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MRCS Part B May-2009
MRCS Part B May-2009
rhabdomyolysis. Asked questions about this- management and investigations. Who should be involved in decision to
operate.
16. Umanned. CXR of ?tension p.t. and sub dural bleed. Questions on them. Chest drain etc. who to contact,
Advice: Read around the key topics, attend a course or two, but most importantly practice with Regs and
colleagues. Exam technique is as important as knowledge.
Make sure you are entered for the right exam on your entry card, 4 candidates thought they were dong T+T and
L+S. but it was the other way round!
MRCS OSCE 19/2/09 stations
order of theatre list 3 patients with differents problems, MRSA, Diabetes, pacemaker, severe copd,
* pre-op patient with herat block, how to manage, comment on ECG,
* lady admitted with 10 days history of vomiting, epigastric tenderness, severly hyponatraemic and hypokalaemic,
metablic alkalosis, how to manage whom to inform, comment on her chest xray.
* typical hx of cholecystits, comment on ct scan, how to manage?
* define a fistula, what precipitating factors can cause it? how to investigate, what clinical signs to elicit, how to
assess nutritional requriement through TPN, what complications can TPN Cause?
* knee examination
* hernia examination/ management
* communication skills, jehova's witness, refuses blood transfusion, due for a big surgery discuss risks, and
management.
* discuss with a consultant on the phone a patient with post cholecystectomy biliary leak, needs transfer explain the
picture?
* anatomy (3 stations) -> lungs, heart, phrenic nerve, vagus nerve, thyroid gland parathyroid gland (blood supply,
innervation), function, hoarsness after surgery? causes?, brachial plexus, what happens if injury to c5-c6? describe
the path of a clot from calf veins to pulmonary arter?
identify caecum, appendix, illeum, external oblique, internal oblique, and name some positions for appendix
* perform exicision and skin suturing of a benign skin naevus, difficult to approximate wound edges?
* take history from a patient with dysphagia, present
* cardiovascular exam and pre op assessment present
* history from a patient with chest pain post op, and present to examiner
* two rest stations.
*two preparations stations ( for communication skill stations)
20/02/09:
1) acute appendicitis - abdo examination
2) Parotid swelling - examination
3) telephone conversation regarding transfer of traume patient with widened mediatinum(CXR) with CT consultant
@ regional cardiothoracic centre.
4) Pt with splenic hematoma wanna go home - convince him to stay back.
5) pt for hip replacement - assess whether she is fit to give consent.
6) history taking - micturition problems.
7) cardiovascular examination - pre op assessment (post op valve replacement).
8) excision of skin naevus and suturing ( not able to approximate properly).
9) trauma pt details - questions based on it - liver laceration.
10) Anatomy - lower limb ( leg) - nerve & reflexes root values, muscles spotters and muscles for foot movements.
11) Bone spotters - shoulder, hip, knee, wrist & elbow - muscles, nerves et al
12) Pathology - aortic aneursym ( specimen) - prosection of abdomen - abdominal aorta & questions based on it.
13) theatre list with three patients - prioritise which one to be done first
a) diabetic with mrsa ulcer foot for bka.
b) diverticulitis for sigmoid colectomy ( allergic to iodine & penicillin)
c) man with pacemaker & on warfarin for RIH repair.
14) pt with burns management ( critical care scenario)
15) write a letter to gp about the management of pt on warfarin for inguinal hernia surgery as the pt is anxious about
warfarin & surgery.
16) lady with metastatic ovarian carcinoma with abdopain/distension, vomiting - dd/management & blood results
given
17) rest station
18) rest station
19) preparation station ( for telephonic conversation)
20) prepartatoin station ( for conversation with pt with splenic hematoma)
burns
ARDS
HDU/ICU monitoring
base of skull
lower leg + compartments
root values of leg nerves
surface anatomy of shoulder/arm/leg
trauma
bowel obstruction
clinical scenarios:
parotid swelling
abdo exam
throat swelling history
consent in confused pt
CVS exam (heart murmur)
discussion with cardiothoracic consultant over phone re trauma scenario
excision of skin lesion on fake arm + primary closure
*from forum
Anatomy: tyhroid, submandibular gland, knee, coronary artery circulation
Critical Care: starling, hyperkaelaemia, ionotropes
Clinical: Stomas, breast, ?branchial cyst, hip
Patient safety: diathermy, ATLS
Applied Surgical Sciences: sutures, complications fractures, CT scan of ruptured spleen, shock
Comm skills: breaking bad news, telephoning consultsny on call
Patholopgy: metaplasia, referral to coroner, audit
Anatomy stations
1-unmanned stations with full body skeleton and marked areas such as humerus , femur etc and there is a paper with
around 13 questions if i remember well, not easy to finish on time and you better check all pages so you know how
many questions u got ...in this stations i couldnt complete all questions due to lack of time !! they asked about
muscle attachments to the head of humerus and greater trochanter, also about name nerves that passes in this are
etc... cant remember the rest
2-manned station with anatomy of the aorta
there is a patients with abdominal aneurysm you ganna operate on him what level the aorta enters the abdomen
whats you surface markings for this entry point
identify the branches of the aorta
what posterior branches of aorta do you know
vena cava and renal veins identify and what lies anterior to renal veins
aortogram identify the branches
small specimen of what looked like a fusiform aortic aneurysm , asked me what do i think this is , define aneurysm
and what its causes...
3-a real person(not a patient) and examiner, all about lower leg reflexes(knee and ankle) , dermatomes ,muscle
groups and compartment syndrome, arterial supply, nerves...then he showed me a leg specimen and asked me to
point to the anterior tibialis....
scenario: you are the surgical SPR, thesister would like to have a chat to you about the theatre list
you enter the cubicle , there is a sister and in the corner an examiner with marking sheet.
sister asks you to have a look at the theatre list and see if you happy with order or you want to change anything
1-patient with for total colectomy, diabetic on insulin, MRSA positive
2-70 yrs old patient for inguinal hernia repair, known severe COPD
3- patient for Lap cholycystectomy, has pacemaker
type of anaesthesia
what post op arrangements HDU, ward etc
what type of diathermy for each procedure
where would you place the diathermy and why