Suggested Books To Read During Your General Surgery Residency (Read More)
Bailey & Love's Surgery, 27th Edition Surgery Essence by Pritesh Singh (PGMEE) Sabiston's Textbook of Surgery
Farquharson's Textbook of Operative General Surgery, 10th Edition Surgery Sixer for NBE by Rajamahendran Surgery PreTest Self-Assessment and Review, Thirteenth Edition

What are Arnold Chiari Malformations?


  • These comprise a group of abnormalities involving the rhombencephalon (hindbrain) and the contents of the CV junction 
  • With common feature of impaired CSF circulation through the foramen magnum  
  • May be Congenital or Acquired
  • Ranging from simple herniation of the cerebellar tonsils through the foramen magnum to complete agenesis of the cerebellum 
  • Presently there is no consensus regarding the precise definition, classification, etiology and the surgical management 
  • Four types 
  • No anatomical or embryological correlation between them 


Historical Background of Arnold Chiari Malformations

  • 1883, John Cleland (Professor of anatomy in Glasgow, Scotland) - described hindbrain hernia in a child with myelodysplasia.
  • 1891 and 1896, Hans Chiari- (Professor of Pathology at German University, Prague, Czechoslovakia): analyzed data from >40 postmortem examinations of patients with hindbrain malformations
  • Chiari malformations I, II and III were coined in the earlier work and Chiari malformation IV was added in 1896 publication. 
  • 1894, Julius A. Arnold(Professor of Pathology at Heidelberg, Germany)- described a single myelodysplastic patient with associated hindbrain herniation.
  • Schwalbe & Gerdig included Arnold name in the eponym & designated it ARNOLD –CHIARI malformation 
Historical Background of Arnold Chiari Malformations

What are the types of Chiari Malformations?

Chiari type 0 malformation

  • alteration in Cerebro Spinal Fluid (CSF) hydrodynamics at the level of the foramen magnum. 
  • they have syringomyelia either without tonsil herniation or with only mild tonsil herniation

Chiari Type I malformation

  • caudal herniation of the cerebellar tonsils more than 5 mm below the foramen magnum
  • typically associated with hydrosyringomyelia.
  • not usually accompanied by descent of the brain stem or IV ventricle, nor associated with the presence of hydrocephalus.
  • Most common type
  • Presents in young 

Chiari type II malformation

  • caudal herniation of the cerebellar vermis, brain stem, and IV ventricle through the foramen magnum. 
  • associated with myelomeningocele, hydrocephalus, and, less frequently, hydrosyringomyelia. 
  • hypoplastic tentorium cerebelli, cranial lacunae, anomalies of the Sylvius aqueduct may exist.

Chiari type III malformation

  • consists of occipital encephalocoele, with some of the intracranial defects associated with Chiari II malformation.

Chiari type IV malformation

  • cerebellar aplasia or hypoplasia, associated with aplasia of the tentorium cerebelli.

Images showing various Chiari malformations


Image of a Type 1 Arnold-Chiari Malformation. The cerebellum has descended 7mm and there are herniated cerebellar tonsils into the foramen magnum.
Image of a Type 1 Arnold-Chiari Malformation. The cerebellum has descended 7mm and there are herniated cerebellar tonsils into the foramen magnum.
Artist's representation of a Chiari II malformation showing the points of potential obstruction that yield different subtypes of hydrocephalus
Artist's representation of a Chiari II malformation showing the points of potential obstruction that yield different subtypes of hydrocephalus
Neonate with Chiari malformation type III.T2-weighted mid-sagittal MRI scan of the patient shows a small posterior fossa, an deep parieooccipitalis fissure (open arrow), ad a partial callosal agenesis (curved arrow), and a caudal herniation of part of the brain stem through the foramen magnum, with inferior tip appearing between C5 and C6 (closed arrow). (https://www.sciencedirect.com/science/article/pii/S1930043315302697)
T1 weighted sagittal MRI showing a so called “Chiari IV” or primary cerebellar agenesis. There is a tiny portion of residual quadrangular lobule just caudal to the tectum and a normal sized posterior fossa. No associated meningomyelocele is present.
T1 weighted sagittal MRI showing a so called “Chiari IV” or primary cerebellar agenesis. There is a tiny portion of residual quadrangular lobule just caudal to the tectum and a normal sized posterior fossa. No associated meningomyelocele is present.

References

There are various informal and online MRCS courses which are being run by various successful candidates which are easy on pocket and promise to provide all the reading material and guidance to the candidates who join. We will be posting useful links and courses which are usually not advertised  so that those preparing for MRCS can benefit. Please choose the courses carefully at your own discretion.


Source: https://m.facebook.com/story.php?story_fbid=509416652979128&id=192474441340019

Do you want to appear in
MRCS PART A APRIL 2020 EXAM ?

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• Full online pastest
• Full materials from A to Z
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• Full Surgery Specialities iFile Lectures made for Paper 2 strengthening
• All Recalls finally and fully answered correctly
• Full guide from 20/12
till January exam day

The Course Fees include

• Online emrcs
• Online pastest
• Organised Daily Plan of Question Posting that force you into our day one to exam day - schedule

• Unlimited Zoom cloud access to all our lectures

• Full MRCS Part A Materials

• The Crash Courserevisiont that involves

1 - Daily Homework for our theory study from MRCSME Book

2 -iFiles - Strengthening your paper two weakness with our selected questions made in pdf files scenarios from highly yielding MRCS Books

3 - iMocks - the most repeated exam questions

4 - iRecalls - previous real solved exams
will be done Online On Zoom Cloud meetings including :

* January 2019
* September 2019
* April 2019
* January 2019
* September 2018
* April 2018
( surprise - scanned complete real exam)
* January 2018
* September 2017
* April 2017
* January 2017
* September 2016
* April 2016
* January 2016

Our Supreme Revision will raise your pass mark by 15% ;
You can check our January Candidates Scores

Answers to FAQs

You can join from now
You will be added to our Course group
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Our new Course Features allow you to attend every day session once you are free. We start 5 pm GMT but we have above 250 Surgeons in our Course ; no one can collect five Surgeons in one place for 4 hours...therefore all Course live discussions and sessions are permanently available once you are free from your list, clinic our hospital.

Course starts in 20/12
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Sharing my preparation plan and resources for preparation of MRCS Part A here. I would rate the difficulty of the exam as moderate, at least it was not something which can be taken lightly. There were times in the exam hall when I was doubting myself over my responses to the questions. Quite a few questions were very tricky, so you have to be on your toes while doing preparation.Until the day of the result I had a doubt over me cracking the exam, but the big day came as a pleasant surprise. Below I will break up the preparation into a few steps:


Step 0 : Understand what is MRCS Part A Exam and Which College to choose?

Step 1: Decide date of the exam giving yourselves enough time and a good headstart over the competition

Step 2: Choose your study resources

Step 3: Join various Facebook communities where students and seniors help each other over study resources and important information regarding the exams

Step 4: Revise what you have read

Step 5: Hold onto your nerves in the examination hall and don't do silly mistakes


Step 0: Understand what is MRCS Part A Exam and Which College to choose?

The MRCS examination is a crucial milestone for a surgical career in the UK; it determines whether a surgical trainee possesses the correct knowledge, skills and attributes to complete basic training and to progress to higher levels of specialist surgical training. Since MRCS is an intercollegiate exam, so after passing part A in any of the above college one can give part B in same or any of the other colleges. Degree will be awarded by the college in which Part B is given. There is no difference in value of degree awarded all are equal only difference is Edinburgh is more immigrant friendly college and Eng is more popular and difficult to get through. MRCS Part A exam is conducted by:

1.RCS England
https://www.rcseng.ac.uk/education-and-exams/exams/search/intercollegiate-mrcs-part-a

2.RCS Edinburgh
https://www.rcsed.ac.uk/exams/the-mrcs-exam

3.RCS Glasgow
https://rcpsg.ac.uk/surgeons/exams/mrcs/part-a

4.RCS Ireland
https://www.rcsi.ie/gensurgerymembersexams



Step 1: Decide date of the exam giving yourselves enough time and a good headstart over the competition

  • Deciding when to give the exam is one of the important factors which will drive your success in the exam
  • It is held three times a year in January, April and September with booking closing approximately 2 months before the exam date.
  • You can follow these two routes
    • Express Preparation: Requires 6 months. Suitable for those who do not have a very tight work schedule and can take out a good relaxed 4-6 hours of time to study each day.
    • Laid Back Preparation: Requires 1 year. Suitable for those who have a very busy work schedule and cannot devote more than 2-3 hours per day of study time.
  • Once you decide about which cohort you would fall in, book a date for the exam
  • Until you don't book a date, your brain will be in a denial about the exam preparation and  you will be as lazy as a toad. So if you are really serious, book a date at the earliest.

Step 2: Choose your study resources

  • What to read to crack MRCS again depends on when are you starting your preparation. 
  • In case you are going the express route your resources will include more of MCQs and EMQs, and less of theory books which will be used only for reference
  • In case you choose to go the laid back route, you have a chance to work on your weak areas, strengthen your basics and mix it with a right proportion of MCQ/EMQ practice everyday
  • Below are few books which are a must for preparation of MRCS Part A 
Best Theory Books for MRCS Part A Preparation

1) MRCS Part A: Essential Revision Notes: Book 1
(Buy Now)


2) MRCS Part A: Essential Revision Notes: Book 2
(Buy Now)


3) Basic Science for the MRCS: A revision guide for surgical trainees (MRCS Study Guides)
(Buy Now)


4) Oxford Handbook of Clinical Surgery
(Buy Now)


Best MCQ/EMQ Books for MRCS Part A Preparation

I cannot over emphasize the importance of doing as many MCQ/EMQs as possible because our brain usually is good at recalling readymade retained information in pressure situations, as in the exam hall it is sometimes difficult to come at conclusions. So having  done a few MCQ/EMQs on the topic given in the exam will increase your probability of giving a right response to the question. Below are a few books you can go through:

1) SBAs for the MRCS Part A: A Bailey & Love Revision Guide
Paperback – 25 Sep 2018
(Buy Now)


2) Bailey & Love Companion Guide Mcqs & Emqs In Surgery
(Buy Now)



3) Rush University Medical Center Review of Surgery
(Buy Now)

4) MRCS Practice Papers Part A: Paper 1 SBAs
(Buy Now)

5) MRCS Practice Papers Part A: Paper 2 EMQs
(Buy Now)

Best MCQ/EMQ Online Resources for MRCS Part A Preparation

  1. Pastest : Over 4,300 MRCS A exam-themed questions
  2. OnExam : Over 1,700 single best answer questions, 1,300 extended matching items and 2015 Mock Test 
  3. eMRCS : Over 2,000 Single Best Answer and Extended Matching questions based on themes from previous exams

Step 3: Join various Facebook communities where students and seniors help each other over study resources and important information regarding the exams

Following are a few communities which can help you understand your competition, keep you motivated and help you with more guidance on the study resources: 

Step 4: Revise what you have read

One month before the exam stop reading anything new and focus only on the revision. Stick to MCQ/EMQs for your revision. Try to take a glance of all of them atleast once. 

Step 5: Hold onto your nerves in the examination hall and don't do silly mistakes

On the D-Day... 
  • Stay composed
  • Read questions carefully
  • Mark the options as you attempt questions
  • Keep a track of time, remember you have less than a minute to attempt each question. Time is one of the important factor which will determine your success.
  • Avoid silly mistakes
  • Keep your senses working 
  • Don't get nervous
  • Take good breakfast, stay energized and well hydrated 
If you have studied well, you will definitely clear the exam.

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Frequently Asked Questions about MRCS Exam preparation


1) What is the best time for appearing in MRCS Part A for Indian doctors?

For MRCS Part A, the best time to prepare and appear in exam in my view is 2nd year, because you have had a good practical exposure to most clinical situations which are asked in the exams by then. This will make reading theory and attempting questions more interesting.


2) Can I appear in MRCS Part A after after successfully completing my pg entrance exams?


However if you think you have enough time available after your pg entrance exams, and you think you are comfortable with basic knowledge of  supespecialties like urology, vascular surgery, orthopaedics, neurosurgery etc, you can go ahead with MRCS Part A.

3) What is the best time for appearing in MRCS Part B exams for Indian doctots?


For MRCS Part B, the best time to prepare is 3rd year, you are very strong clinically by then and you will be able to prepare with minimum effort. Your probability to pass the exam will also be higher. In addition to it, it will also help in preparation of final year general surgery clinicals.

4) After doing MRCS part A, within how much time we have to pass MRCS part B? 

After passing part A, you are required to pass Part B of the examination within seven years. Otherwise successful MRCS Part A result will be considered as expired.


5) Is MRCS Exam mandatory for doing FRCS?

There can be a direct entry to FRCS too but for experienced surgeons only and that too after satisfying a lot of other criteria. But MRCS makes it easier to get GMC registration, Royal college sponsorship, fellowships and jobs in the UK.


6) Can I start my preparation for MRCS immediately after finishing my housejob?

You can start your preparation for MRCS Part A immediately after finishing your housejob but it is always better to have some basic surgical experience before you appear for MRCS Part B.


7) Is MRCS Degree of any use in India?

A degree from western country adds to a surgeon's bona fide. It shows that your standard of knowledge matches the international standards. That is the reason many specialists resort to naming the institution or University from which they obtained the MRCS/ FRCS in brackets after the degree. MRCS is a very standardized examination with emphasis on basic sciences. MRCS can authenticate minimum proficiency in the basic principles of General Surgery.

8) What are the changes in the pattern of MRCS Part A exam?

MRCS A exam earlier used a mixture of single best answer multiple choice questions (MCQs) and extended matching MCQs (EMQs) in Paper 2. From September 2018, only single best answer MCQs are being asked in the paper.


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More on MRCS


ADVANTAGES AND DISADVANTAGES OF DOING MRCS
http://www.worldsurgeryforum.net/2017/07/advantages-and-disadvantages-of-MRCS.html

MRCS PART B PREPARATION FREE VIDEOS
http://www.worldsurgeryforum.net/2016/12/mrcs-part-b-preparation-free-videos.html

FREQUENTLY ASKED QUESTIONS ABOUT MRCS EXAM PREPARATION
http://www.worldsurgeryforum.net/2016/10/frequently-asked-questions-for-mrcs.html

BEST BOOK FOR STUDYING CLINICAL EXAMINATION FOR MRCS PART B
http://www.worldsurgeryforum.net/2016/12/best-book-for-studying-clinical.html

PASTEST VS EMRCS VS ONEEXAM FOR PREPARATION OF MRCS PART A
http://www.worldsurgeryforum.net/2017/01/pastest-vs-emrcs-vs-oneexam-for.html

A DISCUSSION ON MRCS EXAM ELIGIBILITY
http://www.worldsurgeryforum.net/2017/01/a-discussion-on-mrcs-exam-eligibility.html


Psoas Major Anatomy . Check out this awesome diagram on Psoas Major muscle anatomy #MRCS #mrcsprep #anatomy #Muscle via WSF Instagram

Ref: http://www.breannaspainblog.com/blog-posts/2018/6/15/muscular-anatomy-101-a-full-set-of-drawn-muscles-with-attachments-innervations-blood-supplies-and-actions

Biceps Brachii Check out this awesome diagram on Biceps Brachii muscle anatomy | #Muscle #anatomy #MRCS #mrcsprep via WSF Instagram