Basic science for the MRCS : a revision guide for surgical trainees

521 Pages·2012·19.65 MB·English

by  Andrew T Raftery

BASIC SCIENCE
FOR THE MRCS
ForElsevier:
CommissioningEditor:LaurenceHunter
DevelopmentEditor:SheilaBlack
ProjectManager:FrancesAffleck
Designer:StewartLarking
IllustrationManager:BruceHogarth
BASIC SCIENCE
FOR THE MRCS
A revision guide for surgical trainees
Second Edition
Andrew T Raftery
BSc MBChB(Hons) MD
FRCS(Eng) FRCS(Ed)
ClinicalAnatomist.HonoraryTeachingFellow,HullYorkMedicalSchool
FormerlyConsultantSurgeon,SheffieldKidneyInstitute,SheffieldTeachingHospitalsNHSFoundationTrust,
NorthernGeneralHospital,Sheffield;FormerlyMember(formerlyChairman),CourtofExaminers,
RoyalCollegeofSurgeonsofEngland;FormerlyMemberofPanelofExaminers,IntercollegiateSpecialityBoard
inGeneralSurgery;FormerlyMemberofCouncil,RoyalCollegeofSurgeonsofEngland;FormerlyHonorary
ClinicalSeniorLecturerinSurgery,UniversityofSheffield,UK
Michael S Delbridge
MBChB(Hons) MD
FRCS (Vascular)
SpecialistTraineeinVascularSurgery,YorkshireandHumberDeanery,UK
Helen E Douglas
MBChB MRCS(Eng)
SpecialistTraineeinPlasticandReconstructiveSurgery,YorkshireandHumberDeanery,UK
EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO 2012
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Firstedition2006
Secondedition2012
ISBN978-0-7020-4483-0
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Notices
Knowledgeandbestpracticeinthisfieldareconstantlychanging.Asnewresearchandexperiencebroadenour
understanding,changesinresearchmethods,professionalpractices,ormedicaltreatmentmaybecomenecessary.
Practitionersandresearchersmustalwaysrelyontheirownexperienceandknowledgeinevaluatingandusingany
information,methods,compounds,orexperimentsdescribedherein.Inusingsuchinformationormethodstheyshouldbe
mindfuloftheirownsafetyandthesafetyofothers,includingpartiesforwhomtheyhaveaprofessionalresponsibility.
Withrespecttoanydrugorpharmaceuticalproductsidentified,readersareadvisedtocheckthemostcurrentinformation
provided(i)onproceduresfeaturedor(ii)bythemanufacturerofeachproducttobeadministered,toverifytherecommended
doseorformula,themethodanddurationofadministration,andcontraindications.Itistheresponsibilityofpractitioners,
relyingontheirownexperienceandknowledgeoftheirpatients,tomakediagnoses,todeterminedosagesandthebest
treatmentforeachindividualpatient,andtotakeallappropriatesafetyprecautions.
Tothefullestextentofthelaw,neitherthePublishernortheauthors,contributors,oreditors,assumeanyliabilityforany
injuryand/ordamagetopersonsorpropertyasamatterofproductsliability,negligenceorotherwise,orfromanyuseor
operationofanymethods,products,instructions,orideascontainedinthematerialherein.
PrintedinChina
Preface
Theauthors(ATRandMSD)aregratefultothepub- tothechapteroncellularinjury.Thesectiononskin
lishers,ChurchillLivingstone,fortheinvitationtopro- healinghasalsobeenextensivelyrewrittentoinclude
duceasecondeditionofBasicSciencefortheMRCS. sectionsonskingraftingandtheanatomyofflaps.As
Itwasfeltthatanadditionalco-authorwouldbehelp- mostexaminationsareObjective,Structured,Clinical
ful in bringing the book up-to-date. We are pleased Examinations (OSCEs) each chapter now has OSCE
thatHelenDouglas,SpecialistTraineeinPlasticand scenario questions at the end with sample answers
ReconstructiveSurgery,hasagreedtofilltherole. providedinanappendixatthebackofthebook.We
Thebookisaconciserevisionguidetothecorebasic havealsoaddedsomeimagestotheanatomychap-
scienceswhichcomprisetheessentialknowledgefor tersconsistingofMRIandCTscansofthetypethatare
thoseenteringsurgicaltraining.Itisabasicrequirement likelytobeencounteredinOSCEexaminations.
thateverysurgicaltraineehasathoroughunderstanding Nobookofthislengthcouldhopetobecompre-
ofthebasicprinciplesofanatomy,physiologyandpa- hensive and we have therefore concentrated on the
thologyirrespectiveofwhichspecialitywithinsurgery topicsthattendtoberecurringexaminationthemes.
theyintendtopursueasacareer.Itisequallyimportant Aswiththefirstedition,thisbookhasbeenwrittenpri-
thattheyunderstandtheclinicalapplicationofthebasic marily as a means of rapid revision for the surgical
sciences.Thisrevisionguidehasbeenwrittenwiththis trainee.However,itshouldalsoproveusefulforthose
inmind,usingabullet-pointstylewhichwehopewill inhighersurgicaltraining,aswellasforthesurgically
makeiteasierforthereadertorevisetheessentialfacts. inclined, well-motivated medical student. We hope
Muchhaschangedbothintheundergraduatecur- that this second edition will provide a simple and
riculumandinthepost-graduateexaminationsystem straightforward approach to the basic science that
sincethefirsteditionwaspublishedsixyearsago.In underpinssurgicaltraining.
thissecondedition,someofthechaptershavebeen
updatedandsectionsexpandedtocovertopicswhich AndrewT.Raftery
areparticularlyrelevanttoexaminations.Themicrobi- MichaelS.Delbridge
ology chapter has been extensively rewritten and a HelenE.Douglas
sectiononburns,afrequentexaminationtopic,added Sheffield2012
v
Acknowledgements
We are extremely grateful to the publishers, Elsevier Figures8.1,8.12B,8.12C,10.3,10.4,10.5,10.6,
Limited,andinparticulartoLaurenceHunter,Commis- 10.7, 11.1, 11.3, 13.1, 13.5A, 13.5B and 13.6 from
sioningEditor,andSheila Black,Development Editor, McGeown2002Physiology,2ndedn.ChurchillLiving-
fortheirsupportandhelpwiththisproject.Wearealso stone,Edinburgh
grateful to the following colleagues at the Sheffield Figures8.3and8.4fromPocock&Richards2004
TeachingHospitalsNHSFoundationTrustwhoprovided HumanPhysiology: TheBasisofMedicine,2ndedn.
help, advice and criticism: Dr Paul Zadik, Consultant OxfordUniversityPress,Oxford
Microbiologist; DrTC Darton, NIHR Academic Clinical Figures1.1,1.2,1.3,1.4,1.5,1.6,1.7,1.8,1.9,
Research Fellow, Infectious Diseases and Medical 1.11, 1.13, 1.14, 2.1, 2.2, 2.3, 2.4, 2.7, 2.8, 2.9,
Microbiology; Mr BM Shrestha, Consultant General 2.10,2.12,2.13,2.14,2.17,2.18,2.19,2.20,2.21,
andTransplantSurgeon.Wewouldalsoliketothank 2.22,2.23,2.24,2.25,2.27,2.28,2.29,2.30,2.31,
our consultant radiologist colleagues, who provided 2.32, 5.1, 5.2, 5.7, 5.8, 5.16, 5.17, 6.1, 6.2, 6.3,
images: Dr Matthew Bull, Dr Peter Brown, Dr James 6.4,6.7, 6.8,6.9, 6.10,6.11,6.12,6.13,6.15,8.2,
Hampton, Dr Robert Cooper and Dr Rebecca Denor- 8.6, 8.10, 8.12A, 9.2, 9.4, 9.6, 11.4, 12.1, 12.4,
onha. Mr Raftery would like to thank his secretary, 13.8, 19.2, 20.1, 20.2, 20.3, 21.1, 22.1, 22.2 and
Mrs Denise Smith, for thelong hours and hardwork 22.3 from Raftery (ed) 2000 Applied Basic Science
she has put in typing and re-typing the manuscript, for Basic Surgical Training. Churchill Livingstone,
andAnneRafteryforcollatingandorganisingthewhole Edinburgh
manuscriptintoitsfinalformat.Thetaskcouldnothave Figure 17.2Q&A from Raftery & Delbridge 2006
beencompletedwithoutthem. PocketbookofSurgery,3rdedn.ChurchillLivingstone,
The figures in this book come from a variety of Edinburgh
sources,andmanyarereproducedfromotherpubli- Figures 5.35, 6.14, 22.2Q&A, 22.3Q&A and
cations,withpermission,asfollows: 22.5Q&A from Raftery, Delbridge & Wagstaff 2011
Figure3.9fromtheUniversityofMichiganMedical PocketbookofSurgery,4thedn.ChurchillLivingstone,
School,withkindpermissionofThomasRGest,PhD Edinburgh
Figures13.10A,13.10Band13.11fromCrossman Figures1.10,3.1,3.2,3.3,3.4,3.8,3.12,4.1,4.2,
& Neary 2000 Neuroanatomy: An Illustrated Colour 4.3, 4.4, 4.6, 4.7, 4.8, 4.9, 4.11, 4.12, 4.13, 4.15,
Text,2ndedn.ChurchillLivingstone,Edinburgh 4.16, 5.3, 5.4, 5.5, 5.9, 5.10, 5.11, 5.13, 5.14,
Figures3.11and4.14,andTables6.1and6.3from 5.21, 5.22, 5.24, 5.26, 5.27, 5.28, 5.29, 5.30, 5.31
Easterbrook 1999 Basic Medical Sciences for MRCP and 6.16 from Rogers 1992 Textbook of Anatomy.
Part1,2ndedn.ChurchillLivingstone,Edinburgh ChurchillLivingstone,Edinburgh
Figure9.1fromHoffman&Cranefield1960Elec- Figure13.4fromStevens&Lowe2000Pathology,
trophysiology of the Heart. McGraw-Hill, New York 2ndedn.Mosby,Edinburgh
(nowpublicdomain) Figures15.1and15.2,andBoxes15.1and15.2
Figures4.20,4.24,5.25,6.5and6.6fromJacob from Underwood (ed) 2004 General and Syste-
2002AtlasofHumanAnatomy.ChurchillLivingstone, matic Pathology, 4th edn. Churchill Livingstone,
Edinburgh Edinburgh
vi
Contents
I ANATOMY
1 Thethorax 3
2 Theabdomen,pelvisandperineum 22
3 Theupperlimbandbreast 66
4 Thelowerlimb 84
5 Thehead,neckandspine 112
6 Thenervoussystem 154
II PHYSIOLOGY
7 Generalphysiology 181
8 Respiratorysystem 196
9 Cardiovascularsystem 215
10 Gastrointestinalsystem 226
11 Urinarysystem 245
12 Endocrinesystem 253
13 Nervousandlocomotorsystems 272
III PATHOLOGY
14 Cellularinjury 293
15 Disordersofgrowth,morphogenesisanddifferentiation 311
16 Inflammation 319
17 Thrombosis,embolismandinfarction 325
18 Neoplasia 331
19 Immunology 343
20 Haemopoieticandlymphoreticularsystem 355
21 Basicmicrobiology 373
22 System-specificpathology 400
IV APPENDIX
OSCEscenarioanswers 449
Index 481
vii
Intentionally left as blank
I
SECTION
ANATOMY
1 The thorax 3
2 The abdomen,pelvisand perineum 22
3 The upper limb and breast 66
4 The lower limb 84
5 The head,neck and spine 112
6 The nervoussystem 154