What are the four most common causes of a breast lump?

• Breast carcinoma,

• Fibroadenoma,

• Simple breast cyst,

• Localized anomaly of breast development and involution (ANDI).

Less common causes include: fat necrosis (where there is a history of trauma), other breast cysts (galactocele, cystadenoma, retention cyst of gland of Montgomery), breast abscess (clinical signs of infection) and lipoma.

Foreword

The biggest hurdle for the modern orthopaedic trainee is passing the FRCS (Tr & Orth) exit examination. Practice is necessary when preparing for any examination, and the written component of the FRCS (Tr & Orth) is no exception. However, this does need to be focused.

So why another book? These MCQs and EMQs are divided according to subspecialty so the questions can easily be used as part of a revision plan.

What is the anatomical position of the heart within the chest?

The heart is located in the middle mediastinum and is covered anteriorly by the costal cartilages of the third, fourth and fifth ribs.

Describe the reflections of the pericardium and describe the location of the transverse and oblique sinuses

The pericardium is made up of a visceral layer, which is adherent to the heart, and a parietal layer, which forms the inner surface of the pericardial sac. There is a small amount of serous pericardial fluid between the two layers. There are two recesses within the pericardium: the transverse sinus and the oblique sinus. The transverse sinus is bounded anteriorly by the posterior surface of the aorta and the pulmonary trunk and posteriorly by the anterior surface of the interatrial groove. The oblique sinus is the space behind the left atrium and is bounded by the pericardial reflections of the inferior vena cava and the pulmonary veins.

What is the commonest composition of renal calculi?

Calcium oxalate with calcium phosphate.

Which other types of renal stones may form?

Among the rarer type of renal stone, the most frequently identified include: magnesium ammonium phosphate (struvite), cystine and uric acid stones.

Preface

Examinations are always a nuisance, especially as you enter more mature years. Studying becomes less natural and more tedious. Thankfully, the FRCS (Tr & Orth) examination is just about orthopaedics, and so some of the knowledge required would hopefully be second nature. However, MCQ and EMQ examinations always tend to ask about less obvious topics, which do not always feature in routine practice, and this is no different with the FRCS (Tr & Orth).

When many of the authors were preparing for their examination, there was a distinct shortage of practice questions. The vast majority related to American examinations, and our experience was that these are very different to the questions in the British examination.

Define what is meant by diverticular disease

Diverticular disease is herniation of mucosa through the muscularis of the colonic wall. It usually occurs at the site of relative weakness where mesenteric blood vessels pass between the taeniae coli through the colonic muscle wall.

What is the difference between a true and false diverticulum?

A true diverticulum contains all layers of the wall of the viscus (e.g., Meckel's diverticulum). A false diverticulum involves only some layers (e.g., colonic diverticulum).