
and the clinical topics are those commonly encountered both in the wards asnd in postgraduate
surgical examinations. n
Each chapter presents the basic science and clinical topics in a consistent format, in accordance
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with the MRCS syllabus. The clinical chapters aim to cover the whole breadth of surgical special-
ties at a level appropriate for the MRCS examination. Variationis in surgical practice will inevitably
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mean that there will be disagreement with some of the views and recommendations that are
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presented. In potentially contentious areas I have attempted to include opinions that are not too
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extreme, are supported by current research evidence and will hopefully satisfy most examiners.
Within the space available, the book cannot hpope to be exhaustive. Nevertheless, I hope that it
will be a useful tool when working in and st.udying a particular surgical speciality, as well as serving
as a revision tool and aide-mémoire immepdiately prior to the examinations.
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Stephen Parker BSc MS DipMedEd FRCS(Gen)
/ October 2012
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Contents
Preface v
The MRCS examination xi
Glossary xii
Chapter 1 Professional skills in clinical practice 1
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Duties of a doctor r 1
Communication skills i 1
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Clinical governance s 2
Ethics and the law s 5
Medical litigation 5
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Chapter 2 Perioperative care 7
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Preoperative assessment s 7
Preparation for surgery 13
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Principles of anaestheesia 15
Care of the patient under anaesthesia 20
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Haematological problems in surgery 22
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Chapter 3 Postoperative management and critical care 33
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Autonomic nervous system 33
Pain/ 34
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M:etabolic and nutritional support 39
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Postoperative complications 43
t Principles of intensive care 46
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Chapter 4 Surgical technique and technology 55
Surgical wounds 55
Surgical technique 57
Surgical procedures 61
Chapter 5 Evidence-based surgical practice 67
Evidence-based medicine 67
Chapter 6 Surgical pathology and microbiology 73
Surgical pathology 73
Surgical microbiology 74
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Prevention of infection 83
Surgery in hepatitis and HIV carriers 84
Chapter 7 Emergency medicine and the management
of trauma 87
Pathophysiology of trauma 87
Initial assessment of the trauma patient 88
Traumatic wounds 92
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Compartment syndromes r 94
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The eye – trauma and common infections 96
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Chapter 8 Principles of surgical oncology 99
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Cell proliferation n 99
Epidemiology of common cancer 100
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NHS cancer screening programmes 101
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Clinicopathological staginsg of cancer 102
Principles of cancer treratment 103
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Chapter 9 Cardiothoracic surgery 109
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Applied basi.c sciences 109
Cardiac dispease 116
Thoraciic disease 123
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Chapter 10 Ge/neral surgery 133
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Abdominal trauma 133
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Abdominal emergencies 135
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Chhapter 11 The abdominal wall 147
Applied basic sciences 147
Abdominal hernias 149
Intestinal fistulas 153
Chapter 12 Upper gastrointestinal surgery 155
Applied basic sciences 155
Oesophageal disease 159
Gastric disease 163
Chapter 13 Hepatobiliary and pancreatic surgery 169
Applied basic sciences 169
viii Hepatobiliary and pancreatic disease 172
Chapter 14 Colorectal surgery 189
Applied basic sciences 189
Colorectal disease 191
Perianal disease 201
Chapter 15 Breast disease 207
Applied basic sciences 207
Breast disease /207
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Chapter 16 Endocrine surgery . 221
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Applied basic sciences 221
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Thyroid and parathyroid disease 224
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Pituitary and adrenal disease 233
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Chapter 17 Vascular disease 239
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Applied basic sciences 239
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Arterial disease 243
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Venous disease 254
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Lymphatics and spleen 260
Renal failure an.d transplantation 264
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Chapter 18 Otorhinoilaryngology and head and
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neck surgery 269
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Applied basic sciences 269
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pEar, nose and throat disease 270
Salivary gland disease 276
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Chapter 19 Paediatric surgery 281
Applied basic sciences 281
Paediatric trauma 281
Correctable congenital abnormalities 282
Common paediatric surgical disorders 293
Orthopaedic disorders of infancy and childhood 300
Chapter 20 Plastic and reconstructive surgery 307
Applied basic sciences 307
Plastic surgery trauma 309
Pigmented skin lesions 315
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Chapter 21 Neurosurgery 323
Applied basic sciences 323
Neurosurgical trauma 325
Neurosurgical disorders 331
Chapter 22 Trauma and orthopaedic surgery 335
Applied basic sciences 335
Skeletal fractures /344
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Degenerative and rheumatoid arthritis 351
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Infections of bones and joints . 354
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Disorders of the upper limb 357
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Disorders of the hand 359
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Knee injuries 362
Disorders of the foot a 363
Osteoporosis 364
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Metabolic bone disease s 364
Locomotor pain r 365
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Bone tumours and amputations 368
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Chapter 23 Urology 373
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Applied basic sciences 373
Urologiical trauma 377
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Urinary tract infections and calculi 379
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H/aematuria 382
:Urinary tract obstruction 385
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Pain and swelling in the scrotum 388
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Aspects of pelvic surgery 392
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Index 397
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