2010 Second Sitting VIVAs

This station will explore knowledge of beta adrenoreceptor antagonists A 50 year-old man is admitted to intensive care after a suspected myocardial infarction while undergoing gastrectomy for carcinoma of the stomach. Cardiologists have recommended metoprolol 50 mg orally bd. Describe the pharmacokinetics of metoprolol. What parenteral dose would you use for this patient? Candidates were provided with a clinical scenario of a patient unable to take oral formulation of metoprolol and asked to describe the pharmacology associated with an alternative, intravenous preparation, and contrast it with the oral preparation. Candidates were also asked to discuss metoprolol associated adverse effects and their knowledge of agonist – antagonists relationships. Candidates struggled most with applying, and explaining the relevance of, basic pharmacological principles to account for fundamental clinical applications. Dose response curves were also not covered well.

This viva will test your knowledge of cardiac physiology and blood pressure measurement. Outline the factors that affect cardiac output. This viva tested the candidates’ knowledge of cardiovascular physiology, specifically determinants of cardiac output, ventricular stroke work, volume loops, etc. It also tested knowledge of invasive arterial pressure measurement, including that relating to ideal design features of measuring systems and sources and types of errors of measurement. Candidates seemed to only have a superficial understanding of cardiac output and it’s determinants, they lacked depth in their explanations and were less familiar with right sided heart pressures and function. Measurement principles were much better covered.

This station will explore your knowledge of the physiology associated with the interpretation of Blood Gases and oxygen analysis. How would you interpret this Arterial Oxygen Tension? PaO2 = 24.6 mmHg (3.2 kPa) This viva tested the candidates’ knowledge of hypoxaemia, associated respiratory physiology and oxygen measurement. Specifically measurement of oxygen tension, the alveolar gas equation and physiological responses to hypoxia. Measurement of oxygen tension, in particular the principles behind the Clark electrode, was well done. The area candidates struggled the most was explaining and integrating arterial blood gases and the physiological principles surrounding them.

This station will explore the pharmacology of opioid drugs. An elderly man has been admitted after an emergency laparotomy. He is on an infusion of morphine at 5 mg/hr. His serum creatinine has doubled overnight and he is oliguric. What are the pharmacological effects of morphine in this patient and how are they brought about? Similarly in this viva, candidates struggled with an applied knowledge of basic pharmacological principles relating to commonly used drugs. Mechanisms of action of opioids was also an area of weakness.

This viva will explore your knowledge of Cerebral Blood Flow and the pharmacology of benzodiazepines. What is the normal Cerebral Blood Flow and what are its determinants? Candidates had a good knowledge of cerebral blood flow, although struggled to graphically represent the relationship of CBF with, for example changes in PaCO2. Questions relating to effects of benzodiazepines were also well answered.

This viva will test your knowledge on blood coagulation, and the pharmacology of heparin. Candidates had a good knowledge of the coagulation cascade. Heparin pharmacology proved to be an area of weakness, particularly concepts relating to loading dose, and it’s dose-response characteristics.

This viva will test your knowledge about the anatomy of the internal jugular vein. This viva will also test your knowledge of statistics. Describe the anatomical landmarks for cannulation of the internal jugular vein Candidates had only a very superficial knowledge of the anatomy of the internal jugular vein, particularly surface anatomy and it’s course within the neck. Knowledge in very basic statistics (eg medians, means, measures of distribution, box plots) was very disappointing.

This question will examine your knowledge of the functional anatomy and physiology of the Renal Circulation. Draw, and label, the structure of the Nephron, including the circulation. Most candidates had some level of knowledge of the renal circulation, but lacked depth in understanding how anatomy relates to function, blood oxygen tension within the kidney, autoregulation and graphically representing GFR and it’s determinates.