Dr.Shahriar's Surgical Handicraft

23/08/2025

One of Most frequent Recall of MRCS ...

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22/08/2025

A Q bank That Combinds your Most Important eMRCS Pastest and Recall MCQ for Rapid Revision !!!

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17/08/2025

60% of the candidates marked this wrong ...

During an open appendectomy, what is the first layer to be opened?
Options:
A) Skin
B) External oblique aponeurosis
C) Internal oblique
D) Transversus abdominis
E) Peritoneum

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14/08/2025

100% Corrected - Illustrated - Explained -
MRCS Surgical Scenarios of April 2025 ...Best RECALL for MRCS part A ....

Take a look - Trial Version
https://drive.google.com/file/d/1nPqNpjaFMPdZuAJEkJ5TgjpfNd-fatv_/view?usp=drive_link

13/08/2025

Recall Correction Jan 2021 @ Original Q ... But Correct Scenario and answer given in comment section

Question 04 :@ J-2021 @ Surgical Microbiology
An 80-year-old woman with a background of COPD is admitted with acute left-sided lower abdominal pain. She is pyrexial and tachycardic on arrival. Clinical examination reveals tenderness in the left iliac fossa. Her abdominal X-ray is unremarkable. Her white cell count is 12 × 10⁹/L. She is started on intravenous Co-amoxiclav for presumed diverticulitis.
On the seventh day of antibiotic therapy, she develops severe diarrhoea.
What is the most appropriate treatment?
A) Intravenous Meropenem
B) Intravenous Metronidazole
C) Intravenous Vancomycin
D) Oral Clindamycin
E) Oral Metronidazole
Correct Answer: E. Oral Metronidazole
________________________________________
Explanation:
This is a classical case of Clostridioides difficile (C. difficile) colitis following broad-spectrum antibiotic use. First-line treatment for non-severe C. difficile infection is oral metronidazole. Vancomycin (oral) or fidaxomicin is used in severe or recurrent cases, but IV vancomycin is ineffective in the bowel lumen. IV metronidazole is only used if the patient cannot tolerate oral intake.
________________________________________
Why Other Options Are Not Correct:
A) Intravenous Meropenem
A broad-spectrum carbapenem that can worsen C. difficile by further disrupting gut flora.
B) Intravenous Metronidazole
Ineffective for gut lumen pathogens unless oral route is unavailable or patient is critically ill.
C) Intravenous Vancomycin
Systemic vancomycin does not reach the colon effectively; oral vancomycin is used instead.
D) Oral Clindamycin
Clindamycin is a high-risk agent for causing C. difficile infection; not a treatment.
E) Oral Metronidazole
Correct — effective first-line for mild to moderate C. difficile infection.

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12/08/2025

Blunt Trauma of Chest - When o2 when ET

A 56-year-old man falls from a ladder at work and lands heavily on his left side.
On arrival to A&E:

Multiple left-sided rib fractures with visible paradoxical movement

Respiratory rate: 22/min

SpO₂: 94% on air

Difficulty speaking but able to complete full sentences

Arterial blood gas (on air): PaO₂ 9.5 kPa, PaCO₂ 4.8 kPa

BP: 134/80 mmHg, HR: 88 bpm

Question: What is the most appropriate initial management?

A) Immediate endotracheal intubation and mechanical ventilation
B) High-flow oxygen and adequate a**lgesia
C) Insertion of a chest drain on the affected side
D) Urgent thoracotomy
E) Non-invasive ventilation (CPAP/BiPAP)

06/08/2025

“Previously, MRCS questions—especially prior to 2024—tended to include longer clinical scenarios, often involving imaging findings or multidisciplinary discussions to provide context. However, more recent trends show a shift toward shorter, more concise questions, particularly in anatomy, physiology, and basic sciences. While the longer vignette-style format is still used for certain domains like ethics, surgical decision-making, and clinical judgment, it's important to be well-prepared for both question styles in current MRCS assessments.”

Old Q Pattern

A 68-year-old man presents with a large gastric mass and is scheduled for elective gastrectomy. Preoperative CT angiography shows a normal coeliac trunk branching into the left gastric, splenic, and common hepatic arteries. During the surgical planning meeting, the consultant asks the core trainee to identify which of the adjacent upper abdominal structures receives the majority of its parenchymal blood supply from a source not derived from the coeliac trunk.
Which of the following structures is not primarily supplied by a branch of the coeliac artery?
A. Oesophagus
B. Pylorus of stomach
C. Spleen
D. Liver parenchyma
E. Pancreas
Correct Answer: D. Liver parenchyma

03/08/2025

Colorectal Cancer Management
Colon

*If Rt colon upto prox 2/3rd of transvarse -
Right Hemicolectomy+ Ileo-colic Anastomosis
(No defunctioning needed)

*If transvarse colon proximal part-
Extended right hemi + Ileo-colic Anastomosis

*If distal transvarse- Ext Rt Hemi/left hemi

*If descending colon-Left hemi collect+CoCo Anastomosis+ defunctioning loop Ileostomy

*Sigmoid colon- High AR (Descending colon+Sigmoid colon+Part of rectum)+CR anastomosis+Defunctioning Loop Ileostomy

*Re**um-

T1-3N0- surgery
T4-Long time Chemo Radio then SURGERY.

Proximal 2/3rd (>6cm from a**l verge)-
AR (Part of sigmoid+Part of rectum)+CR anastomosis+ Defunctioning Loop Ileostomy

*Lower1/3rd-
APR(Part of sigmoid+Full rectum+Full A**l Ca**l)+End Colostomy


*A**l cancer-
1st chemo radio Then APR

*If liver Mets then first chemo, then surgery*

Obstruction

*Rt colon+transvarse colon-
Same as before

*Descending colon-
(SCEL)
Sub total Colectomy
(Ascending+Transvarse+Descending)+proximal stump:end Ileostomy and distal stump(Sigmoid and rectum):Mucus fistula

OR,LHC+End Colostomy

*Sigmoid colon(Obstruction/Perforation)-
Hartman Procedure (Procto sigmoidectomy +E Col)

*Re**um obstruction-
Emergency DECOMPRESSING LOOP COLOSTOMY proximal to obstruction
Then later staging by MRI
Then AR (upper 2/3rd)/APR(lower 1/3rd) according to necessity


Ulcerative Colitis-
Surgically curable

1st IV steroid 5days

Pt stable?
Go for Pan proctocolectomy+end ileostomy/ileo a**l pouch

Pt unstable?
Go for SCEL(Subtotal Colectomy+End Ileostomy)

Crohn's disease
Not completely curable

Segmental ressection

If fistula then Loose Seton

If sever CD with fistula-
Proctocolectomy e End Ileostomy
(No pouch in CD)

LYNCH(HNPCC)
Pan proctocolectomy e End Ileostomy

Colon perforateion
Ressection and END colostomy.
End To End Stoma Is Contraindicated because contaminated environment will result in Anastomosis failure

29/07/2025

Some Glimpse of our Work

22/07/2025

Let's Pray for Bangladesh 🇧🇩 Lets Pray for our Angels 🤲
O Allah, grant those children the highest place in Paradise, and make them among the birds of Jannah. Heal the broken hearts of their parents, and fill their hearts with patience, acceptance, and tranquility.
O Allah, heal our hearts as well, and fill them with the light of Your mercy and pleasure. Remind us that the meeting in the Hereafter is better and everlasting.