FRCS General Surgery: 500 SBAs and EMIs Alasdair Wilson, Wendy Craig, Lynn Stevenson, Julie Brittenden, David Smith
INDEX
ABCDEFGHIJKLMNOPRSTUVWXZ
Note: Page numbers in bold or italic refer to tables or figures respectively.
A
Abdominal aortic aneurysm (AAA) 282
Abdominal compartment syndrome 36, 37, 53, 59, 59–60
ABO compatibility 40
Absolute risk reduction 48–49
Acanthosis nigricans 72
Achalasia 257–259
primary 264
secondary 263
treatment 259
Addison's disease 44
Adenomatous gallbladder polyps 207
Adrenal incidentaloma 176, 177
computed tomography 167, 167, 176
tumour size 170
Adrenaline 55
Adrenal lesions 170–171
fine-needle aspiration 167, 167
Adrenocortical carcinoma 171
Advance trauma life support (ATLS) protocol 54
Airway management 54–55
Alcohol-based hand rubs 44
Alemtuzumab 239
Allograft 242
α-fetoprotein (AFP) 67, 73–74
Amaurosis fugax 295
Amiloride 72
Aminosalicylates 130
Amputation
Burgess 293–294
Chopart 294
Ray 293
Syme's 293
Amyand's hernia 63
Anal cancer, treatment 133
Anal fissures 66, 132–133, 139
botulinum toxin injection 136, 143
Anaplastic thyroid cancer 162, 163
Anastomotic leak 59
Anastrozole 109
Angiosarcoma of breast 112–113
Ankle brachial pressure index (ABPI) 293
Anorectal manometry 144
Anorectal sepsis 36
ANOVA test 45
Anthracyclines 105, 108
Antiphospholipid syndrome 283
Aortic dissection, DeBakey and Stanford classification 286, 287
Aortobifemoral bypass 289
Appendiceal abscess 35
Appendicitis 219
paediatric 53, 53
Arteriovenous (AV) fistula 292
Asacol 130
Ascending cholangitis 218
Aspirin 282
Autograft 242
Azathioprine (AZA) 131, 232
B
Banff schema 244
Barrett's disease 257, 258
Basal cell carcinoma, surgical margins 43
Basal skull fracture 79
Beck's triad 55
Behçet's disease 291
Benzylpenicillin 85–86
β-human chorionic gonadotropin (β-hCG) 67, 74
Bile duct injury 205–206
Bismuth classification 205
laparoscopic cholecystectomy 206–207
Strasberg classification 205
Biofeedback 132
Black oesophagus syndrome 262
Bleeding, massive 36
Bochdalek hernias 32
Boerhaave's syndrome 84, 261, 262
Botulinum toxin injection 136, 143
Brachiobasilic fistula, transposed 292
Brachytherapy 259
Brainstem death 49, 50
Breast angiosarcoma 112–113
Breast cancer
advanced 106
metastatic 177, 203
MRI 103, 107
Breast lymphoma 113
Breast mouse see Fibroadenoma
Budd–Chiari syndrome 217
Buerger's disease 278
C
Calciphylaxis 72, 177, 178
Calcitonin 170, 182
Calcium oxalate 32
Calf compartments 285–286, 285
Cancer antigen (CA) 19-9 74
Capecitabine 133
Capsular contracture, classification of 106
Carcinoembryonic antigen 170
Carcinoid of large bowel 134
Carcinoid syndrome 215
Cardiopulmonary exercise testing (CPEX) 292
Carotid body tumours 280
Carotid Doppler study 293
Carotid endarterectomy 282
cranial nerve injuries during 278
Case–control study 46, 77
Caval filter 59
C-cell hyperplasia 173
CD8 surface protein 241
CEAP classification, of venous incompetence 289–290, 290
Central compartment dissection, in papillary thyroid cancer 169
Chagas’ syndrome 261
Charcot's foot 277–278
Chemoradiation, pancreatic cancer 216
χ2 test 61, 77
Child–Pugh score 70, 70
Cholangiocarcinoma (CCA) 208
CT with triple phase contrast 219
duplex ultrasonography 220
liver transplantation 235
percutaneous transhepatic cholangiogram 219
Cholecystectomy, laparoscopic 66, 212
Cholecystitis 210, 210, 211–212
Cholecystostomy 211, 211
Choledochal cysts 34
classification 34, 34–35
surgical treatment 35
Choledocholithiasis 211–212
Chromogranin 182, 203
Chronic afferent loop syndrome 260
Chronic lymphocytic thyroiditis 173, 173
Cinacalcet 183
Ciprofloxacin 145
Cisplatin 265
Clostridium difficile infection 44, 46–47, 47, 139, 140
Coagulation cascade 283, 284
Coeliac artery 295
Coeliac nodes 261
Colitis, acute 39
management 145
Truelove and Witts’ classification 40
Colitis with peritonitis 138
Collagen-vascular disorder 141
Colonic bleeding 41
Colonic stenting 42
Colorectal adenoma removal, and surveillance guidelines 136
Colorectal liver metastases 200–201
Colorectal polyps 134
Haggitt classification 134–135, 135
Colorectal surgery, patient outcomes in 142
Common bile duct (CBD)
endoscopic stenting of 216
stones 212, 212
Compartment syndrome 285–286, 285
Complement system, hyperacute rejection 232
Computed tomography (CT)
abdomen 62, 198
adrenal incidentaloma 167, 167
adrenal mass 176, 176–177
anastomotic leak 62
colonic diverticulitis 62
multinodular goitre 174
pneumomediastinum 85
portal vein thrombosis 218
small bowel ischaemia 31
Congenital diaphragmatic hernia (CDH) 32
Conn's syndrome 164, 164
Constipation, slow-transit 141
Coronary artery bypass grafting (CABG) 293
COUGAR-02 trial 265
Cranial nerve testing 50
Crohn's disease (CD) 69, 83, 83–84, 138
terminal ileal 69
Cyanoacrylate glue injection 43
Cyclosporin 131
nephrotoxicity 232, 236
side effects 236
Cystic fibrosis (CF) 75
D
Damage control laparotomy 53–54
Day case surgery lists 50
Debulking surgery 176
Deceleration injury 57
Dendritic cells 240–241
De Quervain's thyroiditis 174
Dermatofibroma 80
Dermoid cysts 80
Dexamethasone suppression test 177
Diabetic mastopathy 106
Diagnostic lobectomy 168–169
Dipyridamole 282
Disseminated intravascular coagulation 56
Dobutamine 55
Docetaxel 107
Donation after brainstem death (DBD) donor 243
Donation after cardiac death (DCD) donor 243
Donor options 243–244
Dopamine 42, 73, 73
Dopexamine 55
Doxazosin 163
Ductography 102
Dumping syndrome 260
Duodenal atresia 74
Duplex ultrasonography 220
Dysplasia
biopsy protocol 258
management 257, 258
E
Early Breast Cancer Trialists Collaborative Group (EBCTCG) 105
Echinococcus infection 218–219
Elemental diet 87–88
Endocrine tumor markers 170
Endoleaks 281
Endoscopic retrograde cholangiopancreatography (ERCP) 65, 65–66, 205–206, 208, 209
Endoscopic therapy 256–257
Endoscopic thoracic sympathectomy (ETS) 281
Endoscopic ultrasound (EUS) 200
Endoscopy and proctoscopy 41
Enteral feeding 88
Enteral nutrition 49
Enterocutaneous fistula 88
Environmental study 46
Epididymal cysts 67, 68
Epiphrenic diverticulum see Pulsion diverticulae
Epirubicin 105, 108, 109
Epstein–Barr virus (EBV) 245
E-selectin 287
Etoposide, leucovorin, and 5-fluorouracil (ELF) 266
Evidence based medicine 48–49
Exemestane 109
External beam radiation therapy
anaplastic thyroid cancer 162, 163, 176
F
Facial nerve palsy 79, 79
Factor V Leiden deficiency 283
Familial adenomatous polyposis (FAP) 130, 141
surveillance guidelines 141–142, 144
Fat necrosis of breast 102, 114
Femoral hernias 82
Femoropopliteal bypass 289
Fibroadenoma 101, 113
Fine-needle aspiration (FNA)
adrenal lesions 167, 167
pancreas 208
thyroid gland 171, 172
Fisher's exact test 77
Fistulae-in-ano 66, 140
insertion of loose seton 137
Park's classification 137, 140
Fluid collections, post-transplant perirenal 231
5-fluorouracil, adriamycin and methotrexate (FAMTX) 266
Folinic acid 143
Follicular carcinoma, metastatic 175, 175–176
Forest plot 75, 76
French Adjuvant Study Group 105
Frey's syndrome 82
Friedman's test 62
G
Gallbladder
carcinoma 207
palpable 210
Gallstone ileus 60
Gallstones 201
Gastrectomy 258
Gastric cancer 84, 258
chemotherapy 266
treatment 264–265
Gastric lymph node stations 261–262
Gastric variceal bleeding 43
Gastrinoma 179
Gastrografin enema 63
Gastrointestinal polyps 142
Gastrojejunostomy 216, 265
Gemcitabine 109
Glasgow coma scale (GCS) 40, 40
Globus hystericus 181
Glossopharyngeal nerve 278
Glucagonoma 215
Glyceral trinitrate (GTN) 55, 129, 132–133, 143–144
Goodsall's rule 66, 67
Graft survival 243, 243
Guedel airway 54
H
Haemoglobin solution 40
Hamartoma 101
Hashimoto's disease see Chronic lymphocytic thyroiditis
Hawthorne effect 46
Heparin-induced thrombocytopaenia (HIT) 283, 290
Hepatic colorectal metastases 200–201
Hepaticojejunostomy 206–207, 206
Hepatitis B surface antibody (anti-HBsAg) 64
Hepatitis B surface antigen (HBsAg) 64
Hepatitis C virus (HVC) polymerase chain reaction (PCR) 64
Hepatocellular carcinoma (HCC) 74, 200, 213
Hepatoduodenal ligament nodes 261
Herceptin see Trastuzumab
Hereditary non-polyposis colorectal cancer (HNPCC) 130, 144
Heterotopic allograft 241
Hirschsprung's disease 75, 141
Human herpes virus type 8 (HHV-8) infection 246
Hydatid cyst 218–219
Hydrocele 82
Hyperparathyroidism
and adenoma 169–170
MEN-1 syndrome 178
primary 183–184
Hypocalcaemia 168
Hypoglossal nerve 278
Hypokalaemia 35
I
Imrie score 71
Infective endocarditis 86
Inferior mesenteric artery 295
Infliximab 145
Inguinal hernia 82
Inguinal lymphadenopathy 82–83
Injury severity score (ISS) 86
Inotropes 73
Inotropic agents 55
Insulinoma 179–180
Internal rectal prolapse 146
Intestinal malrotation 33, 33–34
Intraoperative cholangiogram (IOC) 66
Intussusception, paediatric 51, 51
Iridium-192 259
Islet cell transplantation 234
contraindications 236, 237
indications 236
percutaneous transhepatic route 242
Isograft 242
J
Juvenile polyposis syndrome 144
K
Kaposi's sarcoma 246
Keratoacanthomas 81
Klean-Prep solution 142
Kruskal–Wallis test 44–45, 45, 79
L
Lactate dehydrogenase (LDH) 74
LADD (Laparoscopic Appendicectomy and Duodenocolic Dissociation) 34
Laparoscopic cholecystectomy 209
pregnancy 198
Laparotomy 69–70
intestinal malrotation 33, 33–34
urgent 51
Large bowel carcinoid tumor 134
Large bowel lymphoma 134
Large bowel obstruction 41–42
Lateral internal sphincterotomy 144
Left gastric artery nodes 262
Lentigo maligna 72
Leriche's syndrome 295
Lesser curvature nodes 261
Li–Fraumeni syndrome 171
Likelihood ratio (LR) 76
Limb ischaemia, Rutherford's classification 280
Linear regression analysis 45
Lipomatous disease 115
Liver abscess 219
Liver allograft rejection, acute 244
Liver transplantation 212–213
candidates 234
contraindication 235, 235
living donor 234
Lobectomy 174–175
Longitudinal cohort series 77, 78
Lymphocoele 230–231
Lymphoedema 278–279
Lymphoma of breast 113
M
Magnetic resonance cholangiopancreatography (MRCP) 64–65, 214
common bile duct stones 212, 212
hepatobiliary surgery 198, 199
Magnetic resonance imaging (MRI) 103, 107
Malnutrition Universal Screening Tool (MUST) 47–48, 48
Malrotation of gut 50
Mammary duct ectasia 102, 114
Mammogram 101–102, 113
annual 105
Mann–Whitney U test 45, 61–62, 77
Massive transfusion 36, 55–56
Mastalgia 106, 113
Mastopathy 114
Maydl's hernia 63, 63
May–Thurner syndrome 295
Mechanical ventilation 57
Meckel's diverticulum 32–33, 52
Meconium ileus 75
Medullary carcinoma 173
Medullary thyroid cancer 172
Megestrol acetate 108
Melanomatous lesions, surgical excision 42–43
Mesenteric adenitis 69
Mesenteric ischaemia 31, 31
acute 129
cause 288
Meta-analysis 46, 77
Metabolic equivalent task score (METS) 87, 87
6-Metacaptopurine (6-MP) 131
Metastatic papillary carcinoma 181
Metronidazole 85, 145
Microdochectomy 102
Milroy's disease 291
Mittelschmerz 68
Modified Rankin scale (mRS) 288
Mondor's disease 114
Montgomery's gland 115
Morgagni herniae 32
Muir–Torre syndrome 141
Multiple endocrine neoplasia-1 (MEN-1) syndrome 171, 178, 179, 180, 215
Multiple organ dysfunction score (MODS) 58
Myalgia 291
Mycophenolate mofetil (MMF) 232, 240
Myelofibrosis 217
N
Nasopharyngeal airway 54–55
National Institute for Clinical Excellence (NICE) guidelines
breast cancer 103–105
endoscopic therapy 256
Natural killer (NK) cells 240
Needle aspiration, breast cyst 102–103
Nephrogenic systemic fibrosis (NSF) 291
Nephrotoxicity, cyclosporin 232, 236
Neuroendocrine tumours 203
Neutropenic enterocolitis 139
Non-Hodgkin's lymphoma 245
Non-melanomatous skin cancers, after transplantation 245–246
Non-seminomatous germ cell tumors (NSGCTs) 74
Noradrenaline 55
Nottingham prognostic index (NPI) 108–112
Number needed to treat 49
Nutcracker oesophagus 263
Nutcracker syndrome 288
Nutritional support 49
O
Odds ratios 48
Oesophageal cancers, early 256
Oesophageal caustic injury
first degree 262–263
second degree 263
third degree 263
Oesophageal diverticulum 259–260, 264
Oesophageal spasm, diffuse 260, 264
Oesophageal stenting 262, 265
Oesophagitis 84
Oestrogen receptor (ER)-positive disease 105
Onabotulinumtoxin A 143
Ophthalmic artery 295
Oral contraceptive pill (OCP) 217
Organ procurement and transplantation network (OPTN) 238
Orotracheal airway 54–55
Orthotopic isograft 241
Ovarian ablation 108
Oxaliplatin 133, 143
Oxygen haemoglobin dissociation curve 38, 38
P
Paget–Schroetter syndrome 277, 291
Paget's disease 104, 113
Pancreas tumour, head of 210
Pancreas transplantation 233, 235, 238–239
islet cell transplantation 234, 236
vascular thrombosis 242, 244–245
Pancreatic cancer 74
chemoradiation treatment 216
computed tomography 198
gastrojejunostomy 216
management 199–200
Pancreatic duct stenting 216
Pancreatic necrosectomy 202, 202
Pancreatic necrosis 202, 208
infected 214
laparoscopic drainage of 214, 214
Pancreatic pseudocyst drainage 214
Pancreatitis
acute 32
alcohol consumption 202–203
chronic 202–203
gallstones 201
management 213
severe 201
Pancytopaenia 232
Pantaloon hernia 64
Papillary thyroid cancer (PTC) 171
metastatic 181
Parametric vs. non-parametric data 61
Parastomal hernias 131
Parathyroid adenoma 171, 183–184
Parathyroidectomy 177
Parathyroid glands embryology 165, 165
Parathyroid hormone (PTH) 183
Parathyroid imaging techniques 160, 160
Parathyroid surgery 161, 161
Parenteral nutrition 49
Parotidectomy 82
Parotitis 81, 81
Pentasa 130
Perianal abscesses 36
Perianal sepsis 137–138
Pericardiocentesis 69
Peritoneal dialysis 292
Peutz–Jeghers syndrome 142
Phaeochromocytoma 170, 172, 177, 179
Pharyngeal pouch 181, 182
Phenoxybenzamine 163
Phosphate binders 177
Pilonidal sinus 66
Platelet-derived growth factor (PDGF) 287
Pleuroperitoneal fold 32
Pneumomediastinum 84, 85
Pneumostatic reduction 51
Popliteal aneurysms 282
Popliteal entrapment syndrome 294, 294
Porcelain gallbladder 207, 207
Portal hypertension, treatment of 204–205
Portal vein thrombosis 217, 218
Portal venous embolisation, of tumour 213
Portosystemic varices 43–44
Positive pressure ventilation 57
Post-transplant lymphoproliferative disorder (PTLD) 245
Pouchitis 145
Presinusoidal portal hypertension 217
Primary hyperparathyroidism (PHP) 178
Primary sclerosing cholangitis 209
Proctalgia fugax 129
Progesterones 108
Prosthetic graft infections 279
Prothrombin complex concentrate 38
Proton pump inhibitors (PPIs) 257, 258
Pseudoangiomatous stromal hyperplasia (PASH), of breast 114
Pseudomonas aeruginosa 261
Pseudomyxoma peritonei (PMP) 60–61
Pudendal pain syndrome 145
Pulsion diverticulae 259–260
p-value 75–76
Pyloric stenosis 52
Pylorus-preserving pancreaticoduodenectomy 199–200
R
Radiation menopause 108
Radiation proctitis 129
Radioiodine treatment, metastatic follicular carcinoma 175, 175–176
Radiotherapy
proximal oesophageal cancer 265
rectal cancers 143
Ramsay Hunt syndrome 79
Ramstedt's pyloromyotomy 52, 52
Randomised controlled trials (RCTs) 45–46
Randomised trial of exposure 46
Rectal adenoma, piecemeal excision 135
Rectal prolapse 132
Rectocoele 145–146
Recurrent laryngeal nerve injury 167, 168, 168
Reflux pancreatitis 238–239
Relative risk ratios 48
Renal transplantation 230–231
contraindications 233
delayed graft function impact 236–237
end-stage renal failure and 238
expanded criteria donors for 238
graft survival following 237, 238
living donor renal transplants 243, 243
urinary tract infection 245
Renin–aldosterone axis 164, 164
Resuscitation plan, burns patient 57–58
Retroperitoneal varices 43
Revised trauma score (RTS) 86
Riedel's thyroiditis 174
Right hemicolectomy 44
Rockall risk scoring system 71, 71–72, 260
Root of mesentery nodes 262
Rutherford's classification, of limb ischaemia 279–280, 280
S
Saline nebulisers 167
Sclerosing lymphocytic lobulitis 106
Scrotal oedema, idiopathic 67
Sensory neuropathy 133
Sentinel lymph node biopsy (SLNB) 104
Sentinel pile 66
Sepsis 39
Sequential organ failure assessment score (SOFA) 58–59
Sigmoid volvulus 36–37, 37
Simplified acute physiology score II (SAPSII) 87
Simultaneous pancreas and kidney (SPK) transplantation 235, 239
Simvastatin 73
Sirolimus 239
Sistrunk procedure 180
Sjögren's syndrome 81–82
Snuffbox fistula 292
Sodium picosulphate 142–143
Solitary rectal ulcer syndrome (SRUS) 132, 139
Sphincterotomy 198, 208
Splenectomy 204
Splenic hilum nodes 261
Splenic injury, classification of 41
Squamous cell carcinoma (SCC) 80
surgical margins 43
transplant patients 246
Staphylococcus infection 279
Stapled transanal rectal resection (STARR) procedure 132
Statins
myopathy 291
pregnancy 73
Statistical tests 61
Strongyloides stercoralis 140
Subclavian lesions 282, 283
Subclavian steal syndrome 282–283, 283
Subtotal colectomy and ileostomy
acute colitis 39–40
Subtotal gastrectomy 264
Superior laryngeal nerve, damage to 278
Supraclavicular fossa radiotherapy 105
Systemic inflammatory response syndrome (SIRS) 56, 56
Systemic sclerosis 263
T
Tamoxifen 105
Tandem transplant 242
Taxanes 265
Tension pneumothorax 69
Teratoma 67
Tertiary hyperparathyroidism 177, 178
Testicular germ cell tumors 74
Testicular torsion 68
Testicular vein embolisation 68
Thigh compartments 285, 285
Thiopurine therapy 131
Thoracic outlet syndrome (TOS), neurogenic 277
Thoracic trauma 55
Thoracoabdominal aortic aneurysm (TAA), Crawford classification 286, 286
Thoracoscopic sympathectomy see Endoscopic thoracic sympathectomy (ETS)
Thoracotomy 69
urgent 38
Threadworms see Strongyloides stercoralis
Thromboangiitis obliterans see Buerger's disease
Thrombocytopaenia 290
Thrombolysis, contraindication to 284
Thyroglobulin 170, 171, 183
Thyroglossal cyst 160, 161, 180, 181
Thyroid cancer
anaplastic 176
core biopsy for histology 163
low-risk differentiated 174–175
medullary 182
version 7 TNM staging system 165–166, 166
Thyroid eye disease 162
Thyroid hormone replacement 183
Thyroid swellings, risks of malignancy in 169, 169
Total duct excision 102
Total gastrectomy 264
Total parenteral nutrition 88
Total thyroidectomy 168, 169
beta-blockade 162
central compartment nodal dissection 165
metastatic follicular carcinoma 175, 175–176
Toxic adenoma 162
Toxic megacolon 138
Transfemoral amputation 289
Trastuzumab 107
Trimethoprim 35
Trypanosoma cruzi 261, 263
Tubular adenomas 101
Two-sided t-test 45
Type I error 45, 75–76
U
Ulcerative colitis (UC) 138
Ultrasound, abdominal 62
Ureteric calculi 32
Urinary tract infection (UTI) 245
Urinomas 231
V
Vaccinations 204
Vagal-sparing oesophagectomy 256
Vagus nerve 278
Varicocele testis 68
Vascular endothelial growth factor (VEGF) 287
Vasopressors 73, 73
Ventral rectopexy 132
Vinca alkaloids 109
Vinorelbine 109
Viral gastrointestinal infection 140
Visceral arterial aneurysms (VAA) 284–285
W
Warthin's tumour 81
Wedge resection 213
Weiss criteria, 173
X
Xenograft 242
Z
Zollinger–Ellison syndrome 215
×
Chapter Notes

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1FRCS General Surgery: 500 SBAs and EMIs
2
3FRCS General Surgery: 500 SBAs and EMIs
Alasdair Wilson MBChB MSc MD FRCSEd Specialist Registrar in General and Vascular Surgery, Aberdeen Royal Infirmary; Clinical Lecturer in General Surgery, University of Aberdeen, UK Wendy Craig BSc MBChB MPH FRCS Specialist Registrar in General Surgery, Aberdeen Royal Infirmary; Clinical Research Fellow, Departments of Surgery and Health Services Research, University of Aberdeen, UK Lynn Stevenson MBChB MML FRCS Specialist Registrar in General and Colorectal Surgery, Aberdeen Royal Infirmary, UK Edited by Julie Brittenden MBChB MD FRCS Consultant Vascular Surgeon, Aberdeen Royal Infirmary, Professor of Vascular Surgery, University of Aberdeen, UK David Smith MD FRCSEd Consultant Surgeon and Honorary Senior Lecturer, Ninewells Hospital, Dundee; Convener of Education, Royal College of Surgeons of Edinburgh, UK
4© 2013 JP Medical Ltd.
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5Foreword
This book recognises that assessment drives learning. It provides the opportunity to reinforce understanding, practise exam technique and fill in the gaps in your knowledge. The questions presented utilise the assessment style of the FRCS General Surgery: Section 1 written exam offered by the Intercollegiate Specialty Board (ISB). It introduces and familiarises candidates with the Single Best Answer (SBA) and Extended Matching Item (EMI) question formats. Understanding the nuances of choosing the best answer available in contradistinction to the preconception of a correct answer is a technique best practised before it is employed on the day of the exam itself.
Format apart, this book is also a useful source of information in respect of the subject matter covered in the exam, and provides familiarity with the spectrum of topics. As a resource, therefore, this book is rich in content. It provides exemplars of the requisite facts and knowledge, supported by references and illustrated to consolidate learning objectives.
The exam aspires to test beyond the basic level of knowledge possessed by candidates. By careful construction of questions, the exam tests higher-order thinking and explores the use of facts at numerous levels beyond the foundation level of Bloom's taxonomy. The questions in this book adhere to this aspiration, testing of higher-order thinking, and provide a valuable adjunct to exam preparation.
The authors, all of whom have recent experience of the exam and are therefore well-placed to write this book, have provided a fit-for-purpose educational item. Not in itself a replacement for the fundamental knowledge acquisition needed for success in the exam, this book is nonetheless an easy-to-read and easy-to-use companion which offers valuable preparation prior to sitting the exam and will support and advance candidates' chances of success.
Professor George G Youngson cbe mbchb phd frcpe frcsed
Emeritus Professor, University of Aberdeen;
Vice President, Royal College of Surgeons of Edinburgh, UK
6
7Preface
The purpose of this book is to provide practice questions for candidates sitting the FRCS General Surgery: Section 1 written exam. Each author and editor has successfully sat this exam (or its equivalent), some within the last year or two. We were all aware of a deficiency of reputable practice question material. This book aims to redress the balance, by offering well-researched questions that accurately represent the exam style and, importantly, the expected level of difficulty. Each question has been meticulously reviewed by a team of editors and chosen experts, to ensure that it delivers on both style and standard.
The book is divided into surgical specialities (general and emergency, breast, colorectal, endocrine, hepatobiliary, transplantation, upper gastrointestinal, and vascular and endovascular), to aid structured revision and attention to referenced material. Questions that cover topics such as statistics and ethics are also included, since personal experience has taught us that these subjects crop up frequently. The answers feature full explanations, illustrations and further reading.
Section 1 of the exam comprises two papers. Paper 1 consists of 110 single best answer (SBA) questions, to be answered within 2 hours. Paper 2 consists of 135 extended matching item (EMI) questions, to be answered within 2 hours and 30 minutes. We include both types of question and cover all the specialities. We suggest that readers use this book ‘against the clock’ to practise exam timings in preparation for exam day, when it can be easy to run out of time.
Further details of the exam regulations can be found on the ISB website: www.intercollegiate.org.uk. We recommend reading the content of this website in advance of the exam, since it provides important information on registration for the day of the exam.
We cannot emphasise strongly enough the need to practise, practise and practise some more. We hope that our book provides a wealth of practice questions and an invaluable resource for your exam preparation.
Good luck!
Alasdair Wilson
Wendy Craig
Lynn Stevenson
July 2012
11Glossary AAT
Alanine amino transaminase
ABPI
Ankle brachial pressure index
αFP
Alpha fetoprotein
ANOVA
Analysis of variance
APACHE II
Acute physiology & chronic health evaluation
ASA
American Society of Anaesthesiologists
ATLS
Advanced trauma life support
β-hCG
Beta-human chorionic gonadotrophin
BMI
Body mass index
CBD
Common bile duct
CABG
Coronary artery bypass graft
CEA
Carcinoembryonic antigen
CEAP
Clinical/(a)etiologic/anatomical/pathophysiological
CPEX
Cardiopulmonary exercise testing
CRP
C-reactive protein
CT
Computed tomography
CTA
Computed tomography angiography
DSA
Digital subtraction angiography
ELISA
Enzyme-linked immunosorbent assay
ERCP
Endoscopic retrograde cholangiopancreatography
FDG-PET
Fluorodeoxyglucose positron emission tomography
GGT
Gamma glutamyl transaminase
HDU
High dependency unit
ISS
Injury severity score
IVDA
Intravenous drug abuser
kPa
Kilopascals
LFT
Liver function test
METS
Metabolic equivalent task score
MODS
Multiple organ dysfunction syndrome
MRA
Magnetic resonance angiography
MRCP
Magnetic resonance cholangiopancreatography
MUGA
Multi-gated acquisition scan
O-POSSUM
Oesophagogastric physiological and operative score for the numeration of mortality and morbidity
P-POSSUM
Physiological and operative score for the numeration of mortality and morbidity
PaO2/CO2
Partial arterial pressure of oxygen/carbon dioxide
PFT
Pulmonary function test
PTA
Percutaneous transluminal angioplasty
PTC
Percutaneous transhepatic cholangiography
RTS
Revised trauma score12
SAPS II
Simplified acute physiology score
SIRS
Systemic inflammatory response syndrome
TNM
Tumour-nodes-metastases
TOS
Thoracic outlet syndrome
UNOS
United Network for Organ Sharing
VACTERL
Vertebral anomalies, anal atresia, cardiovascular anomalies, tracheo-oesophageal fistula, renal abnormalities, limb defects.
13Recommended reading
Beard JD and Gaines PA (eds). Vascular and Endovascular Surgery: A Companion to Specialist Surgical Practice, 4th edition. Philadelphia: Saunders, Elsevier, 2009.
Dixon JM (ed). Breast Surgery: A Companion to Specialist Surgical Practice, 4th edition. Philadelphia: Saunders, Elsevier, 2009.
Forsyth JLR (ed). Transplantation Surgery: A Companion to Specialist Surgical Practice, 4th edition. Philadelphia: Saunders, Elsevier, 2009.
Garden OJ (ed). Hepatobiliary and Pancreatic Surgery: A Companion to Specialist Surgical Practice, 4th edition. Philadelphia: Saunders, Elsevier, 2009.
Griffin SM and Raimes SA (eds). Oesophagogastric Surgery: A Companion to Specialist Surgical Practice, 4th edition. Philadelphia: Saunders, Elsevier, 2009.
Jones PF, Krukowski ZH and Youngson GG (eds). Emergency Abdominal Surgery, 3rd edition. London: Chapman and Hall Medical, 1998.
Lennard TWJ (ed). Endocrine Surgery: A Companion to Specialist Surgical Practice, 4th edition. Philadelphia: Saunders, Elsevier, 2009.
Paterson-Brown S (ed). Core Topics in General and Emergency Surgery: A Companion to Specialist Surgical Practice, 4th edition. Philadelphia: Saunders, Elsevier, 2009.
Philips RKS (ed). Colorectal Surgery: A Companion to Specialist Surgical Practice, 4th edition. Philadelphia: Saunders, Elsevier, 2009.
Further details of the exam regulations can be found on the ISB website: www.intercollegiate.org.uk. We recommend reading the content of this website in advance of the exam, since it provides important information on registration for the day of the exam.14
15Acknowledgements
With special thanks to our editors, Mr David Smith and Professor Julie Brittenden, without whom the preparation of this book would not have been possible. Their efforts and organisation have made this process relatively painless. We would also like to thank Professor George Youngson for his insightful Foreword.
Thank you to Louise Smart and Professor Zygmunt Krukowski for their intellectual input and supply of pathology images and illustrations.
We are grateful to Mr Douglas Brown and Mr Pradeep Patil for reviewing the breast surgery and transplant surgery sections and providing editorial support.
Thanks also to JP Medical, our supportive and understanding publisher.
AW, WC, LS