flash cards MRCS

Syndrome Key MRCS Details & Genetics

Cystic Fibrosis Genetics: AR, CFTR gene (Chr 7, \Delta F508).

Surgical: Meconium ileus, DIOS, gallstones, pancreatitis.

Dx: Sweat chloride >60\text{ mEq/L}.

MEN 1 (Wermer) Genetics: AD, MEN1 gene (Chr 11).

3 Ps: Parathyroid (95%), Pancreas (Gastrinoma), Pituitary.

MEN 2A (Sipple) Genetics: AD, RET oncogene (Chr 10).

MPH: Medullary thyroid, Pheochromocytoma, Hyperparathyroidism.

MEN 2B Genetics: AD, RET gene.

MMMP: Medullary thyroid, Marfanoid habitus, Mucosal neuromas, Pheochromocytoma.

Li-Fraumeni Genetics: AD, TP53 (Chr 17p).

SBLA: Sarcoma, Breast, Leukemia, Adrenal.

FAP Genetics: AD, APC gene (Chr 5q21).

Yield: 100% CRC risk by age 40. Gardner's (osteomas) and Turcot's (CNS).

Lynch (HNPCC) Genetics: AD, MMR genes (MSH2/MLH1).

Yield: Right-sided CRC & Endometrial Ca. Amsterdam II 3-2-1 Rule.

VHL Genetics: VHL gene (Chr 3p).

Yield: Clear cell RCC, Hemangioblastomas, Pheochromocytoma.

🎀 Section 2: Breast Carcinoma Recall

Triple Assessment: Clinical exam, Radiology (US <35y, Mammo >35y), and Pathology (Core biopsy/FNA).

Pathology:

Invasive Ductal (NST): Most common.

Invasive Lobular: Often bilateral; associated with loss of E-cadherin.

DCIS: Microcalcifications; basement membrane intact.

Markers: ER/PR +ve (Tamoxifen/AI); HER2 +ve (Trastuzumab - monitor heart).

🫁 Section 3: Pulmonary & Urological Carcinoma

Pulmonary Carcinoma Paraneoplastic Stack

Small Cell (SCLC): Neuroendocrine origin. Associated with SIADH (low Na), ACTH (Cushing’s), and Lambert-Eaton.

Squamous Cell: Central location. Secretes PTHrP leading to Hypercalcaemia.

Adenocarcinoma: Peripheral location. Most common in non-smokers. Associated with HPOA (clubbing/periostitis).

Renal & Urological Malignancies

Renal Cell (RCC): Clear cell type is most common. Look for the triad: Hematuria, loin pain, and mass. Note: Left-sided varicocele can indicate renal vein obstruction by tumor.

Bladder Cancer: Primarily Transitional Cell (TCC). Smoking and aniline dyes are risks. Schistosomiasis specifically causes Squamous Cell Ca.

Prostate Cancer: Usually in the Peripheral Zone. Diagnosed via TRUS biopsy.

🏛 Section 4: Anatomy & Surgical Recall

Epiploic Foramen (Winslow) Boundaries:

Superior: Caudate lobe.

Inferior: 1st part of duodenum.

Anterior: Hepatoduodenal ligament (Portal triad).

Posterior: IVC.

Pringle Maneuver: Clamping the hepatoduodenal ligament; the caudate lobe remains superior to the clamp.

Inguinal Canal Nerves:

Ilioinguinal (L1): Sits on top of the cord; most at risk in open repair.

Genital Branch (L1, L2): Sits inside the cord; enters via the deep ring.

ENT: Cholesteatoma features offensive discharge, conductive hearing loss, and bone erosion (Incus).

Pro-tip for your MRCS A Doc: Use the "Surgical Sieve" (INVITED MD) to organize differentials for any surgical condition: Infection, Neoplasia, Vascular, Inflammatory, Traumatic, Endocrine, Degenerative, Metabolic, Drugs.

Drug Class Key MRCS Recall Points

Induction Agents Propofol: Most common; causes hypotension. Ketamine: Dissociative; causes hypertension/tachycardia (useful in trauma). Etomidate: Hemodynamically stable; causes adrenal suppression.

Muscle Relaxants Suxamethonium: Depolarising; risk of Malignant Hyperthermia & Hyperkalaemia. Rocuronium: Non-depolarising; reversed by Sugammadex.

Local Anaesthetics Lidocaine: Max dose 3mg/kg (plain) or 7mg/kg (with adrenaline). Bupivacaine: Cardiotoxic; longer acting.

🔪 Section 6: Abdominal & Head/Neck Surgery

Abdominal Surgery

Small Bowel Obstruction (SBO): Most common cause is Adhesions (post-op) > Hernias.

Large Bowel Obstruction: Most common cause is Malignancy > Volvulus.

Mesenteric Ischaemia: "Pain out of proportion to clinical findings." Usually involves the Superior Mesenteric Artery (SMA).

Calot’s Triangle: Boundaries are the Cystic Duct, Common Hepatic Duct, and Inferior edge of the Liver. Contains the Cystic Artery.

Head & Neck Anatomy & Surgery

Thyroglossal Cyst: Moves upward on tongue protrusion.

Branchial Cyst: Found at the anterior border of the SCM (upper 1/3); contains cholesterol crystals.

Parotid Gland: The Facial Nerve (CN VII) divides it into deep and superficial lobes. Most common tumor: Pleomorphic Adenoma.

Submandibular Gland: Surgery risks the Marginal Mandibular Nerve (weakness of lower lip).

🦴 Section 7: Trauma (ATLS 10th Ed. High-Yield)

Lethal Triad: Coagulopathy, Acidosis, Hypothermia.

Tension Pneumothorax: Clinical diagnosis (don't wait for X-ray). Needle decompression at 5th ICS mid-axillary line (Adults).

Beck’s Triad (Cardiac Tamponade): Muffled heart sounds, distended neck veins, hypotension.

Flail Chest: \ge 2 ribs fractured in \ge 2 places; paradoxical chest wall movement.

🌡 Section 8: Physiology & Pathology

Physiology (Acid-Base & Fluids)

Shock Stages: * Class II: Tachycardia (HR >100).

Class III: Hypotension starts (SBP drops).

Conn’s Syndrome: Primary Hyperaldosteronism (Low K+, High Na+, High BP, Low Renin).

SIADH: Low Serum Osmolality, High Urine Osmolality, High Urine Sodium.

Pathology (Cellular Changes)

Metaplasia: Reversible change from one cell type to another (e.g., Barrett's Oesophagus: Squamous to Columnar).

Apoptosis: Programmed cell death; No inflammation. Necrosis: Cell death with inflammation.

Wound Healing: * Inflammatory: 0–3 days (Neutrophils/Macrophages).

Proliferative: 3 days–3 weeks (Fibroblasts/Type III Collagen).

Remodelling: 3 weeks–1 year (Type I Collagen replaces Type III).

🫁 Section 9: Pulmonary Oncology (Expanded)

Pancoast Tumour: Apical lung cancer. Causes Horner’s Syndrome (Miosis, Ptosis, Anhidrosis) via involvement of the sympathetic chain.

SVC Obstruction: Facial swelling, fixed raised JVP, Pemberton’s sign positive. Emergency treatment: Dexamethasone + Stenting.

Consolidated Doc Update

Since you are compiling this into a Google Doc, I recommend adding a "Table of Contents" at the top for these new sections.

Would you like me to draft a "High-Yield Anatomy Numbers" table (e.g., nerve roots, vertebral levels) to finish off

the Physiology/Anatomy sections?