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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

¨¨¨     <place>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?

¨¨     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.

¨¨     Thermoregulation: physiological responses to hypothermia

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

¨¨     Stress Response.

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

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

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

¨       Gastric fluids, What is absorbed at the terminal ileum?

¨       White cells and their parameters: Definitions.

¨       What are the causes of hypoglycaemia?

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

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

¨       cardiac cycle and atrial pressures. 

¨       Acid secretion in the stomach. Physiological consequences of total gastrectomy

¨       Vit B12 physiology

¨       ADH - what is it, where produced, actions.

¨       Portal circulation: Definition, causes of portal hypertension and consequences

¨       Pyloric stenosis

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

¨       Analgesic ladder. Pain pathways.

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

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

¨       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.

¨       How does aspirin work?

¨       Spleen: functions. Physiological changes after splenectomy

¨       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.
¨¨     Brain stem death. How is it certified? Persistant vegetative state: Definition
¨¨     Small bowel fistulas: Physiological consequences.
¨¨     Surgical airways: Classification. Insertion of Tracheostomy.
¨¨     Premedications: Indications and classification
¨¨     Burns: definition, classification & management
¨¨     ABGs : normal values, metabolic acidosis, henderson-hasselbach equation 
¨¨     What are the admission criteria for most ITUs. Criteria for accessing HDU. WHat does HDU provide?
¨       Post thyroidectomy complications: Nerve injuries and respiratory distress how to manage?
¨       Diabetes Mellitus management in critically ill patient.
¨       Fat Embolism Syndrome
¨       Arterial blood gas analysis - what happens in gastric outlet obstruction (ie met alkalosis)
¨       Define restrictive/ obstructive lung diseases & Volume-flow loops in restrictive and obstructive lung disease
¨       Post-op bleeding : Classification & aetiology.
¨       Physiological effect of infusion of 2L Normal Saline.
¨       Oliguria: Causes & Physiology.
¨       Define and discuss physiological and pathological respiratory dead space.

Pathology

¨¨¨   Colitis: classification. Crohns Vs UC

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

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

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

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

¨¨¨   Types of jaundice. Investigation

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

¨¨     Pagets disease of bone: definition & complications

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

¨¨     Abscess & Pus. Pelvic Abscess

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

¨¨     DVT prophylaxis

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

¨¨     Types of breast carcinoma.

¨¨     malignant melanoma: definition, classifications, staging/grading

¨       alcoholic pancreatitis

¨       What is a Pathological fracture? Causes? metabolic bone disease

¨       leg ulcers: definition & classification

¨       intracranial bleeding. Management of extradural. Pathology of berry aneurysms

¨       Embolism: definition & classification

¨       Coagulation.Virchow triad.

¨       Granulomas: definition, examples.

¨       Anaemia: Microcytic & Macrocytic Anaemia

¨       UTIs: classification, high risk patients.

¨       Aortic dissection 

¨       Amyloidosis: definition & classification

¨       Pathophysiology of septic shock and definitons

¨       Sensitivity, specificity: definition

¨       What is the American classification of colorectal cancer?

¨       Thyroid cancers.

¨       Pathology of pressure sores and treatment

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

¨       Calcification: definitions & classification

¨       Atypical Microbacteria: Definition & classification

¨       Wound healing; physiological and pathological (Keloid scarring) 

 

Principles of Surgery

 

¨¨¨   DVT prophylaxis: define, predisposing factors, prevention

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

¨¨¨   Name different types of sutures and needles.

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

¨¨¨   Diathermy. Definition & Classification

¨¨¨   Difference between G+S, X-M

¨¨     Types of throid cancers, pathology, epidemiology, etc

¨¨     Consequences of splenectomy - abx coverage
¨¨     Local anaesthetics; dosing, uses, and complications 

¨¨     Ureteric injury at differant levels and management

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

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

¨¨     Fat embolism

¨¨     Fistula in ano classification

¨¨     Gall stone complications + investigations

¨       Management of Acute Ischaemic Limb

¨       Blood transfusion reactions

¨       Radiotherpy.Adjuvant radiotherapy and bowel Ca

¨       Parotid tumours. Surgery and complications

¨       DD of swelling in neck

¨       Principles of skin closure

¨       FFP: constituents, indications for use, complications

¨       Complications of a midshaft femur # & open fractures

¨       ERCP: indications & complications

¨       Management of a surgical patient with diabetes

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

¨       Gunshot wound classification

¨       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

¨¨     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?