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2020_ME
BASIC SCIENCE
FOR THE
MRCS
A revision guide for surgical trainees
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BASIC SCIENCE
FOR THE
MRCS
A revision guide for surgical trainees
FOURTH EDITION
Michael S. Delbridge MBChB (Hons) MD FRCS (Vascular)
Consultant Vascular and Endovascular Surgeon
Norfolk and Norwich University Hospital, Norwich, UK
Wissam Al-Jundi MBBS MSc MEd MBA FRCS (Vascular)
Consultant Vascular and Endovascular Surgeon
Norfolk and Norwich University Hospital, Norwich, UK
Honorary Senior Lecturer, University of East Anglia, Norwich, UK
3
© 2023, Elsevier Limited. All rights reserved.
First edition 2006
Second edition 2012
ird edition 2018
e right of Michael S. Delbridge and Wissam Al-Jundi to be identied as authors of this work has been asserted by them in accordance with the
Copyright, Designs and Patents Act 1988.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying,
recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission,
further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center
and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
is book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).
Notices
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods,
compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verication of
diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or
operation of any methods, products, instructions, or ideas contained in the material herein.
ISBN: 978-0-7020-8540-6
Content Strategist: Alexandra Mortimer
Content Project Manager: Taranpreet Kaur
Design: Renee Duenow
Marketing Manager: Deborah Watkins
Pirated by: Aribbai. #OnlyAribbaiIsReal
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Preface vi
Acknowledgements vii
I ANATOMY
1 The Thorax 2
2 The Abdomen, Pelvis and Perineum 20
3 The Upper Limb and Breast 62
4 The Lower Limb 80
5 The Head, Neck and Spine 106
6 The Nervous System 145
II PHYSIOLOGY
7 General Physiology 171
8 Respiratory System 186
9 Cardiovascular System 204
10 Gastrointestinal System 214
11 Urinary System 232
12 Endocrine System 240
13 Nervous and Locomotor Systems 259
CONTENTS
III PATHOLOGY
14 Cellular Injury 279
15 Disorders of Growth, Morphogenesis and Differentiation 297
16 Inflammation 305
17 Thrombosis, Embolism and Infarction 311
18 Neoplasia 317
19 Immunology 330
20 Haemopoietic and Lymphoreticular System 342
21 Basic Microbiology 360
22 System-Specific Pathology 386
IV APPENDIX
OSCE Scenario Answers 431
Index 490
v
ACKNOWLEDGE
PREFACE
e authors are grateful to the publishers, Elsevier, for the
invitation to produce a fourth edition of Basic Science for
the MRCS.
e book is a concise revision guide to the core basic
sciences which comprise the essential knowledge for those
entering surgical training. It is a basic requirement that
every surgical trainee has a thorough understanding of the
basic principles of anatomy, physiology and pathology irrespective of which speciality within surgery they intend to
pursue as a career. It is equally important that they understand the clinical application of the basic sciences. is
revision guide has been written with this in mind, using a
bullet-point style which we hope will make it easier for the
reader to revise the essential facts.
Much has changed both in the undergraduate curriculum and in the post-graduate examination system since
the rst edition was published 16 years ago. In this fourth
edition, the chapters have been updated where appropriate and sections expanded to cover topics which are particularly relevant to examinations. As most examinations
are Objective Structured Clinical Examinations (OSCEs),
each chapter has OSCE scenario questions at the end with
sample answers provided in an appendix at the back of
the book. More than 20 new OSCE scenarios have been
added to this edition. In addition, to accompany this edition there is an online question bank within the Student
Consult eBook comprising over 200 Single Best Answer
questions (SBAs) based on each chapter in the book. e
reader can access the section from the Table of Contents
in the eBook.
No book of this length could hope to be comprehensive
and we have therefore concentrated on the topics that tend
to be recurring examination themes. As with previous editions, this book has been written primarily as a means of
rapid revision for the surgical trainee. However, it should
also prove useful for those in higher surgical training, as
well as for the surgically inclined, well-motivated medical student. We hope that this fourth edition will provide
a simple and straightforward approach to the basic science
that underpins surgical training.
Michael S. Delbridge
Wissam Al-Jundi
vi
ACKNOWLEDGEMENTS
We are extremely grateful to the publishers, Elsevier, and in particular to Alexandra Mortimer, Content
Strategist, for her support and help with this project. We are also grateful to the following colleagues
at the Sheeld Teaching Hospitals NHS Foundation Trust who provided help, advice and criticism:
Dr Paul Zadik, Consultant Microbiologist; Dr TC Darton, NIHR Academic Clinical Research Fellow,
Infectious Diseases and Medical Microbiology; Mr BM Shrestha, Consultant General and Transplant
Surgeon. We would also like to thank our consultant radiologist colleagues, who provided images: Dr
Matthew Bull, Dr Peter Brown, Dr James Hampton, Dr Robert Cooper and Dr Rebecca Denoronha.
Mr Raery would like to thank his secretary, Mrs Denise Smith, for the long hours and hard work she
has put in typing and re-typing the manuscript, and Anne Raery for collating and organizing the
whole manuscript into its nal format. e task could not have been completed without them.
e gures in this book come from a variety of sources, and many are reproduced from other publications, with permission, as follows:
Fig. 3.9 from the University of Michigan Medical School, with kind permission of omas R. Gest,
PhD
Figs 13.10A, 13.10B and 13.11 from Crossman & Neary (2000) Neuroanatomy: An Illustrated Colour
Text, 2nd edn. Churchill Livingstone, Edinburgh
Figs 3.11 and 4.14, and Tables 6.1 and 6.3 from Easterbrook (1999) Basic Medical Sciences for MRCP
Part 1, 2nd edn. Churchill Livingstone, Edinburgh
Fig. 9.1 from Homan & Craneeld (1960) Electrophysiology of the Heart. McGraw-Hill, New York
(now public domain)
Figs 4.20, 4.24, 5.25, 6.5 and 6.6 from Jacob (2002) Atlas of Human Anatomy. Churchill Livingstone,
Edinburgh
Figs 8.1, 8.12B, 8.12C, 10.3, 10.4, 10.5, 10.6, 10.7, 11.1, 11.3, 13.1, 13.5 and 13.6 from McGeown (2002)
Physiology, 2nd edn. Churchill Livingstone, Edinburgh
Figs 8.3 and 8.4 from Pocock & Richards (2004) Human Physiology: e Basis of Medicine, 2nd edn.
Oxford University Press, Oxford
Figs 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 1.11, 1.13, 1.14, 2.1, 2.2, 2.3, 2.4, 2.7, 2.8, 2.9, 2.10, 2.12, 2.13,
2.14, 2.17, 2.18, 2.19, 2.20, 2.21, 2.22, 2.23, 2.24, 2.25, 2.27, 2.28, 2.29, 2.30, 2.31, 2.32, 5.1, 5.2, 5.7,
5.8, 5.16, 5.17, 6.1, 6.2, 6.3, 6.4, 6.7, 6.8, 6.9, 6.10, 6.11, 6.12, 6.13, 6.15, 8.2, 8.6, 8.10, 8.12A, 9.2, 9.4,
9.6, 11.4, 12.1, 12.4, 13.8, 19.2, 20.1, 20.2, 20.3, 21.1, 22.1, 22.2 and 22.3 from Raery (ed) (2000)
Applied Basic Science for Basic Surgical Training. Churchill Livingstone, Edinburgh
Fig. 17.2 and A.3 (Q&A) from Pretorius & Solomon (2011) Radiology Secrets Plus, 3rd edn. Elsevier,
Philadelphia
Figs 5.35, 6.14, 22.2 & A.5 (Q&A), 22.3 & A.6 (Q&A) and 22.5 & A.7 (Q&A) from Raery, Delbridge
& Wagsta (2011) Pocketbook of Surgery, 4th edn. Churchill Livingstone, Edinburgh
Figs 1.10, 3.1, 3.2, 3.3, 3.4, 3.8, 3.12, 4.1, 4.2, 4.3, 4.4, 4.6, 4.7, 4.8, 4.9, 4.11, 4.12, 4.13, 4.15, 4.16, 5.3, 5.4,
5.5, 5.9, 5.10, 5.11, 5.13, 5.14, 5.21, 5.22, 5.24, 5.26, 5.27, 5.28, 5.29, 5.30, 5.31 and 6.16 from Rogers
(1992) Textbook of Anatomy. Churchill Livingstone, Edinburgh
Fig. 13.4 from Stevens & Lowe (2000) Pathology, 2nd edn. Mosby, Edinburgh
Figs 15.1 and 15.2, and Boxes 15.1 and 15.2 from Underwood (ed) (2004) General and Systematic
Pathology, 4th edn. Churchill Livingstone, Edinburgh
ACKNOWLEDGEACKNOWLEDGE
vii
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