2013 Second Sitting VIVAs

This Viva tested knowledge of the hypersensitivity reactions. It began by asking about different types of hypersensitivity reactions, sought examples for each and also covered aspects of histamine, histamine receptors and adrenaline. Overall most candidates performed well, with knowledge of histamine and histamine receptors being a consistent area of weakness.

This Viva explored knowledge of the physiology of swallowing and the passage of food through the oesophagus. It began by discussing the stages of swallowing, and then moved on to the cough reflex, the lower oesophageal sphincter and metoclopramide. Most candidates had a good knowledge of swallowing, but were less informed about the cough reflex and innervation of the larynx.

This Viva tested knowledge of renal physiology and pharmacology. It began by asking what the normal Glomerular Filtration Rate (GFR) is and what the determinants of GFR are. It also explored knowledge of glomerular-tubular feedback, the counter current system and diuretics. Although most candidates had a good knowledge of GFR and its determinants, fewer were as confident to recall the actual values or to apply that physiology to scenarios like hypovolaemia. Some candidates struggled to explain the counter current mechanism, in particular the “multiplier” effect. Mechanism of action of diuretics was well answered.

This Viva explored knowledge of the principles of the electrocardiography (ECG) and statistical tests. Specifically it tested knowledge of the recording of the normal ECG, sources of error and statistics (sensitivity, specificity, prevalence, etc.). Most candidates performed well, with knowledge of sources of error in the ECG and the measures of performance of a diagnostic test being an area of weakness.

This Viva explored knowledge of the control of the heart rate. It assessed knowledge of the origin of the heart rate, its regulation, and catecholamines. Most candidates performed well. Anatomical location of the SA node, ionic currents related to the action potential, structure-activity of catecholamines and dobutamine pharmacokinetics were areas of weakness.

This Viva tested knowledge of on the physiology of calcium and the pharmacology of calcium channel antagonists. Although some candidates performed well, there was generally a lack of sufficient knowledge of the control of calcium.

This viva examined anatomy of the neck (specifically to the major vessels), ultrasound and general pharmacology. Candidates were shown an axial ultrasound image of the right neck, taken at the time of insertion of a central line, and asked to identify the major anatomical structures. Overall most candidates performed well, with a good knowledge of ultrasound in general, and of general pharmacodynamics.

This focused upon knowledge of aspects of respiratory physiology, measurement and oxygen delivery. Candidates were shown a chest X-ray, and told it represented complete collapse of the left lung. The opening question was what processes might contribute to hypoxia in that patient. It viva then went on to examine knowledge of shunt, dead space and measurement of oxygen. Overall most candidates performed well, with overall the depth of knowledge of the physiological mechanisms of hypoxia being the area of weakness.