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© 2011 Vivian Elwell, Jonathan Fishman, Rajat Chowdhury

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Contents
About the authors vii
Preface ix
Acknowledgements xi

Introduction: The Insider’s Guide to the MRCS Part A xiii

Section 1 Applied Basic Sciences 1

Single best answer questions (SBAs) followed by answers and

explanations

Section 2 Principles of Surgery-in-General 187

Extended matching questions (EMQs) followed by answers and

explanations
Index 234

v
All things are possible until they are proved impossible –
and even the impossible may only be so, as of now.
Pearl Buck, A Bridge for Passing (1962)
About the authors
Vivian A Elwell MB BS, MRCS, BA (Hons), MA (Cantab)
Currently working as a Specialist Registrar in Neurosurgery, Vivian held
posts in Accident and Emergency, Orthopaedics, Neurosurgery, and General
Surgery with the Surgical Rotation at St Mary’s Hospital, Imperial College NHS
Trust, London.
Vivian is an author of undergraduate and post-graduate medical textbooks:
Essential OSCE Topics for Medical and Surgical Finals (Radcliffe 2008),
The Insider’s Guide to the MRCS Clinical Examination (Radcliffe 2009), and
OSCEs for the MRCS Part B: A Bailey and Love Revision Guide (Hodder
Arnold 2009).
She taught clinical skills to medical students and doctors, and was
an anatomy demonstrator at the Imperial College School of Medicine,
London. She served on the Imperial College School of Medicine Curriculum
Development Committee.
Vivian’s awards include: the Swinford Edward Silver Medal Prize for her
OSCE Examination, the Columbia University Research Fellowship at Columbia
College of Physicians and Surgeons in New York City, the Columbia University
King’s Crown Gold and Silver Medal Awards, the Kathrine Dulin Folger
Cancer Research Fellowship and the “Who’s Who of Young Scientists Prize.”
In 2010, Vivian was a finalist for the BMA’s Junior Doctor of the Year Award.
Vivian earned a Bachelor’s Degree in Biological Sciences at Columbia
College, Columbia University, and a MA from the University of Cambridge.
She earned a Bachelor of Medicine and Bachelor of Surgery from the
Imperial College School of Medicine. She is a member of the Royal College of
Surgeons and is a College Instructor on the “Care of the Critically Ill Surgical
Patient (CCrISP)” course.

Jonathan M Fishman BM BCh (Oxon), MRCS (Eng), DOHNS (RCS Eng),

BA (Hons), MA (Cantab)
Jonathan is an Oxford Specialist Registrar in ENT and a member of the Royal
College of Surgeons. He graduated with a First Class Honours Degree in
Natural Sciences from Sidney Sussex College, University of Cambridge, and
completed his clinical training at St John’s College, University of Oxford.
He has held posts in Accident and Emergency, ENT, General Surgery and
Neurosurgery, as part of the surgical rotation at St Mary’s Hospital, Imperial
College, London.
Jonathan has extensive teaching experience and is the primary author of
three undergraduate and three postgraduate medical textbooks, including the
highly successful History Taking in Medicine and Surgery (Pastest Publishing,
2005; 2nd Edition, 2010). He spent part of his medical training at both
Harvard University and the NASA Space Center.
Jonathan was awarded Taylor and Howard-Agg Scholarships at Sidney
Sussex College, Cambridge, and has been awarded the highly prestigious title
of ‘Lifelong Honorary Scholar’ by the University of Cambridge, for academic
excellence. He has been awarded a fellowship from the British Association
of Plastic Surgeons for research at NASA, and from Cambridge University for
research at Harvard University.

vii
 Jonathan is committed to a career in academic ENT, with a strong
ABOUT THE AUTHORS

emphasis on research and teaching. In 2009, he was awarded a

Royal Society of Medicine GlaxoSmithKline Fellowship Award for his
academic achievements to date. In 2010, he was awarded a Foreign and
Commonwealth Office UK-USA Stem Cell Collaboration Fellowship, in
addition to a Royal College of Surgeons of England Surgical Research
Fellowship.
In 2011, he was awarded a prestigious Medical Research Council Clinical
Research Training Fellowship.

Rajat Chowdhury BM BCh (Oxon), MRCS, BSc (Hons), MSc (Lond),

MA (Oxon)
Rajat is a Specialist Registrar in Radiology and has held posts in Accident and
Emergency, Orthopaedics & Trauma, Cardiothoracic Surgery, General Surgery,
and Plastic Surgery with the Surgical Rotation at St Mary’s Hospital, Imperial
College NHS Trust, London. He completed his medical studies at Oxford
University, May Clinic and Harvard University. He is a member of the Royal
College of Surgeons.
He taught clinical skills to medical students and doctors in Oxford
and London, and tutored Biochemistry and Genetics students at Oxford
University. He was an anatomy demonstrator at the Imperial College School
of Medicine, London, and was President of Oxford’s Hugh Cairns Surgical
Society. He is currently pursuing a Postgraduate Certificate in Medical
Education.
Rajat’s academic awards include: Oxford University’s Bristol Myers Squibb
Prize in Cardiology; The Radcliffe Infirmary Prize in Surgery; GlaxoSmithKline
Medical Fellowship; the Warren Scholarship for Paediatric Studies at the
University of Toronto; Exhibition and Kennedy scholarships to Harvard
University. Rajat was also awarded Bachelors and Masters Degrees from
University College London. In 2009, Rajat won the prestigious British Society
of Interventional Radiology Specialist Registrar Prize. In 2010, he was elected
to the chair of the National Trainee Committee of the British Institute of
Radiology. Rajat has been awarded a NICE Scholarship and plans to become
a future NHS leader. He is also the lead author of Radiology at a Glance
(Wiley-Blackwell 2010) and Consent in Surgery (Radcliffe 2010).

viii
Preface
This book has been written as an accompaniment to Bailey and Love’s Short Practice of Surgery
with the MRCS examination in mind. It is dedicated to the Intercollegiate MRCS Part A Examination,
which is the first part of the Intercollegiate MRCS Examination. This new examination was
introduced in the Autumn of 2008 and replaced the MRCS Parts 1 and 2 examinations, in line
with the new pattern of surgical training in the UK. The examination syllabus, format and content
are common to The Royal College of Surgeons of Edinburgh, The Royal College of Surgeons
of England and The Royal College of Physicians and Surgeons of Glasgow. This examination is
designed and set by the Royal Colleges of Surgeons to test the knowledge, skills and attributes
acquired during core surgical training.
The Intercollegiate MRCS Part A examination comprises of two MCQ papers taken on the same
day. Each paper is 2 hours in duration. The first paper covers ‘Applied Basic Sciences’ (single best
answer (SBA) format) and the second paper covers ‘Principles of Surgery-in-General’ (extended
matching questions (EMQ) format). A minimum mark must be obtained in both papers, in
addition to attaining the total pass mark to obtain an overall pass in the Intercollegiate Part A
Examination. Successful completion of the Intercollegiate Part A Examination qualifies the trainee
surgeon to enter the Intercollegiate Part B Objective Structured Clinical Examination.
This book is based on our highly successful Insider Medical MRCS Courses, and the feedback
obtained from candidates who sat the examination. We have, therefore, written this book with
the aim of targeting high-yield topics that are likely to be faced and offer methods to tackle the
challenges that may be posed in the examination. We have drawn from our breadth of experience
of teaching at both the undergraduate and postgraduate levels and have identified common
pitfalls.
A thorough understanding of applied basic science and the ability to problem-solve underpins
surgical science and sets the foundation for future surgical practice. Whilst it is not feasible to
cover the complete syllabus within the remit of this book, we have selected the most important
and high-yield topics to facilitate examination study and revision. The style of questions mimics
those found in the real examination and these will therefore serve well as mock papers. We
are confident that this book will assist any trainee surgeon in their revision for the MRCS Part A
Examination and, in doing so, refine their analytical approach to all areas of their surgical practice.

Vivian A Elwell
Jonathan M Fishman
Rajat Chowdhury

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Acknowledgements
This book would not have been possible without the help, encouragement and ongoing support
of the following individuals:

Mrs Carole D Elwell, Mr Nigel D Mendoza, Mr John A Cervieri Jr., Mrs Eva-Inge Cervieri, Dr George
Leib, Mrs Ingrid Leib, Dr Sandra J Ginsberg, Dr Colette M Magnant, Dr Irene Gage, Dr David S
Fishman, Mrs Wendy F Fishman, Miss Caroline Graham, Mrs Julia Sender, Dr Laura Fishman,
Dr Madhuchanda Bhattacharyya, Miss Monika Chowdhury, Mrs Archana Chowdhury, Mr Ashit
Chowdhury, Dr Stephen Harden and Dr Joanna Fairhurst.

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