Ref: Viva Tips
- General considerations
- Examining: alone, with
- Common questions: etiology, complications, management,
- Short cases
- Bonus points if up to date with the good journals. Read the abstracts of major dz's on
your handheld running up to the most important examinations.
- If possible, do some of the examination, esp. inspection, while you are
asking a low-yield part of the Hx, like a systems review.
- If it is an important examination, let pt know, as they may have had other
times where a student came to visit just as a ward assignment or to prepare
for a tutorial: "This is my final medical examination, my entire
future career depends on it. I have 30 minutes to ask you some questions
in order and do a quick examination. I'm quite nervous and I'm dependent
on your help".
- Ask pt to point out all their relevant scars to you.
- Fetal heart auscultation: ask pt where the nurses are measuring it.
- If potential to be asked to examine something later with examiners, have
- Place whatever relevant equipment on table: tape measure, reflex
hammer, fundoscope. This drops a hint to examiners that it would
be a good question so you can lead them somewhat by what tools
you laid out. It also prevents fumbling pockets looking for the
- Have pt in relevant position (45degrees, etc), and sheets folded
neatly at the level at which to show the presenting part (ie abdominal:
folded across at the level of the pubic symphysis).
- Know how bed and siderail moves up and down.
- Have corner of sheets loose enough that can smoothly remove them
if asked to test leg reflexes.
- If will be presenting in pt's room: remove glossy magazines from table
at end of pt's bed so examiners can't read the covers and lose interest
while you are presenting.
- Tidy the room if things are scattered all over, it looks better.
- If you finish the history and examination early, consider jotting down
your management plans, complications, risk factors, etiology, etc about
the pt's disease. These are the most likely questions that your examiners
will ask when they return, and you can respond quicker and in more detail
if you have already organized them.
- If you feel that you may be nervous, you may wish to write out your introductory
and concluding sentences in full, so that you can read them off if needed,
as these are the most important two sentences to deliver well.
- Can either present as go, or present at end.
- Obs/Gyn: Use a plastic tape measure for examination, not a paper tape,
as sweaty nervous hands will break a paper tape. If possible use a white
plastic tape, instead of one of those so-called "Rastafarian"
tapes that are coloured red, green and yellow every 10 cm.
- A good line to start with when presenting findings after examining alone: "My name
is <Robert O'Connor>, my student number is <34523>. I would
like to introduce <Mrs. Johnston>. These are my examiners: <Dr.
O'Donnell> and <Dr. Bryne>". [They will usually shake hands at
this point, or say "Nice to meet you"]. "Would you like me to begin my
presentation?" [The examiners will then say "Yes", and you are off and
- When presenting the findings, you need a strong introduction of the case,
and a strong conclusion of the case. Some examiners may lose attention
near the middle, especially as the day wears on, and if it is a nice day
outside and you are near the window.
- Don't mention anything you don't know much about, or aren't prepared to
be quizzed upon at the end of your presentation. For example don't mention
"The child's hands show no signs of stigmata of Kawasaki disease"
unless you want to talk about them all.
- If the history is difficult and many admissions, you may wish to cut out all the
individual admissions, and instead say: "She has a long, complicated history of <endometriosis>,
<being admitted to hospital 6 times between 1992 and 2002>".
- If the pt has multiple problems, it is better to give a warning first and then itemize,
so the examiner doesn't get confused. Something like: "He has <3>
problems currently. Number 1:...". If fact, you should prewarn anytime that you
will unexpectedly be presenting multiple items, instead of just one.
- Only use even numbers for pulse and respiratory rate, as you should only
measure for 15 or 30 seconds then multiply to get a figure per minute:
and odd number per minute sounds fishy.
- Depending on the device, most blood pressure readings are in gradations of 2 mmHg--only
report in the gradations possible on the device. Also, only a statistical probability of
1:25 of getting an actual BP reading where they both end in a zero--an even 130:80 reading
seems fishy as though you didn't actually take it properly.
- Pull things together towards a diagnosis. Conclusion should sum up risk factors that
were gained during a history.
- If you are asked about something that you didn't get to examine (or unfortunately
forgot because of nervousness), a good response is: "Given the time
constraints of this exam, I did not have the chance <her eyes>.
It would be important because she is <diabetic>. What I
would be looking for is ..." This lets the examiner know that you
know what to look for in that disease, and also gives a backhanded compliment
that they are a good clinician (especially if there is two examiners present,
they might try to show off to each other a bit).
- Short term complications.
- Long term complications.
- If an emergency dz, then begin with "An emergency situation begins with assessment
of airway, breathing, and circulation. Other dz: begin with "I would take a full
history and perform a complete examination".
- Then investigations, treatment.
- Blood tests:
Hematological: FBC, ESR, WBC, clotting time
Biochemical: LFT, TFT, U&E, amylase, glucose
- Urinalysis: See Urinalysis Reference.
- Function tests:
Lung tests: FEV
X-rays: plain film or contrast [eg barium]
CT scan, MRI, PET
- Some dz's may have an order of investigation, such as first a blood test, then
gastroscopy/biopsy, then CT scan.
- If surgical treatment, almost always need an ECG and CXR to help assess candidacy.
Formulate any response in the phrase "Available treatment comprises of
convervative, medical, and surgical methods", then rhyme them off by
what they are. A good generic one for headers is:
Reduce risk factors
All allied health services [eg homecare, social services]
- Look around room for a classical examination item: glass of water in exam room may mean
- When asked to examine something not visible yet, ask the pt to point to
the problem, as saves some time. Pt might not know the proper terms for
anatomy to describe the location well, but can often point exactly in
under a second.
- Always expose/uncover/inspect the opposite side so can compare for asymmetry.
- Always glance at the whole pt for systemic clues, even when asked to examine one body
- Huge parts of full examination will be cut out for time, so mention somewhere that
"Ideally, I would like to also examine...."