common questions asked in the MRCS Viva Examination.pdf

MRCS Viva Questions Below are common questions asked in the MRCS Viva Examination 2005 - 2009. ♦♦♦ ♦

Very Common question Asked occasionally in last 4-5 years of Examinations

Physiology Critical Care Pathology Principles of Surgery Anatomy Operative Surgery

Physiology ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦

Blood pressure: Definition, Calculation of MAP, Control mechanisms to maintain BP. Oxygen dissociation curve. Shock: Definition, Classification, Physiological mechanisms involved. Body fluid compartments Normal blood gas values & interpreting ABG's Autoregulation: Definition, example of organ. What is the Kellie-Munro doctrine? CVP and PAWP. Draw the JVP curve with labels and then explain the diagram. How is CVP measured on ward?

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How is CO2 carried in the blood? Write equations? Where does carbonic anhydrase live? What is the chloride shift?

♦♦ Calcium homeostasis: Hormones involved. Causes of hypercalcaemia. Calcium distribution. What are the consequences of Vitamin D deficiency? ♦♦ What are differant types/classification of Renal failure? How you will manage them? What is GFR? ♦♦

Role of acid-base on calcium transport and symptoms of hyperventilation.

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Thermoregulation: physiological responses to hypothermia

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Respiratory physiology, chemoreceptors, mechanics of ventilation. What are the forces acting on the lung?

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Stress Response.

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Tell me about the production of thyroid hormones? How would you manage a patient with thyrotoxicosis pre-op?

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What factors are involved in clotting? What factors can help you intra-operatively to gain haemostasis?

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What is a buffer? How does it work? BICARB/co2 equation

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Gastric fluids, What is absorbed at the terminal ileum?

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White cells and their parameters: Definitions.

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What are the causes of hypoglycaemia?

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What are functions, half life, site and mechanism of production, of Erythropoiten?

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Tell me the effects of bed rest on the body. What problems do bedridden patients face?

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cardiac cycle and atrial pressures.

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Acid secretion in the stomach. Physiological consequences of total gastrectomy

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Vit B12 physiology

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ADH - what is it, where produced, actions.

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Portal circulation: Definition, causes of portal hypertension and consequences

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Pyloric stenosis

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RAA axis. What is Renin and what are its functions?

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Analgesic ladder. Pain pathways.

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Blood - principles of crossmatching, it uses and alternatives. Transfusion reactions.

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Asked about small bowel resection and what problems would the individual have.

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Asked to explain principles behind CPAP.

♦ Head injury - asked about CPP, equations, how to manage raised intracranial pressures. Was asked about brainstem death and how to certify. ♦ ARDS and how I would manage a patient in this situation. ♦

Draw the graph seen with a PAFC insertion and explain the different traces.

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How does aspirin work?

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Spleen: functions. Physiological changes after splenectomy

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The Loop of henle. Definition and function

Critical Care ♦♦♦

Sepsis management guidelines.

♦♦♦ What is shock? Types? Tell me about anaphylactic shock, how is it managed? blood loss features & categories of haemorrhagic shock ♦♦♦ Pancreatitis: scoring systems and pathophysiology. ♦♦♦

Pneumothorax: definition, classification. Management of tension pneumothorax.

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Brain stem death. How is it certified? Persistant vegetative state: Definition

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Small bowel fistulas: Physiological consequences.

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Surgical airways: Classification. Insertion of Tracheostomy.

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Premedications: Indications and classification

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Burns: definition, classification & management

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ABGs : normal values, metabolic acidosis, henderson-hasselbach equation

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What are the admission criteria for most ITUs. Criteria for accessing HDU. WHat does HDU provide?

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Post thyroidectomy complications: Nerve injuries and respiratory distress how to manage?

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Diabetes Mellitus management in critically ill patient.

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Fat Embolism Syndrome

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Arterial blood gas analysis - what happens in gastric outlet obstruction (ie met alkalosis)

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Define restrictive/ obstructive lung diseases & Volume-flow loops in restrictive and obstructive lung disease

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Post-op bleeding : Classification & aetiology.

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Physiological effect of infusion of 2L Normal Saline.

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Oliguria: Causes & Physiology.

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Define and discuss physiological and pathological respiratory dead space.

Pathology ♦♦♦

Colitis: classification. Crohns Vs UC

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What different types of aneurysm do you know of? What is the most common cause of false aneurysm?

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What organisms most commonly cause septic arthritis? High risk patients?

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Fistulae: definition & Classification. How do you determine high and low output fistulas?

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Metaplasia, dysplasia, neoplasia: definitions, examples of each.

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Types of jaundice. Investigation

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Mechanisms of Tumour spread. Dukes staging. Advantages & Disadvantages?

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Pagets disease of bone: definition & complications

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Types of necrosis. What is the difference between the necrosis and apoptosis.

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Abscess & Pus. Pelvic Abscess

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What is a frozen section? Why is it unpopular? indications, advantages/disadvantages

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DVT prophylaxis

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Features of a good screening programme. screening and breast cancer,inc triple assessment

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Types of breast carcinoma.

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malignant melanoma: definition, classifications, staging/grading

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alcoholic pancreatitis

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What is a Pathological fracture? Causes? metabolic bone disease

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leg ulcers: definition & classification

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intracranial bleeding. Management of extradural. Pathology of berry aneurysms

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Embolism: definition & classification

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Coagulation.Virchow triad.

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Granulomas: definition, examples.

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Anaemia: Microcytic & Macrocytic Anaemia

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UTIs: classification, high risk patients.

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Aortic dissection

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Amyloidosis: definition & classification

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Pathophysiology of septic shock and definitons

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Sensitivity, specificity: definition

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What is the American classification of colorectal cancer?

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Thyroid cancers.

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Pathology of pressure sores and treatment

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How do you work a COPD patient up pre-operatively? What are the considerations?

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Calcification: definitions & classification

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Atypical Microbacteria: Definition & classification

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Wound healing; physiological and pathological (Keloid scarring)

Principles of Surgery ♦♦♦

DVT prophylaxis: define, predisposing factors, prevention

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What is a graft/Flap? Where do you farm a grafts from? Classification? How do you manage a donor site?

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Name different types of sutures and needles.

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Pancreatitis. Scoring systems. How would you manage a patient with pancreatitis admitted from A&E.

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Diathermy. Definition & Classification

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Difference between G+S, X-M

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Types of throid cancers, pathology, epidemiology, etc

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Consequences of splenectomy - abx coverage

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Local anaesthetics; dosing, uses, and complications

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Ureteric injury at differant levels and management

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What are the different causes of lumps in the femoral triangle, how would you manage each one.

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Closing the abdomen? What is a burst abdomen? What are deep tension sutures?

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Fat embolism

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Fistula in ano classification

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Gall stone complications + investigations

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Management of Acute Ischaemic Limb

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Blood transfusion reactions

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Radiotherpy.Adjuvant radiotherapy and bowel Ca

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Parotid tumours. Surgery and complications

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DD of swelling in neck

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Principles of skin closure

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FFP: constituents, indications for use, complications

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Complications of a midshaft femur # & open fractures

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ERCP: indications & complications

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Management of a surgical patient with diabetes

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Flail chest -assoc injuries - management (ie ATLS) and also re: Mx rib #s

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Gunshot wound classification

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Wound healing: Classification, factors involved. Wound dehiscence.

♦ management of head injury patient, equation for cerebral perfusion pressure, monro-kelly doctrine and secondary brain injury ♦ Pyloric stenosis: cogenital and acquired ♦

Mediastinitis

Anatomy ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦ ♦♦ ♦♦

CT: normally T12, L1 section. Organs, vessels and lesser sac The femoral triangle Cross section of calf & Compartment syndrome Posterior cranial fossa & dural venous sinuses Pneumothorax and chest drain anatomy Insertion of a subclavian line - the landmarks on live model Inguinal ligament, layers dissected through for hernia repair Identify knee joint structures & ligaments Assemble bones in the arm. Classification & complications of nerve injury Gross anatomy of brain and functions

♦♦ Intrinsic muscles in hand ♦♦ The foot: the subtalar joint and muscles of inversion and eversion. Names the bones of the foot? What types of amputation do you know in the foot? ♦♦ Skull x-ray and asked questions on the nasal conchae, where the openings were, where they drained. what is the nasal septum made of? ♦♦ Heart - valves and blood supply. What is the surface anatomy of the heart? ♦ Spine: anatomy of disc + complications of prolapse ♦ Facial Nerve: pathway & injury ♦ Blood supply to stomach ♦ Superior mediastinum - identifying contents in cadaver ♦ MRI shoulder: anatomical/surgical humeral neck, rotator cuff ♦ Sapheno-femoral junction and tributaries ♦ Sigmoid colon: blood supply ♦ Post triangle of neck ♦ Surface Anatomy model: Identify the antecubital fossa, what are the landmark boundaries? What are the contents? ♦ Anatomy and segmentation of liver ♦ Path of accessory nerve & complications of injury ♦ Shown a barium study and asked to identify the different parts of bowel and which parts were retroperitoneal. ♦ What is the nervous innervation of the penis? ♦ Chest Cadaver: identification of impressions on left and right lung specimens. What is the hering-breuer reflex? Identify the structures in the lung hilum. ♦ Upper limb cadaver: identification of upper limb nerves and was asked what would happen if this structure was damaged. ♦ Spleen: anatomy & function ♦ A rib: identification of level and facets etc... ♦ A thoracic vertebra: identification of level and facets etc... ♦ Neck (mostly thyroid and nerves) ♦ Ureter and blood supply ♦ Tell me the anatomical location of the parathyroids? How are they identified? What is their embryological derivation? ♦ Tongue innervation & muscles ♦ Hypoglossal nerve: Anatomy & function

Operative surgery ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦♦ ♦♦ ♦♦ ♦♦ ♦♦ ♦♦

Inguinal hernia repair. Why can testicular atrophy occur in hernia repair? How do you fix a hip? Options and basic operative technique. What is the blood supply to the femoral head? Tracheostomy - indications, anatomy, procedure, instruments required What types of bowel anastomosis do you know? How are they carried out? Breast abscess Compartment Syndrome: Risk factors, Clinical presentation, & management. Chest drain insertion and care Appendicectomy Femoral hernia, with different approaches. High approach Subclavian line. Indications and proceedure Fissure-in-ano Intestinal anastomosis principle What causes fistula. Treatment principles

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Open Fracture Classification and management priniciples Paediatric fractures: classification & management DJ stent: how to insert & complications Anal Fissures Bowel obstruction: Aetiology, investigations, & management Left hemi-colectomy Indications for toe amputation, Ray excision Embolectomy - draw important relevant anatomy and op Crohn's disease of rectum and anus - management. surgical operations Scars: hypertrophic, keloid Peripheral nerve palsies: radial, ulnar, sciatic, common peroneal Acute Ischaemic limb: signs, management What do you understand about preparing patients in theatre? What is Betadine? How would you take an Ankle-Brachial pressure index? When would you use a J shaped needle?