For anyone interested in hand surgery and/or working in developing countries and/or anatomy and/or art:
www.donaldsammut.com
I went to a talk he gave at the RSM on tuesday and it left me very impressed and inspired. In fact the whole evening was a great start to the Plastics section.
Thursday, 10 November 2011
Journal Club - November
Hi all,
I was very impressed by the response to the first journal club paper. This month, I have chosen a paper that is very clinically relevant and addresses a common problem but management is often fraught with controversy. So this month's paper is:
I will pot my assessment in a few days time and would appreciate any input from you guys. Also if you would like to suggest any papers for next month, please go ahead! I would welcome input. FINALLY, I shall be putting up some posts on core training applications soon as well as more MRCS advice...
I was very impressed by the response to the first journal club paper. This month, I have chosen a paper that is very clinically relevant and addresses a common problem but management is often fraught with controversy. So this month's paper is:
J Bone Joint Surg Br. 2011 Oct;93(10):1362-6.
The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of re-rupture.
I will pot my assessment in a few days time and would appreciate any input from you guys. Also if you would like to suggest any papers for next month, please go ahead! I would welcome input. FINALLY, I shall be putting up some posts on core training applications soon as well as more MRCS advice...
Friday, 9 September 2011
MRCS Part B - Stations from yester year
Now please note, these stations are just to help give you an idea of what kind of topics could come up in the exam. There is no guarantee that they will come up again or even if they do the format maybe different as the exam structure has recently changed. MRCS OSCEs are designed to test your core surgical knowledge and ability. If you revise the theoretical stuff and ensure that you get experience in going to a variety of outpatient clinics as well as scrubbing in regularly in the OR then you should not have any problems.
Hope these are useful and good luck!
Clinical Skills and History Taking
1. Examine this ladies neck I started peripherally with a thyroid status exam, but the examiner prompted me to go directly to the neck. She was an afrocarribean lady with what I thought was bilateral parotid enlargement:
Q's
• Causes of symmetrical bilateral parotid enlargement
• What is most likely cause in her (sarcoidosis)
• He asked me about other manifestations outside the neck
2. Examine this lump on a man's back:
Large lipoma- I examined including assessing for fixity to muscle, transillumenence, draining lymph nodes etc
Q's
• What muscle was it overlying
• What is blood supply and lymph drainage of that muscle (was Lat Dorsi)
• To describe how you would excise this lipoma
• Consent patient for procedure
3. HISTORY:
Very simple history for likely colorectal Ca,
Q's
• RF for colorectal ca
• Difference in presentation for IBD and colorectal ca --> why is this change in bowel habit Crohns or UC
• How you would investigate him
• Why CT pneumocolon is inferior to colonoscopy (you can biopsy with latter)
4. CVS Exam:
Patient had AS
Q's
• Other causes of ESM --Hypertrophic cardiomyopathy
• How to investigate to see if fit for surgery- ECHO to look at EF and gradient across valve
• Any important considerations for anaesthesia? No epidural, cause hypotension which can be compensated in AS due to fixed output state
5. Hx and brief resp exam
Completely normal exam, history of long-standing panic disorders
Q's
• Would you pass this lady in pre-assessment for an elective cholecystectomy
• What are the ASA gradings? - what would she be?
• Can you think of ways to optomise her- SSRI trial
Anatomy (3):
1. Upper limb, prosection, live patient and skeleton all in one: Rapid fire 20 questions e.g- where is the insertion of supraspinator, (demonstrate on skeleton), demonstrate pronation and supination (live pt) point out long head of biceps (pro-section)
2. Unmanned prosection of mediastinum and thorax in saggital section. Lots of flags- just had to identify the structures - was v hard !
3. Manned station- very easy, lower GI/ Hepatobillary -prosection of bowels- asked blood supply, significance of water shed area and marginal artery of drummond. Also was given a colonoscopy picture of bowel ca and asked to identify it. Then asked dukes classification. Then hepatobillary anatomy on another prosection Skills
(2): Taking blood cultures Important points: patient was there- there were marks for interacting.
If you spoke to her, she told you she was IVDU and Hep +ve, so u had to take appropriate cautions-eye protection, and noting it on the form for the lab. Change needles before you fill bottles, and fill aerobic first. Offer to label them.
Also they had an obs chart and it said she was Pen allergic.
They said she had a new murmur, and was spiking on obs chart and asked for a differential. I said that I wld query infective endocarditis, they asked organism, I said staph, and they asked me if I want to write up Abx- I did, VANC--> she was penn allergic which was the trick of the station.
Scrubbing Self explanatory
Other stations:
Critical Care: Definitions of sepsis, septicaemia, septic shock etc. Asked for intepretation of a HDU chart, and generally where and how to ressucitate a patient in shock, ABCDE...
Comm skills- Calming an eratic mother whose son had been in accident in playground and was on the table for an emergency splenectomy. Had to tell her risk and complications, long term e.g immunizations. and she was questioning why he was taken to surgery without consent, so u had to to know the legislation that the doc act in interest of child if no consenting adult is available in an emergency Comm skills- Discharge summary.
Information Giving- Polytrauma patient, needed to read notes in prep station and call trauma surgeon at home who is on call. He just asked questions to see if you knew the ATLS guidelines, and about management of open fractures.
Information Receiving (written stations)
ECG: AF with fast ventricular response- asked to inteprate rate/ rhythm, about reversible causes, and treatment
CT- Bilateral pleural effusions in a pancreatitic- asked about ARDS, and glasgow scoring
Erect Chest X-Ray- Perforated viscus
Hope these are useful and good luck!
Clinical Skills and History Taking
1. Examine this ladies neck I started peripherally with a thyroid status exam, but the examiner prompted me to go directly to the neck. She was an afrocarribean lady with what I thought was bilateral parotid enlargement:
Q's
• Causes of symmetrical bilateral parotid enlargement
• What is most likely cause in her (sarcoidosis)
• He asked me about other manifestations outside the neck
2. Examine this lump on a man's back:
Large lipoma- I examined including assessing for fixity to muscle, transillumenence, draining lymph nodes etc
Q's
• What muscle was it overlying
• What is blood supply and lymph drainage of that muscle (was Lat Dorsi)
• To describe how you would excise this lipoma
• Consent patient for procedure
3. HISTORY:
Very simple history for likely colorectal Ca,
Q's
• RF for colorectal ca
• Difference in presentation for IBD and colorectal ca --> why is this change in bowel habit Crohns or UC
• How you would investigate him
• Why CT pneumocolon is inferior to colonoscopy (you can biopsy with latter)
4. CVS Exam:
Patient had AS
Q's
• Other causes of ESM --Hypertrophic cardiomyopathy
• How to investigate to see if fit for surgery- ECHO to look at EF and gradient across valve
• Any important considerations for anaesthesia? No epidural, cause hypotension which can be compensated in AS due to fixed output state
5. Hx and brief resp exam
Completely normal exam, history of long-standing panic disorders
Q's
• Would you pass this lady in pre-assessment for an elective cholecystectomy
• What are the ASA gradings? - what would she be?
• Can you think of ways to optomise her- SSRI trial
Anatomy (3):
1. Upper limb, prosection, live patient and skeleton all in one: Rapid fire 20 questions e.g- where is the insertion of supraspinator, (demonstrate on skeleton), demonstrate pronation and supination (live pt) point out long head of biceps (pro-section)
2. Unmanned prosection of mediastinum and thorax in saggital section. Lots of flags- just had to identify the structures - was v hard !
3. Manned station- very easy, lower GI/ Hepatobillary -prosection of bowels- asked blood supply, significance of water shed area and marginal artery of drummond. Also was given a colonoscopy picture of bowel ca and asked to identify it. Then asked dukes classification. Then hepatobillary anatomy on another prosection Skills
(2): Taking blood cultures Important points: patient was there- there were marks for interacting.
If you spoke to her, she told you she was IVDU and Hep +ve, so u had to take appropriate cautions-eye protection, and noting it on the form for the lab. Change needles before you fill bottles, and fill aerobic first. Offer to label them.
Also they had an obs chart and it said she was Pen allergic.
They said she had a new murmur, and was spiking on obs chart and asked for a differential. I said that I wld query infective endocarditis, they asked organism, I said staph, and they asked me if I want to write up Abx- I did, VANC--> she was penn allergic which was the trick of the station.
Scrubbing Self explanatory
Other stations:
Critical Care: Definitions of sepsis, septicaemia, septic shock etc. Asked for intepretation of a HDU chart, and generally where and how to ressucitate a patient in shock, ABCDE...
Comm skills- Calming an eratic mother whose son had been in accident in playground and was on the table for an emergency splenectomy. Had to tell her risk and complications, long term e.g immunizations. and she was questioning why he was taken to surgery without consent, so u had to to know the legislation that the doc act in interest of child if no consenting adult is available in an emergency Comm skills- Discharge summary.
Information Giving- Polytrauma patient, needed to read notes in prep station and call trauma surgeon at home who is on call. He just asked questions to see if you knew the ATLS guidelines, and about management of open fractures.
Information Receiving (written stations)
ECG: AF with fast ventricular response- asked to inteprate rate/ rhythm, about reversible causes, and treatment
CT- Bilateral pleural effusions in a pancreatitic- asked about ARDS, and glasgow scoring
Erect Chest X-Ray- Perforated viscus
There and back again (almost)
Ok so massive hiatus from the blog and website, I know and I apologise profusely. Its not that IWTBAS is not a huge priority for me, but I have had a lot of work to clear. So now that I managed to get into Core Surgery in London, passed USMLE Step 1 (and revising for 2CK), finished a Plastic Surgery Observership in the USA, completed 3 audits, implemented a DVT pathway at West Middlesex University hospital, written two case reports and finished off a meta-analysis, I am READY to get back to what's important! I will be regularly updating this blog and finishing www.iwanttobeasurgeon.com.
So as a treat, the next post will contain some old stations from friends who sat the exam a couple of years ago and I will also scribble a few words on Core Surgery applications. Again, let me know what you would like to see more of in this blog and also on the site.
Amel
Friday, 18 February 2011
Journal Club
We are starting a monthly online journal club to try and stimulate discussion about the latest research in surgery. We will pick one article per month and post it a few days before we post our appraisal of the paper. Then we hope this will stimulate debate amongst our readers. If there are any particular papers you wish to submit then email us and better still if you would like to contribute to journal club then we would also love to hear from you. The reason we are doing this is it is difficult to keep up with what's happening in research on top of all the clinical and extra-curricular activities. We hope this will help in some small way.
The article I have chosen for this month is:
Eur Arch Otorhinolaryngol. 2011 Mar;268(3):405-14. Epub 2010 Sep 15.
Laryngeal transplantation in minipigs: vascular, myologic and functional outcomes.
Birchall MA, Kingham PJ, Murison PJ, Ayling SM, Burt R, Mitchard L, Jones A, Lear P, Stokes CR, Terenghi G, Bailey M, Macchiarini P.
You can find it on pubmed and sign in via athens/institutional login to get the full text.
Amel
The article I have chosen for this month is:
Eur Arch Otorhinolaryngol. 2011 Mar;268(3):405-14. Epub 2010 Sep 15.
Laryngeal transplantation in minipigs: vascular, myologic and functional outcomes.
Birchall MA, Kingham PJ, Murison PJ, Ayling SM, Burt R, Mitchard L, Jones A, Lear P, Stokes CR, Terenghi G, Bailey M, Macchiarini P.
You can find it on pubmed and sign in via athens/institutional login to get the full text.
Amel
Sunday, 13 February 2011
Website Renovation Part deux...
Hi all
So sorry but moving the website along has proven much more time consuming than I initially anticipated. I can however give you a sneak peak on www.iwanttobeasurgeon.com. There is still so much content to move over including anatomy and videos of clinical skills. However it will all be so much easier to access once its all up there :) You will note that we have added a new research skills section which will contain articles on how to conduct research, how to write up papers and how to get published. We will also be introducing a monthly journal club onto this blog and I hope you will be able to partcipate by adding your comments :)
Anyway, good luck everyone sitting exams and especially those who have been emailing questions to us. Please write back and let everyone know how you get on.
Amel
So sorry but moving the website along has proven much more time consuming than I initially anticipated. I can however give you a sneak peak on www.iwanttobeasurgeon.com. There is still so much content to move over including anatomy and videos of clinical skills. However it will all be so much easier to access once its all up there :) You will note that we have added a new research skills section which will contain articles on how to conduct research, how to write up papers and how to get published. We will also be introducing a monthly journal club onto this blog and I hope you will be able to partcipate by adding your comments :)
Anyway, good luck everyone sitting exams and especially those who have been emailing questions to us. Please write back and let everyone know how you get on.
Amel
Tuesday, 1 February 2011
Website and more
Thanks Amel for improving the website. More contents will be added in the next few weeks.
Good luck to those sitting the MRCS exams, it's a very passable exam.
Few tips to get through the exam:
1. If you don't know the answer to a question; ask the examiner to move on, and come back to that question depending on time. This is because, the marks are allocated per questions, and you do not need to get the questions correct in the order of being asked to progress through the station,
2. Some examiners take your first answer, where as others will permit a few attempts to allow you to get to the correct answer before moving on.
3. Basic finals standard examination, and history taking skills is enough to easily pass the exam.
4. Make sure you are familiar with dry skeletons, and all the points where any significant muscles or bone attaches.
5. Prepare from previous stations as they are likely to repeat stations. At least half of my stations were examined in the previous 2 years.
Good luck, hope you find this useful.
Keep tuned for more updates.
Romesh
Ps: click here for an interesting case report.
Good luck to those sitting the MRCS exams, it's a very passable exam.
Few tips to get through the exam:
1. If you don't know the answer to a question; ask the examiner to move on, and come back to that question depending on time. This is because, the marks are allocated per questions, and you do not need to get the questions correct in the order of being asked to progress through the station,
2. Some examiners take your first answer, where as others will permit a few attempts to allow you to get to the correct answer before moving on.
3. Basic finals standard examination, and history taking skills is enough to easily pass the exam.
4. Make sure you are familiar with dry skeletons, and all the points where any significant muscles or bone attaches.
5. Prepare from previous stations as they are likely to repeat stations. At least half of my stations were examined in the previous 2 years.
Good luck, hope you find this useful.
Keep tuned for more updates.
Romesh
Ps: click here for an interesting case report.
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