MRCS Pakistan

30/12/2025

Lower-Limb Neuropathies | Quick Clinical Anatomy Review
Lower-limb neuropathies commonly arise from involvement of the lumbosacral plexus, a major nerve network supplying the lower extremities.
🔹 Lumbosacral Plexus
Formed by spinal nerve roots T12–S3
Divided into:
Lumbar plexus (L1–L4) → anterior thigh
Sacral plexus (L4–S4) → posterior thigh, leg, and foot
Main role: motor and sensory innervation of the lower limb
🔹 Common Causes of Plexopathy
Diabetes mellitus
Malignancy
Radiation injury
Idiopathic
Occasionally trauma
🔹 Clinical Patterns
➡️ Lumbar Plexus Lesion
Weak hip flexion
Weak thigh adduction
Weak knee extension
Sensory loss over anterior thigh and leg
➡️ Sacral Plexus / Lumbosacral Trunk Lesion
Weak posterior thigh, leg, and foot muscles
Sensory loss in S1–S2 distribution
➡️ Complete Plexus Involvement (Rare)
Severe weakness and muscle wasting of the lower limb
Areflexia
Widespread sensory loss from perianal region to toes
📌 Key Point:
The pattern of weakness and sensory loss helps localize whether the lesion is lumbar, sacral, or the entire plexus.
If you find these anatomy & clinical correlations helpful, follow the page and share to support more high-yield medical content 📚✨

28/12/2025

Ulcerative Collitis
vs
CROHN's Disease

26/12/2025

❇️ Inflammatory Bowel Disease (IBD): Ulcerative Colitis vs Crohn Disease

IBD consists of chronic, immune-mediated inflammatory disorders of the gastrointestinal tract, primarily ulcerative colitis and Crohn disease.

Ulcerative Colitis (UC)
Location

→ Involves colon only
→ Begins in the re**um and extends proximally
→ Continuous inflammation (no skip areas)

Histology

→ Inflammation limited to mucosa and submucosa
→ Crypt abscesses (neutrophils within crypts)
→ No granulomas

Colonoscopy Findings

→ Friable, erythematous mucosa
→ Superficial ulcerations
→ Loss of haustrations → “lead pipe colon”

Stool Pattern

→ Bloody diarrhea
→ Often associated with mucus and urgency

Complications

→ Toxic megacolon
→ Severe bleeding
→ Increased risk of colorectal carcinoma (risk rises with disease duration)

Associated Conditions

→ Primary sclerosing cholangitis (PSC)
→ p-ANCA positivity (exam point)

Crohn Disease (CD)
Location

→ Can involve any part of the GI tract (mouth to a**s)
→ Most commonly terminal ileum and colon
→ Skip lesions (patchy involvement)

Histology

→ Transmural inflammation (entire bowel wall)
→ Non-caseating granulomas (when present)
→ Lymphoid aggregates

Colonoscopy Findings

→ Cobblestone mucosa
→ Deep linear ulcers
→ Creeping fat around bowel

Stool Pattern

→ Watery diarrhea
→ May be bloody, but less consistently than UC

Complications

→ Fistulas (enterocutaneous, enteroenteric, enterovesical)
→ Strictures and obstruction
→ Malabsorption

Associated Conditions

→ Nephrolithiasis (especially calcium oxalate stones)
→ Gallstones (due to bile salt malabsorption)
→ ASCA positivity (exam point)

Key High-Yield Differences (One-Look Recall)

→ UC = Colon only, continuous, mucosal
→ Crohn = Anywhere, skip lesions, transmural

→ UC = Crypt abscess, toxic megacolon, PSC
→ Crohn = Granulomas, fistulas, creeping fat

→ UC = Always bloody diarrhea
→ Crohn = Usually watery ± blood

25/12/2025

❇️ Pancreas: Anatomy & Secretions:

Anatomy
→ Mixed gland with both exocrine and endocrine functions
→ Retroperitoneal organ at the level of L1–L2 vertebrae
→ Length 15–20 cm, weight ~70–100 g
→ Parts: Head, uncinate process, neck, body, tail
→ Uncinate process hooks behind superior mesenteric vessels
→ Head related to duodenum; neck anterior to portal vein formation
→ Body crosses aorta; tail is intraperitoneal and contacts spleen
→ Main pancreatic duct (Wirsung) runs entire length
→ Accessory duct (Santorini) may open into minor duodenal papilla
→ Lymph drainage → pancreaticosplenic & superior mesenteric nodes
→ Venous drainage → portal vein

Histology:
→ Acini form bulk of pancreas → exocrine secretion
→ Centroacinar cells mark beginning of duct system
→ Islets of Langerhans scattered, more numerous in tail

Secretions
→ Exocrine secretion (~1–1.5 L/day), alkaline (pH ~8)
→ Enzymes secreted in inactive form to prevent autodigestion
→ Proteases activated in duodenum by enterokinase
→ Lipase requires bile salts for optimal fat digestion
→ Nucleases digest DNA & RNA
→ Bicarbonate-rich fluid protects duodenal mucosa

Endocrine Hormones
→ Insulin → promotes glucose uptake, glycogenesis, lipogenesis
→ Glucagon → stimulates glycogenolysis & gluconeogenesis
→ Somatostatin → inhibits insulin, glucagon & GI secretions
→ Pancreatic polypeptide → decreases exocrine secretion & gallbladder contraction

Regulation
→ Secretin → ↑ bicarbonate secretion
→ Cholecystokinin (CCK) → ↑ enzyme-rich secretion
→ Vagal stimulation → enhances pancreatic activity

Clinical Correlation
→ Inflammation → pancreatitis
→ Loss of endocrine function → diabetes mellitus
→ Duct obstruction → fat malabsorption & steatorrhea

25/12/2025

Patient presentation:

54 years age
3 weeks History of UGI Bleed.
Sudden significant weight loss
Anoraxia
Now, acute small bowel obstruction

HR: 120 to 130 since 3 weeks
B.P: 140 to 160

What is your Diagnosis?

24/12/2025

Q: Which part of the skull is devoid of Periosteum and why?

24/12/2025

Starting Course for FEB, MARCH, APRIL'S Exam.

You can join by following link.

MRCS COURSE Feb/April 2026 - Google Forms

https://docs.google.com/forms/d/1FB8Zyd6Wdy38tqLM83CLAtJC8sPfVtiEsXY1gAjTnvQ/edit

07/12/2025

Without any doubt, we are the Poineer of MRCS Teaching in Pakistan and ALHAMDO LILLAH with your support, the largest whatsapp Community in Pakistan.

Here are the links to join us, watch us and follow us. I am sharing here for all those personally texting us

This group is created to help, guide, and update the candidates for the MRCS-B exam schedule, the procedure of the exam, and rules and regulations. We don't share any leaked Qs and other's materials.

Please watch this video

https://youtu.be/vHpZ6UUum3Y?si=PQZfguyCRNGQEsko

Link to Telegram Channel:

https://t.me/MRCSpakistan

Link to Whatsapp Group
https://chat.whatsapp.com/KX2dg1if0PREAuyaOCpGnC

Link to FB PAGE

https://www.facebook.com/profile.php?id=100090126027770

07/09/2025

06/09/2025

🤲 Alhamdulillah 🤲

When we started the MRCS OSCE Course in Pakistan back in 2023, it was just the beginning of a dream — to create a structured platform for surgical trainees to prepare with confidence.

Today, after our recent course in Peshawar, seeing the overwhelming response and the fact that 97% of participants recommend attending, my heart is full of gratitude.

🌟 A special thanks to Dr. Wajeeh Ur Rehman and Dr. Nouraiz Shakoor 🌟
Your dedication and efforts to resume and strengthen this journey have been invaluable. You’ve turned this into not just a course, but a community of learning and growth for aspiring surgeons across Pakistan.

May Allah continue to bless this initiative, guide us to benefit more people, and make it a source of success — both in this world and the hereafter. Aameen.

23/08/2025

LAHORE HANDS ON SESSION
MRCS OSCE
11 to 13 September.

Don't miss it

22/08/2025

Aoa. IA we are going to conduct 15th hands on workshop for Mrcs B skill part in LAHORE on 11th to 13th September for October to December 2025 candidates. Those who want to attend kindly register through link below. *Seats* are limited to *30* & will be booked on first come first serve basis. In case of any query you can msg me. Karachi session will be after this iA. Thank you.

https://docs.google.com/forms/d/e/1FAIpQLSdMy_wXCl1LKeMdma8AxFNNHTlXkR8OsxTQ0VhNgHsjwNuPAA/viewform?usp=sharing&ouid=105949640851253932753