MRCS Part B OSCE

MRCS part B OSCE
11.1.2017, Yangon
Total 20 stations
2 rest station, before communication stations
Station 1 (Anatomy)
Prosection of thorax and abdomen
Identify the ascending aorta and arch of aorta,
Tell me the branches of the ascending aorta the right and left coronary
arteries
Identify the right ventricle
What is this structure tricuspid valve, papillary muscles
What is this structure cordae tendonae
Function of this str the cordae tendonae attach the valve and papillary muscles thereby
preventing the prolapse of the tricuspid valve during the contraction
Identify the azygous vein
What are the tributaries of the azygous system the posterior intercostal veins and lumbar
veins on the right and on the left, hemiazygous vein and assessory hemiazygous vein
Identify the sympathetic trunk
What levels of spinal cord contribute to it T1 to L2
What communicates the spinal roots and post ganglionic fibres gray
rami communicantes
Identify spleen
Blood supply of the spleen
Tell me the course of the splenic artery

What structures are supplied by the splenic artery apart from the spleen
What is this str duodenum
How many parts
What ducts enter into it from where
Id this str gall bladder
Surface anatomy of the gall bladder
Station 2 (anatomy)
Prosection of the anterior neck
Show me where is the thyroid gland
How many lobes
Blood supply
What nerves are at risk during the operation
Show me recurrent laryngeal nerve
What is this muscle superior belly of omohyoid
Nerve supply of this muscle
Why thyroid moves upward with swallowing
Infrahyoid strap muscles
Types of thyroid cancers
If there is lymphatic spread, where would it go
If damage to recurrent laryngeal nerve, what would happen
Station 3 (anatomy)
Upperlimb (prosection of forearm, hand x ray and bony model)
Identify the carpal bones in hand X ray

Significance of tenderness in the anatomical snap box
What would u concern with the scaphoid # and why
Prosection identify the flexor digitorum superficialis
Id median nerve sensory deficit if damage
Id ulnar nerve sensory deficit if damage
Show me the attachments of the flexor retinaculum
What structures passing thr it
How would u test for the action of FDS
Show me the actions of the thumb
Station 4 (surgical pathology)
Surgical pathology BCC
Show me a photograph and describe the lesion (I didnt do well)
What would u think BCC
Show me the histology report, margin involvement (+)
The natural history of BCC
If there is a lymphatic spread, what steps need to (I answered the extensive local
destruction and lymphovascular involvement and then it may spread to lymphatics,,, he said no,
at the end of questions, I tried to answer infection??? He said what else. Totally no idea)
Unclear margins what would u do
Station 5 (procedural skill)
Catheterization
Surrogate with a dummy of penis in between his legs
Pt complaint of unable to voide for a night with abdominal pain
U are not allowed to examine his abdomen

Discussion if no urine, what are the possibilities
How would u do it
If no urine after flushing of catheter USG- what gonna find
If no he wants me renal failure pre-renal, renal and post-renal
Scenario middle aged gentle man, with abdominal pain and free gas under diaphragm in
abdominal film, had history of taking NSAID
What do u think
Pathophysiology of peptic ulcer disease
Effect of NSAID on gastric mucosa
Phases of gastric acid secretion
How would u manage DU Vs GU
What medication might pt need for long term? PPI
Mechanism of action of PPI
Do u know NCEPOD, tell me
What operation for this pt according to NCEPOD
Scenario 33 yr old female complaint of weight gain and lathergic, TFT high TSH and low T3
and T4, CBC given macrocytic anaemia
What is your diagnosis
Tell me how is the secretion of thyroid hormone controlled.
If secondary what would be the TFT
Symptoms of hypothyroidism apart from these symptoms
Causes of hypothyroidism in this pt

How do u think of this anaemia
What are the pre, intra and post operative concerns of hypothyroidism
Patient with chrons disease, present with abdominal pain and vomiting, defunctioning ileostomy
was done and ileostomy reversal was done. This is post op day 5, no surgery previously, plain X
ray abdomen given
What do u see in this x ray. Distended loops of bowels
Diagnosis IO
Causes of this condition in this pt
How would u differentiate IO vs ileus
What methods of nutrition enteral and parenteral
Indications for parenteral and enteral
Complications of parenteral and enteral
Patient with sickle cell disease, head injury, accidentally find SOL in brain
What is sickle cell disease
How is it inherited
What is the surgical concerns of sickle cell disease
Why bone pain
Why immunocompromised
What do u think of this SOL brain
Natural history of brain tumours
Biopsy done squamous cells (+)
What do u think secondary metastasis

Where might be the primary of SCC
The wound become infected and the analysis of the discharge fluid
revealed the glucose of g/dl (I dont remember the value but somewhat high) connection
with CSF
Station 10 (procedural skill)
Excision biopsy of a navus
Your consultant is about to perform an excision of the abnormal mole in right thigh of this pt
but he left due to an emergency patient
U have to explain the procedure and explain u will perform instead of ur consultant
Check for the consent
Choose the instruments u need
U have to explain about dressing, the drugs and the biopsy report
Station 11 (rest station)
U have to deal with a chart for the next station
Station 12 (communication station- information giving)
Phone report to the oncall consultant about post op pt
Who gets oliguria (urine output nil for 2 hrs)
Fluid chart fluid deficit
Ask whether u need to admit to HDU or not I said no and I will do fluid challenge first and
inform u whether there is response or not, only after that I will consider admission to HDU
Station 13 (information gathering)
Middle aged lady with lump in neck long standing about 10 yrs, increase in size within 6
mths
There is also symptoms of hyperthyroidism
Station 14 (rest station)

U have to deal with a pt chart
Station 15 (information giving)
Deal with an angry patient who request self-discharge admitted last 2 days for fall from height
He has a job interview which is very important to him
And also his wife was diagnosed with CA breast, and have an appointment to her doctor, he
wants to be with her during the consultation
I explained about the current condition and consequences of discharge from the hospital and
offer options to sit interview from the hospital and he denied
And then I offered transport to interview by our transport and medical cover seems to accept
it
Station 16 (information gathering)
Middle aged pt with bleeding during defecation for 6 mths
Positive family for CRC
Diagnosis, differential, how u investigate, pre-op investigations
Station 17 (physical examination)
Examine cranial nerves functions for this lady who present with
headache and blurred vision
U dont need to test olfactory, visual acuity, color vision, gag reflex and ur not provided with
tuning forks
Pt has bitemporal hemianopsia
What is ur findings
What conditions can give rise to this clinical pictures
Some discussion about the pituitary tumours
Middle aged man with indirect inguinal hernia

Diagnosis, do u want to do any investigation to confirm ur diagnosis I said no, cos the
diagnosis of hernia is mainly clinical
Pre op investigations and issues about underlying cause COPD and BPH
Middle aged man with hernia do pre-op assessment
Pt with sternotomy scar and I think 5 th to 6 th day post op according to wound condition
No signs of heart failure
Obvious metal valve sound, no murmur
The sound is loudest at apex, and therefore I said mitral valve replacement
Pt has bruises at both wrists
Some discussion about pre op and post op warfarin and heparin
Station 20 (Physical examination)
Middle aged man with right knee pain
Full examination of knee
Discuss about OA knee

MRCS Part B OSCE Yangon, January 2017
Day 1, PM session
1. Anatomy (Thorax and abdomen) with cadaver
- Identify pulmonary trunk, papillary muscle, chordae tendinae.
- What is the function of chordae tendinae?
- Identify ascending aorta.
- What are the branches of ascending aorta?
- What is this structure? (Azygous vein)
- What are the tributaries of azygous vein?
- What is this structure? (Sympathetic chain)
- Which spinal segments contribute sympathetic chain?
- What connects sympathetic chain to spinal nerves?
- Identify spleen.
- On which ribs does the spleen lie?
- What structure is susceptible to injury during isolation and ligation of splenic artery?
- Describe the course of splenic artery.
- Which other organs does it supply?
- Identify duodenum.
- How many parts?
- Which artery lies behind the first part?
- Which structures open into the ampulla of Vater?
- Where does AOV drain into?
- What is this? (Fundus of gall bladder)

- Surface marking of it.
- Why does cholecystitis cause shoulder tip pain?
2. Anatomy (Thyroid and its surrounding) cadaver
- Identify thyroid gland and its parts.
- How would you confirm thyroid gland on examination?
- What is the attachment of pretracheal fascia?
- Blood supply of thyroid
- Identify superior thyroid artery.
- Identify infrahyoid muscles.
- What is their nerve supply and root value of that nerve?
- Vocal cord attachment
- Which muscle contraction causes tense vocal cord?
- What is the nerve supply of that muscle?
- What structure is closely related to inferior thyroid artery and what will happen if that structure
is injured?
- What structure is closely related to superior thyroid artery and what will happen if that structure
is injured?
- Which vessels of thyroid gland are related to sympathetic trunk?
- How will you establish upper airway access in case of emergency?
- Identify cricothyroid membrane
3. Anatomy (Hand and forearm) hand X-ray, skeleton and cadaver
- Identify carpal bones on X-ray as well as the skeleton.
- What is the significance of scaphoid fracture?
- Identify the flexor retinaculum. What are its attachments?

- Identify median nerve and ulnar nerve.
- Which intrinsic hand muscles does median nerve supply?
- What is the sensory innervation of the median nerve?
- What structures pass through the carpal tunnel?
- Identify flexor digitorum superficialis and profundus.
- Identify distal attachments of FDS and FDP.
- How will you test the function of FDS and FDP separately?
- Identify common flexor origin.
- What is the root value for intrinsic muscles of the hand?
- What is this structure? (Ulnar artery and superficial palmar arch)
- How will you test sufficient ulnar artery supply to the hand?
- Describe Allens test.
- Movements of the thumb and innervation for each muscle
4. Pathology
Scenario: 58 year old lady with sickle cell disease fell down and injury to the parietal area. CT
scan was done. Brain tumor found.
- What is sickle cell disease?
- Surgical relevance of sickle cell disease.
- Why patients with sickle cell disease are prone to get infections?
- What is the most common primary tumor of parenchymal origin?
- What is the natural history of that tumor if left untreated?
- Biopsy of the brain shows SCC with keratinization. What is the diagnosis and what are the
possible primaries?
- Post-op craniotomy wound is infected. What is the common causal agent?

- Fluid from the wound shows glucose 3.3mmol/l. What does it mean?
5. Pathology
Given the picture of ulcerative lesion near the hairline showing raised and rolled edge,
telangiectasia and surrounding redness,
- What are your physical findings?
- What are your differential diagnoses?
- Biopsy shows BCC what findings you will look for in the report.
- There is no margin clearance in the report. So, what will you plan for marginal assessment in
next operation?
- What is frozen section?
- What are the steps in the metastasis of tumors via lymphatic spread?
Skin graft was done and the patient had graft failure subsequently.
- What was the cause for the graft failure?
- Common organism for wound infection?
- What is MRSA?
- Who will you involve in the management?
Patient developed axillary LN enlargement. LN biopsy showed large cells with bilobed nucleus
with prominent eosinophilic inclusion like nucleoi resembling an owls eye appearance.
- What is your diagnosis now?
6. Critical care and applied physiology
A patient with acute abdominal pain, signs of peritonism, free gas under the diaphragm, had
taken NSAIDs for musculoskeletal pain
- What is the diagnosis?
- What are the aetiologies of peptic ulcer disease?
- What are the causes of increased gastric acid secretion?

- What are the controlling physiological mechanisms of gastric acid secretion?
- What are the phases of gastric acid secretion?
- What medication will you involve in the long term management of this patient?
- What is the mechanism of action of proton pump inhibitors?
- What is the NCEPOD classification for urgency of operations?
- What is the urgency of this case for operation?
- What are the surgical management of PDU and PGU?
7. Critical care and applied physiology
A patient with hypothyroidism, not complaint to medications presented to preoperative clinic for
elective surgery Blood results reduced Hb, increased MCV, high TSH, low T 3 and T 4
- Interpret the TFT and what is your impression?
- Draw and explain the thyroid hormone axis.
- 6 clinical features of hypothyroidism.
- What are the 3 causes of hypothyroidism?
- How can you improve this patients compliance to medication?
- What concerns you most if a hypothyroid patient is to undergo an operation?
- What are the clinical features of myxedema coma?
- How will you prevent this?
8. Critical care and applied Physiology
A patient with Crohns disease post-op 3 rd day ileostomy, plain abdominal X-ray (pre-op)
shows small intestinal obstruction
- What is your diagnosis?
- What are the routes for nutrition in surgical patients?
- What are the indications for parenteral nutrition?

- What are the constituents of parenteral nutrition?
- How does mucosal atrophy occur in TPN and what are possible complications?
- Apart from carbohydrate, which component gives most of the energy?
- What are the complications?
- What are the indications for enteral nutrition?
- What are the complications of enteral nutrition?
9. Procedural Skills
- Urinary catheterization
- Questions
What will you do if no urine coming out aftercatherization?
Management of oliguria, anuria
Fluid challenge
10. Procedural Skills
- Removal of nevus and suturing of the wound
- Questions
After care
Follow-up
11. Physical Examination
- Examination of cranial nerves - Bitemporal Hemianopia
Management of pituitary tumor
- Examination of left inguinal hernia
Management of indirect inguinal hernia

What if the patient has BPH?
- Examination of cardiovascular system Mitral valve replacement (With sternotomy and left
submammary scars, metallic click)
Patient is on warfarin. What is your preoperative management?
- Examination of knee joint Osteoarthritis of right knee joint (With effusion and limitation of
knee flexion)
Differential diagnoses
Management
15. Communication Phone call to consultant
- Post op 2 nd day oliguria
Patients consultant is away. Call to consultant on-call.
16. Communication Request for discharge
- Splenic haematoma due to injury during playing rugby
- Patient wants to be discharge.
- Hb drops 2 mg% from base line 48hr after admission
- Concerns Job interview, Wife
17. Communication Information gathering
- Old age gentleman, bleeding per rectum, mucous stool mixed with blood, LOW, LOA, chronic
constipation
- Diagnosis CRC
- Differential Diverticulitis, Inflammatory bowel disease
Management of CRC
18. Communication Information gathering
- Middle age lady, long standing goiter, recent toxic change
- Diagnosis Toxic multinodular goiter
Management of toxic MNG
All the examiners are really sweet and they just want to get the key points. Almost every
question is a repeat of past year ones, so make sure you practice those repeatedly before the
exam. Good luck!
Hyderabad Jan 2017 Morning session (MRCS Eng)
Anatomy
1.
2. History (Hx) You are going to assist your consultant for AAA. So boss decide to discuss
aorta anatomy with you. Picture of the abdomen given.
a. Identify the abdominal aorta (AA)
b. Starting and end levels
c. Name its branches and vertebral levels
d. Surface marking of the AA
e. What structures lie anterior to AA at L1
f. Demonstrate IVC and its branches.
g. What is an aneurysm
h. Angiogramme given. Identify Coeliac trunk and its
branches, SMA, IMA
3. Hx Rugby player sustained neck injury during a tackle. (Actor + single examiner) picture of
the axis vertebra given on ipad.
a. Identify the vertebra. Name the parts.
b. How many cervical vertebras
c. How many cervical nerves
d. Point to most prominent spinuous process on the patient. Wt vertebra is that. Why
is it prominent?
e. Atlas vertebra picture shown on Ipad. Identify odontoid process. What are the
ligaments attached to it.

f. Point to hyoid bone on patient
g. Point to a structure lies in anterior neck at C6 level cricoid
h. Wt GI structure is related there.
i. Show the boundaries of the posterior triangle on the patient.
j. Where the roots of brachial plexus lie. Between which 2 muscles.
k. Surface mark brachial plexus on the patient
4. Actor sits beside.
a. Demonstrate on patient
i. Eversion and inversion
ii. Action of EHL
iii. Action of combined TA & TP
iv. Action of PL & PB
b. Where to palpate pulses of foot
c. Origin and insertion of P.brevis and P.tertius
d. What are the compartments of the leg?
e. What muscles in each compartment?
f. Arterial and nervous supply of each compartment
g. Root value for superficial and deep peroneal nerves
h. If patient has 1 web space numbness and foot drop, what is the diagnosis
compartment syndrome
i. Root value of knee and ankle jerk
j. Surface mark the area of distribution of deep and superficial peroneal nerves
k. Surface mark S1 dermatome

Pathology/ Critical care
5. Hx 58yr old lady with HTN, Asthma awaiting laparotomy. Still in ward, but going to fetch in
1 hr. Temperature chart last reading 34 C.
a. What is the condition Hypothermia
b. Define hypothermia
c. Risk factors in this patient?
d. Complications of hypothermia
e. What wd u do in the ward.
f. Whom do you inform
g. Do you think need to postpone the surgery?
h. How to prevent hypothermia (expected all the possible causes)
6. Picture of Basal cell carcinoma given.
a. Describe the picture. (Nodule with central ulcer and bleeding.
b. 3 DDs?
c. Name 2 causes for surrounding erythema
d. Define metastasis
e. Describe the pathological meachanism of lymphatic spread in
this patient
7. Hx 60yr old lady with childhood Rheumatic heart disease. Now coming for
Cholecystectomy.
a. Immune mechanism of Rheumatic fever
b. Pathogenesis of Aortic sclerosis and stenosis
c. Define IE
d. What organisms
e. What to look for in 2DE
f. Name 3 lesion found in the hand
g. Name a single investigation to monitor response to Abx
h. If patient not improving then what Aortic valve replacement
i. What other specialities you refer
j. If patient go for cardiac transplant, what to check for organ rejection HLA
k. What are the mechanism of action of known immune-suppressants
l. What are the complications of immunosuppressants
m. What is the mechanism of lymphoma with Immunos?
8. Discussion only. Given history of RTA. Polytrauma. BP 100/60, HR 134, Right chest air entry
diminished. Rigid abdomen.
a. Discuss management. (ATLS principles)
b. Define shock. What shock this patient is in.
c. What IV fluids
d. What Xrays
e. When to do Xray
9. Hx Pregnant lady POA 34 weeks undergoing open cholecystectomy. Intraop tachy cardia
and BP dropping.
a. Define preload
b. Factors governing the preload
c. Why BP drop in this patient?
d. Do you think this surgery is necessary? Give factors for and against. (WTF pt halfway
through the op.) I gave the indications would have been empyema blah blah)
e. What would do you to improve pt condition?
f. How the venous return differs in standing vs Supine
g. How to prevent DVT
h. What is the mechanism of action of DVT stockings
History taking
10. 65yr old gentleman difficulty to pass urine. BPH picture. Irritative and obstructive
symptoms+. No malignant features. Pt has taken nasal drops for last 2weeks.
a. Present ur history
b. How do you manage? I started staying I ll do thorough examination examiner got
pissed said give your management only!
c. Wt blood investigations?
d. What are normal values for PSA? When suggestive of BPH/Cancer
e. Conservative/surgery
f. What medical treatment?
g. Surgical options?
h. What is the relation of nasal drops in causing difficulty passing urine? WTF
11. Instructions- 30yr old lady awaiting cholecystectomy. And you are seeing her in the pre-
assessment clinic. Patient complains of chest pain. Take her history.
Hx 10yr history of dyspnea. Aggravated for last 6 weeks. Specially at night. Non smoker. No
exertional dyspnea. No Orthopnea. (Seems like asthma/COPD) Has visited GP CXR and ECG
taken and found normal. Takes pain killers of abdominal pain
a. Present the history

b. DDs
c. What investigations?
d. After CXR you come to the diagnosis of asthma, What other investigation you do?
Spyrometry
e. What is the relevant family hx you should ask? I said allergies/hay fever. (Examiner
not happy)
Examination
12. Patient with large BL hydrocele. Examine this patients scrotum. Patient was fidgety. C/o of
pain for slightest touch. So excuse and progress. (Pt doesnt speak English. Examiner was not
observing me during the examination)
a. Present your findings. It was a large tense hydrocele. No penis visible.
b. What are your DDs
c. What imaging. USS
d. Wt u expect to find in USS
e. What else? I said CT TAP. Not sure
f. How do you manage? Conservative/surgical. Expected to know the steps of lords
and Jabulouy
13. Hx 10yr duration of Anosmia. Impaired vision for 6 months. Do the relevant examination.
a. I did the cranial nerve examination. (Expected to do fundoscopy/ Snellens chart-
provided). Very poor vision cannot properly count the number of fingers. Rest of the
exam normal
b. Present the findings
c. DDs?
d. What Imaging
e. What surgical approaches
14. Hx- POD4 laporotomy. Complaining of right sided chest pain. Do the relevant examination.
On general examination-Left calf tenderness. CVS/RS normal. Observation chart given.
Which shows Sao2 dropping. RR increasing.
a. Present the findings
b. Whats your diagnosis
c. How do you investigate
d. Management- acute/longterm
Advice Do General examination including ankle oedema/ calf tenderness check for all CVS/RS
examinations.
15. LL peripheral vascular system examination. Patient with right dorsum of foot ulcer, 4 th toe
amputated. 3-5 th toe gangrene. BL DP/PT absent.
a. Present the findings
b. Discuss management.
c. CT or MRI angiogramme is best?
Communication
16. 8yr old son fell from height. Admitted with splenic laceration. Rpt.
a. Mother kept on asking how the surgery is being done.
b. Had to explain the laparotomy from the incision
c. Complications after splenectomy.
d. How to prevent
17. Telephone referral. Instructions said go through the notes (10 pages) and discuss the
findings with senior colleague.
Hx- 83yr old lady from a nursing home ADL I. Admitted with sudden abdominal pain after
breakfast. Diagnosed as abdominal viscus perforation by the consultant and planned for a
laparotomy. But after his next case as patient is stable at the moment. Investigations Hb low,
Urea and S creat high, ABG metabolic acidosis wit partial compensation. (I think it was for
ICU referral. But it wasnt mentioned in the instructions. May be written somewhere in the
case notes. I haphazardly discussed the findings. Next station was a rest station. And I heard
next candidate discussing about the ICU referral.) Did not do well in this station.
So advice read through notes carefully.
Surgical skills
18. Excision of a naevus. LA given already. Consent. Excise. Suture. Pt advice. (Rpt)
19. I and D thigh abscess.(Rpt)
a. Consent. Give LA
b. What needle size?
c. Check LA strength, Expiry date.
d. Incision direction?
e. Why? Langers line
f. Demonstrate langers line direction in thigh.
g. What dressing to pack inside. What dressing outside. (I saw on past papers
somebody had mentioned about giving trade names. But my indian examiner was
not happy when I gave trade names eg: aquacell.
Good luck.
Darshana Chandrakumara
Penang Jan 22 nd , 2017
Stations Topics (Repeat all from Kuching AUG 2016 except LBP)
1 Brachial plexuses and examination of Nerves lesion
Attachments and insertion of UL muscles
Test for each nerve injury (Repeat)
2 Abdomen and organs, blood supply
3 Lower limb Dissection.
Muscle, Sciatic nerve, Hamstring Muscle and their actions (Repeat)
4 MEN 1, Patients with hypoglycemic attacks, Hyperparathyroidism
Genes and 2 hits hypothesis???, Telomere and its action
5 BPH (Patho) (Repeat)
Ca prostate and bilateral orchidectomy rationales
Frozen section
Rectal tumour cell included in Histo examHow to differentiate
(Histo chemical stain???)
6 LBP examination and discussion (Repeat)
7 CVS Examination, AF and anticoagulation
8 Varicose vein examination (Repeat)
9 Sutures
Knot tie
Deep cavity tie
Haemostaic suture (Repeat)
10 Cranial nerve examinations

MMSE (Repeat)
11 Post op pain (Repeat)
12 History taking on Headache (Repeat)
13 History taking on urinary symptoms and DDX
Mx on BPH
14 Inform ICU for pre-op advice and request Post op ICU bed.
Case of perforation after meal in an elderly patient with COPD treated by steroid for 8
years. (Repeat).
15 Splenic rupture in 8-year- old boy with his father
Patient is in OT for emergency Laparotomy. (CT proven)
Mother Qs about surgery without her consent
Upset but calm and ask all the Questions for Post splenectomy
(Information given) (Repeat case but different approach)
16 Patient with Symptoms of TURP,
Give diagnosis and D/Dx.
Interpret the result.
Discuss TURP and its complications. (Repeat)
17 Crohn and Nutrition (Repeat)
18 OT List (Repeat)
Penang Jan 2017 first day, all repeated except the fluid chart and resus, they got real patients and
cadaver
this time. Sure to pass if you well prepared with the past questions in the summary
Station 1 critical care, PUD, repeated questions
Diagnosis, pathophysiology of PUD
Risk factors, different phases controlling gastric acid secretion
Causes?
Meds?
How PPI works?
Station 2- critical carefluid chart (totally new, definitely screwed up and examiner not helpful
also)
Total hip replacement POD0-1
Show 3 pages of fluid chart and asked whats the problem and what medical team should have
done
between some certain time points of A,B,C etc
Define shock
What kind of shock is patient having
Station 3 - critical care- EDH, fully repeated, plz refer to the past questions
Station 4 Anatomy heart, thoracic cavity and abdo (examiner say the heart is made from real
heart!!!)
What is this? chordae tendineae
What it attach to-- -the papillary muscle and cusps
What function it is-- -prevent the valve from collapsing
Point out the pulmonary trunk and aorta

What are the branches of ascending aortaleft and right coronary artery
What is itazygos vein
Name two other trifurcation of azygos veinhemiazygos and accessory hemiazygos
What is itsympathetic trunk
Which spine level it is fromT1 to ?L2
What does it call connecting the spinal nerve and organ?-- - ganglion(didnt get the answer
though)
What is it -- -duodenum
What parts it has-- -1 st to 4 th
Ampulla of vater open to which part2 nd part
What duct is drained though the ampulla of vaterpancreatic duct and common bile duct
When you do the splenectomy, need to preserve what structures? What runs in them?
Station 5 Anatomy Spine (fully repeated, perfectly done within 6 min haha)
Which vertebra are theseLumbar spine
Tell me all the parts of the lumbar spinetransverse and spinal process,superior and inferior
articular facet, lamina, pedicle, pars, vertebral body, spinal canal
Put 2 vertebra together and show intervertebral foramen
What joints the spine have between the two vertebraedisc and facet articular joint
What kind of joint the disc joint issecondary cartilaginous
What motion the lumbar spine have-- -flexion and extension
Show where the ALL, PLL, Lig flavum should be
Shown MRI. Number the lumbar spine and point out the disc
Anatomy of intervertebral discInside is anulus fibrosus, outside is nucleus pulposus
What type of joint the disc joint issecondary cartilaginous

Explained what will happen to the disc while aging-- -dry up and loss of height
How the PID happen? anulus fibrosis rupture and nucleus bulging out
In posterior disc herniation of L4/5, which nerve root will be affectedL5
Sensory area for L5-- - to show on my own body
There is a space called extra Dural Space, what are contents?spinal nerve, lymphatic vessel
and
internal vertebral vein
Whats the significance of internal vertebral vein?-- valveless vein, it is the basis of theory
why easy
for metastasis to spine
Spinal cord ends at which level, adult and childL1 and L3
Which level to do the lumbar puncture and how to define it-- -L3/L4, iliac crest
Whats the content from L4-S2- -- spinal nerve, CSF, cauda equina, conus medullaris, filum
terminale
Station 6 Anatomy Parotid gland a patient model and a plastic model
Surface mark the parotid gland -- to show on the patient
Surface mark parotid duct to show on the patient(not happy enough with middle third
between
phylum and antitragic, need 1-2cm below the zygomatic arch)
Duct opening(upper 2 nd molar teeth)
Point to stylomastoid foramen
Point out all branches of facial nerve after parotid (shit, 2 branches I messed up two with the
external
carotid artery, too nervous)
Other than facial nerve, what may also be damaged during opretromandibular vein and
external
carotid artery which run thru parotid
There is a 5mm lump over parotid, tender, what it will be-- LN
Inflammatory causes of parotid swelling Sjogrens and Mumps
Most common Benign causes of parotid swellingpleomorphic adenoma
Most common Malignant causes of parotid swellingeither mucoepithelial carcinoma or

adenoid
cystic carcinoma
Which cranial nerve supply parasympathetic fibre to parotid glandglossopharyngeal nerve
Explain frey syndrome
Station 7 Pathology TB/lymphoma, repeated but examiner difficult
Young lady back from third world country, developed cervical lymphadenopathy. LOW, night
sweats.
What are your 2 main differentials?-- TB/Lymphoma
What lymphoma you suspect?- non-hodgkins
What test for TB? culture, TB PCR, Interferon gamma assay(need exact name, TB
quantiferon
gold)
What are giant cell of langhans?-macrophage
Name one other mycobacterium commonly seen in immune compromised patient? MAC,
full name
Name three other granulomatous changes, not TB/foreign bodytold her crohn, sarcoidosis,
atypical mycobacterium, leprosy, rheumatic fever, she still need one more, prob cat-scratch
disease
How long does TB culture take
What is the proteinaceous substance can be found in TB? AA amyloid

What should you do after TB diagnosed? Report to CDC and she need more and more, not
sure
Station 8 Pathology diverticulitis, seems repeated but didnt prepare well
Pathophysiology of diverticulitis?
Why endometriosis caused pain?
How did endometriosis get to the colon?retrograde menstruation and ectopic endometrial
tissue
Perforated and got abscess, whats the content inside abscess?
How the neutrophils go to the infection site?
Station 9 Ankle examination-- SP
Examed injured ankle and the examiner reminded me to exam the other side
Tenderness over the right lateral mall and 5 th MT base. Ligaments all ok
It was fracture over right lateral mall, comfirmed by x-ray finding(examiner will tell you)
Management? RICE, slab, limb elevation. If the fracture high like weber C will need above
knee slab,
if low, need below knee slab, examiner say let resume low
What else want to tell patient? Casting 4-6weeks, follow up time, MC
Station 10 Aortic stenosis pre-op examreal patient
Full examination for CVS
Only findings is the systolic murmur, asked what kind of systolic murmur?
Station 11 Herniareal patient
Patient had bilateral hernia but it is a malay patient cannot speak English and he pointed out
only left
side. DO exam both sides
Question: directed or indirect hernia? do you need image to diagnose? how to manage, Cx vs
Sx
Station 12 - thyroid - real patient
The patient thyroid located to extreme right, I thought it was lipoma rather than thyroid
Question: differentials? Lipoma, the other thyroid differentials
Examiner say lets assume it is a thyroid patient, what investigation? TFT, US, FNA
FNA found follicular cell, how to manage?
Station 13 history
Chest pain with SOB
Differetials as PE, AMI
Investigations and treatment
Station 14 history
Knee pain and very typical OA knee, the SP was reading his own note all through the whole
session
haha
Differentials and investigation
Station 15 - Procedure OT listing, repeated questions but not well prepared. Please refer to the
past account,
already well stated. The scenario details combination may change.
Station 16 Procedure Resus on model, new
Got a model and ask for resus, ABC etc. examiner nice and led me through the session, just
need
ACLS knowledge
Station 17, 18 - Communication
Prepared for one session and a lot of info, reported to trauma consultant or vascular
consultant, he
asked quite detailed info, but nicely lead you to the answers
Open fracture or tib/fib with vascular injury
Summarize the management in the end after this discussion with consultant
Station 19, 20 - Communication
To answer a pre-op patient three concerns, this patient due for recurrent hernia repair next
week and heart function not good
Warfarin bridging, anesthesia, very worried
Just need to explained and show your PLC, enjoyed it as last station
Gallstones detected by gp via ultrasound but lif pain and diarrhoea and constipation history
On questioning she will say she is very anxious about having surgery, not being able to afford
being
off work due to money.
Always ask is there anything else ou want to tell me!
Gallstones do not require management immediately
Asked about provisional and differential diagnoses
Asked about investigations
At the end everything was normal ie she had irritable bowel
Asked about what should be for about the gallstones and the rate of progression to something
more
serious
Back pain history
5 year history of back pain
Worse in the last 3 years
MRI 4 years ago showed mild degenerative change with no pid
Spouse is an invalid
No neurological symptoms
No trauma
No weight loss or other sinister red flags
This was a plain lower back pain station
Asked about investigations ie repeat MRI
Refer to chronic pain specialist and then to psychologist
Thyroid mass goitre and dominant toxic nodule history

10 year history of goitre
Now has a dominant lump that is thyrotoxic
What investigations to be done
Treatment
Side effects of carbimazole
Cancelled operation again
TLC
Itu bed request on the phone
Copd, perforated gastric ulcer
Will need a laparotomy
Ask for a bed
Metabolic acidosis on abg
independent ADLs
Daughter busy, patient poor historian
Cr 140
Unstable ie bp dropped and tachycardia
Insertion of chest tube
Blood culture
This guy was an ass
Cardiovascular exam
Mitral regurgitation at pre op assessment
Postpone surgery
ECG, echo
Lady with Acute abdominal pain examination
Go through differential diagnoses
Bph pathology? Benign prostatic hyperplasia-- >
Patient with poor stream and nocturia
What are your differentials? BPH, Carcinoma, bladder stones
What examination would one perform? DRE
What investigations? PSA, DRE, transrectal u/s, biopsy, if biopsy cancer then CT scan, MRI,
bone
scan.
What medications are used? Aplha blocker alfuzoscin, 5alpha reductase inhibitor- finasteride
What happens to testosterone in the body? DHEA-- > testosterone-- > DHT
Why are there sclerotic lesions on X-ray (due to osteoblastic activity)
Initial PSA of 4, becomes 12 after 6 months, worried? Yes cancer
After prostatectomy he returns 6 months later with a PSA of 3, is there a problem? Yes after
prostatectomy PSA should be zero so this guy has recurrence
Lung anatomy an outline
Orientate the lung (right lung)
What nerve lies in front and what behind ant: phrenic nerve, post: sympathetic chain
Name the fissures
How many bronchi pulmonary segments are there?
Talk about DVT
What is the best test? PE: CT angiogramand V/Q scan
Talk through the path of a clot starting in the calf deep veins of the calf -- > popilteal vein,
femoral
vein, ext iliac, common iliac, ivc, atrium, AV valve, pulmonary valve to the pulmonary artery
Lower long saphaneous vein anatomy with some lung anatomy surface anatomy- arises from the
dorsal veins of the foot, passes anterior to the med malleolus, rises in the med aspect of the calf,
lies
4 finger breath post to the med condyle of the femur, rises up the med aspect of the thigh before
ending in the SFJ medial to the femoral artery.
What nerve is in close relation to this vein (saphaenous nerve)
X-ray of a pneumothorax
Where would you insert a chest drain; triangle of safety, 5 th intercoastal space, bounded
anteriorly
by the post border of pectoris major, posteriorly by the mid axillary line
If tension where do you decompress mid calvicular line, 2 nd intercoastal sapce
Lower limb anatomy 5 muscles in the posterior compartment
Action of muscles ant and posterior tibialis cause inversion, peroneal muscles cause eversion,
soles
and gastrocs cause plantar flexion
Cutaneous supply of the lower limb
Nutritional status
How to calculate? Nutritional calculators, age, activity level,
Burns: basal requirement +replacement = 25-30 kcal/kg + 70kcal/kg/% burn
What methods do you know of parenteral and enteral
Nj, ng, peg
What increases requirement -- > sepsis, post surgery,
What is in tpn
What are the complications of an ng/nj dislodgement, infection, aspiration, diarrhea,
colonisation
of bacteria, overfeeding, refeeding syndrome- hypophosphatimia
How is tpn administered and why: thru a central line. Thickness of the fluid and also causes
pheblelitis due to the high osmolarity
Wht happens to the gut after prolonged tpn. Mucosal atrophy
What is the implication of this? Translocation of bacteria to the blood stream causing sepsis
Why is glucose not a good substitute? Higher respiratory quotient, lesser energy value, critically
ill
are glucose intolerant, lack of essential fatty acids
Blood gas. How is co2 transported disolved, in the form of Hco3, carbaminohemoglobin
Patient who has a large dose of morphine
How do you reverse this - naloxone
How would you administer this? IV injection/ IM /Sc, but may need repeated doses as short
acting
competitive antagonist
what drives respiration
Central and periphery chemoreceptors receptors
central: medullary response to PH,
periphery: eg at carotid body response to oxygen levels and co2 levels
mechanical receptors: eg hering breuer reflex: stretching of the lung inhibits inspiration
Respiratory centre in the medullary to control respiration rate
Epidural patient post lobectomy with hypotension and bradycardia -> neurogenic shock, due
to
anasthetics epidural, heart block,

Possible Causes: cardiac event, pneumothorax, epidural
What to do: stop the epidural and fluids
Why cold and not pin prick?????
How do you investigate for pneumothorax clinically and cxr
Good luck!
Our account:
anatomy/patho stations
1. venous cutdown sites, 1st rib, pleural domes, cubital fossa - what
struc might u injure when inserting in median cubital vein (MBTR),
saphenous vein (saph nerve and innervation)
venous cutdown sites: median cubital vein, long saphenous vein ant to the med malleolus
saphenous nerve: innervation: sensory nerve innervating the medial aspect of the leg and the
foot.
2. thorax and abd (damn tough station) - heart (pt out LA, LV, RA,
auricle, PV), liver lobes by falciform lig, identify quadrate lobe and
boundaries, what branch of celiac supplies both liver n stomach, wat
struc might be injured in a stab in epigastrium going upwards, liver
attachments to diaphragm
4. Patho report of testicular Ca, teratoma and blood markers,
undescended testes with teratoma, causes of genital warts and urethral
discharge, (which doctors should see these pts?! - said ID/ uro/ GP
they dun seem satisfied...grr), tell me 3 things about the patho
report that are abnormal (teratoma, lymphovascular invasion, margins

NOT clear), need to refer oncology for chemo (not sensitive to
radiotx) at MDT
surgical skills
1. handwashing, gowning, degowning (will check under UV light!!)
2. insert IDC for ARU - quizzed on causes of anuria
communications skills
1. call ITU reg to ask for bed for pt with COPD, found to have air
under diaphragm and needs laparotomy, blds given - metab acidosis,
ARF, uremic
2. angry pt + breaking bad news - husband with ascites went for
peritoneal tap shows malig cells, CT scanner down, will offer
Ultrasound
critical care
1. acute pancreatitis - given bld test results, hypoCa, amylase >2000,
tell mi wat scoring u know, when u do the scoring, why pt has hypoCa,
where will u manage this patient and why (? ARDS), clinical exam
features, pseudocyst, what is in the wall of the pseudocyst, how to dx
pseudocyst
-glasglow and ranson.
on admission and 2 days after admission.
Hypocal: consumptive , preciptating of calcium soaps from reaction with the fatty acid released
ITU -- > ARDs, need to calculate ranson scring

abdominal pain, shock, hypoperfused, tachycardia, fever if sepsis
oliguria,
usally occurs in the lesser sac lined by granulation and fibrosis tissues
clinical,: mass, ultrasound/Ct scan
2. TURP syndrome (pt post TURP confused, hypoxic, BP low, sats low) -
what is glycine, how to mx this patient, why they use glycine, how to
mx, where will u mx, will u give hypertonic NaCl (NO!!!!), medical mx
- diuretics, tell me how they work and where they act (mug ur renal
physio)
hypotonic glycine is the solution used during TURP for the distension of the bladder and for a
clearer view of the bladder
resus: judicious IV hydartion , momitoring CVP and urine output
- oxygenation
- diuresis
- replacement of sodium but not more than 10mmol/day
- HDU
-Glycine used because non electrolyte so non conductive during electrocautery
-diuretics: potassium sparing: aldosterone antagonist: acts on the distal tubules on the Na/K+
pumps
amloride: sodium pump
Not: frusemide: loop of henle acts on na/k/cl pumps
3. pt coming for cholecystectomy, at PACE, c/o SOB over the last 1
yr?~~ recently with PND but no orthopnoea, some night sweats, take a
hx - mx, causes of SOB/cardiac/lung, pt also eventually found to have
hyperventilation (kan cheong spider) with perioral numbness and
numbness in fingers
Mx: CXR, if coughing with sputum do sputum stain, AFB smear, ECG, FBC, CRP.
Causes of sob: Lung: Tumour., infection, acteletasis, PE, pneumothorax, effusion any causes
Cardiac: Cardiac failure, arrthymia, valvular disorder, Psy: anxous
4. anaes reg inserted CVP and kenna pneumothorax - management (they
will say pt is super stable so no need needle decompression STAT, can
do chest tube), what are the kinds of pneumothorax you know, what are
the immediate complications of CVP insertion (carotid puncture,
thoracic duct mainly), surface mark for IJV, should always do under
ultrasound guidance anyway!
pnuemo- tension and simple
-cvp insertion : bleeding, injury to structireseg nerves,thoracic duct, veins, air embolism,
arrythmias,
IJV : lat to the carotid artery, in between the two head s of the SCM, originates medial to
mastoid
process
history taking
1.right tonsillar enlargement - discuss inx, management
- Tumour/TB, infection/ inflammation tonsilitis, abscess, lymphoma, sarcoidosis
- smear, CT scam, biopsy,
2. difficulty PU X few mths, LUTS - discuss BPH inx and management,

side effects of alpha blockers and 5a-reductase inhibitors
alpha blockers: postural hypotension, syncope and headaches, nasal congestion
5 alpha reductase inhibitor: decreased libido, decreased sperm volume, impotence, depression,
anxiety
physical exam
1. CVS exam - pacemaker, CABG, mitral regurg, read ECG, pre op
preparation for pt with pacemake
refer CVM
pacemaker pre op: ask technician to review the pacemaker and set the pacemaker
set to VOO/DOO: no sensing so no pacing inhibition at cautery, tachytherapy deavticated so no
shocks given during cautery
Intraop: use bipolar if possib le, if monopolar then place pad away from defib eg at LL, if defib
needed place pads away from pacemaker
2.thyroid exam - right lobe diffuse swelling, no eye signs, inx and management
diffused swelling cause: simple colloid goitre, graves disease, hasmimoto's

disease.prominent
nodule of MNG
if single nodule: simple thyroid cyst, prominent nodule, cancer,
Invx: bld: TFT: T4, T3 TSH level ,anti thyoidglobulin antibodies, anti thyroid peroxidase
antibody,
R, u/s, radioisotope scan . Biospy CT scan
Treatment: antithyroid PTU, carbimazole ->inhibits thryoid peroxidase reduces coupling and
idioination of thyroglbulin to become idotyrosine, beta blockers, steroids
RAI, subtotal thyrodiectmy

3. abdo exam - RIF tenderness in female, differential diagnosis, inx,
what bld test can help dx acute appendicits (they want ESR/CRP), rem
to rule out gynae causes/ectopic pregnancy
DD:
Colon: diverticular disease, Ca, IBD, appendicitis
Ileum: ilelitis,
Ureter: stones,
Bladder: UTI
Gyn: ectopic, ovarian cyust, torsion, PID, endometriosis
blood test: FBC< CRP, ESR, cultures, BhCg
Imaging: u/s, Ct abdomen

Cortisol-adrenal cortex medulla function cortisol aldosterone, layers producing what
RA on long term steroids
Stopping steroids ,Addisonian crisis,
ACTH inhibition
RA
Preop management
CVS exam, LBBB pacemaker
Preop optimisation
Pathology slide
Giant cell arthritis- temporal
ESR, histo, cell type, why does it occur- vasculitis, affect visions
Management-steroids, eye , arteritis biopsy, skip lesions-negative biopsy
======================
Hip fracture in steroid usuage-
Causes-Avn, osteoporosis, malignancy-
Cannulation-fluids ATLS, who to call, imaging, trauma series
Excision of lesion-interrutpted ellipse, consent form, go through risks, post op care-dry sto,
discharge
Abdo-RHQ- actor rebound
mx- cholecystitis iv abx emergent or delayed
==============
lower back pain-spine and Neuro PID-
ddx and mx
obs jaundice
cause , blood tests, possible causes of obs
pancreatic cancer
BREAK 10 mins
Communications- hx of dysphagia- GP gerd/reflux
Mx, causes of dysphagia
Bloods
Vascular claudication
Ddx- ix, mx
Prep station
Refer CTVS- RTA widened mediastinum
Long #, CT scan down, diabetic, Hb, psoa shadow cant be seen ,
How do u want to transfer the pt
Im sorry hes not been IDC, not sure if abdo soft (apologise)
Prep stations
Communications
Arthroscopy- case cancelled- consultant has to do trauma case
Offer analgesia, prescription,
Feedback channels, t alk to wife (wife is upset) reschedule apt earlier priority
Rest
Spine= vertebrae- identifies processes, ligaments and nerves- MRI PID at L5
What is dermatome and myotome of L5
Where does the conus medullaris end in children, how is it diff from adult
Where to do lumbar puncture

Disc-annulus propulsus
Cartilage type of disc- fibrocartilage
Heart
Valves, branches of aorta
Thorax
Azygos, symph trunk
Spleen
Course of splenic artery- what organ does it supply
Duodenum-artery lies behind it
Wad organs may be damaged in splenectomy
Thyroid strap muscles, innervation, ansa cervicalis, nerve and artery dmg in thyroidectomy,
thyroid
cartilage- where to do cricothyroidotomy, vocal cord attachements
If u cut symp cervical trunk, what will happen- autonomic dysregulation horners
Intercollegiate MRCS Part B Examination Questions/Stations
1. UPPER LIMB ANATOMY
Scenario motorcyclist involved in RTA with hyperextension injury to neck (most
likely brachial plexus injury is upper trunk)
C5 and C6 nerve roots involved
Demonstrate where C5 and C6 nerve roots exit on skeleton (intervertebral
foramina)
What are the results of upper trunk brachial plexus injury
Questions on shoulder anatomy including demonstrating attachments of shoulder
muscles and identification on prosection.
Questions and demonstration on cadaver muscles of upper part of upper limb (i.e.
attachments of biceps and brachialis.
Know the innervation of muscles in upper limb
Muscles involved in abduction i.e. initiation and top end of movement
Questions on supination muscles responsible
Demonstrate supination on a patient
Demonstrate reflexes of upper limb biceps, supinator, triceps and what the
nerve roots being tested
Sensory supply of upper limbs including anatomy of the cutaneous nerves of the
upper limb
2. GENERAL ANATOMY
Written station asking questions about landmarks on skeleton
Muscle attachments of lower limb muscles on skeleton

Lateral cutaneous nerve of thigh
Common perineal nerve injury questions about course of nerve and effects of
injury
3. CLINICAL SKILLS
Perform skin lesion excision and then suture
Scenario is that you are asked by you consultant to take over seeing a patient who
has a skin lesion that requires an excision biopsy. The consultant has apparently
taken consent and infiltrated the lesion with local.
You have to talk to the patient about what you are doing and what will happen with
the biopsy and follow up.
Make sure you check consent and ask to see the consent form.
You have to set all you equipment up yourself i.e. attaching blade onto scalpel and
disposing of them appropriately; choosing correct suture; wear GLOVES
I think it would be wise to set up a sterile field and measure the lesion and use a
marking pen to delineate where you are going to cut
Check the anaesthetic side of things i.e. its numb
Everyone had difficulty suturing as the suture tends to cheese wire through the
material
Give wound care advice when suture to be removed/infection/etc
TALK while you WORK its a fast station
4. THEATRE LIST ORDERING
You have to order a list and know why
Patients include knee replacement who is IDDM and MRSA; RIH repair on
warfarin; Sigmoid colectomy for diverticular abscess who is iodine allergic;
Another chap with a pacemaker for some procedure I cant remember
Questions about what you need to inform the nursing staff about each procedure
Iodine allergy use chlorhexidine instead but flammable risk
Questions on diathermy risks and how it works and where to put the plate (in
particular with the pacemaker chap)
Questions on warfarin management
5. CRITICAL CARE SCENARIO
Scenario of a lady who has had extensive abdominal surgery with an
enterocutaneous fistula. Patient is in acute renal failure and septic
Questions on management
Understanding of SIRS
Management of fistula (SNAP)
What affects wound healing/fistula formation/healing risk factors for fistula
formation
What fluids to give this patient how fast, etc
Nutrition
Interpret blood results and gases why they are hyponatraemic and hypokalaemic
6. COMMUNICATION SKILLS
Scenario Patient is a Jehovahs witness due to undergo an anterior resection.
They have been told that there is a high risk of death especially if it comes to the
point that a blood transfusion is required. The wife of the patient wants to talk to
you about the operation. She requests that if he needs a blood transfusion that
you give it.
Stand your ground its the patient wish not to be transfused and not her choice.
Legal issues of battery/lack of consent.
Write a letter to GP explaining what will happen to a patient who has a metallic
heart valve and is due to go to hospital for RIH repair i.e. admit early, stop
warfarin, monitor INR, start heparin infusion, then restart warfarin post op, etc.
Remember to document what the f/u with regard to anticoagulation will be.
8. ANATOMY TRUNK & THORAX
Identify the bladder pathology of the bladder e.g. types of neoplasia, type of
epithelium
Blood supply of bladder
Muscle of bladder
Nerve supply of bladder
Peritoneal relationship to bladder
Structures behind bladder
What structures are penetrated during an SPC insertion
Symptoms of bladder neoplasia
Causes of haematuria
Risk factors for UTI
9. HISTORY TAKING & MANAGEMENT
Take history from a young adult who has bloody diarrhoea and abdominal pain for
last 3/12
?IBD
Differentials, investigations and management
10. CLINICAL SKILLS
Take a history and examine the respiratory system for pre-operative assessment
Investigations
What the implications are for laparoscopic cholecystectomy respiratory wise
11. PANCREATITIS
Data interpretation of basically pancreatitis bloods, imaging, etc
Score pancreatitis
Management
Written station
12. GASTRIC OUTLET OBSTRUCTION
Written station
Data interpretation of gastric outlet obstruction
Management
Questions on arterial blood gas
Questions on renal physiology e.g. why hypokalaemic in acidotic state
Telephone call with consultant explaining case and what your management will be
Scenario young adult involved in RTA. 5 min LOC at scene of accident. Injuries
open tib fib fracture; fracture wrist; left flank bruising. US some free fluid in
abdomen but normal spleen, kidneys and liver. Your house officer sees patient as
concern about left being pale. Pulses not palpated. Tells you.
You have not seen the patient but have to speak to consultant about case.
Admit that you have not seen patient
First issue is left open fracture with ischaemic leg most probably vascular
injury.
Second issue free fluid in abdomen even though US normal
Third issue LOC - ?head injury
So you have to present case and discuss management arteriogram, etc.
Discuss about calling anaesthetist and theatres.
Discuss ortho management Ex-fix
May want to do laparotomy free fluid in abdomen
CT Head?
14. ABDOMINAL EXAMINATION
Guy had loads of hernias incisional, umbilical, inguinal
Talk about management
Hernias pathology
15. CLINICAL ASSESSMENT
Take pre-operative history from lady who is fit and well for a lap
cholecystectomy. Thing is that she has intermittent SOB and palpitations for no
reason whatsoever.
Rule out other cause in your history
Discuss management and investigation.
I thought she had anxiety but this is a diagnosis of exclusion
Decide whether you would proceed

16. HEAD & NECK EXAM
Thyroid goiter/lump
Do the assessment and then answer questions about management/investigations
17. CRITICAL CARE
Scenario Lady post anterior resection 5/7 post op. Septic
Talk about management and investigations
Know your SIRS and its management
Interpret blood results and investigations
Scenario Child is brought in after falling. Brought in by father. Child sustains
?splenic injury and US shows free fluid. Decision is to go for laparotomy +/-
splenectomy. You have to talk to mother and explain what has happened
To complicate matters mother and father are separated. There is past history
of injury whilst in the care of the father. The father had alcohol on his breath.
Mother throws a fit issue of who consented
Need to talk about splenectomy and essentially go through consent of operation.
Remember the vaccinations and prophylactic antibiotics
19. COMMUNICATIONS SKILLS
Write a discharge letter to GP scenario of a chap with end stage pancreatic Ca
admitted with pain. Had his pain meds adjusted. He was aware he was going to die
soon and wished no further intervention
20. ABDOMINAL ANATOMY
Shown a double contrast enema asked about anatomy of colon

Asked about pathology of colon and colon cancer
Blood supply of intestine
What operation would you perform for a transverse colon tumour
Identify structure of the portal triad on prosection
Asked about liver anatomy
Relevance of 1st part of duodenum Gastroduodenal artery
21. ANATOMY STATION
Written station with a prosection
Identify azygos vein and its tributaries (what drains into it)
Gall bladder
Bony landmarks of ureter
Blood supply of ureter
Questions on sympathetic trunk pre-ganglionic and postganglionic outflow
22. CLINICAL SKILLS
Take blood cultures from a pyrexial patient who is an IVDU
You have to talk to patient as you are doing it
Find out that she is Hep C +ve and allergic to penicillin
Youve got to fill out the blood form appropriately high risk
23. CLINICAL SKILLS
Hand washing and gowning
Remember to the use the nail brush, etc
When you degown gloves off last
24. TRUNK EXAMINATION

History and examination of a chap with a lipoma on his back
Questions on management
Questions on consent about operation
25. HISTORY TAKING
Take history on rectal bleeding obviously has colorectal tumour
Management and investigations
26. WRITTEN STATIONS
Data interpretation on pancreatitis; anastamotic leak; chest infection
Management of conditions
Ultimately they go to ITU
27. CARDIOVASCULAR EXAMINATION
Pre-opeative assessment of someone with a murmur
Some people had patient with a prosthetic heart valve
28. OTHERS
Base of skull anatomy
Burns management
ARDS
HDU/ICU monitoring
Lower leg anatomy + compartments + nerve anatomy
Parotid swelling - examination
Patient with splenic haematoma wishing to go home convince him to stay
History taking micturition problems
Course of the phrenic nerve

Parasympathetics anatomy
Popliteal fossa anatomy
Sites of IV cannulation complications
Anatomy of the aorta
Anatomy of the duodenum and its relations
Pathology of pulmonary embolism path of the thrombus to the pulmonary artery
Path of the vagus
Thyroid anatomy
Pathology of aneurysms
Trigeminal nerve anatomy

Critical Care Vivas and Physiology
1. Acid base 1. 72y/o man with sudden onset severe abdo pain and shock. Hypotensive, abdo
distended and peritonitic. ABG - pH 7.35, PCO2 2.5, Po2 18.1, HCO3 13.6, lactate 8.0. Interpret
ABG
(metabolic acidosis and resp alkalosis compensated). Clinical correlation (lactic acidosis 2ndary
to
shock and hyperperfusion)? DDx (AAA)? Mx (Ccrisp/ALS ABCDE surgery)?
2. 65 y/o man - acute abdo pain in vomiting. Worse on right side. Worse on inspiration.
Hypotensive, tachycardic. ABG - pH 7.29, PCO2 3.5, PO2 22.2, HCO3 15.3. Biochem - Na 132,
K 4.3,
urea 22.4, Cr 225, Hb 19.3, WBC 30.4. Erect CXR - no free air, no consolidation. Interpret ABG
(metabolic acidosis and resp alkalosis uncompensated), clinical correlation (acute renal failure,
polycythemic, neutrophilia, sepsis)? DDx (acute abdomen, peritonitis, cholecystitis, pneumonia,
urosepsis)? Mx (CCriSP/ALS ABCDE imaging IV antibiotics and +/- surgery)?
3. 60y/o F, schizophrenic, vomited brown fluid, 2x malaena, alcohol related cirrhosis,

schizophrenia,
distressed, hypotensive, tachycardic, abdo SNT. ABG - pH 7.15, PCO2 2.3, PO2 12.3, HCO3
7.4.
Biochem Na 129, K 4.0, Urea 19, Cr 166, Hb 5.2, WBC 16.4. Interpret ABG (Metabolic
acidosis, resp
alkalosis uncompensated, hyponaetremic, acute renal failure, grossly anemic, WCC up, SIRS),
clinical
correlation (ruptured oesophageal varices, duodenal ulcer, gastric ulcer, upper GIT bleed leading
to
shock hypoperfusion, arf and hypovolemia)? DDx? Mx (CCRISP/ALS, ABCDE, IV fluids,

bloods x-
match, minnesota tube/sangstaken blakemore tube, endoscopy for urgent clipping, ?

4. Analgesia - 32y/o F loin to groin pain, renal colic. Stages of analgesic pain management
ladder?
How does paracetamol overdose cause liver injury (toxic metabolite NAPQI depletes glutathione
and
accumulates in liver - free radical injury)? How do opioids work (mu kappa delta endorphines
CNS)?
What are the SE of opioids (resp depression, CNS depression/euphoria and pinpoint pupils, GIT,
voming/nausea/constipation)?
5. Anastomotic leak - 64 y/o 8D post Low AR with primary low anastomosis. Previously well
now
tachy, low grade temp, tender abdomen, had preop RT. Dx (anastomotic leak, collection,
abscess)?
Mx (CT scan collection/leak - drainage of collection, theatre to repair leak, defunctioning stoma,
IV
antibiotics, IV fluids)? What risk factors for leak? (Patient/Wound/surgery - DM/ischemic/low
anastomosis, preop RT, cancer malnutrition, local infection/contamination, poor surgical

technique)
6. ARDS - 38y/o F progressive SOB, 24hrs post bilateral mastectomy and TRAM flap. HR 90.
RR 32,
Sats 88%, Temp 38.2, Urine 25ml/hr. ABG 7.51, PaO2 6.1, PCO2 3.9kPA, HCO3 22, BE 1.
Interpret
ABG (Hypoxic, resp alkalosis - hyperventilating). Causes of Acute respiratory failure (PE,
Pneumonia,
atelectasis, pneumothorax)? Treatment of pneumonia (Iv fluids, IV antibiotics - ceftriaxone,
azithromycin and metronidazole)? 2hrs later - ABG pH 7.49, PaO2 5.8, PCO2 4.3, BE 1. What is
this?
ARDS. How is this defined (non-cardiogenic pulmonary oedema, PCWP <18mmHg, sudden
onset,
bilateral infiltrates, PaO2/FiO2 <26.7kPA)? Common causes of ARDS (Fat embolus,

aspiration
pneumonia, Trauma, Pancreatits, Haemorrhage and Bypass, transfusion, sepsis)? How to MX?
(ICU,
CCRISP/ALS - supportive, treat underlying cause, mechanical ventilation with PEEP, prone, low
tidal
volume and high frequency - Inspiration:Exp ratio 2:1, fluid restrict, inhaled nitric oxide,
steroids,
surfactant)
7. ATLS - Patient fell off 30 feet off house roof. Hypotensive, tachycardic, leg pain, open left
mid-
shaft fmoral fracture, open book pelvic fracture. Assess and manage (ATLS principles trauma
team
resus bay, C-spine control with collar, head blocks and strap, Airway assessment look listen feel,
oropharyngeal airway/NP airway/ETT, B - 15L high Flow O2 through non-rebreather, look at

trachea,
chest movements, feel crepitus, percussion/breathing + RR, pulse oximetry, BP, HR, C- ECG, -
2x large
bore IVC, bloods for FBE, UEC, CMP, LFT, coags, X-match 4 units, BM, lactate, ABG, 2L
warmed NaCL,
look for bleeding - chest, abdo, pelvis, long bones or floor. NGT, IDC/urogram, Pelvic binder,
splint
femoral shaft fracture and apply local pressure, trauma series XR - C-spine, chest, pelvis and
left-mid
shaft, FAST scan for abdomen, always reassessing previous ABC, then assess
AVPU/GCS/pupils,
glucose, expose - cut off clothes and apply warm blankets. Involve orthopods for pelvic and
midshaft
femoral fracture. call consultant on call.)
8. Blood products - Traumatic amputation of leg and haemoglobin of 5g/dl. Name 3 different
blood
components (PRBC, platelets, FFP, cryo, Blood -packed/irradiated/leukodepleted). Give 3
indications
of platelet transfusion (massive transfusion >4 units, platelets <50 and symptomatic for
surgery,
DIC). What is the shelf life of platelets (5 days)? How are platelets transfused (shelf life 5 days,
transfused 30-60min)? What is massive transfusion (replacement of total blood volume

>10units in
24hrs or 4units in 1 hour)? What are the complications associated with massive transfusion
(Haemolytic reaction, TRALI, DIC, ARDS, overload, coagulopathy, thrombocytopenia, acidosis,
hyperkalaemia, hypocalcemia)? What is an autologous transfusion (self to self) and how can it be
collected (cell saver, preop blood donation)?
9. Transfusion reaction - 74 y/o man HDU post transfusion SOB - assess and manage. (stop
transfusion but leave cannula in replace with NaCl, x-check details send back to blood bank and
CCriSP/ABCDE - ?anaphylaxis/haemolysis/TRALI/overload? - run IV fluids, IDC, encourage

diuresis
and maintain renal perfusion with frusemide/dopamine with discussion with intensivist, bloods -
coags, d-dimer, FBE, UEC, anaphylaxis - airway protection, adrenaline, corticosteroids, anti-
histamines) Signs of haemolytic transfusion reaction (fever, hypotension, rash, petechiae,

bleeding
from IVC, haemoglobinuria)? What immunological reactions following a transfusion

(anaphylaxis,
transfusion reaction, TRALI, alloimmunization, Graft vs host)? What blood products available
(Blood
and components)? What is donated blood screened for? (HIV, hep B, hep C, HTLV, syphilis
mandatory, additional based on screening - West nile, CMV, malaria, Trypanosoma cruzi)
10. Transfusion - 67y/o lady on warfarin for AF requiring emergency surgery for bleeding
duodenal
ulcer that cannot be controlled endoscopically. How to reverse INR of 5
(prothrombinex/Beriplex,
FFP, platelets, Vit K)? Why not use vitamin K (slow - hours to act)? What is the definition of a
massive
transfusion (replacement of total blood volume >10units in 24 hours or >4units in 1 hour)?

What are
the complications of a massive transfusion (DIC, ARDS, hypothermia, thrombocytopenia,
coagulopathy, hyperkalaemia, hypocalcemia, TRALI, haemolytic reaction/alloimmunization)?
11. Burns -Father has full thickness burns to right arm, child has partial thickness burns to face,
chest
and abdomen. How do you classify burns (superficial (skin not broken, dry, red and painful),
partial
thickness (red, skin broken, exudate, painful), deep- white and insensate, underlying structures
eg
tendon/bone, also 1st degree/2nd degree/3rd degree)? How do you measure extent of burns (lund
browder/rule of 9s)? What is transfer criteria to regional burns unit (complex - follow NHS -
burns
facility/burns unit/burns centre - essentially, very young or very old, >5% TBSA in children,
>10%
TBSA in adults, smoke inhalational, all full thickness burns, all circumferential burns, burns not
healing in 2 weeks, non-accidental burns, burns on sensitive areas -
hands/feet/face/perineum/genitalia, airway, chemical/electrical/friction/cold injury, unwell child,
multiple co-morbidities)? How to manage fluid resuscitation (parkland formula 4xTBSAxWt, 0.5
given
in 8hrs and 0.5 given in 16hrs)?
12. Burns 2 - from the question previously, what is your immediate concern in the child -
inhalational
injury, burns on face, soot in mouth/nose, entrapped space, SOB? How would you manage this
prior
to transfer (early intubation)? What concerning features may make you suspicious of impending
respiratory distress (RR increase, accessory muscles, cynaotic, grunting, retractions, nostril
flaring,
sweating, stridor, oximetry desats)? What are the complications of burns (inhalational, infections,
sepsis, sirs, toxic shock, ARDS, dehydration and shock, scarring, cosmesis, psychological,
contractures, compartment syndrome, rhabodmyolysis)?
13. Where is calcium stored (mostly in bone, some bound to albumin)? How is it regulated (PTH,
calcitonin, vit D)? What effect does fall in calcium have on the parathyroid gland (increase PTH
release) and how would its response increase extracellular calcium (PTH - increase bone
resorption,
vitamin D formation in kidney, increase kidney reabsorption)? How is vitamin D metabolized

(skin
and UVB from cholesterol - then liver to 25 hydroxycholecalciferol then kidney - 1,25
dihydroxycholecalciferol by 1-alpha hydroxylase (regulated by PTH)) and how does it increase
calcium (increase gut and kidney resabsorption)? Where are parafollicular C cells found (thyroid,
precursors to medullary thyroid cancer)? What do they do (secrete calcitonin - decreases bone
resorption, increases kidney excretion?
14. How can total thyroidectomy affect serum calcium (parathyroids either removed or
devascularized)? What signs and symptoms would a hypocalcemic patient demonstrate (tetany,
chovsteks/trosseus, perioral tingling and numbness, confusion and convulsions, cardiac

arrhythmias
- QT prolongation, then torsades, VF, VT and death)? How would you manage a symptomatic
hypocalcaemic patient (2x 10ml IV calcium gluconate 10% 10minutes + PO calcium

replacement vit D
and cholecalciferol)? What are the possible causes of abdo pain in a patient with hypercalcemia
(renal colic, constipation, PUD)?
15. Compartment syndrome - 26y/o Man closed fracture to midshaft right tibia. POP back slab,
now
increasing pain. What is main concern? What is compartment syndrome? Where else can
compartment syndrome occur? Why do you get foot pulses in patients with lower leg
compartment
syndrome? How to confirm Dx if unsure - manometry - >30mmHg? How would you

manage? 4
compartment fasciotomy with 2 incisions. How to perform emergency fasciotomy lower limb?
THIGH - intertrochanteric line to lateral epicondyle, cut ITB vertically, reflect vastus lat off
lateral IM
septum and cut. medial incision to release adductor compartment. Lower leg - 2 cm lateral to
lateral
margin of tibia. Medial incsion - 2cm posterior to medial margin of tibia. Upper arm?
16. What is CVP? How can it be determined at bedside? Draw normal venous pressure wave -
what
are the waveforms (ACX VY - atrial contraction, ventricular contraction, atrial relaxation, atrial
filling,
atrial emptying into ventricle)? What is the normal value of CVP (5-10mmH20, 3-8mmHg)?
What is
the surface marking of the IJV that is used for insertion of central line (clavicle and SCM
towards
ipsilateral nipple)? How to insert central line (aseptic, US guided, seldinger technique)? What are
the
indications (measure CVP, pass PAC, give fluids, drugs eg chemo, vasopressors,
haemofiltration/dialysis, TPN)? What are the complications? (insertion related - pneumothorax,
bleeding, arterial cannulation, haemothorax, line migration, air-embolism, thrombosis, cardiac
arrhythmia, line infection) What is PCWP? What is swan-ganz? How to draw PCWP curve as
balloon
tip advances (low, in CVP and RA (0-8), wide in RV (3-30) narrower in PA (10-30) then narrow
in PC
(10-18)? if PCWP >20 - likely heart failure.
17. What is FAST scan? What quadrants does it look at? What is DPL? What are the indications?
What are the contraindications? How to perform DPL?
18. What is an epidural? How can epidural cause hypotension? How to perform epidural? What
are
the complications? How to manage hypotensive patient on epidural? O2, IV fluids bolus of
500ml,
IDC urine output, if T6 block - stop infusion, notify anaesthetist, prepare to treat hypotension, lie
patient flat, elevate feet, may need vasopressors and HDU
19. You are called by the nurse re: 49y/o man elective lap chole 3 hrs ago. Early warning score is
5.
HR 105, BP 95/40, RR 26, Temp 37.0, Sats 92% RA, GCS 15. What is rationale of early warning
system - standardize early detection of deteriorating patient to allow for early response? What
parameter is most sensitive (RR) (RR, O2, temp, SBP, HR, conscious level) - 0-4, low, 5-6
medium, >7
high risk? What could cause these findings in this patient (bleed, bowel perf, MI, chest
infection/PE)?
How would you manage this patient CCRISP ALS ABCDE - give O2, IV fluids, send
bloods+ABG+trops
and ECG, Hx and exam, CXR, analgesia, increased frequency of obs and discuss with senior ?
Where
would you manage this patient? ward then HDU if fails to respond to therapy.
20. GCS - Calculate scores and immediate mx?- 45y/o M, laceration to scalp and smelling of
alcohol,
opening eyes when you speak to him, hold conversation but disorientated. Pulls hand away when
you apply nail bed pressure. 18y/o M - MVC, head injuries, opens eyes and extends left arm
when
pain applied. No response is seen on right hand side, no sounds made. Young girl intoxicated,
overdosed, withdraws hand on nail bed pressure, groaning sound, eyes flicker open briefly. 80y/o
M,
NOF# drowsy on ward postoperatively, eyes opening to voice, localizing pain, confused and
disorientated but can form sentences.
21. Inotropes - ARDS and septic shock post Hospital acquired pneumonia - what is inotrope?
How do
they work? How to calculate BP? How to calculate MAP? How are CO, SV and HR related?
What are
the determinants of CO? Where would you manage this patient on inotropes?
22. ICP - CT2 on trauma call, ED Resus, 35y/o M in MVC, unrestrained, head injury, HR 100,
BP
115/60, RR 20, Sats 100% on 15L, GCS 8. Immobilized in collar, blocks, laceration and bruise to
forehead, no other injury. How to assess and manage? Main concern? What is your immediate
management? What ddx seen on CT head? What is pathophysiology of raised ICP? What
happens to
ICP after head trauma?
23. Jaundice - ED mild epigastric pain, radiating to back, new onset jaundice, weight loss and
reduced appetite. What are complications of surgery in jaundiced patient? What are the causes of
post-op jaundice? What is calot's triangle. What is in calot's triangle? What are the
physiological
consequences in removing the gall bladder?
24. MODS - 65yo M, AR for CRC D1 postop, SOB, decreased AE, abdo distended, tender. What
is
MODS? How does MODS develop? How to dx SIRS? What initial investigations? How do you
mx?
25. Necrotising Fasciitis - ED 35y/o IVDU, sudden onset pain and swelling in groin, treated for
cellulitis but increasing in size rapidly. What is necrotising fasciitis? What organisms are
responsible?
What are the clinical signs? How to dx and manage? What is necrotising fasciitis of scrotum and
perineum? How to manage this person? What is hyperbaric O2 and what role does it play?
26. Nutrition 1. 64y/o man post hartmanns for sigmoid colon tumor, recent anorexia, cachexia
and
weight loss. How to assess nutritional status by bedside and biochemically? How to provide
nutrition
to surgical patients? What are the basic components of parenteral nutrition? What are the
complications of parenteral nutrition? What are the nutrional requirements of a normal person
per
day?
27. Nutrition 2. Same man as previously. What is an essential amino acid (cannot be synthesized
and
must come from diet)? What are the fat soluble vitamins (ADEK)? What are they used for in the
body
(A - retinal function, cell membrane stabilizer. D - calcium and bone, E - free radical scavenger,
K-
clotting factors)? What controls regulation of appetite and food intake (hypothalamus (lateral
hunger/feeding centre and ventromedial satiety centre; GIT CCK/GLP/Insulin,
Psychological/behavioural)?
28. Ortho - 29 y/o M MVC, ATLS managed, describe open fracture, how to classify (GUSTILO
ANDERSON CLASSIFICATION)? How to manage in ED? How to manage orthopaedically?

Who to
inform? When to go to theatre? What operation done?

29. What is a pulmonary artery catheter? What are the different lumens (Prox in RA/CVP, distal
in PA
- PCWP, balloon lumen, thermistor lumen, infusion lumen)? What does a PAC measure directly
(CVP,
PCWP, CO, Mixed venous PaO2) or indirectly (LVED volume, LAP, SVR, PVR, SV, CI) with
variables
derived from their measurements? What are the complications of a PA catheter?
30. Pain and LA - different classifications of pain? How do pain sensations travel and what pain
fibres
are there? How does LA work? What are the different types of LA? What is a safe does of LA?
What
signs and symptoms of LA toxicity?
31. Pancreatitis 1 - ED 34y/o M severe epigastric pain raidating to back, vomiting, post alcohol
binge.
DDx? Ix? Mx? What is pancreatitis? What are the causes of pancreatitis?
32. Pancreatitis 2 - ED 74y/o F, teetotal, obese, ED severe pain radiating to back with vomiting,
gallstones on US last week with GP. Where to manage this patient? What factors to make your
decision? What are the complications of pancreatitis? When should this woman have a
cholecystectomy? What are the grading systems of pancreatitis?
33. Peritonitis - 55y/o M, Right hemicolectomy for caecal tumor D9 post op, now increasing
abdo
pain. What is peritonitis? What is the most likely cause here? What are the management
priorities?
What are level 2 (HDU) and level 3 (ICU) care?
34. 45y/o F - post op thyroidectomy, very unwell 6hrs pos op, 1. what are your main concerns?,
resp
distress. 15L face mask, ABG. Manage?

35. Shock 1 - 29y/o M, LOC following bar brawl stab wound in back between scapulae. HR120,
BP
80/50, RR 30, 95% on 15L, GCS 14. What shock might this patient have and why? Define
shock, what
are the types of shock? What should ED assessment include? What are the different grades of
Shock?
36. Shock 2 - 30y/o M fallen 30ft off roof. Hypotensive, tachycardic, femoral open fracture and
open
pelvic fracture, what are the causes of shock in this patient? What are the different features of the
different grades of shock? After primary survey, what is the next step?
37. 13y/o F - MVC blunt trauma to abdo, ATLS principles, CT scan showed splenic injury, 10%
of
surface area, 2cm deep laceration. How are splenic injuries classified? How should this patient
be
managed? Role of interventional radiology? If splenectomy indicated, what are the risks? How to
manage postoperatively?
38. Thoractotomy - 32y/o penetrating chest trauma, sucking wound in left mid thorax, low sats,
SOB,
haemodynamically unstable, left pneumonthorax clinically - how to manage? What is safe

triangle?
What are the recognized indications for emergency thoractomy? (ATLS guidelines say
penetrating
thoracic injuries causing cardiac tamponade, intrathoracic exsanguinating haemorrhage, open
cardiac massage, cross clamping of descending aorta to slow blood loss below diaphragm)
39. VTE - 2 days post TURP now with DVT, - what is virchow's triad? What criteria used
in assessment
of patient with suspected DVT? What blood tests to order in thrombophilia screen? How does
factor
V leiden increase risk of DVT (mutation in factor V protein makes it resistant to inactivation by
protein C, increased factor V and increased DVT)? In patient with extensive DVT, how to
manage and
reduce risk of PE?
40. 54y/o F - neck swelling for 5-6mths, clinically well, no other symptoms, identify a solitary
nodule,
Right thyroid gland. What are the DDx of thyroid nodule? How to investigate patient? What are
the
types of thyroid cancer? FNA shows follicular lesion. No isotope scanning. How to proceed
(hemithyroidectomy)? WHat are the significant post op complications? How to manage in the
long
term?
41. Testicular torsion - 15y/o M, 3hr hx of acute onset R testes pain, lower abdo pain, testes
swollen,
tender, football but no trauma, fit, well, no urinary symptoms, no sexual intercourse, no previous
episodes. What examination findings support torsion dx? What are the ddx? What congenital
abnormalities associated with torsion? How to manage?
42. TURP syndrome - 89y/o M, D0 post TURP for BPH, pmh MI, 20cigs/day, increasing
confusion,
vomiting, HR 85, RR18, BP 180/100, Sats 98% RA, Temp 36, GCS 14 confused. Sodium is 115.
DDx?
What is TURP syndrome? What are the clinical features of TURP syndrome? How to treat TURP
syndrome? How to prevent TURP syndrome?
43. Anticoagulation - How does warfarin work? How is warfarin monitored? How can warfarin
be
reversed rapidly? How does heparin work? How is heparin monitored? How to reverse heparin
rapidly?
44. Bleeding disorders - what is most common congenital bleeding disorder (von willebrands in
1%)?
What are the bleeding disorders out there? How do they increase bleeding risk? How is this
disorder
inherited (VWD - Autosomal dominant)? What bleeding disorder results in deficiency or

abnormality
in coagulation factor 8 (haemophilia A)? How is this disorder inherited (x-linked)? Where is
vitamin K
absorbed in body (small intestine)? Which coagulation factors is vitamin K associated in the
production of (2, 7, 9.10, protein C and protein S)?
DR Exam vivas
45. What is anaesthetic? What are the different types of anaesthesia? How to choose what type of
anaesthesia to use? How does LA work? What are the complications of LA? How to manage LA
toxicity? Please discuss the use of adrenaline with LA. What are the maximum safe doses of LA?
What is a Bier's block? How to perform and what important considerations? What is spinal
anaesthesia? What is epidural anaesthesia? When to use spinal anaesthesia? What are the
complications of spinal anaesthesia?
46. How to calculate pH? (-log10(H+)) What processes generate bulk of body's H+? How
does the
body cope with alterations in H+? (Resp, metabolic, intracellular, extracellular) When are ABGs
useful? How to perform ABGs? What is base excess? How to interpret ABG? What are the
common
causes of a. metabolic acidosis? b. respiratory acidosis? c. metabolic alkalosis? d. respiratory
alkalosis?
47. What is a burn injury? What determines the severity of a burn? How to classify burn injuries?
How to assess burn size? What fluid regime to treat a burn injury? Burn injury in a confined
space -
what to be concerned about and what are the signs of inhalational injury? Which burn injuries to
be
referred to regional burns unit? How to calculate prognosis of patient with burn injury?
48. How does CVP measure left atrial pressure? What is a Pulmonary artery catheter? Draw the
Pulmonary artery catheter pressure recording as it is inserted. What is the significance of wedge
pressure? What are the direct measurements of PAC? WHat are the derived measurements? What
are the complications of PAC insertion?
49. What is cardiopulmonary bypass and how does it work? What are the clinical indications for
CPB? What are the complications?
50. What are the differences between primary and secondary brain injury? What is the monro-
kellie
doctrine? Draw intracranial volume pressure graph. What are the causes of raised ICP? What is
Cerebral perfusion pressure and how does it related to ICP? How is cerebral blood flow
autoregulated? Draw a graph relating MAP and the cerebral blood flow. What is the significant
relevance of a dilated pupils in a patient with head injury? What are the other relevant signs and
symptoms? What are the clinical signs of base of skull fracture? What are the principles of head
injury management? Is it safe to perform LP in patient with head injury?
51. Nutrition - why so important to understand nutrition in surgical patients? What are the
normal
nutritional requirements of a healthy adult? (3.5g/k/day carbs, 1g/kg/day fat, 1g/kg/day protein,
40ml/kg/day H20, 2500kcal/day for males, 2000kcal/day for females. 4.5kcal/g for carbs and
protein,
9kcal/g for fat) How to assess patient nutritional status? (Clinical, hydration, calculation,
anthropometric, biochemical) How to supplement nutrition? Elemental good for critical

illness/short
gut/pancreatic insufficiency, hepatic diet, renal diet, haemolysis diet, pulmonary diet. (Enteral vs
Parenteral) What are the components of TPN (1kcal/ml, macromolecules eg dextrose/amino
acids/fatty acids/lipids/water, micromolecules eg vitamins, trace elements, minerals)? What are

the
risks of TPN? Line vs TPN, why cover TPN bags? - photo-oxidation of amino-acids to free
radicals
causing disease
52. Renal failure - What are the differences in solute between blood and plasma and urine? (5g
vs
25g urea, 0.03g vs 1.6g creatinine, 200g vs 0.1g protein, no glucose or bicarb in blood) What is
oliguria? What is anuria? How to define acute and chronic renal failure? What are the markers of
renal failure? What are the causes of renal failure? How to manage patient with no urine output
postop? Draw a diagram of nephron function and label and outline their functions? What are the
functions of the kidneys? How do diuretics work at the nephron?
53. What is renal replacement? What are the indications for renal replacement? What are the
complications with RRT? How to transfuse surgical patient with CRF?
54. Fluids - what are the fluid compartments in the body? What is the risk of using colloids?
What is
the composition of hartmann's? Composition of Normal saline? Composition of dextrose-

saline?
Distribution of normal saline and dextrose in resus? What are the fluid requirements of a 70kg
male
in 24hrs? What is a suitable IV fluid-replacement regime in a 70kg male in 24hrs? How to

calculate IV
fluid replacement?
55. What is respiratory failure? What are the normal reference ranges for PaO2 and PaCO2?
(PaO2 -
10-14kPa, PaCO2 4.5-6kPa) What are the causes of hypoxaemia? What are the causes of
respiratory
failure? (type 1 and type 2) What is a mixed defect respiratory failure? What is acute lung injury?
What is ARDS? What are the causes of ALI and ARDS? How to diagnose ALI and ARDS? What
are the
pathological changes in ALI/ARDS? How treat ALI/ARDS?
56. How to deliver O2? What modes of ventilation do you know of? What is ventilation? What is
mechanical ventilation? What are complications of O2 therapy?/What are complications of
mechanical ventilation?
57. What is pancreatitis? What are the classical clinical features? What are the causes of acute
pancreatitis? How to manage patient with acute pancreatitis? What are ransons criteria? What is
modified glasgow criteria? What are complications of acute pancreatitis?
58. What is SIRS? What are the features of SIRS? What causes SIRS? What is the
pathophysiology of
SIRS? What are the role of cytokines and mediators in progression of SIRS? Define: Infection,
bacteraemia, septicaemia, sepsis, severe sepsis, septic shock, septic syndrome. What is MODS?
What is the multiple hit hypothesis? Treatment strategies of patients with SIRS or MODS? (Early
goal-directed therapy and circulatory support to manage haemodynamic status to reduce

mortality
and morbidity with organ support) What is MOFs? What are the unfavourable predictive factors?
59. ICU admission - when to admit to ICU? What is the difference between ICU and HDU?
60. How to confirm brainstem death?
61. How is calcium distributed throughout body? What hormones are responsible of calcium
homeostasis and how do they work? What are the functions of calcium? What are the causes and
clinical features of hypocalcaemia? What are the causes of hypocalcaemia? What are the
treatment
options for hypocalcaemia?
62. What is the structure of a peripheral nerve? What are the important physiological principles
relating to nerve injuries? What are the types of nerve injuries? Draw a nerve action potential and
explain the events that occur. What is saltatory conduction? Draw a neuromuscular junction and
explain the electrophysiological events that occur. What are the muscular relaxants used as part
of
anaesthesia and how do they work? What condition is characterised by presence of IgG Ab
against
ACh receptors and what are the clinical features? How to diagnose myaesthenia gravis?
63. What equation describes relationship between BP and CO? (BP=COxSVR) What are the
neurohumoral mechanisms maintaining BP? Discuss the RAAS system in detail.
64. Please draw the cardiac cycle pressure/time wave form in Ventricle, atrium/aorta in detail and
correlate to ECG. How long is the cardiac cycle? What is Ejection fraction? What is stroke
volume?
What does S1 and S2 correspond to? How to calculate MAP from arterial pressure curve? What
effect does exercise have on cardiac cycle? What effect does aortic valve disease have on arterial
wave form?
65. Draw a pacemaker action potential. Draw a ventricular action potential and explain the
stages.
What is the vaughan williams classification system? Give examples of anti-arrythmic

medication.
66. What is the normal resting value of cardiac output? What is the distribution to organs/tissues?
What is frank starling's law of the heart? Draw the frank starling curve. What shifts the
Frank-starling
curve up? Down? How to measure cardiac output?
67. Define shock. What are the types of shock? What are the hallmark features of each type?
Patient is in anaphylactic shock - how to manage? What are the causes of cardiogenic shock?
What is
the neurohormonal response to the cardiogenic shock? What are the classes of shock and the
clinical features of each class? How to treat patient in shock? What are vasopressors and
inotropes?
How do these work? Why not give adrenaline in shock all the time?
68. What is the function of the lung? Draw a spirometry trace, and what are the measureable and
immeasurable volumes on spirometry? How do you measure RC and TLC? What is the helium
dilution method? How do you interpret spirometry? How is oxygen transported? What are the
factors affecting this? Draw and label the oxygen dissociation curve - what is this? Label the
axis?
What causes left and right shift? What is cooperative binding of O2? What is the Bohr Effect?
What
is the O2 content in blood? How to improve physiological O2 delivery to tissues? What factors
increase risk of Post-op hypoxaemia in surgical patient?
69. How is temperature change detected by body? How does the body respond to hypothermia?
What are the causes of hypothermia? How to manage a patient with hypothermia? What are
complications of hypothermia?
Dr Exam Pathology Vivas
1. What types of bone do you know of? What is the composition of bone? How to classify
fractures?
What is the salter-harris fracture classification? What are the phases of fracture healing? What
are
the principles of fracture treatment? What factors affect bone healing? What are the
complications
of fractures? What is osteomyelitis? What are the causes of osteomyelitis? What are the causative
organisms of OM related to specific disease? What is the pathogenesis of OM? What are the
complications of OM? How do you manage a patient with OM? How to treat?
2. What is septic arthritis? What is the routes of infection? What are the clinical features of septic
arthritis? How would you manage suspected septic arthritis? What are the complications of septic
arthritis?
3. What is the reconstructive ladder? What adjuncts to these procedures? What is the difference
between a graft and flap? What is the difference between STSG and FTSG? What are the
advantages
and disadvantages? What is a scar? How to classify complications of scarring? What factors
affect
scarring? Spot dx- keloids. What are the differences between keloid and hypertrophic scarring?
How
are keloid scars managed?
4. Muscle - what types of muscle are there and what are the differences? What type of skeletal
muscle fibres do you know of? What is the structure of skeletal muscle? Draw a sarcomere and
label
it. Describe the phenomenon of excitation-contraction coupling and use skeletal muscle as an
example. What is cartilage? What types of cartilage are there? Give examples of each. How does
cartilage repair after damage?
5. What are the inherited syndromes causing tumors of the endocrine system? What are the
different syndromes?
6. What is gynaecomastia? What are the causes of gynaecomastia? How to classify

gynaecomastia?
How to investigate? What are the surgical options to treat gynaecomastia?
7. What are the parathyroid glands? Where are they located? What do they develop from? How is
hyperparathyroidism classified? What are the clinical features of hyperparathyroidism? How
does
serum PTH and calcium relate to hyperparathyroidism? What are the specific treatment
principles of
hyperPTH?
8. What is cushing's syndrome? What is cushing's disease? How are the causes of
cushing syndrome
classified? How are the clinical features of cushing's syndrome classified? How is
cushing's syndrome
diagnosed? How is cushing's syndrome treated?
9. What is carcinoid syndrome? How do these present? What is carcinoid syndrome? How to
diagnose carcinoid syndrome? What blood tests available/Tumor markers for carcinoid tumors?
How
is carcinoid syndrome treated?
10. Which hormones produced by thyroid gland and where? How are the thyroid hormones
controlled? How are the effects of thyroid hormone classified? What factors affect thyroid
function?
What blood tests for thyroid function?
11. What is screening? What are the principles of a screening program? What types of bias are
associated with screening? What is sensitivity and specificity? What screening programmes in
the
UK?
12. What is staging of cancer? What is grading of cancer? What is the TNM staging system?
13. What is a BCC? How are BCCs classified? What are the risk factors? Clinical features of
BCCs?
What are the treatment options? What excision margins? (5mm if less than 2cm, 15mm if more
than
2cm) What is moh's micrographic surgery?

14. What is a SCC? What are the RFs for SCC? What are the pre-malignant lesions of SCC?
What is
the clinical appearance of SCC? How is cutaenous SCC staged? What are the treatment options?
What excision margins suitable for excision of SCC?
15. What is a malignant melanoma? What are the RFs for MM? What are the suspicious clinical
features of a melanom? ABCDE. What are the subtypes of malignant melanoma? What is the
surgical
mx of a malignant melanoma? What is Breslow thickness? What is Clarks levels? What excision
margins for Breslow thickness? How to stage MM? What other tests to perform for MM? When
to
perform SLNB for MM? Who is in the MM MDT?
16. What is the epidemiology of thyroid CA? What are the common types of thyroid CA? How is
thyroid malignancy investigated? Can you differentiate follicular adenoma and follicular
adenocarcinoma on FNAC? How to treat thyroid CA?
17. Salivary glands - what is the epidemiology of salivary gland neoplasms? What are the
common
parotid and submandibular salivary gland tumors? What is a pleomorphic adenoma? What is a
warthin tumor?
19. Breast - what is the epidemiology of breast cancer? What are the RFs for breast CA? What
investigations to guide tx for breast disease? How to assess metastasis? What types of breast CA
do
you know of? How to stage breast ca? What are the medical/surgical options for breast Ca? What
are the reconstructive options after mastectomy?
20. What is the epidemiology of liver cancer? What are the different hepatic tumors you know
of?
What are the treatment options for liver Ca? What are the risk factors for liver ca?
21. What is the epidemiology of pancreatic ca? What are the pathological features of pancreatic
ca?
What are the risks of pancreatic Ca? What is trousseau's sign? What treatment for
pancreatic Ca?
What endocrine tumors of the pancreas do you know?
22. How are renal tumors classified? How to investigate patients with renal tract tumor? What is
RCC? What are the risk factors for RCC? What are the clinical features of RCC? How is RCC
staged?
Robson's staging? Why does RCC present as left varicocele? What are the treatment
options for
RCC?
23. What are the types of bladder ca? What is TCC? How does it present? What are the RFs for
TCC?
What is field change? How do TCCs spread? What are the treatment options for renal tract TCC?
24. What is a wilm's tumor? What is the pathology? What is the epidemiology? How does
it present?
What are the common surgical treatment options?
25. What are intestinal polyps? How are intestinal neoplasms classified? What is the malignant
potential of a colorectal adenoma? What is the epidemiology of CRC? What are the RFs? What
is
FAP? What is HNPCC? What is adenoma-carcinoma sequence? What is multi-hit hypothesis in
carcinoma progression? What are the clinical features of CRC? What investigations for a patient
with
suspected CRC? How is CRC staged? What is dukes' staging? What are the surgical
options for
patient with CRC?
Dr Exam Biochemistry
1. What are plasma proteins and where are they made? What are the functions of plasma
proteins?
What is the normal range of calcium and how to calculate corrected calcium?
2. What is urate and what is the normal reference range? What are the causes of hyperuricaemia?
What are the consequences of hyperuricaemia? What are the pathological features of gout?
3. What are the functions of the liver? What is bilirubin and what is the normal reference range?
Can
you draw the bilirubin metabolism cycle and explain each step?
4. Explain the following terms - Agenesis, Atresia, Atrophy, Aplasia, Apoptosis, Hypoplasia,
Necrosis.
How to classify causes of atrophy? What is hyperplasia and hypertrophy? How to classify
hyperplasia/hypertrophy? What is a harmartoma?
5. What is a calculi and where do calculi form? What are the different compositions of renal
calculi
and their % occurrence? How to classify the causes of urinary calculus precipitation? What are
the
sequelae of renal calculi?
6. What are the compositions, macroscopic features and % occurrence of gallstones? What is bile
composed of and what is its function? Can you explain the bile production and storage process?
Why
do gallstones occur? What complications are associated with gallstones?
7. What is amyloid? What types of amyloid do you know of? What structures are affected by
amyloid
depositions and what associated conditions?
8. How to classify anemia? What effect does macrocytic anemia have on bone marrow and
circulating blood cells? What are the causes of iron deficiency anemia? What do you find on the
blood film of a patient with Fe2+ deficiency anemia? What are the causes of B12 deficiency
anemia?
What would you expect to find in the blood film of a patient with B12 deficiency anemia? What
are
the causes of folate deficiency?
9. What are the causes of the haemolytic anemias? What is the pathogenesis of sickle cell
anaemia?
What states result in vaso-occlusive disease in sickle cell anemia? What are the clinical feature of
sickle cell anemia? What are the management strategies of sickle cell anemia? What do you find
on
the blood film?
10. What is the genetic basis of thalassaemia? What types of alpha thalassaemia are there? What
types of beta thalassaemia are there? What do you find on the blood film of a patient with beta
thalassaemia? What are the characteristic clinical features?
11. What is polycythaemia? How to classify polycythaemia? What are the underlying
mechanisms
allowing for conditions that cause polycythaemia to be classified?
12. What occurs during haemostasis? What are the functions of platelets? What is the role of
platelets in haemostasis? What is the clotting cascade? Where are clotting factors made and what
are they? Draw the clotting cascade. What are the pathways that counter-regulate the clotting
cascade?
13. What is DIC? What are the causes of DIC? What are the pathological and clinical features
and
investigations of DIC? How to treat DIC?
14. What is the ABO blood grouping system? Which Genotype/Antigen/Serum antibodies in
each
group? What is the universal donor and recipient? What blood groups can receive and donate to
each other? What is the Rhesus system? What happens with sensitisation of a Rh-D negative
mother? How prevalent is each blood type?
15. What is group and save mean? What is a cross match? What is an autologous blood
transfusion?
What are the advantages and disadvantages of autologous blood transfusion? What is a cell saver
and why is it important in surgery? In transfusion, how is whole blood processed and what
products
are used? How to store the different products? What is the difference between FFP and
cryoprecipitate?
16. How to classify transfusion reactions? What are the other complications of blood
transfusion?
How to manage a transfusion reaction? What are the blood transfusion substitutes?
17. What is oedema? What is lymphoedema? What is exudate? What is transudate? What forces
govern the net filtration across a capillary? What are the causes of oedema? What are the
treatment
options for lymphoedema? What is ascites? What are the causes of ascites?
18. What is a hypersensitivity reaction? What are the pathophysiological processes occuring in a
type 1 HS reaction eg asthma? What mediators and cytokines do you know of and what are their
actions?
19. What is the complement cascade? Can you draw and discuss the 4 pathways involved in the
complement cascade? What is the function of the complement cascade?
20. What are immunoglobulins and what structure do they adopt? What is immunodeficiency?
What
do you understand by the term immunity? What are the classes of antibodies and what are their
functions?
21. Explain - Autograft, allograft, isograft, xenograft. What drugs used in transplantation and
rejection. What side effects are associated with non-steroidal immunosuppressant medications in
transplantation? What is transplant rejection?
22. What are the 5 features of acute inflammation? What are the processes of acute
inflammation?
What is leukocyte margination and emigration? What can the final result of acute inflammation
be?
23. What are the causes of chronic inflammation? What is chronic inflammation? What are the
processes of chronic inflammation? What is a granuoloma?
24. Explain - a cyst, peudocyst, abscess, sinus, fistula. How to classify cysts? What is a dermoid
cyst?
What is a sebaceous cyst? What is pus composed of?
25. What are the stages of wound healing? What are the roles of macrophages in wound healing?
26. What are surgical site infections? What organisms are involved in wound colonization and
surgical site infections? What factors increase the risk of wound infection?
27. What are the risk factors for pneumonia? How does neurological disease increase the risk of
pneumonia? What are the bacterial causes of pneumonia? How to treat and manage patient with
penumonia? What other organisms cause pneumonia? What are the complications of pneumonia?
28. What are the RFs for UTI? What micro-organisms cause UTI? What is the pathogenesis of
UTI?
What are the clinical features and how are they classified? What are the key points in relation to
MSU collection and processing? What are the complications of a UTI?
29. What are endotoxins and exotoxins? How do they affect the body? What diseases or effects
on
the body are due to endotoxin/exotoxin release?

30. What are commensal bacteria? What are some examples? What is a nosocomial infection?
What
increase the risk of nosocomial infection?
31. What is your understanding of the concept of immunization? What types of vaccine do you
know
of?
32. Can you draw and label the cell cycle and describe each phase? What factors control
progression
of the cell cycle? What factors control cellular growth during inflammation and wound healing?
What is dysplasia, metaplasia and neoplasia?
33. What is a tumor marker? Give some examples? What is carcinogenesis? What is a
carcinogen?
What is an initiator? What is a promoter? What cancers and their corresponding carcinogens do
you
know of? How to classify carcinogens?
34. What are the macroscopic and microscopic pathological features of malignancy? Do
benign/neo-
plastic masses have the potential to cause morbidity and mortality? What malignant tumours do
you
know of? What types of carcinoma are there? In what organs is carcinoma most prevalent? What
carcinomas are associated with highest mortality rates?
35. What are paraneoplastic syndromes? How to classify paraneoplastic syndromes?
36. What is a clot? What is a thrombous? What is an embolus? What is virchow's triad?
37. What is an atheroma? What are the risk factors for atheroma formation? What are the
theories
that contribute to atheroma formation? What is the pathophysiology? What can happen as a
consequence?
38. What is infarction? What is ischaemia? How to classify the causes of infarction and
ischaemia?
What features influence the damage severity due to arterial infarction or ischaemia?
39. What is an aneurysm? How can aneurysms be classified? What are the causes of aneurysms?
What is the difference between a true and false aneurysm? What is a dissecting aneurysm? What
are the complications of aneurysms? How to treat a AAA?
Dr Exam Surgical Technology
1. What is the purpose of a clinical trial? What must take place before a clinical trial can begin?
What
are the phases of clinical trials? (Phase 1-4) What is randomization? What is blinding? What
levels of
clinical evidence do you know of? What strengths of evidence based recommendations do you
know
of?
2. How to reduce DVT and VTE risk in surgical patients? What pressure to be applied by TED
stockings? How do decide on VTE prophylaxis strategy for a patient?
3. What is the importance of correct patient positioning? What are the complications of poor
positioning? How are pressure sores classified? Which nerves are most at risk in an anaesthetised
patient?
4. Patient safety for theatre - how is patient safety for surgery maintained? Admission - pre-
operative/intraoperative/post-operative. What are the NCEPOD codes for surgery?
5. What are the components of OT suite? What are the different zones? What is the airflow
system
in OT? What level of bacteria counts in theatre air?
6. How to define asepsis, antisepsis, disinfection and sterilization? What methods of disinfection
are
there? How methods of sterilization are there?
7. What are Lasers? How are Lasers classified? which class is used in medicine? What types of
lasers
are used in medicine?
8. What is a tourniquet? What uses do they have in medicine? How to ensure safe application
and
removal of tourniquet? What are the contraindications for tourniquet use? What are the
complications of tourniquets?
9. What is diathermy? Why use such high frequencies? What are the differences between
monopolar and bipolar? What are the complications of diathermy? How would you ensure safe
use
of diathermy?
10. How to classify suture materials? What are the common suture materials and what are their
properties? What are essential suture characteristics? How are sutures absorbed? What are the
range of suture sizes used? How to classify suture needles? What alternatives to sutures exist?
11. What is a drain? How are drains classified? What are the complications of drain usage?
12. What are the functions of dressings? How are dressings classified? What are the suitable
dressings for common wound types? What organisms may be used in wound care? What is
negative
pressure dressing? What level of pressure is used? What are the contraindications to vac
dressing?
What are the advantages of VAC dressing?
Anatomy Vivas
1. Abdominal Wall - Four main muscles? Arcuate line? Rectus sheath? LIF drain - what artery?
Branch of what vessel? What does it anastomose with? Congenital developmental abnormalities
of
abdominal wall? What's the difference between them?
2. Perianal fistula - Define a) abscess b)sinus c) fistula, what is aetiology of perianal fistulae?
Why
wound swab? What is goodsalls rule? What are the locations of perianal abscesses and the
management? What are the boundaries of the anus? What are the boundaries of the rectum?
3. What is adductor canal? What are the boundaries of adductor canal? Where does the canal
start
and where does it end? What passes thru the adductor canal? Why atherosclerotic disease at the
canal?
4. Anterior and posterior triangle - what are boundaries of anterior triangle, what are boundaries
of
posterior triangle, what are the smaller triangles and their boundaries? What are the contents of
the
anterior triangle? What are the contents of the posterior triangle? What major nerve runs through
submandibular (digastric) triangle and what does it supply? what is unique about the submental
triangle? What structures pass through carotid triangle? What are the levels of the neck? What is
the path of the accessory nerve?
5. Aortic aneurysm - how are aneurysms classified? What causes AAA? How should patient
AAA in
extremis and abdo pain be managed? What are the roles of screening and elective surgery?
6. Foot anatomy - what muscles cause inversion of foot, what muscles cause eversion of foot,
what
nerves supply inversion and eversion? How many arches of the foot are there? What makes up
the
arches? What is the name of the thick layer of deep fascia protecting base of foot and to what
does
it attach to? What nerves supply plantar aspect of foot? What anatomical landmarks to identify
foot
pulses? What are the layers of the foot?
7. Base of Skull - how is skull base divided? What are the boundaries between anterior, middle
and
posterior fossa? What structures travel through the superior orbital fissure? What does
vestibularcochlear nerve do and what boney fracture may cause this to be damaged? How to test
patient hearing? What runs thru jugular foramen? Label the openings in the cranial fossa. What
runs
through each opening (Optic canal, foramen rotundum, foramen spinosum, foramen ovale,
foramen
lacerum, Internal auditory meatus, jugular foramen, foramen magnum, hypoglossal canal)
8. What is the course of the facial nerve in the skull and out of the skull and what branches in the
parotid gland? What is the function of the facial nerve? How would middle meningeal artery
injury
occur? Which bones make up the pterion?
9. Most common bone tumor in pagets? How does it present in pagets? What percentage of
pagets
disease develop osteosarcoma? What other age group does this tumor affect? What other cancer
is
related to this? What is the treatment for potentially curable tumor of this type? What is the most
common malignant lesion of bone?
10. Brachial plexus - draw and label the brachial plexus. What is the relationship to the axillary
artery? Where does it come out from?
11. Breast anatomy - what are the landmarks of the breast? What muscles does the breast overly?
What are the ligaments of the breast called? What is the nerve supply of the breast? What is the
blood supply of the breast? What is the lymph node drainage of the breast? What nerves would
you
encounter in an axillary dissection? What are the borders of the axilla? What are the contents of
the
axilla? What are Level 1, 2 and 3 nodes? How to do sentinel lymph node biopsy?
12. Name and label the carpal bones. What are the borders of the flexor retinaculum? What are
the
contents of the carpal tunnel? What is the carpal tunnel? What may be injured in a carpal tunnel
decompression? What is guyon's canal?
13. What are the boundaries of the anatomical snuff box? What are the contents of the snuff box?
What does pain in the anatomical snuff box suggest? Why is this significant? What is an
alternative
test?
14. What travels through the cavernous sinus? Which cranial fossa is the cavernous sinus sited?
What causes cavernous sinus thrombosis? How would a patient with cavernous sinus thrombosis
present? Which organism is most commonly responsible for cavernous sinus thrombosis?
15. Draw and label the circle of willis. What is most common cause of subarachnoid
haemorrhage?
Where are the most common locations of berry aneurysms? How to confirm diagnosis? How to
grade SAH?
16. Colonoscopy - normal, polyp and tumor - describe and action plan. What other endoscopic
procedures to visualize large bowel? What are you looking for and what procedures can you
perform?
17. 62yo F with change in bowel habit, weight loss. What investigations to arrange? What are the
indications for colonoscopy? What are the complications of colonoscopy?
18. Cross-sectional anatomy - draw and label humerus x-section. Draw and label lower leg x-
section.
19. Ear anatomy - draw and label the external ear. Sensory supply to the external auditory
meatus?
Blood supply to the external ear? What makes up the external auditory meatus? What are the
boundaries of the middle ear? What are the contents of the middle ear? How does the cochlea
work? Label the contents of the middle ear. What is the chorda tympani and what is its origin?
What
does it supply? What is the principle of sound transmission in the middle ear?
20. Eye - what are the orbital muscles and their actions? What is the innervation of the orbital
muscles? Draw and label the eye. What makes up refractory media of the eye? What are cataracts
and how are they treated? In retinal artery occlusion what might cause a patient to maintain an
area
of central vision and not suffer from complete blindness?
21. Femoral anatomy - what are the boundaries of the femoral triangle? What are the contents of
the femoral triangle? What are the superficial landmarks for locating the femoral artery? What is
the
femoral sheath? What is the femoral canal? What are the boundaries of the femoral canal? What
is
the purpose of the femoral canal?
22. First rib - draw and label the first rib. What muscle attaches to the scalene tubercle? What
does
this muscle separate running above the first rib? Which of the two structures referred to earlier
runs
in the groove posterior to scalene tubercle? Which other structure runs below it? Which muscle
attaches to large rough quadrangular area between posterior groove and tubercle? Which
structure
from medially to laterally lie in contact with anterior border of neck of first rib?
23. Arterial supply of the heart - draw and label the arterial supply of the heart. Where do left and
right coronary arteries arise? What are the branches of the right and left coronary artery and
where
do they run? What is the venous return of the heart? Where is the SA node and AV node located?
24. Valvular system of the heart - draw and label the valvular system of the heart and the
ligaments/tendons and muscles involved as well as the conducting system. How many leaflets
does
the mitral valve have? Draw and label an ECG. How do you measure the axis of an ECG? What
are
the values of a normal PR interval, QRS interval, QT interval? What is the path of
electrostimulation
of the normal heart.
25. Describe H.pylori - what does it look like and what does it produce? What is the
pathophysiology
of h.pylori? What diseases is it associated with? How to test for H.pylori? How is it acquired?
How do
you treat H.pylori? How to test for recurrence?
26. 45y/o man with short hx of pain, erythema, swelling, restricted ROM of right knee, ?septic
arthritis. What are the DDx? What investigations? Knee aspirate - no organisms, 3+ polymorphs,
monosodium urate crystals, urate 480mmols/L, CRP 102. What are these crystals under polarised
light? Causes of hyperuracemia? How to manage this gentleman with gout?
27. Lower leg - how many compartments in lower leg? Which muscles in these compartments?
Name causes of compartment syndrome? What is the definition of compartment syndrome?

What
are the clinical signs and symptoms? How to test? What are the surface markings for fasciotomy?
28. Blood supply to the liver? Primary functions of the liver? Anatomical lobes of the liver?
Functional lobes of the liver? How to divide functional lobes (cantile's line between GB
and IVC). into
how many segments is liver divided? Draw and label these segments. What constitutes a hepatic
lobule? Draw and label the liver. What are the peritoneal attachments and relations of the liver?
What is the surface marking of the liver?
29. What is the epiploic foramen? What is the lesser sac? What is the lesser omentum? What are
the
boundaries of the epiploic foramen? Why is this important in surgery? What does kocherizing the
duodenum mean? What is the blood supply of the pancreas and duodenum? What are the
branches
of the celiac trunk? Draw and label the celiac trunk and the structures it supplies. What is the
anatomy of the duodenum?
30. Identify the hilum of the lung. Draw and label the lung hilum. What are pulmonary
segments?
How many and can you name them? What is the surface marking of the pleura in relation to the
ribs? What is the pleura and what are the layers of the pleura? Which nerves innervates the
parietal
pleura? What is the blood supply of the parietal pleura? What is the surface marking of the lung?
31. What are the boundaries of the mediastinum and its subdivisions? What are the contents of
each
subdivision of the mediastinum? What is the course of the vagus nerve?
32. What is the function of the phrenic nerve? What is the course of the phrenic nerve? With
which
vessels does the phrenic nerve travel through the thorax? Does the phrenic nerve have a sensory
component? What are the branches of the cervical plexus? What do they innervate?
33. 54 y/o man with acute lower back pain L4/L5 after heavy lifting, decreased sensation over
shin,
dorsum of foot and weakness of big toe. What are the "red flag" back pain
symptoms? What is the
initial mx for this patient? What are the clinical findings in L4/L5 prolapse and L5/S1 prolape?
What
is Brown-sequard syndrome? What is syringomyelia and the clinical symptoms?
34. Please draw and label the popliteal fossa, the boundaries and contents and their relations.
What
are the boundaries of the popliteal fossa? What are the ddx for swelling of the popliteal fossa? If
the
patient has foot drop, which nerve is damaged and where does this occur?
35. Salivary glands - what are the main salivary glands and what secretions do they produce?
What
are the boundaries of the parotid gland? What nerve passes through and divides within parotid
gland? What are the relations of the parotid gland and what vessels do you encounter in a
parotidectomy? Where does the parotid duct enter the oral cavity? What is the parasympathetic
innervation of the salivary glands? Where would you make the incision for submandibular gland
surgery and why? What are the nerves you have to be careful of in submandibular gland surgery?
Frey syndrome - what is it and how is it caused? How to treat?
36. Sciatic nerve - what is the course of the sciatic nerve? What are the roots of the sciatic nerve?
How is sciatic nerve related to piriformis? What are the two main branches of sciatic nerve? what
are the divisions of common peroneal nerve and what do they supply? How is common peroneal
nerve injured commonly? what are the clinical manifestations?
37. Shoulder - describe the bony anatomy of the shoulder. What is the ligament that provides the
main stability of the acromoclavicular joint. What is the main bursae surrounding the shoulder?
What are the muscles of the rotator cuff? What are the ligaments of the joint capsule? Which
muscle is most frequently involved? Which muscles allow abduction of shoulder and which point
in
the arc are these causative?

38. Skin - what are the layers of the skin? What is the function of the skin? What cosmetic
considerations when making skin incisions? Why is this important? What are the layers of the
epidermis?
39. What are the different types of malignant melanoma? What are the risk factors for
melanomas?
How to stage melanoma? What are adequate clearance margins for a melanoma? What is a BCC?
What is an SCC? Where can you find SCCs? What is the histology of SCC, BCC and
melanoma?
40.Spine - differences between cervical, thoracic and lumbar vertebrae? What do intervertebral
discs consist of? What direction do IV discs prolapse? Which discs most commonly affected by
prolapse? What is name of bacterial infection of the spine and the most common causative
organism? What primary tumors commonly metastasize to bone? What is batson's venous
plexus
and how relevant to infections and spine mets?
41. Draw and label the sternum? Correspond this to vertebral levels. In fact, what are the major
structures at each vertebral level? What are the other components of the thoracic wall? What is
the
type of joint between first costal cartilage and manubrium? what is the type of joint between 2nd
to
7th constal cartilages and sternum? What is the joint between manubrium and sternum and
sternum and xiphoid process?
42. What is a surgical stoma? Draw and label the common stoma sites. What are the indications
for
forming a stoma? What are the complications of a stoma? How to tell difference at clinical
examination between ileostomy and colostomy?

43. What are the nine surface regions of the abdomen? Draw and label. What are the dividing
lines?
What is the linea albea? What is the arcuate point? What is murphy's point? What is
McBurney's
point?
44. Hip anatomy - what approach for 87y/o F with fractured NOF for hemiarthroplasty? How to
make incision? Which layers of skin to pass through to bone? Which nerves involved or at risk in
this
operation? Which nerves at risk in anterior or posterior or lateral approaches? What are the
contents of greater sciatic foramen? What are the contents of lesser sciatic foramen?
45. Surgical scars - draw and label the surgical scars and the operations involved. Why
paramedian
incision so rarely used now? What nerves damaged in Lanz incision and what complication risk
might
this increase?
46. Testicular lump - what is the DDx? What are the different types of testicular cancer? What
are
the risk factors of testicular cancer? How to Ix? How to manage? What is the staging system?
What
are the layers of the scrotum to testes? What is a hydrocele and what are the different types of
hydrocele? What does x in T2NxMx mean? What is difference between stage and grade? What is
mx
if T1N0M0 seminoma? How would post op mx change if has teratoma, large mets and and query
lung mets?
47. What is the anatomical features of thyroid gland? Which triangle of neck? What is the blood
supply? What is the venous drainage? Where is the superior and recurrent laryngeal nerves?
Where
are the parathyroids? What is the course of the left and right recurrent laryngeal nerve? What is
the
fascia covering the thyroid? What is the deep cervical fascia of the neck? What are the contents
of
the carotid sheathe?
48. What is the origin of the vagus nerve? How does the vagus exit the skull? where does it
travel in
the neck? where does it loop around? What structures supplied by anterior vagal trunk? Whatis
supplied by the posterior trunk? What are the clinical features of unilateral and bilateral
recurrenet
laryngeal nerve palsy?
49. Venous drainage of the limb - what are the most commonly used veins in trauma? What is the
course of the long saphenous vein? What is the course of the short saphenous vein? How to
locate
the SFJ? What nerves travel with long and short saphenous vein. What are the causes of a groin
swelling?
50. What is the course of a DVT from posterior tibial to cause a right PE? How can this result in
a
CVA? What are the superficial veins draining the upper limb? Where can AV fistulas be formed
in the
right hand dominant patient? Give an indication for creating AV fistula and how does it work?
51. What are the 3 main types of wound healing? When would you use each type of healing?
What
are the factors affecting wound healing? What is the difference between a keloid scar and
hypertrophic scar?
52. What is the length of the oesophagus? What are the constrictions of the oesophagus? What is
the blood supply of the oesophagus? What is the innervation of the oesophagus? What is the
lower
oesophageal sphincter and what makes up the LES? What is achalasia? Where do oesphageal
cancers arise?
53. What is the levator ani? What forms the pelvic floor? What are the supporting pelvic
ligaments?
What are the nerves at risk of injury during pelvic dissection? What is the course of the ureters?
How
do you recognize the ureters intraoperatively? What are the structures that can be injured during
a
nephrectomy?
Dr Exam Anatomy vivas
1. Atlanto-axial joint and cervical vertebrae - identify structures. What type of joint is the atlanto-
axial joint and what ligament reinforces it? What runs through the foramen of the transverse
process and what structure does it originate from? What is the path of the vertebral arteries?
What
are the features of a typical cervical/thoracic/lumbar vertebrae?
2. Mandible and TMJ - label the mandible and skull. What runs through mental foramen? What
is the
anatomy of the TMJ? What are the muscles of mastication?
3. Tongue - what are the muscles of the tongue? What is the innervation of the tongue? What are
the taste modalities of the tongue and how is this achieved?
4. Parotid - Label the parotid gland and pes ansinarus and branches of facial nerve. What are the
borders of the parotid gland? What structures run through the parotid gland? What is the
path/surface anatomy of the parotid duct? What is the path of the facial nerve? What are the
branches of the facial nerve and what do they supply?
5. Thyroid - Label thyroid. What is the blood supply and venous drainage of the thyroid? What is
the
anatomy of the recurrent laryngeal nerve? How to identify recurrent laryngeal nerve during
thyroidectomy? Simon's triangle?
6. Triangles of the neck - what are the borders and contents of the anterior and posterior
triangles?
What is the path of the accessory nerve? What is the deep cervical fascia and its components and
what do they surround? What are the minor triangles of the neck? What are the levels of the
neck?
7. Draw and label first rib. What are the protuberances in the first rib? What structures lie in front
and behind of scalene anterior? What is dx of man with tingling in arm and hand, blue fingers
when
cold and worse when stacking shelves high up. Thoracic outlet syndrome - what are the causes?
What is Roo's test? What are the treatment options for patient?
8. Mediastinum - Identify structures? What is angle of louis? What are the borders of
mediastinum?
What are the contents of the mediastinum?
9. Label heart, label coronary arteries. What are the origins and paths and branches of the
coronary
arteries? What is the venous drainage of the heart? What is the surface anatomy of the heart and
the borders? What is the structure covering the heart?
10. Lungs - label the lung and the hilum and the fissures and the impressions. What is the
anatomical
position/surface anatomy of the lungs? What structures cover the lungs and what is the surface
anatomy?
11. Label and identify cross-section of thorax. Label diaphragm. Oesophageal anatomy - blood
supply, venous return, lymphatic drainage, nerve supply, length and constrictions? What makes
up
the LES. What are the openings in the diaphragm? what passes through them? What is the
diaphragm? What else passes through diaphragm? from Thorax to abdomen?
12. Liver - label. What are the peritoneal attachments? What is the porta heaptis? What is the
falciform ligament? What is the ligamentum teres? What is the ligamentum venosum? What is
the
functional anatomy of the liver? What are the borders of winslow's foramen/epiploic
foramen?
What is the lesser sac? What is the lesser omentum? What is pringle's manouevre?
13. What are the retroperitoneal structures? What are the branches of the abdominal aorta What
are the branches of celiac trunk? the SMA? the IMA? Where do these run? What are the
boundaries
of the anal canal? What are the boundaries of the rectum? How to identify ileum from jejunum?
14. Penis and scrotum - identify and label x-section. What is the lymphatic drainage of the
scrotum
and testes? What is the significance of this? What is the anatomy of the male urethra? What are
the
fascial layers of the spermatic cord? What are the contents of the spermatic cord?
15. Patient with episodic dizziness, vertigo and left arm claudication - subclavian steal syndrome
-
what is that? What causes subclavian steal syndrome? (stenosis of subclavian artery) What is the
arterial supply and venous drainage of the upper limb? What are the branches of the axillary
artery?
What are the branches of subclavian artery?
16. Rotator cuff - what are the rotator cuff muscles and their movements? What structures ensure
shoulder stability? What are the ligaments of the shoulder joint? What are the bursae? What other
muscles involved in GH joint movement? What are the compartments of the upper arm and the
contents? What are the compartments of the lower arm and the contents? What are the muscle
attachments to the humerus?
17. Antecubital fossa - what are the borders of the antecubital fossa? what are the contents?
18. What is the carpal tunnel and what are the contents of the carpal tunnel? what are the
boundaries of the carpal tunnel? What is the flexor retinaculum and its attachments? What are the
borders of the anatomical snuffbox? What is the contents? What is the clinical significance?
What
are the extensor compartments and what are the contents?
19. Femur and hip joint - Draw and label. What are the muscle attachments to the femur? What
muscles attach to lateral surface of greater trochanter? What muscles attach to lesser trochanter?
What attaches to the linea aspera? How to classify fracture of NOF? What is the blood supply of
head of femur? How to surgically repair intracapsular and extracapsular fractures? What
stabilizes
the hip joint? What is the anatomical path/surface anatomy of the sciatic nerve? What passes
through the sciatic foramen? What passes through the obturator foramen?
20. Femoral artery anatomy - structures. How does arterial supply continue in foot? What veins
drain the lower limbs? What is the path/surface anatomy of the long saphenous vein? Where to
find
the saphenofemoral junction? what are the tributaries to the SFJ? What is the surface anatomy of
the short saphenous vein? Femoral triangle - borders? Contents? Origin and attachment of
inguinal
ligament? Anatomical position/surface anatomy of femoral artery?
21. What is the femoral sheath? Femoral canal? Borders? Contents? Borders of the femoral ring?
Inguinal canal? Delineate the hernia relevant surface anatomy? Marking of the deep ring - what
is it?
Marking of the superficial ring - what is it? What is the inguinal canal? What are the borders of
the
inguinal canal? Where is a direct inguinal hernia found? What are the borders of the adductor
canal?
What is the anatomical position of the adductor hiatus? What are the contents of the adductor
canal?
22. What type of joint is the knee joint? What are the relevant structures? What gives stability to
knee joint? Popliteal fossa - What are the borders of popliteal fossa? What are the contents?
Lower
leg compartments - what are the compartments and contents of the compartments?
23. Ankle and foot - What are the arches of the foot and what contributes to them? What are the
ligaments of the foot? What are the layers of the foot? What are the contents of the superior and
inferior extensor retinaculum of the foot? What are the contents of the flexor retinaculum of the
foot? What are the contents of the peroneal retinaculum?
24. Draw and label the bones of the right orbit anterior view. What are the borders of the orbit?
What passes through the skull foramina? Clinical significance of the pterion?
25. What are the functions of the different parts of the cerebral hemisphere? What is the blood
supply to the cerebral hemispheres - the territory of the MCA, ACA and PCA? What are
Wernicke's
and Broca's area? What are the structures - superior/inferior colliculus and what do they
do? Draw
and label the circle of willis.
26. Describe the flow of CSF and production and amount? Cranial nerves - where do they
originate at
the brain stem? and their courses?
27. What are the functions of the ascending spinal pathways? What is the anatomy of the
ascending
spinal pathways? What are the functions of the descending spinal pathways?
28. Draw and label the brachial plexus. Clinical features of brachial plexus injuries? What is the
cervical plexus? What are the branches? What are the branches of the lumbosacral plexus?
29. Course of the common carotid artery? What is the carotid sheath and the contents? What are
the branches of the external carotid artery? What are the tributaries of the IJV? What is the
retromandibular vein and what does it divide into?
Dr Exam Operative Vivas
1. Thyroidectomy - indications, incision, anatomy, major structures to identify and

preserve/injure,
layers to get through, complications. Pertinent steps.
2. Parotidectomy - indications, incision, layers to get through, major structures to identify and
preserve and can injure? complications.
3. Submandibular gland excision - indications, incisions, layers, major structures to
identify/preserve/injure? Complications
4. CVP - indications, sites for insertion, technique f insertion? Describe the process of inserting a
right IJV CVP. Complications?
5. What are the surgical airways - indications? How to perform needle cricothyroidotomy? How
to
perform surgical cricothyroidotomy? What are the complications? What size ETT tube to use?
6. What are the indications for tracheostomy? How to perform tracheostomy? What are the
complications of tracheostomy? What size trache tube to use?
7. Mastectomy - what is total mastectomy? What other kinds of mastectomy are there? What is
the
arterial/nerve/lymph supply to the breast? What is the anatomy of the breast? How to perform
mastectomy? What are the complications? What is a WLE? What is axillary node clearance?
What
are complications of axillary node clearance? What is a SLNB? What is the advantage of SLNB
over
axillary node clearance? What are the operative principles of SLNB? What are the reconstructive
options in breast cancer surgery?
8. What are the indications for cardiac pericardiocentesis? What is cardiac tamponade? How to
dx
cardiac tamponade? How to perform pericardiocentesis? What are the complications? What are
the
indications for emergency room thoractomy? What are the complications?
9. What are the indications for chest drain insertion? What size chest drain to use? How to insert
chest drain? Small bore/large bore? What is the safe zone for chest drain insertion? Why insert
chest
drain just anterior to MAL? What are the complications of chest drain insertion?
10. How is laparotomy performed? How to close abdomen? What are the principles of bowel
anastomosis? What are the principles of successful anastomosis? What types of bowel
anastomosis
are there? How are sutured anastomosis performed? How are stapled anastomoses performed?
What are the potential complications of bowel anastomosis?
11. What are the indications for Hartmanns? How to perform? What anatomy? What are the
indications for performing a right hemicolectomy? What incisions for right hemicolectomy?
How is
right hemicolectomy performed? How to recognize ureter? How might the ureter be injured?
How
to manage ureteral injury? What should post op care include? What are the complications?
12. What procedures are there for rectal tumors? How to perform anterior resection? How to
perform APR? What are the complications of laparotomy with bowel resection for tumor?
13. Anatomy of the gall bladder. How to diagnose cholecystitis? What radiological features?
What is
calot's triangle? what can be found in calot's triangle? What is the function of the
GB? How to
diagnose GB disease? What are indications for cholecystectomy? How to perform Lap chole?
What
are the pros and cons of laparoscopic surgery? What are the cx of Lap chole?
14. Splenectomy - anatomy of spleen. Functions of spleen? Indications for splenectomy? When
to
suspect splenic trauma? How to perform open splenectomy? Principles? What are the
complications? How to grade splenic trauma? How to guard against OPSI?
15. Abdominal bleeding - how to manage?
16. Appendicectomy - what is the anatomy of the appendix - what are the variations? What is
appendicitis? How to diagnose appendicitis? What is the Ddx? How to perform open
appendicectomy? How to perform laparoscopic appendicectomy? (What ports and what size?)
What
is an appendix mass? What specific treatment options are there for an appendix mass?
17. Inguinal hernia repair - what indications? What repairs do you know of? How to perform
lichenstein's repair? What are the complications?
18. Femoral hernia repair - what are the indications? What are the common approaches? What
are
the operative principles for both operations? What is intestinal stenosis of Garre?
19. Haemorrhoidectomy - pathology an aetiology of haemorrhoids. How to classify? What
treatments available? How to perform a haemorrhoidectomy? What are the complications?
20. Suprapubic catheter - how to introduce suprapubic catheter? What are the contraindications
of
suprapubic catheter? How to perform suprapubic catheter? What are the complications?
21. Renal trauma - what clinical findings suggest renal injury? How to grade renal trauma? What
are
indications of renal trauma? What are the anatomical relations of the kidney? What are the
indications for operative approaches for nephrectomy? What is the difference between simple
nephrectomy and radical nephrectomy? How to perform radical nephrectomy by anterior

approach?
How to perform using loin approach? What specific imaging ordered prior to nephrectomy?
What
complications?
22. Testicular torsion - how to diagnose? Operative steps for exploration and repair. What layers?
What is the blood supply? Lymphatic drainage? How to perform orchidectomy? What are the
indications for circumcision? How to perform circumcision? What method available in children?
What are the complications of circumcision?
23. Vasectomy - important counselling points? How to perform vasectomy? Complications of
vasectomy?
24. Hydrocele repair? - different types of hydrocele? What are the procedures available?
25. Carpal tunnel decompression? What is carpal tunnel syndrome? What are the causes of carpal
tunnel syndrome? What are the management options? How to perform a decompression? What
are
the complications of carpal tunnel decompression?
26. How to perform a hemiarthroplasty via anterolateral approach? Incision? Layers? What nerve
at
risk? Posterior approach - incision? Layers/structures? nerve at risk? Anterior approach -

incision?
What layers? What nerves at risk? Lateral approach? - skin incision? What layers? What nerves
at
risk? Medial approach - what layers? What nerve at risk? Complications of hemiarthroplasty?
27. Zadek's procedure - what is an ingrown nail? What are the tx options? How to perform
zadek's
procedure? What are the contraindications to zadeks? What are the complications of surgery?
28. Compartment syndrome - what is it? What are the clinical features? What can make dx
difficult?
How to perform lower leg fasciotomy? What are the complications? What are the sequelae of
untreated compartment syndrome?
29. What are the important points in assessing hand injuries? How to repair flexor tendons in the
finger? What post-operative advice to give? What are the complications of tendon repair?
30. Lower limb amputation - what are the indications? How would you perform a BKA? What
other
BKA flaps can be used? What are the contraindications to BKA? How to perform AKA? What
are teh
complications of amputation?
31. Femoral embolectomy - what are the principle steps? What are the complications?
32. Varicose vein surgery - What are the tributaries of the long saphenous vein of the thigh?
What
are the indications for treating VV? What treatment options are there? How to perform surgery
for
LSV varicosities secondary to VV incompetence? What are the complications?
33. AAA repair - what are the indications? What pre-op investigations needed? How to perform
open AAA repair? What are the complications? What are the alternative techniques?
34. Burr hole - what is a craniotomy? What are the indications for performing a craniotomy?
How to
perform a craniotomy? What are the potential complications related to a craniotomy? When
would
a non-neurosurgeon consider performing an emergency burr-hole? How is an emergency burr-
hole
performed?
35. ICP monitor insertion - what is ICP monitor? What are the indications? How to insert ICP
monitor? What are the complications of ICP monitor insertion?
36. LP - what is the terminal point of the spinal cord? what are the landmarks to perform an LP?
What important structures at L1 to L4? What anatomical structures passed through during LP?
How
to perform an LP? What are the contraindications? What are the complications? What are the
normal values for protein/lymphocytes/glucose/and opening pressure?
Clinical and procedural skills
1. Abdo pain hx - epigastric pain, 4hrs, 9/10 pain, radiating to back, constant, sharp, no vomiting,
no
bowel/urinary symptoms. Non-smoker, recent alcohol binge yesterday. DDx? Ix?
2. PR bleed - Hx, DDx? most likely in a 75yr old?
3. Chest drain - interpret CXR. ATLS. Safe insertion of chest drain.
4. Cranial nerve examination. How to examine? 52yo F, worsening vision, headaches, seizure
and
vomiting. Right eye movement fixed in inferior lateral gaze (down and out). Ddx? How to mx?
5. What is surgical cricothyroidotomy? How to perform surgical cricothyroidotomy? How to
demonstrate adequate ventilation after surgical cricothyroidotomy? What are the indications?
What
are the indications of a tracheostomy?
6. What is day surgery? what is required before the day of surgery if patient having GA? What
instructions to give to patients before they come to hospital on the day of surgery? what is in the
discharge protocol for written information and criteria to be met prior to DC?
7. How does diathermy work? What are the two modes of diathermy? When would you use
bipolar?
What are the advantages/disadvantages of each? What measures to ensure diathermy safety?
8. ECG - please calculate rate, rhythm, axis. What is the PR interval? What is the abnormality?
(prolonged PR interval) What is the pathophysiology of this condition?
9. Foot and ankle examination - how to perform foot and ankle examination?
10. Pathophysiology of hallux valgus. What are the treatment options?
11. Describe a fracture on imaging. In colles fracture, what other fracture is associated with
fracture
of the distal radial head? What are the analgesia options for closed reduction (haematoma block,
beirs block, nerve block, etonox, sedation and midaz) What is the method for closed reduction?
12. Options for closure of a) 10cm clean deep forearm lac. b)5cm skin defect over healthy
muscle
tissue. c) distal tibia open fracture and significant soft tissue loss, d) 20cm fasciotomy wounds.
What
is the reconstruction ladder? How does the donor site of a STSG heal? What are the factors
affecting
wound healing?
13. Hernia - examination, history, ddx and mx?
14. How to examine the hip?
15. Radiological features of OA? Pathophysiology of OA? why pain in OA? Causes of
trendelenburg
gait? How to manage patient with severe OA hip?
16. Incisional hernia - DDx, what factors predispose to incisional hernia? how to manage patients
warfarin for metallic heart valve before Op.

17. Inguinal hernia exam. Ddx of lump in groin? How to differentiate clinically inguinal hernia
and
femoral hernia? Mx plans?
18. Abdominal masses? Over RLQ and overlying scar - transplanted kidney.
19. DDx of painful knee? How to manage OA non-surgically? What changes on XR? What
surgical
options if no response.
20. Limping child - hx. Ddx? Mx? What are the most common causes of hip pain in children?
What
other symptoms may they have? what initial investigations? What is hilton's law (nerves
innervating
joint will innervate muscles acting on it and skin over the attachments)? XR showed subchondral
crescent-shaped radiolucent line - dx (perthes - avn)? What dx if boy is 13y/o obese with acute
on
chronic pain (SCFE)
21. Median nerve examination. What is carpal tunnel syndrome? What travels through carpel
tunnel? What are the causes of carpal tunnel syndrome? What investigations to help dx? What is
the
mx plan for patient? What is the course of the median nerve?
22. Neck lump - examination, ddx, investigations, mx?
23. Lower back pain L4/L5 and lower limb neurological deficit - examination and ddx?
24. Intraosseus puncture - how to carry out intraosseus puncture? How to ensure correct
placement? What are the relative indications for intraosseus puncture? What are the
complications
of an intraosseus puncture?
25. Radial nerve examination. What is the course of the radial nerve? what clinical deficit would
you
expect to see in radial nerve palsy and at which sites? What are the causes of radial nerve palsy?
26. Rheumatoid hand examination - how to examine? What are the radiological features of RA?
What are the clinical features of RA? What is the dx criteria for RA? How to manage RA?
27. Screening - What is screening? What are the requirements of screening programme? What
are
the screening programmes in the UK? What recent CRC screening programme do you know?
What is
sensitivity and specificity? What is the number needed to treat? What is relative risk? What is
risk
reduction? What is null hypothesis? What is a randomized controlled trial?
28. How to scrub up for theatre? What is sterility? What is disinfection? What is the difference
between sterilization and disinfection? What are the methods of sterilization and what are they
used
for? What is the indicator test for sterility? What is laminar flow in theatre? How is a theatre
organized?
29. How to put in an IDC. What are the indications of an IDC? what are the complications of an
IDC?
Patient is bleeding post IDC, blood into the bag. What do you do? How to treat UTIs? How to
treat
pyelonephritis?
30. Skin lesion examination - What is a BCC? What is an SCC? What is bowen's disease?
What is
actinic keratosis? What is the difference between BCC and SCC? What is melanoma? what is the
common types of melanoma? How to manage skin lesion? How to stage melanoma? What are
the
red flags for melanoma?
31. What are universal precautions? What additional precautions to take when patient in OT has
HIV/Hep B or Hep C? How to order a theatre list? What do you look out for? Who goes first?
Who
goes last?
32. What are the properties of suture material? What are Vicryl? Monocryl? PDS? Catgut?
Prolene?
Silk? Ethilon? How would you excise a benign lump from patients upper arm? Different types of
LA?
What dose of LA is safe?
33. What are the two common times when tourniquets are used in surgery? What are the relative
contraindications to tourniquet use? What are the steps to be taken from application to removal
fo a
tourniquet to maximize patient safety? How long can a tourniquet be inflated? What risks are
associated with tourniquets?
34. Ulnar examination - what is the course of the ulnar nerve? where can the ulnar nerve be
injured?
What are the causes of ulnar nerve palsy? What is the ulnar paradox?
35. Varicose veins examination - how to examine? How to investigate and manage varicose
veins?
36. Venepuncture - how to perform venepuncture
37. Advantages of laparoscopic surgery? Disadvantages of laparoscopic surgery?

Contraindications
to laparoscopic surgery?
38. Breast lump - examination and history? RFs for breast cancer. How to investigate breast
lump?
What are the poor prognostic factors?
39. Perform a peripheral vascular exam. Claudication - ddx? how to investigate? How to
manage?
Signs of acute limb ischaemia? Main causes of acute ischemia? grading of acute ischemia?
Grading of
claudication? What causes reactive hyperaemia in buerger's test? What are the clinical
intervals for
ABPI?
40. Dysphagia history - causes of dysphagia? DDx? In oesophageal cancer, geographical

distribution
of disease? What associated disease - GORD, barrett's? What is Barrett's? Most

appropriate
investigations? Treatment options of oesaphageal cancer? Causes of oesophageal motility

disorder?
What is achalasia?
41. Haematuria history - causes of haematuria? Ddx? What are the most common types of
bladder
cancer in different parts of the world? Why is SCC more common in non-western countries?
42. IBD history - what is ddx of bloody diarrhoea 10x day? How to investigate? How to manage?
What are indications of emergency surgery for IBD? What are the clinical features of severe
episode
of UC? What are the pathological differences between UC and IBD?
43. Jaundice history including weight loss - ddx of jaundice? What are the causes? How to
investigate? How to manage? What level does serum bilirubin need to get to before it becomes
detectable? What is courvoisier's law? What are the RFs for pancreatic cancer? Types of
pancreatic
cancer? Prognosis and treatment for pancreatic cancer?
Communication skills
1. Breaking bad news to patient
2. Assessing capacity. What are the causes of confusion? Is the patient fit for theatre? What steps
to
take next if patient is confused? Mental capacity - how to prove capacity? What is Gillick
Competence? Different types of consent forms?
3. DNAR orders - what is DNAR? how to approach family meeting to broach DNAR?
Aggressive and
demanding patient demanding full resus in 94 year old demented old lady with faecal peritonitis,
MODS and ARDS.
4. How to use interpreter?
5. Writing letter to GP regarding preoperative anticoagulation (clexane bridging - how to bridge
clexane? stop warfarin 6 days, start LMWH 2 days later, 1.5mg/kg SC OD until admission, if
renal
failure, 1mg/kg SC OD, please optimize other aspects of his health and check INR)
6. Referral to specialist unit
7. Write an op report
8. Patient self-DC against medical advice
9. Angry confrontational patient because of death
10. Angry confrontational patient because of complication
11. Angry confrontational and litigious patient because of error made by colleague
12. Breaking bad news to relative
13. Patient refuses to let you give bad news to patient
14. Amputation versus death - reaching the right decision
15. Consenting patient for surgery - mastectomy, hernia, appendicectomy, lap chole
16. Type 4 consent, breaking severe bad news about child possibly dying
17. Organ donation in a child who is on ventilator but pronounced brain dead
18. Jehovah's witness - child who needs blood, or patient will need blood transfusion
19. Patient only wants to see consultant and not SHO/ST1
20. Unexpected results given to patient
21. Dealing with hypochondriac patient
22. Good news turns to bad news
23. Explaining a diagnosis and treatment to a misinformed patient
24. Patient refuses treatment
25. Apologising for a mistake that occurred
26. Consenting a patient for a clinical trial
27. Ethical and legal principles
28. Principles of organ donation
29. Principles of advanced directives
30. Principles of consent
31. Principles of confidentiality
OSC E checklist:
Cardiovascular exam
Respiratory exam
Lump exam
Thyroid exam
Thyroid status exam
Neck lump exam
Parotid gland exam
Submandibular gland exam
Abdominal Exam
Stoma exam
Hernia exam
Scrotum exam
Breast exam
Peripheral vascular exam
Varicose veins exam
Neck exam
Shoulder exam
Elbow exam
Hand exam
Spine exam
Hip Exam
Knee Exam
Foot and Ankle Exam
Cranial nerve exam
Upper limb neuro exam
Median nerve exam
Ulnar nerve exam
Radial nerve exam
Lower limb neuro exam
GCS
MMSE
Trauma exam
Venepuncture (Blood cultures)
Insertion of IVC
Insertion of IDC
Insertion of chest drain
Insertion of central line
Suturing a laceration (Mattress, interrupted, subcuticular, flap)
Excising a lump
Drainage of abscess
Hand knot and instrument tying
Scrubbing, Gowning and gloving and unscrubbing
Writing a medication chart

MRCS Part B OSCE

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MRCS Part B OSCE

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MRCS part B OSCE

2 rest station, before communication stations

Prosection of thorax and abdomen

Identify the ascending aorta and arch of aorta,

Identify the right ventricle

What is this structure tricuspid valve, papillary muscles

What is this structure cordae tendonae

Identify the azygous vein

Identify the sympathetic trunk

What levels of spinal cord contribute to it T1 to L2

Blood supply of the spleen

Tell me the course of the splenic artery

What is this str duodenum

How many parts

What ducts enter into it from where

Id this str gall bladder

Surface anatomy of the gall bladder

Prosection of the anterior neck

Show me where is the thyroid gland

How many lobes

What nerves are at risk during the operation

Show me recurrent laryngeal nerve

What is this muscle superior belly of omohyoid

Nerve supply of this muscle

Why thyroid moves upward with swallowing

Infrahyoid strap muscles

Types of thyroid cancers

If there is lymphatic spread, where would it go

If damage to recurrent laryngeal nerve, what would happen

Upperlimb (prosection of forearm, hand x ray and bony model)

Identify the carpal bones in hand X ray

What would u concern with the scaphoid # and why

Prosection identify the flexor digitorum superficialis

Id median nerve sensory deficit if damage

Id ulnar nerve sensory deficit if damage

Show me the attachments of the flexor retinaculum

What structures passing thr it

How would u test for the action of FDS

Show me the actions of the thumb

Station 4 (surgical pathology)

Surgical pathology BCC

Show me a photograph and describe the lesion (I didnt do well)

What would u think BCC

Show me the histology report, margin involvement (+)

The natural history of BCC

Unclear margins what would u do

Station 5 (procedural skill)

Surrogate with a dummy of penis in between his legs

Pt complaint of unable to voide for a night with abdominal pain

U are not allowed to examine his abdomen

If no urine after flushing of catheter USG- what gonna find

If no he wants me renal failure pre-renal, renal and post-renal

Station 6 (surgical pathology)

Pathophysiology of peptic ulcer disease

Effect of NSAID on gastric mucosa

Phases of gastric acid secretion

How would u manage DU Vs GU

What medication might pt need for long term? PPI

Mechanism of action of PPI

Do u know NCEPOD, tell me

What operation for this pt according to NCEPOD

Station 7 (surgical pathology)

What is your diagnosis