Common Viva questions

Physiology
 Blood pressure: Definition, Calculation of MAP, Control mechanisms to
maintain BP.
 Oxygen dissociation curve.
 Shock: Definition, Classification, Physiological mechanisms involved.
 Body fluid compartments
 <place>Normal blood gas values & interpreting ABG's
 Autoregulation: Definition, example of organ. What is the Kellie-Munro
doctrine?
 CVP and PAWP. Draw the JVP curve with labels and then explain the
diagram. How is CVP measured on ward?
 How is CO2 carried in the blood? Write equations? Where does carbonic
anhydrase live? What is the chloride shift?
 Calcium homeostasis: Hormones involved. Causes of hypercalcaemia.
Calcium distribution. What are the consequences of Vitamin D deficiency?
 What are differant types/classification of Renal failure? How you will
manage them? What is GFR?
 Role of acid-base on calcium transport and symptoms of hyperventilation.
 Thermoregulation: physiological responses to hypothermia
 Respiratory physiology, chemoreceptors, mechanics of ventilation. What
are the forces acting on the lung?
 Stress Response.
 Tell me about the production of thyroid hormones? How would you manage
a patient with thyrotoxicosis pre-op?
 What factors are involved in clotting? What factors can help you intra-
operatively to gain haemostasis?
 What is a buffer? How does it work? BICARB/co2 equation
 Gastric fluids, What is absorbed at the terminal ileum?
 White cells and their parameters: Definitions.
 What are the causes of hypoglycaemia?
 What are functions, half life, site and mechanism of production, of
Erythropoiten?
 Tell me the effects of bed rest on the body. What problems do bedridden
patients face?
 cardiac cycle and atrial pressures.
 Acid secretion in the stomach. Physiological consequences of total
gastrectomy
 Vit B12 physiology
 ADH - what is it, where produced, actions.
 Portal circulation: Definition, causes of portal hypertension and
consequences
 Pyloric stenosis
 RAA axis. What is Renin and what are its functions?
 Analgesic ladder. Pain pathways.
 Blood - principles of crossmatching, it uses and alternatives. Transfusion
reactions.
 Asked about small bowel resection and what problems would the individual
have.
 Asked to explain principles behind CPAP.
 Head injury - asked about CPP, equations, how to manage raised
intracranial pressures. Was asked about brainstem death and how to certify.
 ARDS and how I would manage a patient in this situation.
 Draw the graph seen with a PAFC insertion and explain the different traces.
 How does aspirin work?
 Spleen: functions. Physiological changes after splenectomy
 The Loop of henle. Definition and function
Critical Care

 Sepsis management guidelines.

 What is shock? Types? Tell me about anaphylactic shock, how is it
managed? blood loss features & categories of haemorrhagic shock
 Pancreatitis: scoring systems and pathophysiology.
 Pneumothorax: definition, classification. Management of tension
pneumothorax.
 Brain stem death. How is it certified? Persistant vegetative state: Definition
 Small bowel fistulas: Physiological consequences.
 Surgical airways: Classification. Insertion of Tracheostomy.
 Premedications: Indications and classification
 Burns: definition, classification & management
 ABGs : normal values, metabolic acidosis, henderson-hasselbach equation
 What are the admission criteria for most ITUs. Criteria for accessing HDU.
WHat does HDU provide?
 Post thyroidectomy complications: Nerve injuries and respiratory distress
how to manage?
 Diabetes Mellitus management in critically ill patient.
 Fat Embolism Syndrome
 Arterial blood gas analysis - what happens in gastric outlet obstruction (ie
met alkalosis)
 Define restrictive/ obstructive lung diseases & Volume-flow loops in
restrictive and obstructive lung disease
 Post-op bleeding : Classification & aetiology.
 Physiological effect of infusion of 2L Normal Saline.
 Oliguria: Causes & Physiology.
 Define and discuss physiological and pathological respiratory dead space.

Pathology
 Colitis: classification. Crohns Vs UC
 What different types of aneurysm do you know of? What is the most
common cause of false aneurysm?
 What organisms most commonly cause septic arthritis? High risk patients?
 Fistulae: definition & Classification. How do you determine high and low
output fistulas?
 Metaplasia, dysplasia, neoplasia: definitions, examples of each.
 Types of jaundice. Investigation
 Mechanisms of Tumour spread. Dukes staging. Advantages &
Disadvantages?
 Pagets disease of bone: definition & complications
 Types of necrosis. What is the difference between the necrosis and
apoptosis.
 Abscess & Pus. Pelvic Abscess
 What is a frozen section? Why is it unpopular? indications,
advantages/disadvantages
 DVT prophylaxis
 Features of a good screening programme. screening and breast cancer,inc
triple assessment
 Types of breast carcinoma.
 malignant melanoma: definition, classifications, staging/grading
 alcoholic pancreatitis
 What is a Pathological fracture? Causes? metabolic bone disease
 leg ulcers: definition & classification
 intracranial bleeding. Management of extradural. Pathology of berry
aneurysms
 Embolism: definition & classification
 Coagulation.Virchow triad.
 Granulomas: definition, examples.
 Anaemia: Microcytic & Macrocytic Anaemia
 UTIs: classification, high risk patients.
 Aortic dissection
 Amyloidosis: definition & classification
 Pathophysiology of septic shock and definitons
 Sensitivity, specificity: definition
 What is the American classification of colorectal cancer?
 Thyroid cancers.
 Pathology of pressure sores and treatment
 How do you work a COPD patient up pre-operatively? What are the
considerations?
 Calcification: definitions & classification
 Atypical Microbacteria: Definition & classification
 Wound healing; physiological and pathological (Keloid scarring)

Principles of Surgery

 DVT prophylaxis: define, predisposing factors, prevention

 What is a graft/Flap? Where do you farm a grafts from? Classification? How
do you manage a donor site?
 Name different types of sutures and needles.
 Pancreatitis. Scoring systems. How would you manage a patient with
pancreatitis admitted from A&E.
 Diathermy. Definition & Classification
 Difference between G+S, X-M
 Types of throid cancers, pathology, epidemiology, etc
 Consequences of splenectomy - abx coverage
 Local anaesthetics; dosing, uses, and complications
 Ureteric injury at differant levels and management
 What are the different causes of lumps in the femoral triangle, how would
you manage each one.
 Closing the abdomen? What is a burst abdomen? What are deep tension
sutures?
 Fat embolism
 Fistula in ano classification
 Gall stone complications + investigations
 Management of Acute Ischaemic Limb
 Blood transfusion reactions
 Radiotherpy.Adjuvant radiotherapy and bowel Ca
 Parotid tumours. Surgery and complications
 DD of swelling in neck
 Principles of skin closure
 FFP: constituents, indications for use, complications
 Complications of a midshaft femur # & open fractures
 ERCP: indications & complications
 Management of a surgical patient with diabetes
 Flail chest -assoc injuries - management (ie ATLS) and also re: Mx rib #s
 Gunshot wound classification
 Wound healing: Classification, factors involved. Wound dehiscence.
 management of head injury patient, equation for cerebral perfusion
pressure, monro-kelly doctrine and secondary brain injury
 Pyloric stenosis: cogenital and acquired
 Mediastinitis

Anatomy

 CT: normally T12, L1 section. Organs, vessels and lesser sac
 The femoral triangle
 Cross section of calf & Compartment syndrome
 Posterior cranial fossa & dural venous sinuses
 Pneumothorax and chest drain anatomy
 Insertion of a subclavian line - the landmarks on live model
 Inguinal ligament, layers dissected through for hernia repair
 Identify knee joint structures & ligaments
 Assemble bones in the arm.
 Classification & complications of nerve injury
 Gross anatomy of brain and functions
 Intrinsic muscles in hand
 The foot: the subtalar joint and muscles of inversion and eversion. Names
the bones of the foot? What types of amputation do you know in the foot?
 Skull x-ray and asked questions on the nasal conchae, where the openings
were, where they drained. what is the nasal septum made of?
 Heart - valves and blood supply. What is the surface anatomy of the heart?
 Spine: anatomy of disc + complications of prolapse
 Facial Nerve: pathway & injury
 Blood supply to stomach
 Superior mediastinum - identifying contents in cadaver
 MRI shoulder: anatomical/surgical humeral neck, rotator cuff
 Sapheno-femoral junction and tributaries
 Sigmoid colon: blood supply
 Post triangle of neck
 Surface Anatomy model: Identify the antecubital fossa, what are the
landmark boundaries? What are the contents?
 Anatomy and segmentation of liver
 Path of accessory nerve & complications of injury
 Shown a barium study and asked to identify the different parts of bowel
and which parts were retroperitoneal.
 What is the nervous innervation of the penis?
 Chest Cadaver: identification of impressions on left and right lung
specimens. What is the hering-breuer reflex? Identify the structures in the lung
hilum.
 Upper limb cadaver: identification of upper limb nerves and was asked
what would happen if this structure was damaged.
 Spleen: anatomy & function
 A rib: identification of level and facets etc...
 A thoracic vertebra: identification of level and facets etc...
 Neck (mostly thyroid and nerves)
 Ureter and blood supply
 Tell me the anatomical location of the parathyroids? How are they
identified? What is their embryological derivation?
 Tongue innervation & muscles
 Hypoglossal nerve: Anatomy & function
Operative surgery

 Inguinal hernia repair. Why can testicular atrophy occur in hernia repair?
 How do you fix a hip? Options and basic operative technique. What is the
blood supply to the femoral head?
 Tracheostomy - indications, anatomy, procedure, instruments required
 What types of bowel anastomosis do you know? How are they carried out?
 Breast abscess
 Compartment Syndrome: Risk factors, Clinical presentation, &
management.
 Chest drain insertion and care
 Appendicectomy
 Femoral hernia, with different approaches. High approach
 Subclavian line. Indications and proceedure
 Fissure-in-ano
 Intestinal anastomosis principle
 What causes fistula. Treatment principles
 Open Fracture Classification and management priniciples
 Paediatric fractures: classification & management
 DJ stent: how to insert & complications
 Anal Fissures
 Bowel obstruction: Aetiology, investigations, & management
 Left hemi-colectomy
 Indications for toe amputation, Ray excision
 Embolectomy - draw important relevant anatomy and op
 Crohn's disease of rectum and anus - management. surgical operations
 Scars: hypertrophic, keloid
 Peripheral nerve palsies: radial, ulnar, sciatic, common peroneal
 Acute Ischaemic limb: signs, management
 What do you understand about preparing patients in theatre? What is
Betadine?
 How would you take an Ankle-Brachial pressure index?
 When would you use a J shaped needle?

Viva Questions

Applied Physiology

1.How is oxygen carried in the blood?

◦What is the mechanism of binding of oxygen to haemoglobin?
◦What is this called?
◦Draw the oxygen dissociation curve?
◦What does 50% saturation mean?
◦What partial pressure does 92% saturation correspond to?
◦What partial pressure does 50% saturation correspond to?
◦What is the right shift called? (Bohr effect)
◦What are the factors determining right shift?
◦What is the physiological consequences? Why is this useful?
◦Draw the shape of the ODC for methaemoglobinaemia
◦What is the pathophysiology of methaemoglobinaemia?
◦What is the affinity ratio in methaemoglobinaemia for oxygen with respect to normal
haemoglobin?

2.What is ARDS?
◦What are the defining features? What are the criteria?
◦What are the causes of ARDS?
◦What direct lung causes do you know?
◦What systemic causes of ARDS do you know?
◦How do you manage ARDS?
◦What are the ventilatory options?
◦How do you improve lung compliance?
◦How does nitric oxide work? / prostacyclin
◦How else can you treat pulmonary hypertension?

3.What muscle relaxants do you know?

◦What classes of muscle relaxants do you know?
◦How does suxamethonium work? What is it's structure?
◦How is suxamethonium metabolised at the neuromuscular junction?
◦What other cholinesterases do you know?
◦Why would you want to use a muscle relaxant? When is paralysis useful?
◦What is myasthenia gravis?
◦What is the deficiency in myasthenia gravis?

Critical Care

1.What uses of central lines do you know?

◦What information can you determine from a central line?
◦How would you perform a fluid challenge? What fluid would you give? How much would
you give?
◦What is the tracing of the central line waveform?
◦How is the CVP related to the right atrium? What does that mean?
◦How do you insert a CVP line?
◦What do you need to do before you use your central line (check tip, ensure tubing correct,
calibrate)
◦What fluid is used for CVP transduction tubing?
◦Draw the graph for CVP change following a fluid challenge in an underfilled patient

2.What options are there for pain control?

◦What is the pain ladder?
◦What routes of administration of analgesics do you know?
◦How can you give opiates?
◦What is the metabolism of morphine?
◦What is the bioavailabilty of morphine? How much is metabolised in the liver?
◦What is the problem with intermittent bolusing of opiates?
◦What is the analgesic effect of morphine?
◦Draw the graph of efficacy/potency of morphine analgesia with regards to its half life
◦What is PCA?
◦How is it delivered?
◦Is it safe? Why?
◦What do you know about epidurals?
◦What drugs are used in epidural analgesia?

3.What is a pneumothorax?

Pathology

1.What is an embolus?
◦Give examples of embolus - fat, thrombus, amniotic fluid, air, nitrogen, septic
◦What is a pulmonary embolus?
◦What is the source of the embolus?
◦What effects would a deep venous thrombosis present with?
◦What are the features of a pulmonary embolus?
◦What are the features of arterial thrombi?
◦What are the sources of arterial emboli (Left atrium/ventricle, narrowed peripheral
circulation, atheromatous diease)
◦What organs are affected and what are the clinical manifestations?
◦What is a fat embolus?
◦What is the aetiology? What are the pathophysiological theories behind fat emboli?
◦What types of patients get fat emboli?
◦What are the clinical features?
◦What are the risk factors for arterial emboli?

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

Priniciples of Surgery

1.What is a subphrenic abscess?

◦Have you seen one before?
◦What are the causes?
◦What are the clinical features of a subphrenic abscess?
◦What are the nerve supplies to the diaphragm seeing as you brought it up...?
◦What are the biochemical changes?
◦Do you always get pain?
◦What features would you see on a chest x-ray?
◦What other imaging would you do apart from ultrasound?
◦How would you treat this?
◦What is the principle in treatment of an abscess?
◦What drainage options are there for subphrenic abscesses?

2.What is mediastinitis?
◦What are the defining features?
◦How do you get mediastinitis?
◦What is rupture of the oesophagus known as (Boerhaave's phenomena)
◦What imaging modalities would you do?
◦What can you see on a chest x-ray (surgical emphysema)
◦What are the principles of treatment?
◦What would you treat? When would you treat? How would you treat?

3.What is your approach to scrotal pain?

◦What are the causes of scrotal pain?
◦What is the nerve supply to the testicle?
◦How does it enter the scrotum?
◦What are the causes of testicular inflammation?
◦What is testicular torsion?
◦Who gets testicular torsion?
◦Why do patients have abdominal pain?
Applied Surgical Anatomy

1.Shown a right femur

◦What is this?
◦What type of joint is the hip joint?
◦What six movements are possible at the hip joint?
◦What biochemical property of the femur allows it to be so mobile?
◦What is the blood supply to the head of the femur?
◦How does it get to the head of the femur?
◦What are the ligaments of the femur?
◦Which of these is the strongest?
◦Illustrate the attachments of the femoral capsule? Why is it important to know this?
◦What is the significance of the foveal blood supply?
◦When is the blood supply via the ligamentum teres important?

2.Shown a saggital section of the pelvis

◦What is this? What type of scan is it? What kind of section is it?
◦What are the structures that you can see?
◦What are the limits of the peritoneal markings?
◦How far exactly does the peritoneum extend inferiorly?
◦How much of the bladder is covered by peritoneum?
◦How much of the uterus is covered by peritoneum? What is the broad ligament?
◦What is the space behind the uterus called?

3.Shown the facial nerve

◦What is this?
◦What is this gland (the parotid)?
◦How many branches of the facial nerve are there?
◦Name them
◦How can you test the facial nerve? What muscles in particular can you test?
◦What's this (submandibular gland)?
◦What is the nerve supply to the submandibular gland?
◦If the cervical branch of the facial nerve is injured, what deficits would you expect to see?

4.Shown the Sigmoid colon on a cadaver

◦What is this?
◦How do you know?
◦How can you tell large bowel apart from small bowel?

Operative Surgery

1.A patient presents with a dorsally angulated distal radius fracture in casualty.
◦What is your approach?
◦How would you examine the patient?
◦What features would you look for?
◦What analgesia would you give?
◦How would you perform a haematoma block?
◦What anaesthetic do you use?
◦What is the appropriate dose of lignocaine?
◦What are the features of local anaesthetic toxicity?
◦Would you use anything else with the local anaesthetic (adrenaline)
◦Why would adrenaline help?
◦In what circumstances would you not use adrenaline?
◦What other local anaesthetics do you know?
◦What is special about bupivacaine? Under what circumstances have you used it?
◦What is special about marcaine? What is it's specific gravity? Why is that important to
anaesthetists

2.How do you manipulate a fracture?

◦What is Newton's third law?
◦How would you manipulate a distal radius fracture?
◦What are you doing to the fracture when you increase the tilt?
◦Why are you doing this?
◦What is dis-impaction?
◦How would you apply the plaster? How many layers of plaster?
◦Where would you plaster from and to? Why? (immobilise joint above and below) What
physical property are you using?
◦What follow up would you do for this patient?
◦How long does an upper limb fracture take to heal?

3.What is a gastrostomy?
◦When would you use it?
◦What type of patients require it?
◦What methods of insertion do you know of?