MRCS Part A revision topics

01

Upper limb & breast

1 topics · 80 questions in the bank

Upper limb and breast anatomy is the regional anatomy of the shoulder girdle, axilla, arm, forearm and hand, with the breast and its axillary lymphatics grouped here because they share the axilla. Applied surgical anatomy is 75 of the 180 Paper 1 questions; upper limb and breast contribute 8 of them. The brachial plexus is the spine of the domain — roots, trunks, divisions, cords and branches, and the deficit each lesion produces — followed by the course and relations of the axillary, radial, median and ulnar nerves, the cubital fossa, the compartments of the forearm, the carpal tunnel and Guyon’s canal, and the arterial supply from the subclavian artery to the palmar arches. Breast questions turn on the levels of the axillary nodes, the nerves at risk in axillary surgery and the lymphatic drainage. Most stems describe an injury, a surgical approach or an examination finding and ask which structure explains it.

• Upper limb & breast anatomy

  Shoulder girdle & axilla · Brachial plexus · Arm, cubital fossa & elbow · Forearm compartments & nerves · Wrist & hand · Breast & axillary lymphatics

  80

02

Lower limb

1 topics · 70 questions in the bank

Lower limb anatomy runs from the gluteal region and hip joint, through the femoral triangle and adductor canal, to the popliteal fossa, the four compartments of the leg, the ankle and the foot, with the arterial tree, the venous system and the lymphatics of the limb alongside. Applied surgical anatomy is 75 of the 180 Paper 1 questions; the lower limb contributes 7 of them. The domain is built on relations that matter at operation and after injury: what lies in the femoral triangle and in what order, where the sciatic nerve runs in relation to the hip, where the common fibular nerve is exposed at the neck of the fibula, which nerve and artery supply each compartment, and how the great saphenous vein relates to the medial malleolus and the saphenofemoral junction. Questions typically present a fracture, a dislocation, a vascular procedure or a varicose vein operation and ask which structure explains the finding or is at risk.

• Lower limb anatomy

  Hip joint & gluteal region · Thigh, femoral triangle & adductor canal · Knee & popliteal fossa · Leg compartments & nerves · Ankle & foot · Vessels, veins & lymphatics of the limb

  70

03

Thorax

1 topics · 60 questions in the bank

Thoracic anatomy covers the chest wall and intercostal spaces, the pleura and the diaphragm with its openings, the heart, pericardium and coronary circulation, the trachea, bronchi and lungs, and the mediastinum with the great vessels, the oesophagus and the nerves that cross it. Applied surgical anatomy is 75 of the 180 Paper 1 questions; the thorax contributes 6 of them. The useful knowledge is procedural: where to place a chest drain and why the neurovascular bundle sits under the rib, which lobe an inhaled foreign body reaches, what each diaphragmatic opening transmits and at which vertebral level, which coronary artery supplies the inferior wall, and how the phrenic, vagus and recurrent laryngeal nerves relate to the great vessels. Questions in this domain tend to describe a procedure, an injury or a radiograph and ask for the structure involved.

• Thoracic anatomy

  Chest wall, pleura & diaphragm · Heart, pericardium & coronary circulation · Lungs, trachea & bronchi · Mediastinum, great vessels & oesophagus

  60

04

Abdomen & pelvis

5 topics · 210 questions in the bank

Abdomen, pelvis and perineum is the largest anatomical domain. Applied surgical anatomy is 75 of the 180 Paper 1 questions, and this domain contributes 21 of them: abdominal wall and peritoneal cavity 6, abdominal viscera 6, abdominal vessels 3, pelvis 4 and perineum 2. It covers the layers of the abdominal wall and the inguinal canal, the peritoneal reflections, mesenteries and the lesser sac, the foregut, midgut and hindgut organs with their blood supply, the liver, biliary tree and Calot’s triangle, the pancreas and spleen, the kidneys, ureters and adrenals, the aorta and its branches, the portal system and its portosystemic anastomoses, the bony pelvis and pelvic floor, the rectum, bladder, prostate and uterus with their vessels and nerves, and the anal canal and urogenital triangle. Questions are rooted in operations — hernia repair, cholecystectomy, colectomy, nephrectomy, anterior resection — and in the relations a surgeon has to know to avoid the ureter, the common bile duct or the pelvic nerves.

• Abdominal wall & peritoneal cavity

  Layers, inguinal canal & hernia anatomy · Peritoneum, mesenteries & spaces

  60

• Abdominal viscera

  Oesophagus, stomach & duodenum · Liver, biliary tree & Calot's triangle · Pancreas & spleen · Small & large bowel, appendix · Kidneys, ureters & adrenals

  60

• Abdominal vessels

  Aorta & its branches · Portal system, IVC & collaterals

  30

• Pelvis

  Bony pelvis & pelvic floor · Rectum, bladder, prostate & uterus · Pelvic vessels & nerves

  40

• Perineum

  Anal canal & ischioanal fossa · Urogenital triangle & external genitalia

  20

05

Head, neck & neuro

4 topics · 180 questions in the bank

Head, neck and neuroanatomy brings together the skull, scalp and face, the orbit, ear and sinuses, the oral cavity, tongue and pharynx, the salivary glands and the cranial nerves that run through them; the triangles and fascial layers of the neck, the thyroid and parathyroids with the laryngeal nerves, the larynx and airway, and the carotid sheath and lymph nodes; the meninges, ventricles and CSF, the cerebral blood supply, the brainstem and cranial nerve nuclei, and the cortex and its tracts; and the autonomic nervous system. Applied surgical anatomy is 75 of the 180 Paper 1 questions; this domain contributes 18 of them — head 5, neck 5, brain 6 and the autonomic nervous system 2. The recurring themes are the nerves at risk in thyroidectomy, parotidectomy, neck dissection and carotid surgery, the relations that make an airway or a tracheostomy safe, the vessels behind an extradural, subdural or subarachnoid haemorrhage, and the localisation of a lesion from a cranial nerve or cortical deficit.

• Head

  Skull, scalp & face · Orbit, ear & paranasal sinuses · Oral cavity, tongue & pharynx · Salivary glands & cranial nerve relations

  50

• Neck

  Triangles & fascial layers · Thyroid, parathyroids & laryngeal nerves · Larynx, trachea & airway · Carotid sheath, great veins & lymph nodes

  50

• Brain & cranial nerves

  Meninges, ventricles & CSF · Cerebral blood supply & circle of Willis · Cranial nerves & brainstem · Cortex, tracts & localisation

  60

• Autonomic nervous system

  Sympathetic chain & plexuses · Parasympathetic outflow & ganglia

  20

06

Spine & embryology

3 topics · 150 questions in the bank

This domain gathers three blueprint lines that sit outside regional anatomy. Spine and spinal cord covers the vertebrae, discs and ligaments, the cord with its roots, dermatomes and myotomes, and the levels at which the cord and the dural sac end. Surgically related embryology covers the rotation of the gut and the malrotations and atresias that follow, the pharyngeal arches and pouches and the descent of the thyroid, the heart and great vessels, the urogenital system, and the limbs, body wall and diaphragm. Surface and imaging anatomy covers the landmarks and vertebral levels a surgeon uses to plan an incision or read a radiograph, and the cross-sectional anatomy of CT and MRI. Applied surgical anatomy is 75 of the 180 Paper 1 questions; these three lines contribute 15 of them — spine 3, embryology 8 and surface and imaging anatomy 4. Embryology is tested through the congenital conditions it explains rather than for its own sake.

• Spine & spinal cord

  Vertebrae, discs & ligaments · Spinal cord, roots & dermatomes

  30

• Surgically related embryology

  Gut development & rotation · Pharyngeal arches, thyroid & face · Heart & great vessels · Urogenital development · Limbs, body wall & diaphragm

  80

• Surface & imaging anatomy

  Surface landmarks & vertebral levels · Cross-sectional & plain-film anatomy

  40

07

Physiology

7 topics · 450 questions in the bank

Applied surgical physiology is the largest single line in Paper 1: 45 of its 180 questions — general principles 15, and cardiovascular, respiratory, gastrointestinal, urinary, endocrine and neurological physiology 5 each. General principles covers the fluid compartments and electrolytes, acid–base balance and its interpretation, cell physiology and membrane transport, the metabolic response to injury, thermoregulation and starvation, and the physiology of haemostasis. The system lines follow: cardiac output and its control, the oxygen dissociation curve and ventilation–perfusion, gastric secretion and the gut hormones, glomerular filtration and the handling of sodium, potassium and water, the hormonal axes and calcium metabolism, and cerebral blood flow with intracranial pressure. Questions here are quantitative and applied — a set of blood gases, a fluid chart, a postoperative sodium — and the best answer usually comes from understanding one mechanism well enough to predict what the numbers will do.

• General physiological principles

  Fluid compartments & electrolytes · Acid–base balance · Cell physiology & membrane transport · Metabolic response, temperature & starvation · Haemostasis & coagulation physiology

  150

• Cardiovascular physiology

  50

• Respiratory physiology

  50

• Gastrointestinal physiology

  50

• Renal & urinary physiology

  50

• Endocrine physiology

  50

• Neurological physiology

  50

08

Pathology

15 topics · 370 questions in the bank

Applied surgical pathology is 37 of the 180 Paper 1 questions. General pathological principles contribute 9 — acute and chronic inflammation and wound healing, cell injury, necrosis and apoptosis, thrombosis, embolism and infarction, and growth, adaptation and amyloid — and the remaining 28 come as 2 each from immunology, haematology, clinical chemistry, neoplasia and oncology, and the pathology of the cardiovascular, respiratory, digestive, genitourinary and nervous systems, skin cancer, the lymphoreticular and musculoskeletal systems, the breast and the endocrine glands. The questions are the mechanisms behind the conditions a surgeon sees: why a wound dehisces, how a tumour spreads and is staged, what a raised calcium or a transfusion reaction means, and which histological description fits which diagnosis. The system lines are short but broad, so breadth of recognition matters more than depth in any one of them.

• General pathological principles

  Inflammation & wound healing · Cell injury, necrosis & apoptosis · Thrombosis, embolism & infarction · Growth, adaptation & amyloid

  90

• Surgical immunology

  20

• Surgical haematology

  20

• Surgical clinical chemistry

  20

• Principles of neoplasia & oncology

  20

• Cardiovascular pathology

  20

• Respiratory pathology

  20

• Digestive system pathology

  20

• Genitourinary pathology

  20

• Central & peripheral nervous system pathology

  20

• Skin cancer

  20

• Lymphoreticular pathology

  20

• Musculoskeletal pathology

  20

• Pathology of the breast

  20

• Pathology of the endocrine glands

  20

09

Pharmacology & micro

4 topics · 230 questions in the bank

This domain gathers the four smaller lines of Paper 1, which together contribute 23 of its 180 questions: pharmacology 8, microbiology 7, imaging 5, and data interpretation and audit 3. Pharmacology covers the anaesthetic agents, local anaesthetics and analgesics a surgeon prescribes or watches being given, antimicrobials and prophylaxis, anticoagulants, antiplatelets and their reversal, and the perioperative drugs that must be stopped, continued or covered. Microbiology covers the surgically important organisms, surgical site infection and sepsis, sterilisation, disinfection and infection control, and blood-borne viruses and needlestick injury. Imaging covers the modalities, contrast agents and radiation doses, and the interpretation of plain films, CT, ultrasound and MRI. Data interpretation covers study design, the statistics behind a trial or a screening test, and audit and clinical governance. The questions are short and factual, and they reward a tidy set of numbers and classifications held in memory.

• Pharmacology in surgical practice

  Anaesthetic agents, local anaesthetics & analgesia · Antimicrobials & prophylaxis · Anticoagulants, antiplatelets & reversal · Perioperative drugs & interactions

  80

• Microbiology in surgical practice

  Surgically important organisms · Surgical site infection & sepsis · Sterilisation, disinfection & infection control · Blood-borne viruses & needlestick

  70

• Imaging

  Modalities, contrast & radiation · Image interpretation

  50

• Data interpretation, statistics & audit

  Statistics & study design · Audit, evidence & clinical governance

  30

10

Surgical conditions

12 topics · 450 questions in the bank

Common congenital and acquired surgical conditions is the largest line of Paper 2: 45 of its 120 questions. Gastrointestinal disease and orthopaedic conditions contribute 7 each; vascular, cardiovascular and pulmonary, genitourinary, skin, head and neck, and endocrine disease 4 each; breast disease 3; and neurology and neurosurgery, lymphoreticular disease, cancer therapy and palliative care, and acute surgical emergencies 2 each. It is the clinical core of the exam — the presentation, investigation and first-line management of the conditions a core trainee meets in clinic, on the ward and in the emergency department — and the level expected is that of a trainee two to three years after qualification, not a specialist. Questions describe a patient and ask for the most likely diagnosis, the most appropriate next investigation or the most appropriate initial management, and the best answer is almost always the one that current UK guidance would support.

• Gastrointestinal disease

  Oesophagogastric & hepatobiliary · Colorectal & anal · Acute abdomen & obstruction · Hernias

  70

• Breast disease

  30

• Vascular disease

  Arterial disease & aneurysms · Venous & lymphatic disease

  40

• Cardiovascular & pulmonary disease

  40

• Genitourinary disease

  40

• Orthopaedic conditions

  Degenerative & inflammatory joint disease · Bone & joint infection, tumours · Spine & nerve entrapment · Paediatric orthopaedics

  70

• Diseases of skin, head & neck

  40

• Neurology & neurosurgery

  20

• Endocrine disease

  40

• Lymphoreticular disease

  20

• Principles of cancer therapy & palliative care

  20

• Acute surgical emergencies

  20

11

Perioperative care

8 topics · 350 questions in the bank

Perioperative management is 35 of the 120 Paper 2 questions: preoperative assessment and management 7, intraoperative care 5, perioperative care 2, postoperative care 8, nutrition 2, haemostasis and blood products 3, coagulation, DVT and embolism 3, and metabolic and endocrine disorders 5. It follows the patient from the decision to operate to discharge — risk scoring and the optimisation of comorbidity, consent, marking and the WHO checklist, anaesthesia and the airway, positioning, diathermy, tourniquets and lasers, sutures, drains and technique, the recognition of postoperative complications and the critical care that supports a failing organ, fluids and analgesia, nutritional support, transfusion and the management of coagulopathy, thromboprophylaxis, and the perioperative care of the diabetic, the steroid-dependent and the patient with thyroid or adrenal disease. These questions are the day-to-day work of a core trainee, and the best answer is the step that current UK guidance would have you take next.

• Preoperative assessment & management

  Risk assessment & scoring · Optimising comorbidity · Consent, marking & checklists

  70

• Intraoperative care

  Anaesthesia & airway · Positioning, diathermy, tourniquets & lasers · Surgical technique, sutures & drains

  50

• Perioperative care

  20

• Postoperative care

  Complications & their recognition · Fluids, analgesia & recovery · Critical care & organ support

  80

• Nutritional management

  20

• Haemostasis & blood products

  30

• Coagulation, DVT & embolism

  30

• Metabolic & endocrine disorders

  50

12

Trauma

6 topics · 300 questions in the bank

Trauma is 30 of the 120 Paper 2 questions: general principles 4, shock 2, wounds and soft tissue injuries 4, burns 2, fractures and dislocations 8, and organ-specific trauma 10. It is examined in the language of ATLS — the primary survey, the classification of haemorrhagic shock, the lethal chest injuries and the indications for laparotomy, CT or transfer — alongside the principles of wound management and tetanus prophylaxis, burn assessment and resuscitation, the classification, healing and complications of fractures, and the specific injuries of the head and spine, chest, abdomen and pelvis, and the vessels and limbs. The best answer is nearly always the next step in a sequence: airway before breathing, decompression before a chest radiograph in tension pneumothorax, a pelvic binder before the CT scanner, fasciotomy before the pulse disappears. Questions reward knowing the thresholds — the GCS that mandates a CT head, the urine output that guides burn resuscitation, the pressure that defines compartment syndrome — and the order in which things are done.

• Trauma: general principles

  40

• Shock

  20

• Wounds & soft tissue injuries

  40

• Burns

  20

• Fractures & dislocations

  Fracture principles & healing · Upper limb injuries · Lower limb & pelvic injuries · Complications: compartment syndrome, fat embolism, non-union

  80

• Organ-specific trauma

  Head & spinal injury · Chest trauma · Abdominal & pelvic trauma · Vascular & limb trauma

  100

13

Children & medico-legal

2 topics · 100 questions in the bank

Two short lines of Paper 2 sit together here and contribute 10 of its 120 questions: surgical care of children 7, and medico-legal aspects of surgical practice 3. The paediatric line covers the neonatal and congenital conditions a core trainee must recognise and refer — oesophageal atresia, malrotation, necrotising enterocolitis, Hirschsprung’s disease, anorectal malformations and congenital diaphragmatic hernia — the common conditions of infancy and childhood such as pyloric stenosis, intussusception, inguinal hernia and hydrocele, the undescended testis, appendicitis and the acute scrotum, and the physiology, fluid prescribing and consent that differ from adult practice. The medico-legal line covers consent, capacity and confidentiality, including in children and young people, the Mental Capacity Act and its equivalents, negligence and the Montgomery standard, the duty of candour, clinical governance and the GMC’s Good medical practice. Both lines are small but precise, and a few hours of focused revision secure them.

• Surgical care of children

  Neonatal & congenital conditions · Common paediatric surgical conditions · Paediatric physiology, fluids & consent

  70

• Medico-legal aspects of surgical practice

  Consent, capacity & confidentiality · Governance, duty of candour & the law

  30