MRCS Topics

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This is a list of topics that appear within the MRCS syllabus. For the full syllabus which gives much greater detail about the level of knowledge expected on each topic please see:

Contents

Generic theoretical knowledge for clinical settings

  1. Pre and peri-operative care
    1. Consent and the surgical patient
    2. Risk assessment and scoring systems for the surgical patient
    3. Principles of local, general and regional anaesthesia
    4. Use of blood and its products in the surgical patient
  2. Postoperative management and critical care
    1. Pain relief in the surgical patient
    2. Fluid balance and homeostasis
    3. Thrombo-embolic prevention and management in surgical illness
    4. Nutrition and the surgical patient
    5. Antibiotics and the surgical patient
    6. Critical care and the surgical patient
    7. Principles of organ failure and its management
    8. Management of severely injured patient
    9. Management of coexisting medical morbidity
    10. Care of the terminally ill patient
    11. Principles of organ donation
  3. Surgical techniques and technology
    1. Safe surgery for the patient and the surgical team
    2. Sharps safety
    3. The use of diathermy, laser and other devices for haemostasis and tissue destruction.
    4. Principles of day case surgery
    5. Suturing in its various forms and the materials used
    6. Principles and indications for endoscopic surgery
    7. Radiation
    8. Communicable diseases
  4. Diagnostic techniques
    1. Principles of diagnostic and interventional radiology
    2. Indications for imaging-guided biopsy
  5. Managing oneself and others
    1. Coping with crisis and mortality
    2. Time management
    3. Principles behind team working
  6. Management and legal issues
    1. Ethics and medical negligence
    2. Understanding the certification of death and administrative arrangements
    3. Clinical governance and critical incidents

Generic clinical processes

  1. History
  2. Examination
  3. Investigation
  4. Working diagnosis and management planning
  5. Use and interpretation of evidence-based practice
  6. Instigation of initial management
  7. Review of surgical intervention/and management strategy/continuity of care
  8. In-patient management
  9. Communication with team and other colleagues
  10. Planning of operative care and ordering of operation lists
  11. Communication with patient and relatives in all aspects
  12. Verbal and written communication with GPs and other doctors at all levels
  13. Principles of multidisciplinary meetings
  14. Record keeping
  15. Data collection for audit

Generic technical/operative skills

  1. Expertise in the surgical discipline of that unit (i.e. understanding the indications for the operations performed by the team albeit not being required to be competent in them independently)
  2. Patient positioning and safe handling
  3. Draping the patient
  4. Familiarity with operating sets and diathermy
  5. Making incisions
  6. Methods of wound closure
  7. Various methods of biopsy including FNA, CORE, OPEN
  8. Wound management
  9. Ordering of operation lists
  10. Planning of post-operative care
  11. Writing/dictating operating notes and discharge letters

Applied Surgical Anatomy

Development, organs and structures, surface and imaging anatomy of the:

Thorax

Abdomen, pelvis and perineum

Upper limb and breast

    • Pectoral girdle
    • Breast
    • Axilla
    • Brachial plexus
    • Scapular region
    • Arm
    • Cubital fossa
    • Forearm
    • Hand including carpal tunnel
    • Shoulder joint
    • Elbow joint
    • Radio-ulnar joints
    • Wrist joint
    • Hand joints
  • Surface & imaging anatomy
    • Cubital fossa
    • Wrist structures
    • Thumb movements
    • Arteries & pulses
    • Superficial veins & lymphatics
    • Nerves:
      • axillary
      • radial
      • musculocutaneous
      • ulnar
      • median
    • Dermatomes & tendon reflexes
    • Arteriography/ venography

Lower limb

  • Anatomy
  • Surface & imaging anatomy
    • Femoral triangle
    • Popliteal fossa
    • Arteries & pulses
    • Superficial veins & lymphatics
    • Nerves
      • femoral
      • sciatic
      • tibial
      • common peroneal
    • Dermatomes and tendon reflexes
    • Arteriography/venography

Head, neck and spine

  • Development
    • Branchial arches
    • Face, palate
    • Thyroid & parathyroid glands
    • Spine
  • Head
    • Face
    • Scalp
    • Cranial cavity
    • Dural venous sinuses
    • Pituitary gland
    • Orbit, eyeball
    • Ear
    • Parotid gland
    • Temporomandibular joint
    • Nose & paranasal air sinuses
    • Mouth, tongue
    • Submandibular & sublingual glands
  • Neck
    • Anterior triangle
      • Thyroid & parathyroid glands
      • Larynx & trachea
      • Pharynx & oesophagus
      • Carotid sheath
    • Posterior triangle
      • Spinal accessory nerve
      • Cervical plexus
    • Root of neck
      • Thoracic duct
  • Spine
    • Vertebral column
    • Vertebral canal
  • Surface & imaging anatomy
    • Middle meningeal artery
    • Neck blood vessels
    • Central venous catheterisation
    • Laryngeal structures
    • Airway access
    • Skull & cervical spine
    • Arteriography
    • CT/MRI

Nervous system (central, peripheral and autonomic)

  • Central nervous system
    • Cerebral hemispheres
    • Ventricles
    • Cerebellum, brain stem
    • Spinal cord
    • Meninges
  • Peripheral nervous system
    • Cranial nerves
    • Spinal nerves
    • Peripheral nerves
  • Autonomic nervous system
    • General organisation
  • Surface & imaging anatomy
    • Arteriography
    • CT/MRI

Physiology

General physiological principles

Respiratory system

Cardiovascular system

Gastrointestinal system

Renal system

Endocrine system

Central nervous system

Thyroid & parathyroid

Glucose homeostasis

General Pathology

Inflammation

  • Classification
  • Acute inflammation with an infective organism as the primary agent; microscopic and macroscopic features including microscopic appearances
  • Chronic inflammation with an infective organism as the primary agent: non-specific and specific(classified by the infective organism or the host reaction); microscopic and macroscopic features, mechanisms and effects (local and systemic)
  • Abscess, sinus, fistula formation: definitions, complications

Cellular injury other than by infection

  • chemical injury (chemical burns, poisoning, chemotherapy),
  • physical injury (direct destructive trauma),
  • radiation injury,
  • injury as a consequence of genetic abnormalities

Wounds and wound healing

  • classification of wounds
  • ulcer and erosion (resolution and repair)
  • first and second intention healing
  • scar formation
  • healing in the central nervous system
  • fractures
  • pathological fracture

Vascular disorders

  • Thrombosis and clot formation
  • hypercoagulable states
  • Embolus formation
    • aetiology
    • complications
  • Atheroma
  • Ischaemia and infarction
  • Aneurysms and varicosities
  • Oedema, ascities, transudate, exudate
  • Coagulation deficits:
    • classification,
    • tests
    • complications

Disorders of growth, differentiation and morphogenesis

Neoplasia

Surgical immunology

Surgical haematology

Surgical Microbiology

  • Surgically important microorganisms
  • Exotoxins and endotoxins
  • Pathophysiology of sepsis
  • Disinfection and sterilisation
  • Immunisation
  • Commensals
  • Nosocomial infections

Surgical biochemistry

Systems Pathology

Nervous system

Musculo-skeletal system

Respiratory system

Breast disorders

Cardiovascular system

Endocrine system

Genitourinary system

Gastrointestinal system

Dermatological diseases

  • Burns: classification, assessment of depth and extent, complications
  • Skin cancer in general: classification and aetiology
  • Melanoma: classification, staging

Lymphoreticular System

Surgery in general

Perioperative Care

  • Assessment of Fitness for Surgery
    • Preoperative assessment and risk scoring systems
    • Laboratory testing and imaging
  • Management of Associated Medical Conditions
  • Organ specific diseases
  • Issues related to medications
  • General factors
  • Preparation for Surgery
    • Informed consent
    • Pre-medication
    • Risk management
  • Principles of Anaesthesia
  • Monitoring of the Anaesthetised Patient
    • Non-invasive monitoring
    • Invasive monitoring
  • Care of the Patient Under Anaesthesia
    • Positioning of the patient in surgery
    • Avoidance of nerve injuries

Postoperative management and critical care

Surgical Technique and Technology

  • Surgical Wounds
    • Classification of surgical wounds
    • Principles of wound management
    • Pathophysiology of wound healing
    • Scars and contractures
  • Surgical Technique
    • Principles of safe surgery
    • Incisions and wound closure
    • Diathermy and laser
    • Sutures and ligature materials
    • Basic surgical instruments
  • Surgical Procedures
    • Minor surgical procedures
    • Day care surgery
    • Principles of anastomosis
    • Endoscopic surgery and laparoscopy
  • Tourniquets in the Operating Theatre
    • Indications for tourniquet use
    • Tourniquet application
    • Effects and complications of tourniquets

Management and legal issues

  • Evidence Based Surgical Practice
    • Decision making in surgery
    • Statistics
    • Principles of research and clinical trials
    • Critical evaluations of surgical innovations
  • Management Aspects of Surgical Practice
    • Clinical audit
    • Clinical governance
    • Medico-legal aspects of surgery
  • Communication Skills
    • Psychological effects of surgery
    • Communication skills in medicine and surgery
    • Working in teams
    • Breaking bad news
    • Dealing with conflict
    • Management of crises
  • Medical Litigation
    • Avoidance and management of errors
    • Ethics and medical negligence

Clinical microbiology

  • Surgical Microbiology
    • Sources of surgical infection
  • Prevention of Infection
    • Principles of asepsis and antisepsis
  • Modern Antibiotic Usage
    • Commonly used antibiotics
    • Selecting the right antibiotic
    • Antibiotic resistance
  • Surgery in Hepatitis and HIV Carriers
    • Blood-borne viruses
    • Universal precautions
    • Surgical precautions
    • Immunisation
    • Management of sharps injuries

Emergency medicine and trauma

  • Pathophysiology of Trauma
    • Shock and cardiovascular physiology
    • Metabolic response to injury
  • Adult respiratory distress syndrome (ARDS)
  • Initial Assessment of the Trauma Patient
    • Principles of pre-hospital care
    • Major incident triage
    • Clinical assessment and scoring systems
    • Resuscitation after trauma
  • Management of the Unconscious Patient
    • Brain injuries
    • Assessment and resuscitation of the comatose patient
  • Traumatic Wounds
    • Principles of management
    • Gunshot and blast injuries
    • Stab wounds
    • Human and animal bites
  • Management of Skin Loss
    • The wound
    • Skin grafts
    • Skin flaps
  • Traumatic Oedema and Compartment Syndrome
    • Pathogenesis and physiology
    • Diagnosis and treatment
  • Environmental Emergencies
    • Hypothermia
    • Heat exhaustion
    • Management of a radiation incident
  • Miscellaneous
    • Acute loss of vision
    • Red eye: injury and infection
    • Needle-stick injuries

Principles of surgical oncology

  • Epidemiology of Common Cancers
    • Epidemiology studies and cancer registration
    • Common cancers
  • Screening Programmes
    • breast,
    • cervical,
    • prostate,
    • colorectal
  • Clinico-Pathological Staging of Cancer
    • Staging and grading cancer
    • Clinical staging
    • Pathological staging
  • Principles of Cancer Treatment
    • The role of surgery
    • Radiotherapy
    • Chemotherapy
    • Hormone therapy
    • Immunotherapy
  • Palliative Care
    • The palliative care team
    • Pain and other symptoms

Surgical Specialities

Cardiothoracic Surgery

  • Haemodynamic Control
    • Haemodynamic principles
    • Cardiovascular homeostasis
    • Pharmacological haemodynamic control
  • Cardiac Surgery
    • Surgical disorders of the heart vessels and heart valves
    • Cardio-pulmonary bypass
  • Thoracic Trauma
    • Pathophysiology of thoracic trauma
    • Presentation, assessment and management
    • Specific thoracic injuries
  • Thoracotomy and Chest Drainage
    • Assessment and Preparation
    • Indications for thoracotomy
    • Chest drainage and pericardiocentesis
  • Surgical Disorders of the Lung
    • Lung cancer
    • Other indications for lung resection
  • Complications of Thoracic Operations
    • General complications
    • Specific complications
  • Pneumothorax
  • Empyema thoracis

General Surgery

Abdomen

  • Abdominal Trauma
    • Penetrating abdominal trauma
    • Blunt abdominal trauma
    • Assessment and management of abdominal trauma
    • Specific organ injuries
  • Common Abdominal Problems
    • Abdominal pain
    • Abdominal masses
    • The acute abdomen
  • Abdominal Emergencies
    • Intestinal obstruction
    • Peritonitis and abdominal and pelvic abscess
    • Gastrointestinal haemorrhage
    • Abdominal Hernia
    • Inguinal hernia
    • Femoral hernia
    • Incisional hernia
    • Rare hernias
  • Intestinal Fistulas
    • Classification of intestinal fistulas
    • Assessment and management
  • Gastrointestinal Stomas
    • Gastrostomy
    • Ileostomy
    • Colostomy
  • Surgery of the Spleen
    • Splenic disease and injury
    • Treatment of splenic disease and injury
    • Post-splenectomy sepsis

Upper Gastrointestinal Surgery

  • Diagnosis of oesophagealdisorders
  • Specific oesophageal disorders
    • gastro-oesophageal reflux disease,
    • motility disorders,
    • oesophageal carcinoma,
    • oesophageal diverticulum
    • oesophageal foreign body
  • Peptic ulcer disease
  • Carcinoma of the stomach

Hepatobiliary and Pancreatic Surgery

  • Jaundice
  • Gall stones and gall bladder disease
  • Acute pancreatitis
  • Chronic pancreatitis
  • Carcinoma of the pancreas
  • Benign and malignant biliary strictures
  • Portal hypertension and ascites

Colorectal Surgery

  • Clinical presentation of colorectal and anal disease
  • Surgical disorders of the colon and rectum
    • Ulcerative colitis and Crohn’s disease
    • Colorectal cancer
    • Diverticular disease
    • Faecal incontinence
    • Rectal prolapse
  • Surgical disorders of the anus and perineum
    • Pruritus ani
    • Fissure-in-ano
    • Haemorrhoids
    • Fistula-in-ano
    • Anorectal abscess
    • Carcinoma of the anus
    • Pilonidal sinus and absces

Breast & Endocrine Surgery

  • Common Breast Disorders
    • Breast lumps
    • Breast pain
    • Breast cysts
    • Nipple discharge
    • Gynaecomastia
  • Breast Carcinoma
    • Risk factors
    • Pathology
    • Diagnosis
    • Treatment
    • Breast reconstruction
  • Surgery of the Thyroid Gland
    • Indications for surgery in thyroid disease
    • Thyroid cancer (types and management)
    • Complications of thyroidectomy
  • Parathyroid Disorders
    • Calcium metabolism
    • Clinical presentation of hypercalcaemia
    • Investigation of hyperparathyroidism
    • Management of hyperparathyroidism
  • Adrenal Disorders and Secondary Hypertension
    • Causes of hypertension
    • Conn’s syndrome
    • Phaeochromocytoma
  • Endocrine Disorders of the Pancreas
    • Insulinoma
    • Gastrinoma
    • Neuroendocrine tumours
    • Other rare endocrine tumours

Vascular Surgery

  • Arterial Surgery
    • Peripheral vascular disease and limb ischaemia
    • Arterial embolism and acute limb ischaemia
    • Arterial aneurysms
    • Carotid disease
    • Renovascular disease
    • Arterial trauma
  • Venous Disorders of the Lower Limb
    • Venous insufficiency and varicose veins
    • Venous ulceration
    • Deep venous thrombosis and pulmonary embolism
  • Lymphoedema

Organ transplantation

  • Basic principles of transplant immunology
  • Clinical organ transplantation
  • Organ donation and procurement
  • Immunosuppression and prevention of rejection

Oral and Maxillofacial Surgery

  • Maxillo-facial Trauma
    • Classification of facial fractures
    • Presentation of maxillofacial fractures
    • Assessment and investigation
    • Treatment of facial fractures
  • Common Conditions of the Face Mouth & Jaws
  • Principles of Soft Tissue Repair of Mouth Face Head & Neck

Neurosurgery

  • Neurological Trauma
    • Head injuries
    • Spinal cord injuries
    • Paralytic disorders
    • Nerve disorders
  • Surgical Disorders of the Brain
    • Clinical presentation of the intracranial mass
    • Tumours of the nervous system
    • Epilepsy
    • Congenital and

developmental problems

  • Intracranial Haemorrhage
    • Subarachnoid,
    • Intracerebral,
    • Subdural,
    • extradural and
    • intraventicular
  • Brain Stem Death
    • Diagnosis and testing for brain stem death
    • Principles of organ donation
  • Surgical Aspects of Meningitis
    • General features of meningitis
    • Surgical considerations
  • Rehabilitation
    • The rehabilitation team
    • Pain management
    • Rehabilitation

Otorhinolaryngology

  • Ear, Nose & Throat Disorders
    • Inflammatory disorders of the ear, nose and throat
    • Foreign bodies in the ear, nose and throat
  • Common Neck Swellings
    • Congenital and rare swellings
    • Inflammatory swellings
    • Head & neck cancer
  • Salivary Gland Disorders
    • Infections and inflammation of the salivary glands
    • Tumours of the salivary glands
    • Stones of the salivary glands
    • Miscellaneous conditions

Eye Surgery

    • Trauma to the eye
    • Common eye infections

Paediatric Surgery

  • Principles of Neo-natal & Paediatric Surgery
    • History and physical examination of the neonate and child
    • Maintenance of body temperature
    • Assessment of respiratory and cardiovascular function
    • Metabolic status
    • Fluids, electrolytes and the metabolic response
    • Vascular access
  • Correctable Congenital Abnormalities
    • Congenital abnormalities of the GI tract
    • Congenital heart disease
    • Abdominal wall defects
    • Diaphragmatic hernia
    • Neural tube defects
    • Urological abnormalities
  • Common Paediatric Surgical Disorders
    • Pyloric stenosis
    • Intussusception
    • Inguinal hernia and hydrocele
    • Undescended testes
    • Torsion of the testes
  • Orthopaedic Disorders of Infancy and Childhood
    • Gait disorders
    • Hip problems
    • Knee disorders
    • Foot disorders

Plastic Surgery

  • Burns
    • Classification and pathophysiology
    • Initial assessment and management
    • Treatment including secondary surgery
    • Burns of special areas (i.e. face, eyes, hands, perineum)
  • Soft Tissue Infections
  • Principles of Hand Trauma (tendon, nerve, nail bed)
  • Hand Disorders
    • Dupytren’s disease
    • Carpal tunnel syndrome
  • Benign Skin Lesions
  • Malignant Skin Lesions (
    • basal cell carcinoma,
    • squamous cell carcinoma,
    • malignant melanoma)
  • Principles of Skin Cover
    • Split skin grafts
    • Full thickness skin grafts
    • Local flaps
    • Distant flaps
    • Free transfer flaps
  • Principles of Microvascular Surgery
  • Wound Healing

Trauma and orthopaedics

  • Skeletal Fractures
    • Pathophysiology of fracture healing
    • Classification of fractures
    • Principles of management of fractures
    • Complications of fractures
    • Management of joint injuries
  • Common fractures and joint injuries
  • Soft Tissue Injuries and Disorders
    • Nature and mechanism of soft tissue injury
    • Management of soft tissue injuries, including compartment syndrome
  • Common Disorders of the Extremities
    • Disorders of the hand,including
      • trigger finger,
      • ganglion,
      • carpal tunnel syndrome and
      • Dupytren’s Disease
    • Disorders of the foot
  • Degenerative and Rheumatoid Arthritis
    • Osteoarthritis
    • Rheumatoid arthritis
    • Other inflammatory conditions
    • Surgical treatment of joint diseases
  • Infections of Bones and Joints
    • Osteomyelitis
    • Other bone infections
  • Locomotor pain
    • Low back pain and sciatica
    • Pain in the neck and upper limb
  • Bone Tumours and Amputations
    • Primary bone tumours
    • Metastatic bone tumours
    • Amputations
  • General
    • Imaging techniques e.g. MRI, CT, bone scan,ultrasound
    • Neurophysiological investigations

Urology

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