OSCEs for the MRCS Part B

A Bailey & Love Revision Guide, Second Edition

Jonathan M. Fishman, Vivian A. Elwell, Rajat Chowdhury

• Publisher: CRC Press
• Year: 2017
• eBook ISBN: 9781315352190
• Edition: 2
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

This is a fully updated edition of the hugely successful OSCEs for the MRCS Part B: A Bailey and Love Revision Guide. The content has been revised in line with recent changes to the examination, such as the introduction of microbiology and applied surgical sciences and changes from patient safety to clinical and procedural skills.Popular with trainee surgeons preparing for the oral element of the MRCS (the objective structured clinical examination, or OSCE), this revision guide will maximise the chances of success in surgical examinations.

CHAPTER 1: ANATOMY

Introduction

Embryology

Head, Neck and Vertebral Column

Thorax

Abdomen and Pelvis

Upper and Lower Limbs

INTRODUCTION

Many students find preparing for the anatomy part of the examination a daunting task. It has been many years since you were last in the dissection room and it feels like there is a vast amount of material to learn in a short space of time. It is all too easy to spend all your revision time on anatomy alone, at the expense of other areas of the exam. Although the examiners place a lot of emphasis on anatomy (and rightly so as after all you cannot be a surgeon without knowing your anatomy well), do not neglect other areas of the exam. After all, you must pass all the other areas of the objective structured clinical examination (OSCE) too in order to obtain an overall pass.

As a few top tips:

•Be concise and accurate in your answers.

•Do not say anything you have not been asked about.

•Be systematic and logical.

•Try to apply your answer to surgical practice. The emphasis now is on applied anatomy.

•Do not dig yourself into any holes!

•Remember images that you are asked to comment on in the exam may be normal and the emphasis is on pointing out the key anatomical features, rather than the pathology! So if you are asked to comment on a barium enema do not necessarily go looking for a stricture!

We would recommend that you

•Visit the dissection room prior to the exam and look at some prosections.

•Invest in a good atlas of anatomy.

•Know and be able to demonstrate surface anatomy on a model or patient actor.

•Familiarise yourself with the main bones (osteology).

•Be prepared to be handed ‘props’ in the exam – bones, prosections, images (e.g. plain radiographs, computed tomography [CT]/magnetic resonance imaging [MRI], contrast studies, angiograms), clinical photographs etc.

•Note that some of the images presented to you in the exam may in fact be normal.

•Know in detail the ‘college favourites’ which are listed below and also described in this chapter:

–Skull base, cavernous sinus and pituitary gland

–Thyroid and parathyroid glands

–Hand and shoulder joint

–Blood supply of the stomach

–Oesophagus and ureters

–Diaphragm and its openings

–Portosystemic anastomoses

–Brachial plexus and axilla

–Femur, hip and knee joints

–Heart and coronary artery circulation

–Surface anatomy (e.g. knee joint, posterior triangle of the neck)

Embryology

Changes at birth

What changes occur at birth?

There are several important changes that take place at birth:

•The urachus (allantois) becomes the single, median umbilical ligament.

•The umbilical arteries become the right and left, medial umbilical ligaments, respectively.

•The left umbilical vein becomes the ligamentum teres (round ligament) in the free edge of the falciform ligament.

•The ductus venosus becomes the ligamentum venosum.

•The ductus arteriosus becomes the ligamentum arteriosum.

•In 2% of cases, the vitello-intestinal duct may persist as a Meckel’s diverticulum.

•The foramen ovale in most cases obliterates at birth to become the fossa ovalis, but remains patent into adulthood in some 20% of cases.

Why is this important to know about?

Aberrations of this normal developmental process may lead to pathology:

•Failure of the urachus (that normally connects the bladder to the umbilicus) to obliterate may lead to a urachal fistula, sinus, diverticulum or cyst, often with leakage of urine from the umbilicus.

•Failure of the ductus arteriosus to obliterate at birth leads to a patent ductus arteriosus, resulting in non-cyanotic congenital heart disease.

•In 2% of cases, the vitello-intestinal duct persists as a Meckel’s diverticulum with its associated complications.

•In some 20% of cases, the foramen ovale fails to obliterate completely at birt...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Contents
• Preface
• Acknowledgements
• Authors
• Introduction
• Applied Knowledge
• Applied Skills
• Abbreviations
• List of figures
• Index