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MRCS: Viva Questions

Viva Questions
Applied Physiology
1.How is oxygen carried in the blood?
What is the mechanism of binding of oxygen to
haemoglobin?
What is this called?
Draw the oxygen dissociation curve?
What does 50% saturation mean?
What partial pressure does 92% saturation
correspond to?
What partial pressure does 50% saturation
correspond to?
What is the right shift called? (Bohr effect)
What are the factors determining right shift?
What is the physiological consequences? Why is this
useful?
Draw the shape of the ODC for methaemoglobinaemia
What is the pathophysiology of
methaemoglobinaemia?
What is the affinity ratio in methaemoglobinaemia for
oxygen with respect to normal haemoglobin?
2.What is ARDS?
What are the defining features? What are the criteria?
What are the causes of ARDS?
What direct lung causes do you know?
What systemic causes of ARDS do you know?
How do you manage ARDS?
What are the ventilatory options?
How do you improve lung compliance?

How does nitric oxide work? / prostacyclin


How else can you treat pulmonary hypertension?
3.What muscle relaxants do you know?
What classes of muscle relaxants do you know?
How does suxamethonium work? What is it's
structure?
How is suxamethonium metabolised at the
neuromuscular junction?
What other cholinesterases do you know?
Why would you want to use a muscle relaxant? When
is paralysis useful?
What is myasthenia gravis?
What is the deficiency in myasthenia gravis?
Critical Care
1.What uses of central lines do you know?
What information can you determine from a central
line?
How would you perform a fluid challenge? What fluid
would you give? How much would you give?
What is the tracing of the central line waveform?
How is the CVP related to the right atrium? What does
that mean?
How do you insert a CVP line?
What do you need to do before you use your central
line (check tip, ensure tubing correct, calibrate)
What fluid is used for CVP transduction tubing?
Draw the graph for CVP change following a fluid
challenge in an underfilled patient
2.What options are there for pain control?
What is the pain ladder?
What routes of administration of analgesics do you

know?
How can you give opiates?
What is the metabolism of morphine?
What is the bioavailabilty of morphine? How much is
metabolised in the liver?
What is the problem with intermittent bolusing of
opiates?
What is the analgesic effect of morphine?
Draw the graph of efficacy/potency of morphine
analgesia with regards to its half life
What is PCA?
How is it delivered?
Is it safe? Why?
What do you know about epidurals?
What drugs are used in epidural analgesia?
3.What is a pneumothorax?
Pathology
1.What is an embolus?
Give examples of embolus - fat, thrombus, amniotic
fluid, air, nitrogen, septic
What is a pulmonary embolus?
What is the source of the embolus?
What effects would a deep venous thrombosis present
with?
What are the features of a pulmonary embolus?
What are the features of arterial thrombi?
What are the sources of arterial emboli (Left
atrium/ventricle, narrowed peripheral circulation,
atheromatous diease)
What organs are affected and what are the clinical
manifestations?
What is a fat embolus?

What is the aetiology? What are the


pathophysiological theories behind fat emboli?
What types of patients get fat emboli?
What are the clinical features?
What are the risk factors for arterial emboli?
2.What is an ulcer?
What factors affect ulcer healing?
What is the pathophysiology of peptic ulcer disease?
What is helicobacter pylori?
How does it cause ulcerations in the stomach?
What are the ways in which helicobacter can be
diagnosed?
Do you know of any blood tests?
What is the urease breath test?
What is the tissue pathological test?
What is the CLO test?
What does CLO stand for?
What infections cause ulcers?
What nutrient deficiency causes ulcers?
What skin tumours causes ulcers?
Name as many skin tumours as you can!
3.What is hyperparathyroidism?
How is hyperparathyroidism classified?
If 85% is due to a secreting adenoma, what is the rest
due to?
What is secondary hyperparathyroidism?
What are the causes?
Who gets secondary hyperparathyroidism?
What is teritiary hyperparathyroidism?
What are the biochemical changes in each?
What is the physiogical effect of parathyroid
hormone?
What are the effects?

Priniciples of Surgery
1.What is a subphrenic abscess?
Have you seen one before?
What are the causes?
What are the clinical features of a subphrenic abscess?
What are the nerve supplies to the diaphragm seeing
as you brought it up...?
What are the biochemical changes?
Do you always get pain?
What features would you see on a chest x-ray?
What other imaging would you do apart from
ultrasound?
How would you treat this?
What is the principle in treatment of an abscess?
What drainage options are there for subphrenic
abscesses?
2.What is mediastinitis?
What are the defining features?
How do you get mediastinitis?
What is rupture of the oesophagus known as
(Boerhaave's phenomena)
What imaging modalities would you do?
What can you see on a chest x-ray (surgical
emphysema)
What are the principles of treatment?
What would you treat? When would you treat? How
would you treat?
3.What is your approach to scrotal pain?
What are the causes of scrotal pain?
What is the nerve supply to the testicle?
How does it enter the scrotum?
What are the causes of testicular inflammation?

What is testicular torsion?


Who gets testicular torsion?
Why do patients have abdominal pain?
Applied Surgical Anatomy
1.Shown a right femur
What is this?
What type of joint is the hip joint?
What six movements are possible at the hip joint?
What biochemical property of the femur allows it to be
so mobile?
What is the blood supply to the head of the femur?
How does it get to the head of the femur?
What are the ligaments of the femur?
Which of these is the strongest?
Illustrate the attachments of the femoral capsule?
Why is it important to know this?
What is the significance of the foveal blood supply?
When is the blood supply via the ligamentum teres
important?
2.Shown a saggital section of the pelvis
What is this? What type of scan is it? What kind of
section is it?
What are the structures that you can see?
What are the limits of the peritoneal markings?
How far exactly does the peritoneum extend
inferiorly?
How much of the bladder is covered by peritoneum?
How much of the uterus is covered by peritoneum?
What is the broad ligament?
What is the space behind the uterus called?
3.Shown the facial nerve

What is this?
What is this gland (the parotid)?
How many branches of the facial nerve are there?
Name them
How can you test the facial nerve? What muscles in
particular can you test?
What's this (submandibular gland)?
What is the nerve supply to the submandibular gland?
If the cervical branch of the facial nerve is injured,
what deficits would you expect to see?
4.Shown the Sigmoid colon on a cadaver
What is this?
How do you know?
How can you tell large bowel apart from small bowel?
Operative Surgery
1.A patient presents with a dorsally angulated distal
radius fracture in casualty.
What is your approach?
How would you examine the patient?
What features would you look for?
What analgesia would you give?
How would you perform a haematoma block?
What anaesthetic do you use?
What is the appropriate dose of lignocaine?
What are the features of local anaesthetic toxicity?
Would you use anything else with the local anaesthetic
(adrenaline)
Why would adrenaline help?
In what circumstances would you not use adrenaline?
What other local anaesthetics do you know?
What is special about bupivacaine? Under what
circumstances have you used it?

What is special about marcaine? What is it's specific


gravity? Why is that important to anaesthetists
2.How do you manipulate a fracture?
What is Newton's third law?
How would you manipulate a distal radius fracture?
What are you doing to the fracture when you increase
the tilt?
Why are you doing this?
What is dis-impaction?
How would you apply the plaster? How many layers of
plaster?
Where would you plaster from and to? Why?
(immobilise joint above and below) What physical
property are you using?
What follow up would you do for this patient?
How long does an upper limb fracture take to heal?
3.What is a gastrostomy?
When would you use it?
What type of patients require it?
What methods of insertion do you know of?