📖MRCS On The Go 👣/
📚Chapters covered
📚
Chapters covered

MRCS Part A Exam Structure

The MRCS Part A exam is a 5-hour-long MCQ (multiple choice question) exam consisting of two papers taken on the same day - one in the morning (which tests applied basic sciences) and another one in the afternoon (which tests the principles of surgery in general).
The morning paper is 3-hours-long (180 questions) while the afternoon paper is 2-hours-long (120 questions). A 1-hour break is typically scheduled between the two papers.
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Ever since early 2022, the MRCS Part A exam has been conducted at computer based testing centers (i.e., Pearson Vue) in the UK, Ireland and across multiple countries, while some countries still conduct the exam on paper (i.e., Oman, Jordan and Sudan).
 

MRCS On The Go covers the following chapters (which are part of the 10 modules of the MRCS Part A exam syllabus):

Paper 1 - Applied Basic Sciences (180 questions)

(Toggle the following topics for more information)
Anatomy
Upper limb
  • Pectoral region: Clavipectoral fascia, muscles, etc.
  • Shoulder muscles (including rotator cuff muscles) and actions
  • Muscles of the back
  • Axilla: Brachial plexus, axillary nerve, artery, etc.
  • Intermuscular spaces, cubital fossa
  • Muscles of the arm, flexors and extensor muscles of the forearm
  • Cutaneous and motor innervation of the arm, forearm and hand
  • Carpal bones, muscles of the hand, anatomical snuffbox
Lower limb
  • Venous system of the lower limb
  • Muscles of the lower limb: Gluteal region (gluteal muscles and hip abductors), thigh and leg
  • Muscles of the thigh and leg (and their respective compartments)
  • Femoral triangle, femoral sheath, femoral ring, femoral canal and adductor canal
  • Nerve innervation of the lower limb muscles
  • Popliteal fossa and its contents
  • Foot and the retinaculum
Head and neck
  • Scalp
  • Triangles of the neck and their respective contents and boundaries
  • Muscles of the face
  • Glands of the head and neck
  • Common carotid artery and its branches
  • Foramina of the skull base, cavernous sinus, pituitary gland, circle of Willis, vertebral arteries, basilar artery
  • CNS, PNS, brainstem, cranial nerves, ganglia and their associated relations
  • Spinal cord, lumbar puncture and the CSF
Thorax
  • Heart: chambers, pericardium, arterial supply and venous drainage, conducting system, surface anatomy of heart valves, etc.
  • Mediastinum, diaphragm, pleura, lungs, esophagus, trachea, etc.
  • High yield structures: Internal mammary artery, azygos vein, thoracic duct, phrenic nerve and SVC
  • Pharyngeal arches and fetal circulation
  • Chest drain
Abdomen
  • Muscles of the anterior abdominal wall, rectus sheath and abdominal planes
  • Inguinal ligament, inguinal canal, inguinal triangle and types of abdominal hernia
  • Spermatic cord, scrotum, testis, etc.
  • Arterial supply of the GIT
  • Venous drainage of the GIT
  • Gastrointestinal organs: Duodenum, jejunum, ileum, large intestine, cecum, appendix, pancreas, liver
  • Other organs and structures: Spleen, kidneys, adrenal glands, bladder, ureter, urethra, lumbar plexus, rectum, anus, prostate gland, uterus, etc.
  • Posterior abdominal wall
Physiology
Arterial blood gas
  • High yield acid-base disorders and their causes
  • Compensatory mechanisms
General physiology
  • Classes of shock: Distributive shock, hypovolemic shock, cardiogenic shock, and obstructive shock
  • Stress response
  • Vitamin deficiency
  • Cell metabolism
  • Cell cycle
  • Apoptosis and necrosis
  • Total body water distribution and fluid resuscitation in burn patients
  • Cerebral perfusion pressure
  • Thermoregulation
Cardiovascular system
  • Cardiac muscle contraction and its phases of action potential
  • Heart sounds
  • Contractility, preload, afterload, end diastolic volume, end systolic volume, stroke volume, ejection fraction, cardiac output, blood pressure, pulse pressure, coronary perfusion pressure, etc.
  • Jugular venous pressure waveforms
  • Kussmaul’s sign
  • ECG waveforms
  • Arterial baroreceptors, atrial baroreceptors, and Bainbridge reflex
  • Autonomic effects on the CVS
Respiratory system
  • Mechanics of breathing
  • Lung compliance, surfactant, lung volumes and capacities
  • Pulmonary function test, FEV1/FVC ratio, oxygen binding capacity, and oxyhemoglobin dissociation curve
  • Carbon dioxide transport
  • Respiratory failure
  • Breathing control: Neurological regulation and chemoreceptors
  • Mechanical ventilation
Gastrointestinal system
  • Layers of the GIT and intrinsic innervations
  • Stomach secretions and the mechanism and regulation of gastric acid secretion
  • Hormones of the stomach
  • Peptic ulcer: medical and surgical management
  • Exocrine pancreatic secretion
  • Factors affecting gastric motility: pharmacological agents and hormones
  • Complications of delayed gastric emptying
  • Vitamins, electrolytes and water absorption
  • Physiological changes post-GI surgeries: Dumping syndrome, vagotomy, duodenectomy
Renal system
  • Renal blood flow and autoregulation, Renal plasma flow, clearance and glomerular filtration rate
  • Tubular functions of the kidney and the Counter current multiplier mechanism
  • Renin-angiotensin-aldosterone system
  • Electrolyte disturbances: Serum calcium, potassium, sodium, uric acid, and magnesium
Endocrine system
  • Pituitary gland: Growth hormone, prolactin, ADH, oxytocin, etc.
  • Appetite regulation
  • Thyroid gland, thyroid hormones, and anti-thyroid medications
  • Parathyroid gland, parathyroid hormones, vitamin D, and calcitonin
  • Adrenal cortex
  • Cushing syndrome, Cushing disease, dexamethasone suppression test, and actions of glucocorticoids
  • Pancreatic hormones
Pathology
General pathology
  • Acute inflammation and chronic inflammation
  • Wound healing, amyloidosis, collagen, etc.
  • Cell death
  • Pathological calcification
  • Aggressive fibromatosis
  • Oncology: Tumor markers, oncogenes, oncoviruses, paraneoplastic syndrome, etc.
  • Genetics and surgical diseases
  • Cardiac murmurs
  • Lead poisoning
  • Types of nerve injuries
Endocrine pathology
  • Pituitary gland: ADH disorders, etc.
  • Adrenal cortex: Cushing’s syndrome, Conn’s syndrome, Addison’s disease, Waterhouse-Friderichsen syndrome, etc.
  • Adrenal medulla: Pheochromocytoma, etc.
  • Multiple endocrine neoplasia
Blood and Immunology
  • Coagulation cascade and disorders of coagulation, anticoagulants, and hypercoagulability
  • Bleeding and DIC
  • Hematology disorders: Sickle cell anemia, hereditary spherocytosis, etc.
  • Post-splenectomy blood film changes and sepsis
  • Blood transfusion reactions, massive transfusion and hypersensitivity reactions
  • Hodgkin’s lymphoma
Microbiology / Infectious diseases
Gram negative bacteria
  • Escherichia coli
  • Campylobacter jejuni
  • Yersinia enterocoliticia
  • Shigella spp.
  • Salmonella enterica
  • Vibrio cholera
  • Helicobacter pylori
Gram positive bacteria
  • Clostridium difficile
  • Actinomycosis
  • Streptococci
  • Staphylococcus aureus
  • MRSA (Methicillin-resistant Stpahylococcus aureus)
  • Mycobacteria
  • Polymicrobial infections
Parasitic infections
  • Enterobiasis
  • Ancylostoma doudenale
  • Ascariasis
  • Strongyloidiasis
  • Cryptosporidiosis
  • Amebiasis
  • Giardiasis
  • Trypanosoma cruzi
  • Wuchereria bancrofti
  • Hydatid cyst
Viral infections
  • DNA viruses: Hepatitis B, EBV
  • RNA viruses: HIV, Hepatitis C
  • Antibiotics and their mechanisms of action
Ethics and Statistics
Professional skills in clinical practice
  • Consent and the various consent forms
  • Clinical governance
Statistics
  • Types of data and types of studies
  • Statistical hypothesis
  • Measures of central tendency
  • Normal distribution curve
  • Statistical errors
  • Incidence and prevalence
  • Risk quantification: Risk, relative risk, number needed to treat, odds and odds ratio
  • Sensitivity and specificity
  • Significance tests
  • Level of evidence

Paper 2 - Principles of Surgery in General (120 questions)

(Toggle the following topics for more information)
Perioperative care
  • ASA scoring
  • Preoperative care: Fluids, IV access, anesthesia, airway management, muscle relaxants and their adverse effects
  • Blood products and cross-matching
  • Pain management
  • Sterilization of surgical equipment, laparoscopy, sutures, tissue reconstruction, bleeding management, etc.
  • Circulatory support, nutrition support, refeeding syndrome
  • Postoperative care: POCD, pulmonary embolism, thromboprophylaxis, surgical drains, nutritional support, etc.
  • Surgical complications
Emergency and Trauma
  • Glasgow coma scale
  • Burns; Compartment syndrome
  • Acute conditions: Addisonian crisis, anaphylactic shock, acute coronary syndrome, myocardial infarction, pneumothorax, thoracic aorta rupture and trauma, oculogyric crisis, etc.
  • Trauma management - e.g., trachoestomy
  • ECG emergencies: Ventricular tachycardia, Torsades de Pointes, etc.
General surgery
  • GIT surgery: Abdomen and Upper GIT, hepatobiliary disorders, colorectal and stomas
  • Breast surgery
  • Thyroid and parathyroid surgery
Neurosurgery
  • Head trauma and injuries (i.e., different types of hematomas)
  • Cushing’s reflex
  • Stroke
  • Spinal cord injuries
  • Neurological eye conditions and visual defects
  • Hereditary conditions
Head & Neck
  • ENT: Neck lumps, nasal and sinus disorders, throat and mouth disorders, ear infection and hearing assessment
  • Maxillofacial surgery: Craniomaxillofacial injuries
Urology
  • Scrotal swelling
  • Testicular disorders: Benign and cancerous disorders
  • Penile disorders: Erection and fracture
  • Prostate disorders: Benign prostatic hyperplasia and prostate cancer
  • Renal stones, masses and infections
  • Lower genitourinary tract trauma
  • Functional renal imaging
  • Vasectomy
Transplant
  • Types of transplant grafts: Allograft, isograft, autograft, etc.
  • Immunosuppressants used in organ transplantation and their adverse effects
  • Complications of transplant surgeries: Types of organ rejections (hyperacute rejection, acute rejection, etc.) and the types of complication in post-renal transplants
  • Immuno-histocompatibility
  • Graft failure
Pediatric surgery
  • Congenital cardiovascular disorders
  • Gastrointestinal disorders: Congenital conditions, bilious vomiting, proctological diseases, etc.
  • Acute emergencies in children
  • Fluid management
  • Umbilical disorders
  • Urological conditions in the pediatric population: Prepuce disorders, infections, vesicoureteral reflux, cryptorchidism, etc.
Vascular surgery
  • Peripheral vascular diseases: Acute and chronic
  • Vascular diseases of the upper and lower limbs
  • Congenital malformation
  • Vascular investigations
  • Management: Amputation, Homans, Charles procedures, lymphovenous anastomosis, etc.
Orthopedics
  • The basics of investigating and managing orthopedic diseases
  • Types of fractures and their management
  • Joint injuries (knee, ankle, etc.)
  • Diseases affecting the vertebral column
  • Pediatric fractures and orthopedic diseases
  • Acute orthopedic diseases
  • Bone tumors
  • Shoulder disorders
Dermatology & Plastic surgery
  • Skin diseases: Malignant and Non-malignant
  • Management of suspicious skin lesions
  • Hand lumps
  • Conditions of the hand
 

FAQ

What are the 10 modules?
The 10 modules comprise the exam syllabus, which tests the candidates’ knowledge in applied sciences and general principles in surgery.
The 10 modules are:
  • Module 1: Basic science knowledge relevant to surgical practice
  • Module 2: Common surgical conditions
  • Module 3: Basic surgical skills
  • Module 4: The assessment and management of the surgical patient
  • Module 5: Perioperative care of the surgical patient
  • Module 6: Assessment and early treatment of the patient with trauma
  • Module 7: Surgical care of the pediatric patient
  • Module 8: Management of the dying patient
  • Module 9: Organ and tissue transplantation
  • Module 10: Professional behavior and leadership skills
How many questions can you expect from from each topic?
Paper 1 - Applied Basic Sciences
  • Paper 1 has 180 questions in total, of which at least 1/3 of the questions are related to Anatomy topics.
Toggle for Paper 1 breakdown:
  • Anatomy - 75 Q’s
  • Physiology - 45 Q’s
  • Pathology - 37 Q’s
  • Pharmacology - 8 Q’s
  • Microbiology - 7 Q’s
  • Imaging - 5 Q’s
  • Data interpretation and audit - 3 Q’s
  • Given the above breakdown, we can see that Anatomy and Physiology make up at least 60% of the exam questions, followed by Pathology, which makes up around 20%.
Paper 2 - Principles of Surgery in General
  • Paper 2 contains 120 questions, of which around 1/3 are related to common and acquired surgical conditions and perioperative management.
Toggle for Paper 2 breakdown:
  • Common and acquired surgical conditions - 45 Q’S
  • Perioperative management - 35 Q’s
  • Trauma - 30 Q’s
  • Surgical care of children - 7 Q’s
  • Medicolegal issues - 3 Q’s
  • From the above breakdown, it is interesting to note that Trauma alone constitutes 25% of the exam questions, almost as much as Perioperative management.
Am I eligible for this exam?
To be eligible, you should hold a PMQ (Primary Medical Qualification) that is acceptable according to GMC’s (UK General Medical Council) or IMC’s (Irish Medical Council) standards.
 
  • In short, having your MBBS / basic medical degree is sufficient to apply for the MRCS Part A exam. You are not required to undergo surgical training prior to taking this exam. However, you are advised to have at least some surgical experience.
How can I sign up for the exam?
You may sign up for the exam via the individual Royal College of Surgeons’ websites:
  • Traditionally, exam takers were required to send physical copies of their applications and documents via international post / mail. Fortunately, post-pandemic, these documents can be sent via email.
  • Kindly be informed that the deadline for applying for the MRCS Part A exam is usually around 3 months before the exam date.
When is the exam usually held?
  • MRCS Part A is usually held three times within a year in January, April / May, and September, simultaneously by each royal collages.
MRCS Part A exam locations.
UK and Ireland
  • Belfast
  • Cardiff
  • Coventry
  • Dublin
  • Edinburgh
  • London
  • Manchester
  • Newcastle
  • Nottingham
  • Stirling
Internationally
Asia countries
  • Bangladesh
  • Burma
  • Hong Kong
  • India
  • Malaysia
  • Nepal
  • Pakistan
  • Philippines
  • Singapore
  • South Korea
  • Sri Lanka
  • Thailand
  • Vietnam
Middle East, Europe and Central Asia countries
  • Afghanistan
  • Azerbaijan
  • Bahrain
  • Cyprus
  • Iraq
  • Jordan
  • Israel
  • Kazakhstan
  • Kuwait
  • Lebanon
  • Oman
  • Palestine
  • Qatar
  • Saudi Arabia
  • United Arab Emirates
  • Uzbekistan
Africa countries
  • Botswana
  • Cameroon
  • Egypt
  • Ghana
  • Kenya
  • Morocco
  • Namibia
  • Nigeria
  • Senegal
  • Sierra Leone
  • Sudan
  • Tunisia
  • Zambia
 
When will I get my results?
  • The date when your results are available will be specified in an email when you complete the exam - it usually takes around 4 weeks for the royal college to release your results.
  • Unless specified, please note that results will be published on the royal college’s website depending on which college you register for the exam with. You will also receive a personalized email of your results.
What is the passing mark?
  • As frequently advocated, one must score at least 70% in order to pass MRCS Part A.
  • To increase your chances of passing, we suggest you aim for 75% and above during your exam preparation when doing question banks and mocks.
What is the average passing rate?
The passing rate for MRCS Part A is rather low, around 40%, as seen in previous exams:
January diet
April / May diet
September diet
  • September 2020 - 42.2%
  • September 2019 - 36.3%
  • September 2018 - 33.2%
  • Although the statistics might appear daunting, from our experience, well-prepared candidates usually pass the exam on their first attempt.
The exam seems difficult. Does the difficulty level differ from college to college?
  • No, the standard of the MRCS Part A exam is set following the ‘Angoff procedure,’ which ensures the standard required to pass is consistent for everyone. However, each paper contains different questions, so the pass mark may vary.
  • We understand that international doctors usually choose to take the exam with certain royal colleges depending on accessibility / location; hence, rest assured that regardless of colleges and exam center locations, it does not affect the difficulty level of the exam paper.
If I fail in my first try, how many attempts do I have for MRCS Part A?
  • You are allowed a total of 6 attempts for MRCS Part A, and it is valid for 7 years, which means you should attempt to pass Part B within 7 years of completing Part A.
How much time should I spend to prepare for the exam? 💭
  • While there is no hard and fast rule, and everyone’s circumstances differ, we recommend preparing for at least 4-6 months by using reliable resources - including concise study materials to build your understanding and knowledge on the tested topics (for which we highly recommend our MRCS On The Go Part A Companion) and a question bank of your choice.
 
 
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