2020 compilation

Last updated 7 June 2020

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Crit care
24 male falls off ladder,
- body parts injured?
- constituents of GCS?
- single blood test to confirm diagnosis - CT head – extradural
- management of raised ICP
- GCS drops – management?
- Cause of secondary GCS drop?
Hx
Hx of pleuritic chest pain, PE 5 days post THR
- Dad had clot
- Non compliant with teds
- Haemoptysis
- Investigations
- Treatment?
- Embolectomy vs thrombolysis
Path station BCC
- describe lesion
- causes for erythema – telangiectasia
- DDX?
- How tumour spreads? Lymphatic spread – embolus
- Intraoperative investigations
- Path report (owl eye sign) Reed Sternberg cell (hodgkins lymphoma)
Anatomy
- Right heart (papillary muscles, chordae tendinae, azygos vein tributaries
and drainage - SVC)
- Purpose of chordae tendinae
- Branches of ascending aorta (coronary arteries)
- Anatomy of spleen (ribs overlying – 9-11), duodenum,
- Organs supplied by splenic artery
- What not to damage during splenectomy (tail of pancreas)
- Describe course of splenic artery (coeliac trunk, lienorenal ligament,
posterior to stomach)
- Surface markings of gallbladder
- Why referred pain to shoulder tip
Skill – remove naevus
LA given, cleaned and draped, ?WHO, allergies, anticoagulants -same as previous
C-spine anatomy – -Structure at C3, C6, - part of gut at C6
- explain parts of C2

- talk through open mouth view of xray

- talk through lateral view
- ligaments of odontoid peg
- ligament passing posteriorly (transverse) - why C7 vertebra prominent?
Point to brachial plexus
Point to hyoid and cricoid on actor Course of vertebral artery Atypical vertebrae (C1, 2, 7)
Comms
- Read through notes – MVR awaiting hernia op, warfarin bridging, blind
guy, as previously described
Knowledge
Hand anatomy
Point to median and ulnar nerve
Sensory supply
Motor supply
FDS and FDP attachments
Contents of carpal tunnel
Attachments of flexor retinaculum
What attaches to flexor retinaculum
Xray of hand – name carpal bones
How to test action of FDS
Movements of thumb (extension, abduction, flexion, opposition) Nerves innervating each action
Exam – confusing station
5 days post left hemi, unwell, irreg. HR, febrile (exam says please examine appropriately – we think
do CCRISP)
A-E – CCRISP +ve findings, fast AF, sternotomy scar, LIF guarding
Insert another cannula
Management of patient? Hartmans procedure
Sepsis 6
DDx – anastomotic leak, subphrenic absess, ischaemic bowel
Patient had sternotomy and laparoscopic ports (?oesohagectomy)
Ear exam
- inspect
- test hearing
- otoscopy
- rinne + webers
- facial nerve
- chorda tympani
- balance
- what investigations (pure tone audiometry and tympanometry), CT
- describe picture (haemotympanum)

Knee – 25y.o. 3 hours post football tackle Fixed flexion deformity

Medial joint line tendnerss
Unable to WB
Pain on medial collateral stress test Cruciates normal
No effusion
Differentials – meniscal tear, fracture, MCL MMX – analgesia, splint, arthroscopy, repair
Catheter – as previously described
- question re: causes of no urine output
Trauma
-
-
-
-
-
-
man stabbed in epigastrium
given blood results – raised lipase, free air in abdomen – which organs damaged? Bowel, pancreas,
blood vessel
drain inserted – high output ?test (amylase)
cause of low calcium (saponification)
cause of hypoglycaemia (inadequate endocrine function)
Histology of ARDS?
groin abscess
Hx –
Referred in by GP
IVDU
No other medical issues
Pulsatile swelling
Anxious about getting next hit
Investigations – duplex, CTA
Managemnt – US guided compression, thrombin injection, ligation of artery What is % chance of leg
loss? 10%
Bone cancer – 48 y.o lady with pathological fracture Thyroid primary
Folliciular cells
What tumours commonly metasatsise to bone What tests would you do?
What further tests? Immunohistochemistry
Radiological test? Radioiodine
What tumour doesn’t show up on radioiodine scan? – medullary because parafollicular c cels don’t
participate in iodine uptake
Aortic stenosis
-sequaelae of aortic stenosis - define LVH on ECG
Trauma transfer Aortic rupture

Femoral fracture
Reduced GCS
Potentially abdominal injury
Causes of mediastinal widening? Aortic transection and pericardial effusion Plan?
-Thomas splint
C spine xray
Send with retrieval team to receiving hospital and blood in ambulance
PE
Crit care, left sided chest pain ?DDX Unwell on ward, tachy, low sats ABG, CXR, bloods
ABG shows T1RF
Management?

Critical care
Epidural bleed
24 year old fell from 3 meters
CT scan: Epidural bleed, mid line shift, loss of Grey white matter differentiation, effacement of
ventricle
CT head indications
GCS of 6 needing tubing
Investigations
Causes of low GCS in this patient from blood tests especially What else would you be worried about :
cervical spine Management
Critical care
Aortic stenosis
Patient for TURP, on bendro and doxazosin, ejection systolic murmur in aortic area.
Likely pathology ie aortic stenosis
Pathophysiology of aortic stenosis and effect on myocardium Presentation
Risk and benefits of surgery
ECG with LVH
Calculate HR
Other investigations like ECHO and invasive intra op monitoring Side Effect of bendro and risk in
surgery
Effect of postponing TURP surgery
NICE guidelines regarding antibiotics
Critical care
Acute Pancreatitis
Alcoholic, high BMI and diabetic, blood tests
Likely diagnosis
Differentials
Management
Investigations
Why hypocalemia
MRCP and ERCP
VTE Prevention
What is a pseudocyst
When would you suspect and the clinical features Why might be amylase be low in Pancreatitis
Is amylase useful in prognosis
State the scoring that you know and describe one. Where would you manage this patient.
Pain control
Pathology BCC

Describe the lesion : rolled edge, ulceration, telengectasia, erythema, size Why is there erythema
Differentials
How to ensure complete resection intra op
Describe Moh's
MCS shows E. coli
Likely contaminated so repeat swab MSRA Treatment and barrier nursing Infection control
notification
Pathology
SSI and Nec fas
Post lap chole, diabetic and obese
Histopathology of gallstone in the gallbladder eg fibrosis, inflammation Erythema so likely SSI,
Give possible organisms
Management
Not getting better why? possibly drug resistance, or progression to Nec fas Risk factor of obesity and
DM
Now necrotic and black
Likely organisms
Which blood test would point to possible NEC fas FBC EUCr
Pathology
GIST
Histopathology report showing GIST, sarcoma, ulceration, CD 117, nodal involvement, no spread
otherwise. H. Pylori
Difference between GIST and gastric adenocarcinoma
How is the tumor likely to behave ( it had gone through lymph nodes but no distant metastasis) Why
is the patient jaundiced
What is jaundice
Patient develops ascites how do you investigate ( cytology and liver biopsy for recurrence) What is
CD 117 ( happy with immunohistology marker)
What is H. pylori
What does it causes
Clinical skills
I and D
Give local
Look at consent form Langer lines
Would it scar? What about pain?

Test local
Pack the wound
How would you dress
Why MCS
What would you expect to grow
Clinical skills
Suturing
Hand tie with silk on the rig (non absorbable braided) Hand tie at depth with vicryl
Instrument tie Figure of 8 with prolene
Problems with tying at depth
Benefits of braided sutures
Examination
ABCDE exam
Ten days post op with right sided chest pain so assess. Obs chart present
Pain on inspiration Calf tenderness Likely diagnosis Investigations Treatment
Patient collapses what would you do.
Examination
Carpal tunnel
Right hand pain and tingling worse at night Positive phalens and tinels
Parasthesia
No muscle weakness
Diagnosis
Risk factors
Treatment
Examination
Cholecystitis
Upper abdominal pain and perform any other necessary exam eg face and hand RUQ with Murphys
positive
When to perform lap chole: early or late
Getting better but jaundice so likely CBD stone
How to manage

MRCP and ERCP

Examination
MMSE and CN examination
Long standing anosmia now coming with headache and vomiting.
Pen touch and peppermint provided.
Do the relevant CN exam and a MMSE (I don't think you're actually supposed to complete this in 6
minutes so I did AMTS)
Likely diagnosis Investigations
Communication
Motorcycle RTA
Bilateral haemothorax, chest tube in drained 200mls Mediasternal widening
Left femoral fracture
Discuss with consultant
Ensure to clear cervical spine
Places he could be bleeding from
Treatment of aortic disruption
How would you transfer
Communication
Canceled op
Same classic meniscus injury canceled arthroscopy scenario
Communication (history taking)
Back pain
Take history of lower back pain, has IBS, previous MRI, uses walking aid Likely diagnosis
Red flag symptoms
Investigations
Treatment
Communication (history taking) Pseudoaneurysm
IVDU
Management of pseudoaneuryms Investigations ( HIV HBV)

Anatomy
Lower limb anatomy
Femoral triangle
Name four muscles you can see Femoral canal ( boundaries and function) Adductor canal
Dermatome
Supply of saphenous nerve
Roots of femoral nerve
Landmark of femoral artery
CT Angio and branches of femoral artery
Anatomy
Thorax and abdomen
Azygos vein and tributaries Pulmonary trunk
Ascending aorta and branches Papillary muscles and function sympathetic trunk and the limits
duodenum and parts
landmark of gallbladder
Splenic artery and supply Location and ribs of spleen Artery behind D1
Referred pain to shoulder tip
Anatomy
Skull
Foramen spinosum
ovale
rotundum
cavernous sinus and nerves
Symptoms of cavernous sinus thrombosis Middle ear infection and spread
Nerve around middle ear
Cause of papilloedema
Many thanks questions. I passed.
1. Procedure station : Naevus excision.. straight forward. Patient and examiner very cooperative.
When to remove sutures? Will there be pain? Recurrence?
2. Anatomy station : C5,C6 nerve root anatomy. Scenario : Chap who has fell from height and had
abduction injury.
Que - where do C5, C6 root arise. Show on skeleton.
Dermatomes. SSP origin n insertion. What initiates abduction? Musculocutaneous nerve supplies?
Show biceps n supinatir reflex on model. How to test trapezius. Nerve supply to it. Test elbow
flezion.
3. Anatomy station. Abdominal aorta branches. IVC tributaries. Abd aorta surface marking.
Bifurcation level and marking. Show me different arteries supplying GIT. What crosses in front of
aorta transversely - 3 structures.
4. Anatomy station : Child fallen from tree. Swelling at elbow. Anatomy station : SC humerus.
Articulate bones. Median nerve supply. Relation of median brachial art n radial nerve. Ulnar paradox
muscle? Median nerve injury abovr elbow results in? Radial nerve course and relation to humerus..
show artery, nerve etc. Brachilradialis action.
5. Surgical pathology. Female who had pathological fracture of femur. What is pathological fracture?
Causes? Classify bone tumors? What metastasises to bone - 5 tumors? Thyroid follicular carcinoma
mode of metastasis? What will u look in histology single most imp finding? Thyroglobin. How to test?
Radioiodine. Which thyroid tumor not detected by radioiodine? Why? Medullary as from para
follicular. Where else does ectopic thyroid can b found apart from chest n neck? Examiner hinted to
gonads..
5. Surgical pathology : metal plate in tibia 3 year ago now with knee swelling : What is cause? What
are sequelae of tibial abscess? What is sequestrum? Involucrum? 4 organisms causing septic
arthritis? Why metal work needs to b removed? Sinus vs fistula? Why antibiotics wont work?
6. Arrange OT list and give reasons. Just same as pastyear questions. Hartmans procedure, mrsa foot
amputation and pacemaker guy with hernia.. Precautions for using cautery. Justifications for
arranging..
7. Critical care : lady postop day 2 after colon resection: sats droppin.. tachy.. pao2 dropped.. left
sided chest pain..3 reasons for this? What will u ask in history? Abga shows type 2 failure. Reason?
Pulm embolism investigation of choice? What will u see on investigation? How to prevent DVT?
What to do intraop to prevent? Saddle embolis found on CT what to do? : Embolectomy.
8. Critical care. 40 yr old bicycle hit at high speed. On spine board.. sats droppin tachy, patient can
speak and oriented.

Que : diagnosis. Immediate management:- as per atls. What investigation?Cervical xr shows c3-4
dislocation. What to do? Intubate. Whom will u involve? Neurosurgeon n anesthetist.. physiological
reason for sats droppin? What is line of thot for management onwards from ER?
Second round :
1. Hand examination. Label said gentleman who has problem with function in his dominant hand.
Father and grandfather had amputation. He is diabetic.. do relevant examination n other system if
needed..
Vague station as everyone thought of arterial n nerves exam.. however many of us did only hand
exam. Showed dupuytren's contracture.
Que- etiology? Treatment?
2. Communication : Talk to ITU reg. lady admitted today. COPD. Generalised peritonism. Amylase
raised. Only 1 bed available..
Que - why bed required? COPD what will u do? Will u give antibjotics? What to do before giving
antibiotics? Whats her fluid balance? Ecg taken? What if it shows atrial fibrillation? Repeat the main
points.
3. Communication : man with ascites. Tap shows malignant cells. CT not working. Man in pain and
discomfort. Wife is here.. knows that cancer is present. Talk to her and address questions... straight
forward.. dont forget to read in notes that he was workin in dye industey so can be bladder
carcinoma.. also that surgical reg has told if ptnt uncomfortable than do therapeutic tap to help..
4. History.. vascular claudication. Pain in calf.: stops after rest. Smokes a lot. Not radiating.. que :
what favors vascular over neuro? How will u manage? What lifestyle modifications to advise?
5. History : vague station. U r neuro trainee. Ptnt referred from other hospital. No other information.
Go n talk to her. Turns out to be a subarachnoid hemorrhage.. what r riskfactors? How will u treat?
Mentions that her relative had this.. berry aneurysm.. I C E.
6. Examination. Abdominal exam with cholecystitis.. murphy positive. Straightforward..
7. Examination : submandibular swelling. Same as before.
8. Examination : CVS. A fragile lady with real clubbing n palmar erythema.. mitral regurgitation
murmur.. thats what I said.. dnt knw for sure.. what r ur preop n intraop concerns? What will ECHO
tell u?
Many thanks to previous examinees who took time to post questions. It really helped. I was very
nervous after exam as I thought I waffled at many stations. In the end I managed to pass on first
attempt! :)

Advice : just what all is universally told. Take enough rest. If one station goes wrong do not panic. Be
yourself and be honest. You can change your mind if you think you answered wrongly and let
examiner know. All the best!

1. Hand exam - carpal tunnel syndrome, causes and management

2. I+D of abscess - orientation of incision, which packing, which dressing
3. 40yo with weight loss and change in bowel habit, FHx of bowel Ca - ???do a lymph
node exam ?differentials – in retrospect, to complete the “lymphoreticular examination” I would
have also palpated for hepatosplenomegaly for Xtra gold stars***
4. Pancreatitis - clinical hx and bloods presented. Why would amylase be normal? (very early, or late
pancreatitis) What scoring systems? How do you decide to escalate care? Cause of hypocalcaemia?
What is a pseudo cyst? How does it present? (Gastric outlet obstruction)
5. Pathology - red hot knee. Differentials, what test, what to send for in lab, commonest crystal
arthropathy. Given path report G+ cocci, what is this? Commonest organisms, why does metal work
have to be removed, what is an abscess, what process is this? (Osteomyelitis), sequestrum and
involutrum
6. RTA ped vs vehicle. LOC then GCS 15, then unresponsive - what is this interval called? How would
you assess if pt needs urgent CT head. Image of extradural. What is the monroe kellie doctrine and
how does it explain lucid interval. What causes the bradycardia and hypertension. What is CPP
7. PREP station
8. Phone trauma consultant - ED RTA cyclist vs car. LOC at scene now GCS 15.
Obvious open tib/fib but clinically stable. Had IV, bloods, Abx, tetanus and fluids in ED. CXR nad, blds
NAD. USS abdo ?fluid L subphrenic area. What are the priorities for mgmt (c spine, splint #, assess pt,
call other specialties, CTs)
9. You are neurosurgery SHO - in clinic, hx young man, sudden severe headache back of head,
photophobia, vomiting. FH - Aunt died of SAH. What DDx, what is your management, would you
admit the patient
10. Submandibular gland examination - DDx, management
11. Abdo exam - 63M LIF pain, diarrhoea. Obs show tachy, febrile and raised WCC. OE
- midline sternotomy and x3 port scars. LIF tenderness with guarding. DDx, mgmt of sepsis, scan?
Definitive mgmt, how long will he stay in hospital, can you reverse stoma later (yes if histology not
ca), how to counsel pt for stoma reversal
BREAK
1. Stem - otitis media. Anatomy of base of skull. What attaches here? Cavernous sinus -
what is contained inside, how does thrombosis happen, how does it present. How does infection
spread from middle ear. Where does CNV ganglion sit, mechanism of papilloedema, significance of
ophthalmic artery
2. Chest drain insertion, shown CXR pneumothorax first, what equipment you need, select drain size,
how do you mark where to insert, drain stitch, name 3 complications of chest drain? E.g. infection,
pain, damage to local structures, bleeding. (funnily enough the CXR showed a left pneumothorax but
the model could only have insertion on the right!)
3. Articulate humerus, radius and ulna. Biceps tendon insertion. Median nerve transection at elbow
and wrist, radial nerve transection at wrist, ulnar nerve functions and paradox. Shown anatomy
diagram - point out the artery and nerves, how do they pass at the elbow
4. Rest
5. Prep
6. Speak to wife - husband referred with asymptomatic ascites, found to be malignant,
awaiting staining, awaiting tumour markers. CT scanner broken. Consultant in theatre

7. 34 week pregnant lady undergoing surgery for abscess related to perfd necrotic GB. Modified
trendelenburg, becomes hypotensive. Adv and risks of doing this surgery, why is she hypotensive,
what can you do about it, what is preload, how can body increase preload, how does body sense
changes in BP, how does normal body increase venous return when stranding
8. History - woman with multiple life stressors presents with back pain which varies in location and
has no red flag Sx. ?Functional back pain
9. Anatomy - pictures of illustrations and prosections of pancreas and duodenum, blood supply
pancreas and duodenum. Relations of both to peritoneum. What is in front of and behind the
pancreas and D3. Embryology of pancreas. Pancreatic ducts and where they drain
10. Path - stem – “you will be tested on path and shown a picture”. Picture of colon with multiple
polyps. Dx? Pt presents age 22 what tx would be, name 3 extra intestinal manifestations of FAP,
what is APC, what is an ulcer
11. Pt POD4 post laparotomy. R sided CP. obs tachycardia, tachypnoeic, borderline pyrexia and
dropping sats. A-E assessment - signs/paraphernalia. O2 mask next to pt, dry wound dressing and
tender L calf. How would you manage. What investigation? Any other imaging besides CTPA? Tx
options
12. Rest

Anatomy:
• Elbow/forearm anatomy
• Coeliac trunk, pancreas (terrible quality photographs)
• Base of skull/cranial nerve
Critical care/physiology:
• Necrotic gallbladder in a pregnant patient – positioning, cardiac output and preload
• Extradural haematoma Pathology:
• FAP – polyp types, management options, extraintestinal manifestations
• Infected metalwork in an orthopaedic patient – associated pathogens, treatment options,
biofilm formation etc
• Pancreatitis – scoring systems, hypocalcaemia
Communication:
• Angry wife – husband has been told about malignant cells in an ascitic tap, told that there are no
treatment options, CT scanner is broken. Consultant unavailable – calm the wife down, apologise,
explain what has been found, concerns and treatment options (unknown primary, so surgery,
chemotherapy, radiotherapy, symptom based etc).
• Consultant conversation – trauma patient with ?compartment syndrome after tib/fib #. Vascular
consultant is in theatre with reg and you haven’t seen the patient yet.
Examinations:
• Abdominal exam: acute abdomen/LIF pain in SAU
• Hand exam: carpal tunnel syndrome
• Abdominal exam: painless jaundice
• Submandibular gland examination
• ABCDE: 10 days post ‘major abdominal surgery’ patient has right sided chest pain, left calf tender
on examination; PE. Overall, a badly run station.
History:
• Headache: young man with sudden onset headache, photophobia. Clinically well. Family history of
?SAH

• Back pain: 10 year history of back pain, no red flag symptoms Practical procedure
• Insertion of a chest drain
• Drainage of an abscess, local anaesthetic injection

1) Anatomy
-Show on skeleton
*identify acromion and coracoid process
*Tell me the rotator cuff muscles and show on skeleton origin and insertion
*show me the spiral groove and what runs in it
*show me medial epicondyle and what runs under it
*Tell me one major sensory loss when the radial nerve is injured
*identify ASIS and what muscle on it
*Tell me one nerve injured which runs under of ASIS and what is the syndrome called (lateral
cutaneous nerve of thigh)
*Show me Gluteus medius origin and insertion
*Function of Gluteus medius on walking
*Could you show me the Quadratus femoris muscle origin and insertion
2) Communication Phone call
ITU registrar
* What is your plan of action ?
*Have you checked the urine output?(say not done)
*Have you given any antibiotics (say not given). What antibiotics do you prefer ? (Broad spectrum
with blood cultures)
*Have you done blood culture (not done)
*What percent of oxygen saturation would you like to keep for COPD?(88-92%) and why (because
co2 retention)
*How much litres of oxygen would you prefer (2-4L)
*Why is the patient acidotic ? (because lactic acidosis due to hypoperfusion and anaerobic glycolysis)
*Any other blood test you specifically like to repeat? (potassium)
*ECG findings you expect ? and How to deal with it? (contact cardiologist)
*Bed not available, what to do ?
*Do you think the patient will improve with surgery ? Who do you want to contact ?(family
members)
3) History
Back pain with IBS history
*What dx and what differentials ? *Investigations
* Treatment (please say social worker)
4)Communication
OGD

Questions patient asked - Wife and family members sad , Complications , Blood reports finding ,
explain the procedure , how can i understand when the complications arise after i reach home .
5) Critical care (Head Injury)
*Components of Airway and Breathing
*Components of circulation
* 2 neurological signs (Oculomotor and abducens nerve palsy , False localizing sign)
*Patient felt from 3 meters height so where would he injured himself?( basically tell all the sites)
*Investigation you would like to do for head injury?
*Treatment
*CT scan criteria ?
*Comment on the ct scan of head ( EDH)
* 1 definitive treatment for this ct scan findings (Craniotomy with burrhole or open)
*Patient gcs was 15 and now declined what do you think is the cause and what are the causes
behind it?(say trauma , tumor , hemorrhage)
*Components of CPP?
6)Critical care (Obstructive jaundice)
*Blood picture with Raised - ggt and ALP and bilirubin what is your idea? (Obstructive jaundice)
*Classify Jaundice
*Give examples of jaundice
*Classify Obstructive Jaundice ( Intraluminal , luminal and extraluminal) *Why clotting deranged in
Obs Jaundice?
*Explain the whole enterohepatic circulation ?
*Imagings you would love to do ?
* Which one has diagnostic and therapeutic value and what can it do ? (Stent and dormia basket
stone retrieval)
*Function of Bile salts in digestion of fat?
*Composition of bile ?
7)Critical care (Abdominal pain)
*First thing you see while you scan through reports of your hospital? (demographics like name age ,
dob)
*D/D of perforated viscus on an OLD person?
*Features in XRAY - Gas under Diaphragm
*Features in ECG - absent P waves
*Features on an ECG ( P, qrs , T waves , Heart rate, voltage )
*What can AF cause ? ( Surgical failures , stroke , MI)
*Why MI (Decrease diastolic time)
*Surgical cause of AF ( Hypokalemia , sepsis , MI , Thyrotoxicosis , Valvular heart lesions , sick sinus
syndrome , hypoxia and many more)
*Treatment of AF

*Since the patient has dementia, how would you like to proceed ? ( Contact family members and
consent paper 4)
*What does the ECG show. why is the HR on the ECG and the HR on the BP cuff different?
8) History
BPH(Classic findings- Slow stream , increase frequency , terminal dribbling , hesitancy , urgency ,
Nocturia)
Patient takes Sudafed nasal drops
*Differentials
*Investigations - Say I would first like to examine the abdomen and perform DRE to check for
hardness , irregularities , firmness )
*Treatment
9)Examination ( Stem - Headache and vision problems)
Classic cranial nerve examination which fits 6 mins) *D/D
*Investigations
*treatment
10)Examination ( Stem - Postoperative 4 days of surgery, now complaining chest pain)
CRISP examination Pulmonary embolism == MAKE SURE YOU AUSCULTATE THE BACK OF CHEST and
SQUEEZE THE CALF)
*D/D
*Investigations
*You scrubbed in OT. now patient complains of chest pain ? (crash call ) *Treatment
11)Examination ( Stem - acute abdomen)
Classic Abdominal examination Right iliac fossa pain - Acute Appendicitis *D/D for both male and
female
*Investigations for both male and female(b hcg in urine)
*Treatment (why lap chol for female patient )
*Now you see blood in the abdomen, what will you do ? usual talks about calling obstetrician *Will
you make the incision bigger ?
12) Examination ( Stem - examine the superficial venous system)
Classic Varicose examination , Doppler provided , 2 tourniquets also provided) -Perform tourniquet
on both sfj and above knee
-Try to perform a doppler or just say you want to end examination with doppler *D/D
*Investigations
*Treatment
*a women taking OCP, what would you advice ?

13) Procedure (OT LISTING)

* why would you like to place Strangulated hernia at first (More chance of Ischemia and Obstruction)
* Anaesthesia for Strangulated hernia
* Pacemaker complications
* Diathermy adjustments
*Why Allergic to penicillin at second
*what antibiotics ?( i said erythromycin , vancomycin because he didn’t accept cefazolin/cefuroxime)
*What to give for allergic to Iodine?
*2 words for diabetic patients, preoperative management ? - GKI SLIDING SCALE
*why MRSA at last ?( He didn’t accept Cross contamination or to ensure adequate cleaning of
theatres, NO idea what he wanted lmao)
*What anaesthesia for BKA? (say GA because he has AF with warfarin so regional/spinal will cause
hematoma/bleeding)
*What antibiotics for MRSA ? If resistance to Vancomycin, what antibiotics? ( Give Tigecycline) *How
to manage Atrial fibrillation ?
14)Procedure (Nevus excision)
* Will it pain afterwards?
* Is it cancer?
* My mom is scared ? ( nothing to worry about, hopefully it won’t be nothing serious, we will call
you after the results are out )
* Any scar marks ?
* When i need to remove the stitches?
Dispose sharpies
15)Anatomy
Pictures from Mcminn
*Show the boundaries of Posterior Triangle
*Show accessory nerve
*What muscles it supply ?
*Function of these muscles ?
*Show posterior auricle nerve ( hint above sternocleido) .What does it supply?
*Show submandibular gland . What secretions ?
*Imagine a muscle above it and between skin, what is it? (platysma) nerve supply?(cervical branch of
the facial nerve)
*Show Omohyoid ?nerve supply of it with roots?
*Show posterior belly of digastric ?nerve supply ?
*Identify Internal carotid artery and External carotid artery .How can you identify ( First branch given
by superior thyroid artery in eca)
*Given microscopic picture of Melanoma in lymph nodes
*What spreads in lymph nodes(lymphoma,leukemia,metastasis). Common sites for metastasis

16) Anatomy
Picture of abdomen vessels
*Identify Aorta and IVC
*Aorta starts and ends level
*what is transpyloric plane?
*Anterior relations of Aorta ?
*Show me branches of aorta both in cadaver dissection picture and MRA? *Posterior branches of
Aorta?
*IVC starts and ends level
*Tributaries of IVC
*Picture of a specimen showing Saccular aneurysm below renal veins of Aorta
*What is aneurysm ?
* what is dissecting aneurysm ?
* what percentage of arterial wall should increase till you say it’s an aneurysm ? ( I said 30-60%)
17) Pathology
Non healing skin ulcers
*So if this is a SCC
*what is a carcinoma ?
*what are the histology reports you need to be aware for SCC?
*what are the treatment options? (take wider excision and radiotherapy)
*Tell me 2 Pathological investigations for this SCC ( Frozen section and excision biopsy) *What is
frozen section ?
*Discharge Yellow pus after placement of graft, what do you think is happening ? *Any
investigations ? any microbiological investigations?( gram stain and c/s) *Wound C/S shows MRSA ?
Treatment and Eradication therapy in brief ?
*Tell me 5 steps on how metastasis occurs from skin to lymph nodes ( the usual)
18) Pathology
Breast cancer
*What is Culture and Histology ?
*When do you say the culture is inadequate ? (was able to answer only inadequate tissue) *What is
sensitivity and specificity?
* Histology report show Pleomorphism with epithelial cells with C4 grading
*What are the gradings ? (c1-c5)
*What is the action of Oestrogen receptors ?
*what is the action of herceptin ?
*While performing the graft placement, the surgeon noticed redness, edema around the site of
lesions. what do you think is happening ?(paget’s disease or eczema)
*what are the causes of paget's disease in breast ?
*suddenly the patient developed a decrease in bp soon after the surgery with one dose of antibiotic.
what do you think is happening ? ( anaphylaxis ). Explain Mechanism and what type of
hypersensitivity reaction ?

Anatomy
9
8
6
7
4
5
3
2
1
– Anastomotic Leak
– ATLS C Spine
–BCC
– Pancreatitis
–PE
– Pancreatitis
– Preload in pregnancy, VTE prophylaxis
– Extradural Haemorrhage, ICP
– Renal Failure [Pre,Renal,Post]
– Aortic Stenosis ECG
10
8
9
2
1
– Upper Limb c5/6 lesion following RTA
– Lower Limb, Femoral Triangle and Adductor canal
– Hand bone, Intrinsic muscle hand
– Posterior Mediastinum, Heart, Spleen
– Cervical Vertebra
– Cranial vault, Middle Cranial fossa, Papilledema
– Upper Limb elbow
– Upper GI, Pancreas relations, lesser sac
– Skull, foramina, middle cranial fossa
–Axis,Atlas[Surfaceanatomy]
3
7
4
5
6
10
Critical care
Pathology
6
–
5
–
4
–
3
–
2
–
9
8
7
6
5
4
1
– Colorectal cancer
–GIST
– Infective Endocarditis
– Aortic Stenosis
– BCC, Lymphoma
– Pathological Fracture
– Thyroid Ca
– FAP and Colorectal Ca
– Abscess, Osteomyelitis, Healing, Ulcer
–ThyroidCa
–Metastasisproliferation,lymphatic
2
3
10
11
History
1
–
Claudication
Pancreatitis
Chest Pain post total Hip
Groin Swelling in IVDU, Psudoaneurism
back Pain
head Ache in young guy SAH

Examination
8
9
7
6
5
4
3
1
– PE, Resp examination
– Abdo RUQ pain, Obstructive Jaundice
– Ankle Fracture
– Abdo examination, LLQ, Diverticular Perf
– Knee examination
– Ear & Cranial Nerves examination
– ABCDE Anastomotic Leak
– Hands carpal tunnel
– Hands ulnar deficit
– CcriSP, PE
– Abdomen LIF Pain
– Submandibular Gland
– Arterial/Venous Fistula
– Gynecomastia
2
10
11
12
13
14
Communications
3
2
1
– Chest drain
– Abscess
– Catheter
5
4
3
1
– Warfarin counselling blind patient
– Referring Trauma patient to cardiothoracic Centre
– Young RTA with abdo pain discuss with consultant
– Chat with wife of guy with malignant cytology and CT broken
2
Procedures