Intercollegiate MRCS syllabus

Based upon Version 6 (August 2008) of the Intercollegiate Membership of the Royal College of Surgeons syllabus. (Content copyright RCS(Eng), RCS(Ed), RCS(Glas), RCS(Ir))

Basic Sciences

Applied Surgical Anatomy

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

Thorax

Development
  • Heart and great vessels
  • Fetal circulation
  • Oesophagus
  • Diaphragm
Thorax
  • Thoracic wall
  • Mechanics of breathing
  • Thoracic cavity and viscera: superior and inferior mediastinum, heart and pericardium, lungs, pleurae
Surface and Imaging Anatomy
  • Heart, heart valves
  • Auscultation sites
  • Lungs and pleurae
  • Plane of sternal angle
  • Dermatomes
  • Chest drains, incisions
  • Chest x-ray
  • CT/MRI

Abdomen, pelvis and perineum

Development
  • Foregut, midgut, hindgut
  • Gut rotation
  • Anal canal
  • Kidneys and ureters
  • Bladder and urethra
  • Testis
Abdomen and Pelvis
  • Anterior abdominal wall
    • Inguinal canal and spermatic cord
    • Inguinal hernia
  • Posterior abdominal wall
  • Pelvic floor and wall
  • Lumbar plexus, sacral plexus
  • Peritoneal cavity
  • Intra-abdominal spaces
Abdominal Viscera
  • Oesophagus, stomach
  • Small and large intestine
  • Appendix
  • Liver, gall bladder, bile ducts
  • Pancreas
  • Spleen
  • Kidney and ureter
  • Adrenal gland
Pelvic Viscera
  • Rectum
  • Bladder
  • Prostate
  • Seminal vesicles
  • Uterus, uterine tubes, ovaries
  • Vagina
Perineum
  • Anal triangle
    • Anal canal and ischiorectal fossa
  • Male urogenital triangle
    • Scrotum
    • Testis and epididymis
    • Penis and urethra
  • Female urogenital triangle
    • Vulva
Surface and Imaging Anatomy
  • Abdominal quadrant/nine regions
  • Planes: subcostal, transpyloric, transtubercular
  • Dermatomes
  • Abdominal incisions
  • Rectal and vaginal examinations
  • Imaging appearances of abdomen, gastrointestinal, biliary and urinary tracts
  • Arteriography
  • CT/MRI/Ultrasound

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 and Imaging Anatomy
  • Cubital fossa
  • Wrist structures
  • Thumb movements
  • Arteries and pulses
  • Superficial veins and lymphatics
  • Nerves: axillary, radial, musculocutaneous, ulnar and median
  • Dermatomes and tendon reflexes
  • Arteriography/venography

Lower limb

  • Gluteal region
  • Thigh, front, medial side, back
    • Femoral triangle
    • Femoral sheath and canal
    • Femoral hernia
    • Adductor canal
  • Popliteal fossa
  • Leg, compartments
  • Foot, arches
  • Hip joint
  • Knee joint
  • Ankle joint
  • Foot joints
Surface and Imaging Anatomy
  • Femoral triangle
  • Popliteal fossa
  • Arteries and pulses
  • Superficial veins and lymphatics
  • Nerves: femoral, sciatic, tibial, common peroneal
  • Dermatomes and tendon reflexes
  • Arteriography/venography

Head, neck and spine

Development
  • Branchial arches
  • Face, palate
  • Thyroid and parathyroid glands
  • Spine
  • Face, scalp
  • Cranial cavity, dural venous sinuses, pituitary gland
  • ORBit, eyeball
  • Ear
  • Parotid gland
  • Temporomandibular joint
  • Nose and paranasal air sinuses
  • Mouth, tongue
  • Submandibular and sublingual glands
Neck
  • Anterior triangle
    • Thyroid and parathyroid glands
    • Larynx and trachea
    • Pharynx and oesophagus
    • Carotid sheath
  • Posterior triangle
    • Spinal accessory nerve
    • Cervical plexus
  • Root of neck
    • Thoracic duct
Spine
  • Vertebral column
  • Vertebral canal
Surface and Imaging Anatomy
  • Middle meningeal artery
  • Neck blood vessels
  • Central venous catheterization
  • Laryngeal structures
  • Airway access
  • Skull and 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 and Imaging Anatomy
  • Arteriography
  • CT/MRI

Physiology

General Physiology

  • Homeostasis
  • Thermoregulation
  • Metabolic pathways
  • Sepsis and septic shock
  • Fluid balance and fluid replacement therapy
  • Causes of metabolic acidosis/alkalosis
  • Colloid and crystalloid solutions
  • Coagulation and bleeding

System Specific Physiology

Respiratory system
  • Central nervous control of ventilation
  • Normal ventilatory cycle
  • Intermittent positive pressure ventilation (IPPV)
  • Blood gases, normal and abnormal
  • Causes of post operative respiratory failure
  • Acute respiratory distress syndrome (ARDS)
Cardiovascular system
  • Cardiac pressure cycle
  • Control of cardiac output
  • Haemorrhagic shock
  • Blood pressure and its control mechanisms
Gastrointestinal system
  • Gastric emptying
  • Gut hormones
  • Pancreatic function
  • Peristalsis and ileus
Renal/Genito-urinary system
  • Function of the nephron
  • Renal autoregulation
  • Renin-angiotensin system
  • Causes of a poor urine output
  • Types of renal failure
Endocrine system
  • Function of the pituitary gland
  • Function of the adrenal gland and effects of steroids
  • Calcium metabolism
  • Erythropoetin
Central nervous system
  • Causes of post-operative confusion
  • Physiology of space-occupying lesions
  • Cerebral autoregulation
Thyroid and Parathyroid
  • Thyroid hormones
    • Hypothyroidism
    • Hyperthyroidism
  • Parathyroid hormones
    • Disorders of parathyroid hormones and calcium homeostasis
Glucose homeostasis and diabetes

Pathology

General Pathology

Inflammation
  • Classification
  • Acute inflammation
  • Chronic inflammation
  • 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 and pathological fractures
Vascular disorders
  • Thrombosis and clot formation, hypercoagulable states and tests
  • Embolus formation: aetiology, complications
  • Atheroma
  • Ischaemia and infarction
  • Aneurysms and varicosities
  • Oedema, ascites, transudate, exudate
  • Coagulation deficits: classification, tests, complications
Disorders of growth, differentiation and morphogenesis
  • Failure of growth or maintenance of growth: agenesis, aplasia, hypoplasia, atrophy, apoptosis, necrosis
  • Overgrowth with normal cell differentiation: hyperplasia, hypertrophy, metaplasia, hamartoma formation
  • Growth and overgrowth with abnormal cell differentiation: giant cells, dysplasia
  • Accumulations and depositions: amyloid (definition, causes, diagnosis, effects), haemosiderosis and haemochromatosis, calcification, calculi (definition, causes, complications)
Neoplasia
  • Classification of tumours, e.g. carcinoma, sarcoma, blastoma, teratoma
  • Diagnosis: cytology, biopsy, frozen section
  • Benign neoplasms: complications
  • Carcinogenesis: normal and disordered cell replication, behaviour of cancer cells
  • Typing, grading and staging of cancer
  • Teratoma: definition, sites, behaviour
  • Paraneoplastic syndromes
  • Epidemiology of common cancers and cancer registration
  • Principles of screening
  • Molecular biology of cancer: cell cycle and human genome, mechanisms of tumour genesis, tumour markers (classification and uses), mechanisms of invasion and routes of metastasis
Surgical immunology
  • Hypersensitivity reactions
  • Complement cascade functions
  • Immunoglobulins and their functions
  • Chemotaxis and cytokines
  • Diseases mediated by immunological mechanisms:
    • Graves’ disease, pernicious anaemia, rheumatoid arthritis
  • Immunodeficiency
  • Transplantation, graft-v-host reactions
Surgical haematology
  • Anaemia: iron deficiency, B12 and folate deficiency, haemolytic, sickle cell disease, thalassaemia
  • Polycythaemia
  • Blood transfusion: components of stored blood, group-and-save and cross-matching, transfusion of large volumes, alternatives to blood transfusion
  • Bleeding disorders, DIC, platelets
  • Hypercoagulable states
Surgical microbiology
  • Surgically important microorganisms
  • Exotoxins and endotoxins
  • Pathophysiology of sepsis
  • Disinfection and sterilization
  • Immunisation
  • Commensals
  • Nosocomial infections
Surgical biochemistry
  • Hypercalcaemia
  • Plasma proteins
  • Hepatic function and jaundice
  • Hyperuricaemia

System Specific Pathology

Nervous system
  • Head injuries including intracranial haemorrhage (extradural, subdural, subarachnoid, intracerebral, intraventricular)
  • Raised intracranial pressure
  • Neoplasms: classification
  • Spinal cord and peripheral nerve injuries
Musculoskeletal system
  • Bone and joint infection
    • Osteomyelitis
    • Septic arthritis
  • Pathophysiology of fractures and healing
  • Complications of fractures: non-union, mal-union
  • Pathological fractures
  • Traumatic oedema and compartment syndromes
  • Osteoarthritis: causes, joints affected, effects
  • Tumours of the musculo-skeletal system (primary and secondary)
  • Metabolic bone diseases, including gout (classification, aetiology, effects)
  • Rheumatoid arthritis: joints affected, complications
Respiratory system
  • Carcinoma of the bronchus and lung
  • Pneumothorax
  • Lung conditions including pneumonia, empyema thoracis and bronchiectasis
Breast disorders
  • Benign and malignant tumours
  • Breast cancer: screening principles, assessment, classification, staging systems
  • Infections
  • Gynaecomastia: causes
Cardiovascular system
  • Atherosclerosis
  • Ischaemic heart disease
  • Aneurysms, including dissecting
  • Peripheral vascular disease
  • Varicose veins
  • Deep venous thrombosis
Endocrine system
  • Thyroid: causes of hyperthyroidism and hypothyroidism, classification of thyroid cancers
  • Parathyroids: classification of hyperparathyroidism, associations
  • Adrenals: causes and effects of Addison’s disease, neoplasms of the cortex and medulla
  • Pituitary: Cushing's disease, acromegaly
  • Carcinoid syndrome
  • Multiple endocrine adenopathy
Renal/Genito-urinary system
  • Gynaecological causes of acute abdominal pain
  • Pelvic inflammatory disease
  • Ovarian disease, including cancer
  • Ectopic pregnancy
  • Endometriosis
  • Urinary stone disease
  • Tumours, including kidney, bladder, penis, testis and scrotum: classification and presentation
  • Urinary tract infections
  • Haematuria: causes, effects
Gastrointestinal system
  • Intestinal fistulas
  • Colonic polyps: classification, aetiology, complications
  • Colonic carcinoma: classification, aetilogoy, genetics, staging systems, complications
  • Ulcerative colitis
  • Small bowel disease: Crohn’s disease, hamartomatous polyps
  • Diverticula: definition, classifications, causes, complications
  • Oesophageal carcinoma
  • Peptic ulceration: sites, aetiology
  • Gastric carcinoma: aetiology, complications, complications of gastrectomy
  • Gall stones, obstructive jaundice
  • Pancreatitis: causes and effects of acute and chronic pancreatitis
Dermatological diseases
  • Burns: classification, assessment of depth and extent, complications
  • Skin cancer in general: classification and aetiology
  • Melanoma: classification, staging
Lymphoreticular system
  • Splenic function
  • Splenectomy: indications, complications, precautions
  • Lymphoma: classification, prognoses

Principles of Surgery-in-General

Peri-operative Care

Assessment of Fitness for Surgery

  • Pre-operative 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
  • Thromboprophylaxis

Principles of Anaesthesia

  • General anaesthesia
  • Local anaesthesia
  • Regional 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

Post-operative Management and Critical Care

Anaesthetic Management

  • Postoperative monitoring
  • Ventilatory support
  • Pain control
  • Intravenous [...] delivery

Metabolic and Nutritional Support

  • Fluid & electrolyte management
  • Nutrition in the surgical patient

Postoperative Complications

  • General surgical complications
  • Respiratory failure
  • Acute renal failure
  • Systemic inflammatory response syndrome (SIRS)
  • Multiple organ dysfunction syndrome (MODS)

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, laser, principles of cryosurgery
  • 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

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

Aspects of Surgery in Childhood

  • Basic understanding of child protection law
  • Understanding of Children's rights
  • Working knowledge of types and categories of child maltreatment, presentations, signs and other features (primarily physical, emotional, [...], neglect, professional)
  • Understanding of personal role, responsibilities and appropriate referral patterns in child protection
  • Understanding of the challenges of working in partnership with children and families

Clinical Microbiology

Surgical Microbiology

  • Sources of surgical infection

Prevention of Infection

  • Principles of asepsis and antisepsis

Modern Antibiotic Usage

  • Commonly used antibiotics
  • Selection of appropriate antibiotics
  • Antibiotic resistance

Surgery in Hepatitis and HIV Carriers

  • Blood-borne viruses
  • Universal precautions
  • Surgical precautions
  • Immunisation
  • Management of sharps injuries

Cutaneous Infection/Necrosis

  • Cellulitis
  • Necrotising fasciitis
  • Gangrene

Emergency Medicine and Management of Trauma

Pathophysiology of Trauma

  • Shock and cardiovascular physiology
  • Metabolic response to injury
  • Acute 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
  • Airway management and tracheostomy

Thoracic Trauma

  • Pathophysiology of thoracic trauma
  • Presentation, assessment and management
  • Specific thoracic injuries
    • Pneumothorax

Thoracotomy and Chest drainage

  • Assessment and Preparation
  • Indications for thoracotomy
  • Chest drainage and pericardiocentesis

Neurological Trauma and Management of the Unconscious Patient

  • Head injuries
  • Intracranial haemorrhage (Subarachnoid, Intracerebral, Subdural, Extradural, Intraventricular)
  • Brain injuries
  • Spinal cord injuries
  • Assessment and resuscitation of the comatose patient
  • Peripheral nerve injuries
  • Paralytic disorders

Abdominal Trauma

  • Penetrating abdominal trauma
  • Blunt abdominal trauma
  • Assessment and management of abdominal trauma
  • Specific organ injuries

Urological Trauma

  • Renal, ureteric, bladder, urethral, penile and scrotal trauma

Vascular Trauma

  • Effects of blunt and penetrating injuries to arteries and veins
  • Assessment of vascular injury
  • Iatrogenic injuries
  • Complications of intravascular [...] abuse

Traumatic Wounds

  • Principles of management
  • Gunshot and blast injuries
  • Stab wounds
  • Human and animal bites

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

Management of Skin Loss

  • The wound
  • Skin grafts
  • Skin flaps

Traumatic Oedema and Compartment Syndrome

  • Pathogenesis and physiology
  • Diagnosis and treatment

Burns

  • Classification and pathophysiology
  • Initial assessment and management
  • Treatment including secondary surgery
  • Burns of special areas (i.e. face, eyes, hands, perineum)

Brain Stem Death

  • Diagnosis and testing for brain stem death
  • Principles of organ donation

Principles of Surgical Oncology

Epidemiology of Common Cancers

  • Epidemiology studies and cancer registration
  • Common cancers

Screening Programmes

  • Screening for cancer: breast, cervical, prostate, colorectal and skin

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

Generic Surgical Topics

The Abdomen

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

Intestinal Fistulas

  • Classification of intestinal fistulas
  • Assessment and management

Gastrointestinal Stomas

  • Formation and management
  • Other 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 oesophageal disorders
  • Specific oesophageal disorders (including gastro-oesophageal reflux disease, motility disorders, oesophageal carcinoma, oesophageal diverticulum and 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 anal canal and perineum

  • Pruritus ani
  • Fissure-in-ano
  • Haemorrhoids
  • Fistula-in-ano
  • Anorectal abscess
  • Carcinoma of the anal canal
  • Pilonidal sinus and abscess

Breast and Endocrine Surgery

Common Breast Disorders

  • Breast lumps
  • Breast pain
  • Breast cysts
  • Nipple discharge
  • Gynaecomastia
  • Breast abscess

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 and Cushing’s syndromes
  • 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

Venous Disorders of the Lower Limb

  • Venous insufficiency and varicose veins
  • Venous ulceration
  • Deep venous thrombosis and pulmonary embolism

Lymphoedema

Urology

Urinary Tract Infections and Calculi

Haematuria

  • Classification, aetiology and assessment
  • Tumours of the kidney, bladder, prostate and testis

Urinary Tract Obstruction

  • Urinary retention
  • Disorders of the prostate

Pain and Swelling in the Scrotum

  • Scrotal skin conditions
  • Non malignant testicular swellings
  • Inflammatory conditions
  • Testicular torsion
  • Testicular tumours

Chronic Renal Failure

  • Dialysis
  • Principles of transplantation

Aspects of Pelvic Surgery

  • Gynaecological causes of acute abdominal pain
  • Pelvic inflammatory disease
  • Disorders of urinary continence

Organ Transplantation

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

Head and Neck Surgery

Common Neck Swellings

  • Congenital and rare swellings
  • Inflammatory swellings
  • Head and neck cancer

Salivary gland disorders

  • Infections and inflammation of the salivary glands
  • Tumours of the salivary glands
  • Stones of the salivary glands

Skin Lesions

Benign skin lesions

Malignant skin lesions

  • Basal cell carcinoma
  • Squamous cell carcinoma
  • Malignant melanoma

Hand Disorders

  • Dupytren’s disease
  • Carpal tunnel syndrome

Surgical Disorders of the Brain

  • Clinical presentation of the intracranial mass
  • Tumours of the nervous system

Differences Between the Paediatric and Adult Surgical Patient

Principles of Neo-natal and 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 gastrointestinal 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

See Also

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