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Fissure in ano is a longitudinal tear in the epithelial skin and anal mucosa, most commonly in the posterior (6 o'clock) position. Fissures may occur in the 12 o'clock position in approximately 10% of cases and are more common in women following childbirth.
What is the underlying pathophysiology of this condition?
It is thought that the initial insult may involve traumatic injury, e.g., from the passage of hard stool. However, in the majority of cases this heals without leading to development of a chronic anal fissure. It is likely that, in those patients developing anal fissure, there is an underlying abnormality of the internal anal sphincter leading to hypertonicity. This spasm exacerbates the relative ischaemia of the anodermal mucosa posteriorly and as a result can lead to the development of a fissure.
What are the common approaches to the thoracic cavity?
The patient is positioned supine on the operating table. A midline skin incision is made from the jugular notch to the xiphisternum. Using monopolar diathermy this is then extended through the subcutaneous fat, being careful to remain in the midline until the sternum is reached. Blunt dissection with a finger is then used to clear tissues below the xiphisternum and around the top of the manubrium. The interclavicular ligament is divided with diathermy and the xiphisternum is cut with McIndoes scissors. The sternal saw is then used to divide the bone and a retractor is placed to expose the anterior mediastinum.
The patient is positioned prone or in a lateral position dependent on the structures to be accessed. A long parascapular incision is made, running from a point midway between the medial scapular edge and the thoracic spine and following a curve that runs 2 cm below the inferior scapular angle, to the midpoint of the axilla.
What proportion of traumatic blunt splenic injuries are successfully treated conservatively?
What diagonistic modalities are useful in the assessment of the patient following blunt abdominal trauma?
Focused assessment for sonography in trauma (FAST) - This includes examination of the peri-splenic region, Morrison's pouch, subxiphoid pericardial view, suprapubic region and examination of pleura for haemothoraces.
In the face of the changing style of the intercollegiate MRCS examination, ‘older’ revision texts are no longer up to date with the novel exam format. In writing this book we aim to preserve the ‘Socratic’ method of question-and-answer that has previously been so well received amongst candidates. At the same time, we draw on our own personal experiences, of those students we have taught, and of those that have taught us, providing a novel text based on what you really need to know.
By combining a systems-based approach with the related anatomy and physiology, we hope that this book will not only act as a quick reference guide during a night on call, but also improve your overall understanding of each topic, providing that background information that we so greatly crave but often have insufficient time to search for.
What are the four most common causes of a breast lump?
Simple breast cyst,
Localized anomaly of breast development and involution (ANDI).
Less common causes include: fat necrosis (where there is a history of trauma), other breast cysts (galactocele, cystadenoma, retention cyst of gland of Montgomery), breast abscess (clinical signs of infection) and lipoma.
What is the anatomical position of the heart within the chest?
The heart is located in the middle mediastinum and is covered anteriorly by the costal cartilages of the third, fourth and fifth ribs.
Describe the reflections of the pericardium and describe the location of the transverse and oblique sinuses
The pericardium is made up of a visceral layer, which is adherent to the heart, and a parietal layer, which forms the inner surface of the pericardial sac. There is a small amount of serous pericardial fluid between the two layers. There are two recesses within the pericardium: the transverse sinus and the oblique sinus. The transverse sinus is bounded anteriorly by the posterior surface of the aorta and the pulmonary trunk and posteriorly by the anterior surface of the interatrial groove. The oblique sinus is the space behind the left atrium and is bounded by the pericardial reflections of the inferior vena cava and the pulmonary veins.
The new MRCS structure replaces the vivas and clinical style examinations with an OSCE-based system. This revision guide - the first in a series - fully reflects this new format and provides a structured, systems-based approach to revision. Key aspects of anatomy, physiology, critical care, surgical pathology and operative care are combined whilst focusing on the questions commonly asked in the exam. The material is presented in a practical, question-and-answer based format to help readers retain details whilst providing all of the essential information needed for examination success. MRCS Revision Guide: Trunk and Thorax is a concise, clear pocketbook that reduces the need for bulky textbooks by providing a quick reference guide for busy surgical trainees. If you are studying for the MRCS examination, you need this book.
Diverticular disease is herniation of mucosa through the muscularis of the colonic wall. It usually occurs at the site of relative weakness where mesenteric blood vessels pass between the taeniae coli through the colonic muscle wall.
What is the difference between a true and false diverticulum?
A true diverticulum contains all layers of the wall of the viscus (e.g., Meckel's diverticulum). A false diverticulum involves only some layers (e.g., colonic diverticulum).