Below are common questions asked in the MRCS Viva

Examination 2005 - 2009.

***** Very Common questions:-

* 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

*¨¨¨ 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?