MRCS Oct 2012 Edinburgh ( Trunk Thorax / Limbs / Head and Neck )

There were so many Singaporeans at this exam i think it should have been MRCS (Singapore).
Anyway here goes:

1) Anatomy
- specimen of hip, anterior posterior
- identify Femoral vein
- wats the structure medial to it
- whats the muscle underneath (rectus femoris) said vastus but he just continue to ask questions as
if it was rectus
- wats the function of rectus femoris, innervations
- show me ITB
- what inserts into ITB, whats the purpose of ITB
- whats the muscle? Gluteal medialis, what inervates it, whats the purpose of it
- show me bicep femoris, whats its innervations
- show me common peroneal nerve
- trick question: point at gastroc and ask “is this innervated by the same nerve?”
- whats does common peroneal supply?
- what dorsiflexes the toe? Supple?

2) Crit Care
- Registrar inserted IJV CVP and then show me xray of complication
- pneumothorax
- what do u check when looking at xray
- is this film rotated?
- what are the causes of pneumothorax: he was looking for Open VS Closed, Simple vs tension, and
not the causes like primary or secondary
- how is IJV CVP inserted? Between the head of the SCM
- he kept emphasizing on how, wasn’t satisfied with caudal-anterior direction, in then found out he
wanted to hear the 30degree angle
- what are the structures that can be injured by IJV CVP

3) Excision of navus
- presumed cleaned and given lignocaine
- check consent, make some banter
- take instruments that u need, the examiner is obviously a big shot surgeon who have not assisted
for dam long, he opened the knife towards me which fell towards my friggin foot and i had to dodge
it lol.
- pinch and check for sensation
- excise blah blah
- discovered to my horror that the friggin sample sucks, dam soft, so my suture tore through
- told him i would do buttress suture in view of the soft tissue, he say i have no time, just do
interrupted
- 3 stitch and then steristrips
- ask abt analgesia and followup

4) Crit Care
- scenario that looks like GOO
- hypo K, Hypo Na and Alkalotic
-asked abt cause of alkalosis in this case
- examiner led me on to production of H+ in parietal cell in stomach, and then ask me how is H+
made, eventually i reached it ( the cell makes H + from carbonic acid, and then it will pump H+ out,
and the bicarb gets pumped into intravascular space in exchange, THEREFORE LET THERE BE
ALKALOSIS) wicked sick M1 stuff God Bless Yong Loo Lin
- talk abt hyponatremia
- tell me about causes : this part was buang, forgot abt causes of hyponatremia
- tell me who u will involve in the management, wasn’t happy with anaesthetist and nephrologist lol.
Dun noe the answer still

5) Burns patient
- calculate burns
- exam panic forgot my 9 multiplication table tmd, be prepared to do mental sums lol
- ask me how to manage, ABC: got soot around mouth and nose so what u do, give oxygen and stuff,
nebulise saline, even offered nasoendoscope to look at vocal cord, chest physio, but they didn’t look
very impressed ( maybe the examiners never work at burns unit before)
- ultimately must intubate
- talked abt ARDS and diagnosis
- how to manage ARDS
- after this station during the 1 min reading time, i realise i was speaking too fast, i think she couldn’t
really understand my explanation about PEEP. Forced myself to slow down subsequently

6) Pre-op assessment
- repeat question : cockanathan Hyperventilation before cholecystectomy
- take history and basic examination
- harped on a history of smoking for 2 months lol wtf (i did ask, but i did not present as significant,
but of course when they ask just say its not significant la wtf. Must have been a marking point on
their marking scheme)

7) Appendix Anatomy + Trunk anat

- show me Ex. Oblique, internal oblique, where they insert and originate
- whats inguinal ligament
- what forms the deep ring
- show me the deep ring (from intraperitoneal )
- show me the appendix (be gentle there lollllllll)
- whats the common location of the appendix
- why got pain over umbilicus: referred pain, parietal peritoneum localises it there
- what surgery do u do for appendicitis
- is it muscle splitting or cutting? Show me how its done: he put 2 sticks together and say assume this
is the external oblique and show me how the muscle is split
- what is this? Sigmoid colon
- what is the space in front: rectouterine pouch, whats the other name for it

8) Catherisation
- standard blah blah
- forgot to put back foreskin but i think he didn’t realise lolllllll because i was standing between him
and patient
- assuming no urine comes out: what are the causes
- causes of renal failure

9) H Pylori
- what is CLO
- what is the new funky name for it now ( lol this is verbatim) H Pylori
- what does this patient have : h Pylori ulcer
- whats the Mx
- look at Renal panel FBC and calcium : tell me another cause of the ulcer -> hypercalcemia
- now tell me causes of hypercalemia
- most common is PTH from parathyroid adenoma
- tell me about adenoma
- tell me what happens intra-op : Frozen section
- tell me what is frozen section
- tell me why need frozen section : 2 reasons: to look for malignancy, and to make sure what ur
cutting is the parathyroid (he said no one could get that reason so far)
- appeared to be happy that i could get the last reason, and then ended the exam, sat and talk cock
for 2 minutes wtf. He guessed that i was a MO in the army once i told him i was from Singapore
wtfffffff

10) Anat station

- what is this : urinary bladder
- what is the epithelium: transitional
- where else in body got transitional: pelvis calyx ureter
- how to does the urether enter the bladder: at an acute angle
- what is the purpose : physiological valve
- what are the cancers of the urinary bladder: TCC SCC Adeno
- how do they present: painless haematuria
- what other symptoms: wanted Frequency and urgency most of all
- whats the structure behind the bladder: the seminal vesicles and vas deference
- peritoneal cover of bladder

11) History taking

- diarrhoea with blood
- with constitutional symptoms
- diagnosis IBD crohns

12) OA knee
- history taking typical

13) Examine cardio

- PACER scars
- couldn’t hear murmur, looks like they just listed him for the chest scar
- what to do in ops with pacer: asynchronus mode and turn off defib

14) Appenditis
- fake patient
- examiner seems happy when i told him i want to skip the stupid fluid thrill and other non-essential
shit like peripheral exam coz low diagnostic yield
- basically RIF pain over mcburney with rovsing’s and rebound tenderness
- patient was not primed with psoas stretch so she appeared confused when i asked her to do that
hhaha
- rather pretty actress i must say, hence apparently she felt awkward when some other candidate
when to ask to see the groin for inguinal, therefore lesson is to feel the cough impulse, no need to
look
- invx and mx
- they are looking out for important steps like rule out ectopic and definitive management
- basically in UK everyone gets IV antibiotics on diagnosis (in Singapore some bosses dun like because
they claim the definitive treatment is the appendicectomy, hence in a non ruptured appendicectomy
, the dose at induction is enough, but then examiner corrected me)

15) PID
- examine the patient
- really fucking broad stem, it just say to examine
- didn’t do a lot of shit, but i realise they just want to see that u reach the diagnosis and do the
important things
- seem satisfied that i do the tip toe and lean back on heel so did not zham me for the rest of the
exam
- management and invx

16) Thyroid
- straight forward
- found out it was MNG with nodule
- but i felt diffuse goitre
- didn’t alter discussion much, he did get me to say MNG as a diagnosis / differential
- standard discussion