MRCS Part B Questions

18/5/09 MRCS OSCE Limb + spine and Trunk + thorax.

Generally straight forward exam, although some parts were tricky. No particular surprises, just the instructions were
not always clear as to what is required. But apart from that, as expected.
1. Scrubbing and gowning- gel initially on hand, and examiner acts as scrub nurse. First scrub of day. Cap and mask
not needed, really assessing scrubbing and no touch technique when gowning, practice this! Also asked to show how
one de-gowns, and alcohol b4 leaving.
2. Burns. ATLS steps. Asses airway, ?needs tubing. Calculate % burns (60%) (diagram given), how do u calculate?
Fluids, how to calculate, what fluids, all crystalloid or colloid as well?
Shown cxr, pulmonary infiltrates-desiderating and 60 % - ARDS, define, how to manage, where? (?ITU).
3. Prep station, child with ?splenic rupture, shocked anaemic, ?fell from climbing frame, farther drunk.?NAI.
Having laparotomy. Asked to speak with mother, but told this was info giving, ?need to get more hx from mother?
?Tell her we need to invx ?NAI. ?Tell her of risks of death.
4. Write d/c summary to GP for pt who was admitted over wknd with poor pain control. Bkgd of Pancreatatic ca,
and palliative decompression procedure. No f/u. MST increased during visit.
5. Anatomy 1. Shown skeleton, which bones make up hip joint, stabilising factors, why iliofemroal ligament
strongest? Muscles of walking and climbing stairs on cadaver.
Chap in room, hit side on whilst cycling, extensive question about knee joint. Menisci, collaterals, blood supply,
point on cadaver. What invx? Shown MRI of knee, but not asked to comment, just asked, what would u see?
What other injury, com peroneal, how to test (on pt)? Also about ankle ligaments.

6. Anatomy 2. Veins for iv cannulation in arm and legs, structures at risk in median cubital cannula, demonstrate on
cadaver, shown xray with pneumothorax, where to insert chest drain. Position of neurovascular bundle of rib, order.
How to insert subclavian line, show on cadaver, what would u do next (CXR)? Nerve supply to parietal and visceral
pleura, how to insert tracheostomy, layers, on cadaver.
7. Anatomy 3. Spotters. Prosected myocardium and chest/abdo. About 16 questions. Ascending Aorta, brances,
azygous vein and tributaries, sympathetic trunk, origins. Position of spleen behind ribs, structures at risk during
splenectomy. Artery behind 1st part of duodenum. GB, why it causes shoulder tip pain. Ureter, bony relations and
blood supply.
8. Take blood cultures using universal precautions, and ask appropriate questions. Many candidates felt this was
ambiguous. When asked, he said he had hep C. Label bottles but not forms.
9. Prep station. 72yr Lady with probable perf on med ward. Needs laparotomy, given bloods and ABGs. D/w ITU
reg for bed pre /post op. Told only one available, he agrees she is unwell, but 24 year old asthmatic in A+E, may
need ITU, asks if you could negotiate with medics?! Then asks if this lady deserves ITU (pre morbid sate, which
you are not told). ?Arrange transfer. Again a bit unclear.
10. Hx takng. 50yrs male 5/7 post THR. Sudden onset chest pain, some haemoptysis, classic PE hx. Present to
examiners. Differentials, how to manage.
11. Varicose veins, Doppler etc, Tourniquet test, asked about signs on inspection management, and what is Doppler.
12. Scrotal swelling, examine and present. A bit uncertain if they wanted a full exam, or just scrotum. Definitely
inguinal hernia, but torches were there, ?Transilluminate. Differentials, ?Further invx, tumour markers for scrotal
swellings.
13. Hx from lady with 6/12 hx of sciatic back pain. Recent onset of urinary symptoms, (only when asked), present to
examiners, differentials further invx. MRI-how soon, ie. Concern about cauda equina.
14. Pre op assessment. Examine precordium. Again unclear what exactly needed, but probably wanted entire CVS
exam. Had aortic murmur , mechanic heart valve. Peri op management, warfarin/anbx etc.
15. Unmanned. Details about chap with crush injury, fractures, subsequent loin pain and microscpic haematuria-
rhabdomyolysis. Asked questions about this- management and investigations. Who should be involved in decision to
operate.
16. Umanned. CXR of ?tension p.t. and sub dural bleed. Questions on them. Chest drain etc. who to contact,
Advice: Read around the key topics, attend a course or two, but most importantly practice with Regs and
colleagues. Exam technique is as important as knowledge.
Make sure you are entered for the right exam on your entry card, 4 candidates thought they were dong T+T and
L+S. but it was the other way round!

MRCS OSCE 19/2/09 stations

order of theatre list 3 patients with differents problems, MRSA, Diabetes, pacemaker, severe copd,
* pre-op patient with herat block, how to manage, comment on ECG,
* lady admitted with 10 days history of vomiting, epigastric tenderness, severly hyponatraemic and hypokalaemic,
metablic alkalosis, how to manage whom to inform, comment on her chest xray.
* typical hx of cholecystits, comment on ct scan, how to manage?
* define a fistula, what precipitating factors can cause it? how to investigate, what clinical signs to elicit, how to
assess nutritional requriement through TPN, what complications can TPN Cause?
* knee examination
* hernia examination/ management
* communication skills, jehova's witness, refuses blood transfusion, due for a big surgery discuss risks, and
management.
* discuss with a consultant on the phone a patient with post cholecystectomy biliary leak, needs transfer explain the
picture?
* anatomy (3 stations) -> lungs, heart, phrenic nerve, vagus nerve, thyroid gland parathyroid gland (blood supply,
innervation), function, hoarsness after surgery? causes?, brachial plexus, what happens if injury to c5-c6? describe
the path of a clot from calf veins to pulmonary arter?
identify caecum, appendix, illeum, external oblique, internal oblique, and name some positions for appendix
* perform exicision and skin suturing of a benign skin naevus, difficult to approximate wound edges?
* take history from a patient with dysphagia, present
* cardiovascular exam and pre op assessment present
* history from a patient with chest pain post op, and present to examiner
* two rest stations.
*two preparations stations ( for communication skill stations)


20/02/09:

1) acute appendicitis - abdo examination
2) Parotid swelling - examination
3) telephone conversation regarding transfer of traume patient with widened mediatinum(CXR) with CT consultant
@ regional cardiothoracic centre.
4) Pt with splenic hematoma wanna go home - convince him to stay back.
5) pt for hip replacement - assess whether she is fit to give consent.
6) history taking - micturition problems.
7) cardiovascular examination - pre op assessment (post op valve replacement).
8) excision of skin naevus and suturing ( not able to approximate properly).
9) trauma pt details - questions based on it - liver laceration.
10) Anatomy - lower limb ( leg) - nerve & reflexes root values, muscles spotters and muscles for foot movements.
11) Bone spotters - shoulder, hip, knee, wrist & elbow - muscles, nerves et al
12) Pathology - aortic aneursym ( specimen) - prosection of abdomen - abdominal aorta & questions based on it.
13) theatre list with three patients - prioritise which one to be done first
a) diabetic with mrsa ulcer foot for bka.
b) diverticulitis for sigmoid colectomy ( allergic to iodine & penicillin)
c) man with pacemaker & on warfarin for RIH repair.
14) pt with burns management ( critical care scenario)
15) write a letter to gp about the management of pt on warfarin for inguinal hernia surgery as the pt is anxious about
warfarin & surgery.
16) lady with metastatic ovarian carcinoma with abdopain/distension, vomiting - dd/management & blood results
given
17) rest station
18) rest station
19) preparation station ( for telephonic conversation)
20) prepartatoin station ( for conversation with pt with splenic hematoma)

burns
ARDS
HDU/ICU monitoring
base of skull
lower leg + compartments
root values of leg nerves
surface anatomy of shoulder/arm/leg
trauma
bowel obstruction

clinical scenarios:
parotid swelling
abdo exam
throat swelling history
consent in confused pt
CVS exam (heart murmur)
discussion with cardiothoracic consultant over phone re trauma scenario
excision of skin lesion on fake arm + primary closure

*from forum
Anatomy: tyhroid, submandibular gland, knee, coronary artery circulation
Critical Care: starling, hyperkaelaemia, ionotropes
Clinical: Stomas, breast, ?branchial cyst, hip
Patient safety: diathermy, ATLS
Applied Surgical Sciences: sutures, complications fractures, CT scan of ruptured spleen, shock
Comm skills: breaking bad news, telephoning consultsny on call
Patholopgy: metaplasia, referral to coroner, audit




Anatomy stations
1-unmanned stations with full body skeleton and marked areas such as humerus , femur etc and there is a paper with
around 13 questions if i remember well, not easy to finish on time and you better check all pages so you know how
many questions u got ...in this stations i couldnt complete all questions due to lack of time !! they asked about
muscle attachments to the head of humerus and greater trochanter, also about name nerves that passes in this are
etc... cant remember the rest

2-manned station with anatomy of the aorta
there is a patients with abdominal aneurysm you ganna operate on him what level the aorta enters the abdomen
whats you surface markings for this entry point
identify the branches of the aorta
what posterior branches of aorta do you know
vena cava and renal veins identify and what lies anterior to renal veins
aortogram identify the branches
small specimen of what looked like a fusiform aortic aneurysm , asked me what do i think this is , define aneurysm
and what its causes...

3-a real person(not a patient) and examiner, all about lower leg reflexes(knee and ankle) , dermatomes ,muscle
groups and compartment syndrome, arterial supply, nerves...then he showed me a leg specimen and asked me to
point to the anterior tibialis....

scenario: you are the surgical SPR, thesister would like to have a chat to you about the theatre list
you enter the cubicle , there is a sister and in the corner an examiner with marking sheet.
sister asks you to have a look at the theatre list and see if you happy with order or you want to change anything
1-patient with for total colectomy, diabetic on insulin, MRSA positive
2-70 yrs old patient for inguinal hernia repair, known severe COPD
3- patient for Lap cholycystectomy, has pacemaker

type of anaesthesia
what post op arrangements HDU, ward etc
what type of diathermy for each procedure
where would you place the diathermy and why




Advice, not questions

most commonly asked:
abdominal wall
branches of the aorta
stomach blood supply
carpal tunnel
snuffbox
humerus
femur
ulnar/radial/median/facial nerve
compartments of the legs
inguinal canal
adductor canal
fermoral triangle
leg reflexes, dermatomes and muscle groups responsible(i had this in my exam)