MRCS part A Revision

Kamal Aryal
Core Surgery Educational Lead
Anatomy
 Nucleus
I,II – olfactory bulb
and lateral geniculate
nucleus post to optic
chiasma

III,IV – midbrain
V,VI,VII,VIII – pons
9,10,11,12 – medulla

Origin/exit
1, 2- bulb, optic
chiasma
3 – midbrain and
pontine junction
4 – post part of
midbrain
5 – pons
6,7,8 – pons and
medulla junction
1. Crista galli
2. Olfactory foramina in the Cribriform
plate of the Ethmoid bone
3. Lesser wing of the Sphenoid bone
4. Anterior clinoid process
5. Foramen ovale
6. Foramen spinosum
7. Posterior clinoid process
8. Clivus
9. Greater wing of the Sphenoid
10. Optic canal
11. Sella turcica (Hypophyseal fossa is
inside)
12. Foramen lacerum
13. Arcuate eminence located on the
Petrous portion of the Temporal bone
14. Jugular foramen
15. Foramen magnum
Cranial nerve exit
What type of nerve?
• Sensory – I, II, VIII
• Motor – III, IV, VI, XI, XII,
• Mixed - V, VII, IX
Geniculate ganglion
 • Oesophagus
• Right and left vagus nerves
• Oesophageal branches of left
gastric artery/vein

T8
• Inferior vena cava
• Terminal branches of • Aorta
right phrenic nerve • Thoracic duct
• Azygous vein
Carpal tunnel syndrome
What lies deep to flexor retinaculum
FPL, FDS and FDP – have same synovial sheath
Median nerve – supply – thenar muscles, lateral 2
lumbricals, sensation
Thenar muscle wasting in carpal tunnel syndrome
The cutaneous sensation in thenar area comes from
a branch arising above the wrist
Ulnar nerve injury at elbow
• Recurrent branch of median nerve supplies only thenar muscles (intrinsic muscles of
thumb abductor pol brevis, opponens policis and supf head of flex policis brevis)
• 1st and 2nd lumbricals are supplied by palmar digital branch of the median nerve
which also supply lateral 3 and half digits.
• The palm sensation on lateral palm is given by palmar cutaneous branch which
comes off in forearm before entering the carpal tunnel
• All other intrinsic muscles including adductor policis, medial 2 lumbricals, interossei
are supplied by ulnar nerve
• Froment’s sign – unable to adduct the thumb in ulnar nerve injury
• Unable to hold card between fingers due to interossei loss of function in ulnar nerve
injury
Ulnar claw hand
• Ulnar nerve Injury at wrist
• Extension of MCP joint – 4,5 fingers due to unopposed action of
extensors
• Flexion of IP joints – 4,5 – unopposed action of FDP and FDS
Colon blood supply
Femoral triangle
Superior gluteal nerve supplies
Gluteus medius and minimus
responsible for Trendelenburg gait

Inf gluteal nerve supplies Glu

maximus
 Popliteal fossa (left)

Lateral biceps femoris Medial semimebranosus

Lateral head of Medial head of gastrocnemius
gastrocnemius

Contents form medial to

lateral – artery –deepest
Vein, tibial nerve, common
peroneal nerve
Muscle innervation
Initial abduction by supraspinatus
Lying anterior to the ankle the order of structures from medial to lateral is
• tibialis anterior
• extensor hallucis longus
• anterior tibial vessels
• deep fibular (peroneal) nerve and
• extensor digitorum longus.
THVND

Lying posterior to the medial malleolus the order of structures from medial to lateral is: (ant to post)
• tibialis posterior,
• flexor digitorum longus
• posterior tibial vessels
• tibial nerve
• flexor hallucis longus
(TDVNH)
Physiology
• Liver bilirubin metabolism
• Kidney reabsorption
• Fluid and electrolyte requirement
• Renin angiotensin mechanism
• Aldesterone function
• Ventillation and physiology
• Metabolic response to trauma
• Metabolic abnormalities – how to read blood gases
• Dumping syndrome
Cancer prognosis
Hyperparathyroidism
Third nerve palsy
• Ptosis
• Mydriasis
• Eye down and out ( LR6 SO4 All 3)

• Cavernous sinus thrombosis

• Posterior communicating artery berry aneurysm
Sepsis infection and score 2 or more
Sepsis
• Presence of infection with NEWS >3
• Monteggia Vs Galeazzi fractures
Types of rejection in transplant
• Hyperacute immediate
• Acute first week to 3 months
• Chronic over many years
• A MET is defined as the resting metabolic rate, that is, the amount of oxygen
consumed at rest, sitting quietly in a chair, approximately 3.5 ml 02/kg/min (1.2
kcal/min for a 70-kg person).

• * As such, work at 2 METS requires twice the resting metabolism or 7.0 ml O,/kg/min

• Three METS requires three times the resting metabolism (10.5 ml 02/kg/min),and so
on.
• Patients who cannot meet 4 times the metabolic demands of normal daily activities
are at increased risk
• Climb a flight of stairs, Run a short distance
• Perform moderate recreational activities (golf, dancing, bowling)
Salivary gland tumours
• Sublingual 85% malignant
• Submandibular 50% malignant
• Parotid – 10-20% malignant
Brain tumours
• Gliomas
• Astrocytoma
• Grade 1 pilocytic astrocytoma
• Grade 2 diffuse astrocytoma
• Grade3 anaplastic astrocytoma
• Grade4 Glioblastoma multiforme - 6th decade of life most common adult glial tumour
• Oligodendroglioma
• Ependymoma
• Choroid plexus tumour