Part 1 of ebook Textbook for MRCOG-1: Basic sciences in obstetrics and gynaecology provide readers with content about: principles of clinical practice; anatomy; physiology; biochemistry and nutrition; pathology; microbiology and immunology;... Please refer to the part 1 of ebook for details!
O R t Tex book for M C G-1 Basic sciences in obstetrics and gynaecology Textbook for MRCOG-1 Basic sciences in obstetrics and gynaecology Richa Saxena MBBS MD (Obstetrics and Gynaecology) PG Diploma in clinical research Obstetrician and Gynaecologist New Delhi, India The Health Sciences Publisher New Delhi | London | Philadelphia | Panama Jaypee Brothers Medical Publishers (P) Ltd Headquarters Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: jaypee@jaypeebrothers.com Overseas Offices J.P Medical Ltd 83, Victoria Street, London SW1H 0HW (UK) Phone: +44 20 3170 8910 Fax: +44 (0)20 3008 6180 Email: info@jpmedpub.com Jaypee-Highlights Medical Publishers Inc City of Knowledge, Bld 237, Clayton Panama City, Panama Phone: +1 507-301-0496 Fax: +1 507-301-0499 Email: cservice@jphmedical.com Jaypee Brothers Medical Publishers (P) Ltd 17/1-B Babar Road, Block-B, Shaymali Mohammadpur, Dhaka-1207 Bangladesh Mobile: +08801912003485 Email: jaypeedhaka@gmail.com Jaypee Brothers Medical Publishers (P) Ltd Bhotahity, Kathmandu Nepal Phone: +977-9741283608 Email: kathmandu@jaypeebrothers.com Jaypee Medical Inc 325 Chestnut street Suite 412, Philadelphia, PA 19106, USA Phone: +1 267-519-9789 Email: support@jpmedus.com Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2016, Jaypee Brothers Medical Publishers The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and not necessarily represent those of editor(s) of the book All rights reserved No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners The publisher is not associated with any product or vendor mentioned in this book Medical knowledge and practice change constantly This book is designed to provide accurate, authoritative information about the subject matter in question However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications It is the responsibility of the practitioner to take all appropriate safety precautions Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book This book is sold on the understanding that the publisher is not engaged in providing professional medical services If such advice or services are required, the services of a competent medical professional should be sought Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com Textbook for MRCOG-1: Basic sciences in obstetrics and gynaecology First Edition: 2016 ISBN 978-93-85891-28-1 Printed at Dedicated to My mother Mrs Bharati Saxena For always being there… “My mother was the most beautiful woman I ever saw All I am I owe to my mother I attribute all my success in life to the moral, intellectual and physical education I received from her.” -George Washington Preface “I wanted a perfect ending Now I have learnt, the hard way, that some poems don’t rhyme and some stories don’t have a clear beginning, middle, and end Life is about not knowing, having to change, taking the moment and making the best of it, without knowing what is going to happen next It is a delicious ambiguity.” −Gilda Radner Years ago, after acquiring the MD (Obstetrics and Gynaecology) degree, similar to many young Indian doctors, I too wanted to add a foreign qualification in my credentials Though I had completed part of the process, I could not complete it in entirety because of some health-related issues which prevented me in pursuing my career as a surgeon However, life has its own ways and here I am writing a book for the doctors wishing to obtain the degree “Membership of Royal College of Obstetricians and Gynaecologists”, (MRCOG, UK) For more details related to the MRCOG examination, kindly refer to the Royal College of Obstetricians and Gynaecologists (RCOG) website, https://www.rcog.org.uk/ For details related to the part 1 examination, kindly click on the link, https://www.rcog.org.uk/en/careers-training/mrcog-exams/part-1-mrcog/format/ This book, “Textbook for MRCOG-1” is intended for the doctors who are planning to appear in MRCOG part examination The MRCOG examination is meant for those doctors (undergraduates as well as postgraduates) who wish to pursue their specialisation in obstetrics and gynaecology in the UK This comprises of a two-part examination Part 1 MRCOG is a written examination, which helps in the evaluation of basic and clinical sciences relevant to the subject Fundamental aspects of all the important subjects related to basic sciences in medicine have been covered in this book This is inclusive of subjects such as anatomy, physiology, biochemistry and nutrition, pathology, microbiology and immunology, embryology, genetics, biophysics, epidemiology, endocrinology and pharmacology There are also separate chapters on “principles of clinical practice”, “obstetrics” and “gynaecology” The text has been covered in accordance with the latest curriculum and examination format as described by the RCOG and has been written in an easy-to-understand manner, well-illustrated with pictures Though it is not possible to cover the entire subject in a single chapter, most topics, which are important from the point of view of examination, have been adequately described According to the latest RCOG layout, the questions for the MRCOG examination would be in the “single best answer” or SBA format For the purpose of self-assessment, a list of SBAs along with their answer keys has been provided at the end of each chapter In total, approximately 1,000 SBAs are enlisted in this book Therefore, the students preparing for this examination not need to buy a separate book on SBAs Writing a book is a colossal task It can never be completed without divine intervention and approval Therefore, I have decided to end this preface with a small prayer of thanks to the Almighty, which I was taught in my childhood “Father, lead me day by day, ever in thy own sweet way Teach me to be pure and good and tell me what I ought to do.” —Amen Simultaneously, I would like to extend my thanks and appreciation to all the related authors and publishers whose references have been used in this book Book creation is teamwork, and I acknowledge the way the entire staff of M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India, worked hard on this manuscript to give it a final shape I believe that writing a book involves a continuous learning process Though extreme care has been taken to maintain the accuracy while writing this book, constructive criticism would be greatly appreciated Please e-mail me your comments at the e-mail address: richa@drrichasaxena.com Also, please feel free to visit my website www.drrichasaxena.com for obtaining information related to various other books written by me and to make use of the free resources available for the doctors Richa Saxena (richa@drrichasaxena.com) www.drrichasaxena.com Contents Principles of Clinical Practice Evidence-Based Medicine Consent 2 Gillick’s Competence Fraser Guidelines Axon 4 Bolam 4 The Mental Capacity Act 2005 Rights of the Unborn and Newborn Children Audit 5 Confidential Enquiry into Maternal Deaths Clinical Negligence Scheme for Trusts Foetal Intrauterine Death Anatomy Blood Supply to the Brain 10 Anatomy of Thorax 10 Diaphragm 10 The Pleura 12 Nerves of the Thorax 12 Anatomy of the Female Breast 13 Anatomy of the Abdominal Wall 15 Muscles of the Anterior Abdominal Wall 15 Blood Supply to the Anterior Abdominal Wall 17 Lymphatic Drainage of the Anterior Abdominal Wall 18 Nerve Supply of the Anterior Abdominal Wall 18 Rectus Sheath 18 Abdominal Cavity and its Contents 20 Abdominal Aorta 20 Peritoneal Reflections 21 Inguinal Region/Groin 23 Inguinal Canal 23 Inguinal Ligament 24 Anatomy of the Female Pelvis 25 Pelvic Organs 30 Female Internal Genitalia 31 Male Internal Genitalia 38 Pelvic Organs: Part of the Gastrointestinal Tract 38 Blood Supply to the Pelvis 41 Nerve Supply to the Pelvis and the Lower Limbs 43 Lymphatic Drainage of Lower Limb and Pelvis 44 Anatomy of the Urinary Tract 45 Urinary Bladder 45 Anatomy of the Thigh 50 Femoral Triangle 50 Femoral Sheath 51 Femoral Ring 52 Adductor Canal 52 Femoral Artery 52 Great Saphenous Vein 52 Nerve Supply of the Lower Limbs 54 Perineum 54 Anatomy of the Urogenital Region 54 Anal Triangle 55 Anatomy of the Foetus 55 10 Physiology 67 Haematology 67 Blood 67 White Blood Cells 68 Blood Coagulation 70 Homeostasis and the Fluid Balance 72 Body Fluids 72 Transport Mechanisms 73 Acid-Base Balance 74 Abnormalities of Acid-Base Balance 75 Electrolyte Imbalance 76 Physiology of Respiratory System 77 Lung Volumes 77 Lung Capacities 77 Respiratory Diseases 78 Oxygen-Haemoglobin Dissociation Curve 81 Disturbances in Respiration 83 Physiology of Cardiovascular System 83 Blood flow Through the Heart 83 Cardiac Cycle 83 Physiology of Urinary System 88 Microanatomy of Kidney 88 Physiology of Gastrointestinal System 91 Digestive System 91 Physiology of Liver 93 Reproductive System 96 Physiology of Normal Pregnancy 96 Placenta 96 Physiological Changes in Pregnancy 98 Biochemistry and Nutrition 124 Biochemistry 124 Structure and Function of Normal Cell 124 Cytoplasmic organelles with a limiting membrane 124 Cytoplasmic Organelles without Limiting Membrane 127 Carriers of Genetic Information 128 Carbohydrate Metabolism 130 Metabolism of Glucose 130 Other Fuels: Fructose and Galactose 140 Regulation of Blood Glucose 141 Metabolism of Fats 142 Metabolism of Nucleotides 146 Proteins, Peptides and Amino acids 147 Cell Signalling and Second Messengers 151 Nutritional Physiology in Health and Disease 153 Biochemistry of Vitamins 153 Pathology Inflammation 161 Acute Inflammation 162 Chronic Inflammation 163 Wound Healing 164 Factors Influencing wound Healing 166 Adaptive Disorders 167 Cellular Response to Injury 168 Tumourogenesis 169 Diseases of the Blood Vessels 171 161 ... book for M C G -1 Basic sciences in obstetrics and gynaecology Textbook for MRCOG -1 Basic sciences in obstetrics and gynaecology Richa Saxena MBBS MD (Obstetrics and Gynaecology) PG Diploma in clinical... opportunity Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com Textbook for MRCOG -1 : Basic sciences in obstetrics and gynaecology First Edition: 2 016 ISBN 97 8-9 3-8 589 1- 2 8 -1 Printed... Delhi 11 0 002, India Phone: +9 1- 1 1- 4 3574357 Fax: +9 1- 1 1- 4 3574 314 Email: jaypee@jaypeebrothers.com Overseas Offices J.P Medical Ltd 83, Victoria Street, London SW1H 0HW (UK) Phone: +44 20 317 0 8 910