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?