Below are common questions asked in the MRCS Viva Examination 2005 - 2009.
¨¨¨ Very Common question
¨ Asked occasionally in last 4-5 years of Examinations
Principles of Surgery
¨¨¨ 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
¨¨¨ 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.
¨¨¨ 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
¨¨¨ 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
¨¨¨ 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
¨¨ Femoral hernia, with different approaches. High approach
¨¨ Subclavian line. Indications and proceedure
¨¨ 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?