Dr. T.

Ali  PEEP Ventilation in ICU setting

 Monitoring in ICU
 Capnography
 Temperature regulation hypothermia pyrexia

 Diarrhea
 Volumes of fluid produced by GIT

 12year old male comes in with a cut above the face, how would you work him up?
Patient continues to bleed and has an elevated pulse, and also gives a history of his
father being a bleeder as well. What could be the pathology?

 Discuss Haemostasis.
Coagulation Cascade.
Discuss possible coagulation deficits in the surgical patient.
A patient develops DIC. Discuss the pathology occurring.

3) 10 yr old fell on the left side of the Abdomen. He has bruising of the left side.
His pulse is elevated. Discuss your management. Must say you are going to
constantly observe this patient, eg on the to imaging studies. Discuss CT abd vs
Ultrasonography in this particular scenario.
Discuss your classes of Shock.

Discuss your surgical approach to the spleen and structures that can be injured.
Discuss why one would preserve the spleen in this patient.
Discuss the Complement Pathway.
This patient has a splenectomy, what advice would you give to this patient's parents.

A patient comes in shock post splenectomy who has never been vaccinated. Her
temp is elevated and she is unresponsive. Discuss what is occurring here.
OPSI.

You are asked to set up a HDU. Discuss some of the steps you will take I'm setting
up an HDU.
You are asked what type of Audit you have done for your planning of this HDU.
Must know about Audits.

You have a 54 year old patient who came in with a chronic leg ulcer. How would
you manage this patient.
Discuss the possible pathology that could cause a diabetic patient to present to a
Surgeon.

Discuss the use of tourniquet in a patient with a Haemoglobinopathy.

Discuss some of the Surgical pathologies that can arise from a patient with a
Haemoglobinopathy.

Discuss the physiology of Hypersplenism.

24 year old male presents with a swollen painful foot after being stuck with a nail.
discuss the pathology of Gas Gangrene. Saprophytic type and Proteolytic type of
Clostridia.....
Discuss the steps of doing a Gram stain.

Discuss the physiology of Mastication.

A patient had a lesion of the parotid that required a superficial parotidectomy.
 Discuss the consent and the surgical approach to the parotid.

Discuss what is Waldeyers Ring.

Discuss the complications of a Tonsillectomy.

A young patient required a tracheotomy due to enlarged adenoids.

Discuss your surgical approach to an emergency tracheotomy.
 Mr Ali. VIVA PREP (16-11-15)

Draw lung volume curves.

Draw the Carbon dioxide/ Oxygen dissociation curve.

Why does the graph taper off after the initial exponential rise.
Must know the hemoglobin molecule.

MVA patient who has injury to his chest from the steering wheel. On the ward he
becomes dyspneic with a respiratory rate of 30. Describe your management of this
patient.
Must consider Fractured ribs with Pulmonary contusion, Cardiac Tamponade, Flail
Chest, Pneumothorax etc.
With bilateral pulmonary contusions would you prophylactically put in bilateral
chest tubes?
This patient develops SIRS and ARDS. Define these terms.
Discuss the pathology of ARDS.

Discuss respiratory monitoring in the ICU

A patient presents with DVT and develops a pulmonary embolism. Discuss what is
a Ventilation Perfusion Scan.

A diver goes below 60 feet and comes up too quickly, and complains of chest pain
and respiratory problems. Discuss the pathology.
Discuss hyperbaric chambers
Double chamber vs Single chamber

This patient was brought into hospital in respiratory distress after being found in a
car with the hose found inside the window. Discuss the pathology of his
presentation.
Discuss the difference between Hypoxia and Hypoxemia.

Discuss the physiological changes of a Tension Pneumothorax.

What is Shock and discuss the different types of shock.

A patient in Septic Shock develops Ketoacidosis, Describe ketoacidosis and discuss

the Henderson-Hasselbach equation.

Define physiological Homeostasis.

Hyperthermia in a marathon runner, said to be suffering from heat stroke. Define

Heat stroke.
As he cools down he begins to shiver, explain his shivering.

A hundred meter sprinter is very short of breath after his race. Explain his metabolic
changes occurring.
 VIVA QUESTIONS 6/11/15

1) What do you understand by TUMOUR MARKERS? What makes an IDEAL

TUMOUR marker?
Tumor markers in BREAST CANCER? And their significance.

2) If you take a biopsy for a suspected breast cancer, what would you want the
pathologist to report on?
What do you understand by resection margins.
Discuss the role of frozen sectioning in terms of resection margins intra-op.
MUST SAY YOU DO NOT APPLY FIXATIVES, place in sterile water and
immediately sent to lab for frozen section

3) Discuss staging and grading systems.

Discussion on TNM
Name different staging systems other than TNM

4) discuss the importance of the ARC OF RIOLAN.

5) how does food get from the Caecum to the Sigmoid?

3 types of movement within large bowel.
Discuss Hirschsprung's disease.

6) Define Dysphagia and discuss its etiologies.

A patient with is suspected to have Achalasia, how would you determine this
diagnosis? HISTORY AND EXAM 1st.

7) Discuss the anatomy of the Gastroesophageal Junction. Discuss the pathologies

observed at this junction. Barrett's / hiatal hernia etc

8) Discuss the physiology of Micturition....Pressure curve diagram

9) Indications for a Splenectomy

What constitutes Hypersplenism?
What is seen on a peripheral blood smear post splenectomy?

10) A patient presents with pruritus ani? How would you manage this patient?
Dermatological causes/ Parasitic causes / fissures and fistulae / malignancy

11) What are Haemorrhoids?

Discuss some methods of treating Haemorrhoids.

12) A 28 year old male patient presents with soiling and pruritus and his doctor told
him about Godsall's law. What is the possible diagnosis?

13) Discuss Cell Division and its role in Chemotherapeutic drugs.

Must know!

14) A steelband player presents with decreased hearing after 15years of playing pan.
Describe how you will confirm this hearing loss.
Discuss Audiology

15) A patient presents with Vertigo. How does one investigate Vertigo?

16) A 60 year old male came off his anti hypertensives and presents with proptosis?
What is the diagnosis?
 Cavernous sinus thrombosis.
Describe its anatomy.

17) What is the Tarsal tunnel syndrome.

Describe the anatomy of the structures passing through
Know all tunnel syndromes.

18) A young female describes pain in her right hand whenever she reaches behind
and above her. What is the possible diagnosis.
Discuss thoracic the anatomy of the thoracic inlet.
What is scaleneus ant. Syndrome.

19) Describe the anatomy of the popliteal Fossa.

20) Discuss the anatomy of the Brachial Plexus.

21) Discuss the anatomy of the External Carotid.

 VIVA QUESTIONS (Monday)

1) What is sister Joseph's nodule? What is it significance?
Anatomical connections

2) discuss anatomy of the external iliac artery? As well as Internal Iliac.

What is the surgical significance of the inferior epigastric artery? Collateral
connection between upper and lower via thoracoepigastric artery.

3) 56 year old Female for laparoscopic cholecystectomy, during procedure she starts
to desaturate, explain possible causes.
Positioning head down, splinting of diaphragm, increased intra-abd pressure,
decrease lung expansion, abdominal compartment syndrome etc.
Discuss methods to correct. Must deflate and observe

4) discuss the preparation of a 40 year old male preparing to undergo triple bypass.
Thorough history and physical exam. Expand on salient point of the history/exam.
Likely other areas of vasculopathy. Family history also important. Lifestyle
modification.
Mention involvement of cardiologists, tests that they would have done etc.
Mention Consent as well as possibility of repeat surgery post-op if complications
arise.
May be asked vessel anatomy, conduits

5) Discuss the anatomy of the femoral canal. Relate it to Femoral hernias.

Significance of the canal- space to allow femoral vein to expand.

6) Discuss the physiology of the regulation of Renal Blood Flow. Autoregulation.

Discuss the Countercurrent Multiplier effect.

7) Explain the physiology of Dumping Syndrome. Early vs late.

8) young female with episodic hypertensive attacks. Triggered via emotional states.
Discuss methods of investigating this patient.
Preop preparation of a phaeocromocytoma. Mention consent

9) 26 year old female had placenta previa and bled quite a lot. She initially had
problems with breastfeeding and 6 months later husband describes that she Is
 lethargic and her demeanor has changed. Discuss the process occurring.

10) Discuss Erb's palsy with regard to delivery of a baby with the occurrence of
shoulder dystocia.
 VIVA QUESTIONS
1) Production of CSF
Doctrine of the Munro-Kelly doctrine

2) Chest trauma resulting in sudden cessation of Breathing. Explain the physiology

of this.
What reflex is this? Explain the physiology.

3) 65 year old male getting a massage of his neck becomes bradycardic, explain the
physiology.

4) 65 year old male with COPD under GA for bowel resection, placed on PEEP of
10 and becomes hypotensive with respiratory alarms going off. Explain possible
causes of his hypotension

5) Discuss the physiology of swallowing.

6) 75 year old. Bilateral Pain and Deformity of both legs but was referred due to a
collapsing pulse. Explain the physiology of a collapsing pulse. Possible
differentials.

7) upper G.I fistula. Define a high output fistula. Discuss volumes of fluid loss.
Discuss management of this patient to maintain fluid and electrolyte balance.
Management of a blown duodenal stump.

8) abdominal pain in a 40 yr old male. Routine blood examination found to be

hypercalcaemic. Discuss the differential diagnoses.
 henderson haselback acid base balance control of resporation
 Hyper baric oxygen for wound healing
 Oxygen disassociation curve

Dr. S.  COLON CLASS (dr Juman )

Juman
INFLAMMATORY BOWEL DISEASE
UC VS CROHNS
Symptoms
Extra intestinal Manifestations
Historical appearances
Management protocols( medical / Surgical / immunomodulation)
What constitutes FAILED MEDICAL MANAGEMENT

Surgical options for Ulcerative Colitis

Indications for Surgical intervention

Definition of a lower G.I bleed (distal to Ligament of Treitz)

Causes of Lower G.I bleed

Management of a Massive Lower G.I Bleed

What aspect of an N/G effluent is required to rule out an U.G.I.B (bile)
N/G should have sampled some part of duodenum....sometimes bleeding in the
duodenum can cause the pylorus to go into SPASM
Embolization vs Segmental Resection
When is a BLIND subtotal colectomy done? Failure to localize bleed and
haemodynamically unstable

What is a polyp?
Classifications of Polylps
Inflammatory/ Neoplastic / Harmatomatous/ Adenomatous/

What is the Adenoma-Carcinoma Sequence?

Fearson-Volgestein sequence

Screening programmes with Adenomatous Polyps

Criteria for Screening ( Wilson 's Criteria)

Haggitt's Classification
What features of A Polyp warrant further investigation?

Cancer syndromes
Lynch Syndrome (Muir-Torre variant)
FAP
Cowden's Syndrome
Turcot's syndrome

Surgical options for FAP vs LYNCH SYNDROME

SURGICAL options for a 1cm rectal cancer?

Local options:
Fulgaration vs Endoscopic Submucosal Resection vs TME

Staging of Colon Cancer

Dukes
TNM/AJCC

Define Sporadic vs Familial vs Hereditary Breast cancer

Purpose of staging?

How are Hepatic Metastases Managed?

VOLVULUS
Sigmoid:
Definition
Demographics
Radiological Imaging signs
Management
-Indications for a Sigmoidopexy

CAECAL
Misnomer
Differential for RLQ pain

DIVERTICULAR DISEASE
-definition
-False Diverticulae
-Demographics (roller milling of flour in late 20th century)
-Classifications in view of management

Complications of Diverticulitis
Fistula/ Colonic Stricture, etc
What mechanism allows purulent vs faeculent peritonitis? (Neck of the Diverticulae
being SEALED or not)

Options available for faeculent peritonitis?

Novel treatment- LAPAROSCOPIC WASHOUT and INTRA-ABD DRAIN
PLACEMENT

Embryology
?????????????

Defaecation REFLEX

Sensation to pass stool occurs at 18 mmHg in rectum usually

Role of the hypogastric nerve and pudendal nerve
Increases of pressure up to 55mm Hg occur to pass stool
Puborectalis relaxes to decrease anorectal angle

What is the Gastro-Colic reflex?

What are Mechanisms that ensure Continence?

Clostridium Difficile Colitis

What are the normal bacterial flora?
Pathogenesis?
Management

Functions of the Colon?

Motility functions ( how does the colon transport) Peristalisis/ segmental

movement/ mass movement
Absorptive Functions

What would you see in a pathology report for a specimen taken for Colonic cancer
that was resected?

How do you test for the k-ras mutations? Cytokeratin

PRINCIPLES BEHIND DAMAGE CONTROL SURGERY

2 hit Phenomenon

BOWEL PREPARATIONS
Chung et al
Guenaga et al
Poth et al

Advantages vs Disadvantages

NON MECHANICAL ETIOLOGIES OF LARGE BOWEL OBSTRUCTION

 Breast and Axillae Viva class

1. Outline the Anatomy of the breast as well as Embryology

Importance of cooper's ligaments etc

2. Outline the risk factors for Breast Cancer

3. Consent a patient for a Mastectomy and Axillary clearance.

An actual consent explaining to a patient. Must include risk of recurrence and
impact on survival.

4. Types of Dcis and management options.

5. How is an FNA done and what are the stains used. MUST KNOW
How does this differ from a core biopsy
Why do we have to stain FNA samples/ how do the stains work

6. Indications for a Mastectomy / types of mastectomy.

7. How is a sentinel lymph node biopsy done.

8. Discuss SLNB vs Axillary dissection

9. Molecular subtypes of Breast cancers

10. Risk reduction strategies in breast cancer

11. Familial Breast Cancers / breast cancer syndromes

12. How is the form written and sample sent to pathology after resection?

13. Benign breast diseases/ Define Fibrocystic Change.

14. Boundaries of the axilla, anatomical vs surgical groups of lymph nodes in the
axilla.

15. What is immunohistochemistry and its importance In Breast cancer.

Mr. R. Define the Anatomy of the Axilla with respect to nodal Dissection.
Maharaj Contents of the Axilla
Anatomy of the Axillary Artery (1st, 2nd, 3rd parts)
Outline the anatomy of the Subclavian Artery

Pathology involved when a Diabetic steps on a piece of Glass?

-Outline steps of Haemostasis
-What are the receptors that account for platelet adhesion to the endothelium ?
-What accounts for platelet aggregation released from the dense granules?
-Outline the Inflammatory process that occurs (PAMP- Pathogen associated ? That binds to
Mast Cells)
-Outline the steps of Neutrophils reaching desired tissue site from the blood

A 70 year old DM HTN IHD is diagnosed with large Bowel Obstruction. Outline the steps of
management you will institute.
-Pertinent points in History and Exam (Malignancy clues)
-Causes of large bowel obstruction
-What in the examination will increase your urgency?
-how does total body water compared to your body weight?
-How would you monitor your fluid resuscitation?
-What X-Rays would you request and why?

Principles of Screening
So if there is a positive result what must be in place for optimum patient care?
What outlines a Low risk / Average risk / high risk patient for Colon cancer?
Outline Screening methods for Colon Cancer in the average risk patient?
What is necessary to deem a FOBT negative?
How is an FAP patient screened?

Define Tidal Volumes

Lung volumes vs capacities

pancreatitis biscep criteria

How diabetes affects wound healing

Hard and soft signs of vascular injury

Priniciples of vascular anastamosis

Peptic ulcer disease urease breast test

Diagnosis of rlq mass

Breast screening guidlines trinidad and caribbean

Aaa priniciples of management

Smoking dvt prognosis recent study

Which bacteria proliferates in hyperglycemia.. Psudomonas

Nutritition indirenct calormetry harris benidict equation

Consent

Birads
Biopsy of impalable mass
Management of dcis mastectomy vs lumpectomy ? Radiation
Molecular subtypes of breast cancer
Differentials for rlq pain
Consent for appendicectomy in 16 year old
Open vs laparoscopic appendicectomy
Toxic megacolon

Diverticular disease hinchy management based on hinchey. Would you be worried if you get
a diverticulitis in. 30 year old?

40F with epigastric pain radiating to the back with vomiting.

Amylase >1000

Discuss your management of this patient.

Salient points on history and clinical examination

What does the data support in terms of N\S vs Ringer's Lactate?

Expand on the use of Antibiotics in Acute Pancreatitis
Atlanta classification of Pancreatitis.
Modified Marshall's classification?

What are the predictors of severity?

Discuss nutrition in severe pancreatitis.

Discuss the timing of ERCP in severe pancreatitis.

Outline some Principles of Abdominal closure in a patient with a midline incision.

Discuss Difficult abdominal closure such as with edematous bowel
Discuss Abdominal Compartment Syndrome
How is this measured?
Define Intra-abdominal hypertension

60year old patient with pain on walking after 200 yards

Discuss salient features on clinical history and exam that will differentiate the different types
of claudication (ischaemic, Venous, neurogenic)
What are the risk factors for Peripheral arterial disease?
Describe your examination for the lower limb arterial exam.
What are the peripheral pulses examined and what characteristics of the pulse are important?
Where do arterial ulcers occur?
MR MAHARAJ VIVAS 8.03.16
1. Describe the vascular supply to the colon, in sequence from proximal to distal.
2. What is the surgical significance of knowing the blood supply to the colon?
3. Describe the blood supply to the rectum.
4. Describe the branches of the Abdominal Aorta from cranial to caudal.
A patient comes to you with a lump to the anterior aspect of the neck.
How would you manage this patient?
What would be concerning on history and examination of this lump?
What syndromes you know predisposes to Thyroid Cancer?
How would you now investigate this patient?
Features on ultrasound that point out malignancy include?
How will the Fnac help or limit you?
If the Fnac returns as benign, what are your options?
If the Fnac returns as Follicular Adenoma, what are your options?
Discuss the role of Frozen section analysis in this scenario?
How accurate is frozen section analysis with Follicular adenocarcinoma?
If the Fnac returns as Adenocarcinoma cells of a papillary type what are your options?
What are the prognostic scoring systems in Thyroid Cancer?
What is the extent of Lymphadenectomy done with Papillary Thyroid Cancer?
What are the levels of lymph Nodes in the Neck?
A total thyroidectomy was done and in the night the patient develops stridor. What is the
possible causes of this event?

Describe what you know about DVT prophylaxis.

What are the risk factors for DVT formation?
What factors would delineate low risk moderate risk and high risk groups?

A male patient in clinic presents with PR bleeding. What on history and examination will
increase the likelihood of malignancy?
What symptoms are specific for rectal cancer?
What investigations would you carry out if a biopsy of a rectal mass turns as
adenocarcinoma?
What features on the CT/MRI would be important for your management?
If there is no distant spread, how does this affect your management?
Is it standard to do a colonoscopy after a rigid sigmoidoscopy?

What are some of the ways we can prevent wrong site surgery?
 A 55 year old diabetic comes to you with a painful oozing swollen foot after stepping on
something. How would you manage this patient?
What features on exam would you look out for?
Where are the pulses of the foot located?
If this patient were septic, how would that change your management?

Mr. I. How is oxygen transported throughout the body?

Ramnarine Delineate Cell lineage of Red Blood Cell
Life span of the Red Blood Cell?
Why does the Red blood Cell destroyed after 3 months?
What degrades the red blood cell?
Describe the Haemoglobin Molecule
Describe the breakdown of the Haem group
How is bilirubin formed?
Where is Calcium most found?
What are the Regulatory Mechanisms for Calcium?
Common disorders in Calcium Metabolism?
What is the mechanism of action of the Parathyroid hormone? On what cell does it act?
How does renal failure affect Parathyroid Hormone levels?
Differences between a Parathyroid Adenoma and Hyperplasia?
Can Frozen Section differentiate between these?

Pressures of left ventricle . Flow volume looop

Edema
Left ventricular function and pressure
Prof Mohan Bile
Obstructive jaundice
Jg apparatus
What is Angiotensin 3
Ali
Exocrine endocrine pancreas
Response to metabolic acidosis
Wiggers
What is a platlet
What is hemostasis

Dr. M. Davis Lung compliance volumes capacities

One word to describe compliance
Static and dynamic pulmonary test. What to determine accuracy and adequacy of ventilation

Prof V Sural nerve flap gastrocnemius what is blood supply.

Naraynsingh
Mr. J. Head trauma assessment atls.contrast allergies contrast used in ct an mri. Reducing tiak of
Ramdass contrast injury. Using contrast in renal failure
How to do a dpl. Ct vs dpl vs uss
Preventing near misses in surgery

How to reduce complications in laprascopic surgery

Pressures in abdomen effect of pneumoperitonieum
Diabetic foot causes of neuropathy
Stages of charcot's joint
Pros and cons of transverse vs longitudinal incision abdomen
Management rectal cancer
Dr. S. Bile duct anastomoses, types and indications.
Cawich Types of Mesh Repairs, materials used and indications.
Laparoscopic vs Open hernia repairs.
Steps involved in Sx for incarcerated hernia
Surgical Site Infections
Complications of Cholecystitis.
How Chest Tube insertion alleviates the sequalae of a haemothorax, pathophysiology.
Intussusception. Associated malignancy risk. Indications for and against bowel resection.
Principles of Fistulae for dialysis, Indications, criteria to ensure patency.
Veno-occlusive syndromes.
EAST Algorithm on Wound Exploration
Prinicples involved in conductin a TME
VIVA TOPICS BY EXAMINER