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?