A Guide to

MRCS Part B
Jin Xi
Books that I used
1) DrExam Part B MRCS OSCE Revision Guides: Book 1 and 2 (MUST read. This book also
teaches u how to tackle the comms stations. Apparently, the failures are usually due to
comms stations, so be careful. Its good to buy the book cos there’s a lot of coloured stuff
inside which is really useful)
2) Get Through MRCS: Anatomy Vivas By Simon Overstall $42 at Coop (MUST read. Small
book that only takes u 3 days to finish but really good for anatomy as it has all the pictures)
3) Kanani – Critical care and physiology vivas (2 books)
4) Operative Surgery Vivas – Ali Abbassain (the most organised operative surgery viva book. But I
realised that u dun need details for most of the ops. Maybe learn the basic stuff like BKAs,
CTS, appendicectomy, omental patch)
5) Cracking The MRCS Vivas – Iain Au Yong (May be too much for Part B but really exaplains a
lot of stuff. Use if u have time.)
6) Questions for the MRCS Vivas - Goodfellow (good overall book but the info is not presented in
a nice way. Regretted reading it)
7) McMinn’s Human Anatomy

*the ones in bold are the better ones

Tutorials
Didn’t get much except from prof raj on anatomy. That’s all you really need actually. (You have to pay
$200 to the anatomy department. He will show you real dissection specimens like in the MRCS)
email him at [email protected]

You can ask Kenneth mak for tutorials too.

General rules
1) Read according to the syllabus and the past year questions
2) Practice history and physical examination
3) Viva with ur friends
4) You don’t need to know in depth details of most operations. Know the approaches (lap,
open, midline laparotomy, loin incision, etc) and the complications. They did not ask any
details of operative surgery at all.
5) The questions will repeat thru the few days of examinations, so ask ur friends who took it
earlier than u!
6) Read the instructions carefully
7) Examiners and actors will try to get answers out of u. most of them are very nice.
Format of the exam
18 stations:
- 3 physiology and critical care
- 3 anatomy
- 2 surgical skill (plug setting, blood culture taking, suturing, taking out lumps and bumps)
- 1 Pathology station
- 3 communication station + 2 prep stations for the communication stations
- 2 History taking station
- 3 Short cases
- 1 station that seemed like a trial station

1 min to read scenario

9 min for testing (there will be a 6 min and a 9 min bell)
30 min in between the 18 stations to rest and have tea
Questions (Oct 2011)
- basically ur specialty choices will come out more often, so choose wisely
- Choices: Trunk and thorax, head and neck, limbs (including spine), neuroscience

Neuro prob wun come out if you dun pick it. But abdo and thorax stuff will come out all the time,
like in critical care and physio and anatomy.

Physiology and critical care

1. Question on JVP insertion, indications, complications, identify Pneumothorax on CXR and point
out all the lines. Also quizzed on frank-starling mechanism and was asked to draw the curve

2. A case scenario of a hypotensive patient on T4/5 epidural. Asked about physiology and
management. Very unfriendly examiner, have no idea what they were asking.

3. Question on bilirubin metabolism and entero-hepatic circulation. The examiner guided me thru
the whole thing.

Other cases:
Pt with perf DU – quizzed on management and what you would do intraop
Anatomy
(There will definitely be one on your 1st choice specialty, and they will ask you more detailed
questions on it)

1. Scenario: you are the MO assisting in a Whipples procedure

(this is my 1st specialty choice)
Point out the stomach
Name all the parts (cardia, fundus, etc)
Name the blood supply and exactly which part of stomach it supplies, and from which branch of
the aorta and celiac trunk
What is the space between stomach and pancreas? Lesser Sac
What is the entrance called: Foramen of winslow
Point out duodenum, quizzed on its relationship with the peritoneum (which part is retro, which
part in intra-peritoneal)
Posterior relation of the duodenum (aorta and IVC)
Point out the pancreas
Blood supply of pancreas
Ductal system of pancreas (main duct and accessory duct, and where they open into)
Development of pancreas: dorsal and ventral buds was all the examiner wanted

Everything finished within 6 min, examiner looked very pleased

2. Ortho station. Gave you a skeleton and quizzed on it

Point out acromion and coracoid process

Name rotator cuff muscles
Point out its attachments

Upper limb nerves and its innervations. Can’t remember the details. Was asked why a patient
with radial nerve palsy will feel that his grip is weak

Gluteus medius: attachments and action when walking

Quadratus femoris and attachments

3. Head and neck station

Point out esophagus. Quizzed on esophageal varices and name the portal and systemic vessels
Identify facial artery
Identify parotid gland, name of the duct and the opening and facial nerve
Name some levels: bifurcation of trachea, arch of aorta at t4, etc
Quizzed on thoracic outlet syndrome
Quizzed on Asked about subclavian steal syndrome

You probably won’t get any neuro questions if you dun pick neuro.
They seemed to ask more details on ur chosen specialty. My friend who picked limbs as first
choice had to tell examiner about all the ankle ligaments and attachments. Another one was
quizzed on all the details about the brachial plexus, nerve palsy, klumpke and erb’s palsy
Surgical skills
Questions over the 3 days that I was there includes
1) Blood culture taking according to the NHS protocol (my friend who studied in RCS said:
alcohol wipes, no touch technique, change needles and alcohol wipe the bottles)

2) Suturing a wound. They tell you specifically to use non-absorbable and the put a pack of vicryl
and a pack of nylon for you to choose. And then asked you to pick out ur own instruments.

3) Excising a lump. Similar to above, but make sure you do ur own time out. Check patient’s
identity, consent form was there for you to verify with patient. Remember to tell patient
about dressing and suture removal and to come back for histology report. (The patient was
nice and asked me everything so that I can answer them)

4) Set IV plug and then order some fluids on the IMR. Dunno how to use the plug, wasted a lot of
time.

Pathology
Was given a report on a gastrectomy specimen.
- signet ring call carcinoma, invading serosa, margins involved, LN positive. Was quizzed on
prognosis and why, further management, how you would counsel family, later told you
patient came in for ascites – asked about management (confirm malignant ascites,
therapeutic tap, KIV palliative chemo etc). and then patient also had DVT – talk about risk
factors and prevention methods

Other stations from other days

- Lymphoma: quizzed on ann arbour classification
- Uro: tumour in inguinal region, histo report said teratoma. Asked about staging and
treatment. asked about etiology of penile warts (HPV)

Communication station
1. Breaking bad news to patient’s wife. Pt have malignant ascites, consultant wanted to speak to
wife but was called away for op, then CT machine broken down and cannot do any staging
scan or find out source of tumour. Prep station before this for you to read thru the notes.
Everything typed out, so no issues with hand writing. Pen and paper for you to take notes as
well.

2. Pt here for THR, but doesn’t seem to remember anything. Was asked to talk to patient and
see if pt is fit for consent. I took AMT and then did the usual consent taking stuff and asked
the patient to repeat. AMT only 5/10, and he cannot rememeber anything, so its very
obvious. Examiner asked if u think patient can consent, and why, then asked about alternative
consent taking procedure (2 consultant consent) and then what I would do (work up for
dementia, speak to family, ensure there is caregiver post-op)

3. Call ortho consultant on trauma case

Young medical student with RTA. LL open fracture, pulse poorly felt. Only had LOC and left
flank bruising. Just call and present the case, and consultant will ask you some questions. Just
like what we do everyday. This one also had a prep station for you to read thru the notes and
summarise case.

4. kid with ?drunk father and fell and had to have splenectomy. Angry mum to talk to.

The DrExam books have the rest of the communication scenarios that have come out in
previous years. They really do repeat questions, so get the book and the past year questions!
History taking
Specialty choice 1 (trunk and thorax): Case of IBD
Take history, quizzed on investigations, provisional diagnosis, management

Specialty choice 2 (head and neck): Case of BPPV. Pt presented with vertigo
Take history, quizzed on investigation, dix hallpike (how you do it) and apley’s maneuver

Nothing too difficult about history taking. Examiner prompted me about stuff I forgot to ask.

Physical examination
Specialty choice 1 (trunk and thorax ): RHC tenderness
Standard abdo exam like you do in MBBS. DDx, investigations. Lets say US HBS got dilated ducts,
what will u do next? ERCP vs MRCP, but MRCP not invasive, so do MRCP first to look at the cause
of obstruction first.

Specialty choice 2 (head and neck): Parotid stone

No lump on examination, can feel a stone at the opening of the duct
DDX: stone dx
Invx: Sialogram
Treatment: stone removal, sphinterotomy
(Forgot to examine cervical lymph nodes, so examiner asked what other test I wanna do and then
quizzed me on the lymph node groups)

Specialty choice 3 (Limb):

OA hip
Invx: inflammatory markers, Xray, MRI hip
No time to get to management

My friends had varicose veins for the 2 days before me

The guy who chose neuroscience had a case of bitemporal hemianopia
They gave specific instructions to say that you do not speak to the examiner. They will provide all
the equipment but they will hide them, so you have to ask for them.

? trial station
Station on pacemaker and its settings and management. Examiner kept throwing answers at you,
so everyone thought it was a trial run.

Good Luck!