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?