Prof 1 Viva 17July2014

Students who scored 70% marks and above, are called for a distinction viva. The viva panel consists of 3 lecturers, one from each discipline - Anatomy, Biochemistry, and Physiology. There are usually 27-30 A-students, and they are divided into 3 groups. There are 3 groups of panel examiners.

To obtain a distinction in the viva, students had to pass all 3 components of the viva - Anatomy, Physiology and Biochemistry. The panel must come to a unanimous verbal decision whether you get/don't get a distinction.

Group A panel comprised Prof Musalmah Mazlan (Biochemistry, External Examiner, UiTM), Dr Nurul Aiman Mohd Yusof (?) and Dr Liza Nordin (?). Observer: Dr Amida Mohd Safuwan.

Group B panel comprised myself (Biochemistry), Dr Mohd Asnizam Asari (Anatomy), and Dr Ainul Bahiyah Abu Bakar (Physiology). Observer: Dr Nazlahshaniza Shafin.

Group C panel comprised Dr Asma' Hj Hassan (Anatomy), Assoc. Prof. KNS Sirajudeen (Biochemistry), and Dr Che Badariah Ab Aziz (Physiology). Observer: Dr Md Rizman Md Lazim.

My panel interviewed 8 students and we decided not to give any distinction to any of our students as none met our expectations.


Anatomy 

1. Bone specimen. The bone specimen was 2 vertebrae. The students were asked various parts of the vertebrae and what lies in the spinal canal. 
2. Spleen. The students were asked relations to the spleen.

Physiology

1. Thyroid. The students were asked about the thyroid hormones, their syntheses and iodine deficiency. 
2. Goitre. The students were asked about the etiology of goitre.

Biochemistry

1. Macromolecules. There are 4 terms - biomolecules, macromolecules, micromolecules, micronutrients. Biomolecules are all the molecules in our body, ie biological molecules. Macromolecules are large molecules in our body, ie proteins, lipids, carbohydrates, and nucleic acids (DNA and RNA). Amino acids are monomers for proteins. Amino acids are not macromolecules, but proteins are. Fatty acids are components of triglycerides, phospholipids and cholesteryl esters. Fatty acids are not macromolecules, but triglycerides, phospholpids, and cholesteryl esters are. Nucleotides are components of nucleic acids. Nucleotides are not macromolecules, but DNA and RNA are. Micromolecules are small molecules in our body, ie glucose, amino acids, glycogen, acetyl CoA, pyruvate, citrate, etc. Micronutrients are substances that are needed in small quantities by the body, ie vitamins, trace metals, and essential fatty acids (EFA).
2. Metabolism. This time I asked about lipid metabolism (the other 2 choices are protein metabolism and carbohydrate metabolism). I asked about fat metabolism during fasting. Triglycerides are lipid storage molecules in adipose tissues found under the skin and spaces in between organs. There are 2 stages of how we obtain energy during fasting - an early stage and a latter stage. In the early stage, there is glycolysis and protein breakdown. In the latter stage, there is fat mobilisation and ketolysis as energy sources. I asked the students to start with fat mobilisation; some have problems recalling the processes for energy sources during fasting. Triglycerides are complex lipids; they need to be broken down first before the body can use it as an energy source. Triglycerides are hydrolysed by hormone sensitive lipase (HSL) in a stepwise fashion, first to diglyceride (DG), then monoglyceride (MG) and finally to glycerol (G) and free fatty acids (FFA). Fat mobilisation is the breakdown and movement of simple lipids (fatty acids and glycerol) from adipose tissue to the liver, via albumin as a carrier protein. Ketolysis is the breakdown of ketone bodies from muscle and liver, and subsequent oxidation of ketone bodies in the liver. In the long term, the body utilises FFA and ketone bodies as an energy source. Some students prioritised that brain prefers glucose as an energy source, and can't utilise ketone bodies because of the blood-brain barrier (BBB).
3. Hormones. I asked how is blood glucose controlled. Most answered by 2 hormones, insulin and glucagon. I then asked what are the actions of insulin. Some accidentally said insulin raised blood glucose! Most could answer well about the mode of action of insulin. I also asked about the action of glucagon. Many could not answer about action of glucagon. I think students don't know or can't recall that glucagon is considered a counter-regulatory hormone, ie its actions are the opposite of those of insulin. I asked what are the causes of diabetes. Some answered well, but some explained the pathophysiology wrongly. 
4. Cancer. I asked about cancer - causes (DNA mutation, uncontrolled mitosis), treatment (surgery, radiotherapy, chemotherapy), and anti-cancer drugs (enzyme inhibitors). I asked about causes of cancer and some students mentioned DNA mutation. I probed about the nature of the DNA mutation, how the mutation occurs and the nature of DNA damage. I asked if the mutations can be corrected or repaired. Many students talked about presence of repair system that corrected the mutation. Some answered something about the cell cycle, disrupted apoptosis and uncontrolled mitosis, leading to cell proliferation. I asked the students whether they have studied and know about enzymes. Some could hardly recall the enzymes. A few students managed to answer well about the 2 types of enzyme inhibition - competitive inhibition and non competitive inhibition.
5. Antioxidants. I asked about antioxidants - what they are and how they function. I asked what are antioxidants. I asked how free radicals cause damage. I probed about reactive oxygen species (ROS) and body's defenses. Some mentioned the antioxidants are glutathione system. Some answered lipid peroxidation affected lipid bilayers, biomembranes. I asked the significance of lipid peroxidation and related changes to lipid bilayer. Some mentioned lipoproteins and LDL oxidation. I asked about lipoprotein composition (PL, FC, CE, and TG). I asked about function of LDL. I asked about what happened to oxidised LDL (oxLDL). Some students mentioned LDL are easily oxidised to oxLDL, which cause plaque at the arterial endothelium, and lead to atherosclerosis (some said arteriosclerosis). I then asked what happened next after atherosclerosis. Some answered heart attack and (myocardial) infarction. Nobody mentioned stroke. Prolonged hyperlipidaemia leads to oxidation of LDL. Oxidised LDL (oxLDL) are small destructive particles as they can easily penetrate the arterial intima and cause harm. The macrophages consumed the oxLDL till they become foam cells and die, leading to changes in the arterial intima and underlying area.

Prof Faridah

Distinction Viva

To obtain a distinction, you had to pass all three components of the viva - Anatomy, Physiology and Biochemistry. The panel must come to a unanimous decision whether you get/don't get a Distinction. My panel comprised Dr Zul Izhar (Anatomy), Dr Ang Boon Suen (Physiology) and myself (Biochemistry). My panel interviewed seven students and we decided to give a Distinction to only the first Chinese girl.


Anatomy 

1. Bone specimen. The bone specimen was the left clavicle in my group (humerus in the other groups). You had to figure out whether it was the right or left bone and support your answer with a description of the bone - why you thought it was the left bone and not the right bone. You had to name the ends and attachments of the bones. Some students weren't sure whether it was the left or right bone. Most gave the wrong answer! Most cannot describe as they couldn't figure out whether it was the right or left bone. Please review your Anatomy.
2. Ootic nerve. Dr Asma' Hassan covered this topic to great length in her Revision Lecture. I was there in the lecture hall when she reviewed the ootic nerve.
3. Cranial nerve
4. Ciliary ganglion
5. Parasympathetic and outflow
6. Postganglionic
7. Sigmoid sinus
8. Muscles of mastication

Physiology

1. Exercise. The scenario posed by Dr Ang was exercise. The questions asked evolved around exercise.
2. Organ system. Dr Ang asked what systems are affected by exercise. Most students answered correctly, ie the respiratory system and cardiovascular system.
3. Respiratory system. Dr Ang asked what changes occur in the respiratory system during exercise. Answers were correct in most cases except for those who didn't know the answer. Other questions were ventilation rate, perfusion-diffusion during exercise and venous return.
4. Cardiovascular system. Dr Ang asked what changes occur in the cardiovascular system during exercise. Answers were a bit slow (shaky, unsure). A lot of students just guessed the answer! Dr Ang even asked what is the maximum pulse and heart rate, and whether there was a formula for maximum heart rate. Other questions were cardiac output.
5. Physical. To give you a better picture, visualise (just imagine) what happens if you do exercise. Will you breathe harder? Why? Can you explain it? What happens to your pulse, heart rate etc? Why? Can you explain the changes?

Biochemistry

1. Diabetes mellitus and hyperglycaemia. Questions were How is blood glucose controlled. Most answered Endocrine via insulin and glucagon. I then asked What are the actions of insulin? Most could answer. For hyperglycaemia I asked re how blood glucose can be elevated to such high levels. I asked What are the causes of hyperglycaemia? I was asking for the causes and most of you could give a list of possible causes, which was good.Some of you could name the sources of hyperglycaemia - high intake & low intake. Insulin receptors on cell surfaces were not responding to insulin. I asked the effects of high blood glucose. I was expecting glycation, eg glycated hemoglobin (HbA1c or A1C) and AGE (Advanced glycation products) but nobody answered those. 
2. Hyerlipidaemia. Then I asked re hyperlipidaemia and what were the possible causes. I asked What are the causes of hyperlipidaemia? Some took ages to answer about causes of hyperlipidaemia. I asked about the role of lipoprotein lipases (LPL) and some of you could answer alright. I asked re LDL, LDL cascade and role of LDL. I asked how high numbers of LDL behaved in prolonged lipaemia. Most could not answer. The correct answer is prolonged hyperlipidaemia leads to oxidation of LDL. Oxidised LDL (oxLDL) are small destructive particles as they can easily penetrate the arterial intima and cause harm. The macrophages consumed the oxLDL till they become foam cells and die, leading to changes of the artierial intima and underlying area.
3. Free radicals and antioxidants. I asked you to define free radicals and antioxidants. I asked What are free radicals/antioxidants? I asked you what would happen if free radicals won over antioxidants. I asked you to give examples of free radicals and most just answered simply. I then asked How do free radicals cause damage? Some answered all right. I then asked What are cellular defense systems? Some were able to answer - the glutathione system, etc.
4. DNA mutation. I asked you where mutations occurred in the cell. Most answered correctly, within the DNA structure. I asked How does DNA damage occur? Some were able to describe what went wrong at some stage in the cell cycle. I asked whether there are repair systems that can repair mutations as they occurred in the cell. And most students could answer.
5. Cancer. I asked what was the general scientific basis for understanding cancers. I asked How does cancer occur? Most of you just memorised and blurted. It would be better to understand and try to explain slowly but clearly.

Congratulations to the two Chinese medical students who obtained Distinction for their first-year studies. Here are the names of the two medical students: Kwa Schee Li (female) and Tan Fo Yew (male).

I remember Kwa Schee Li. She was the first person to be interviewed by the panel which I headed. She was calm, well-composed and fluent with her answers. To me, she was appropriately dressed as a medical student. She knew her subject matter well and the three of us who interviewed her agreed she deserved a Distinction.

The other male student who got Distinction is from Dental School (PPSG).

Prof Faridah

Professional I Exam 10 May 2011 (Part 5)

Dear Medic 1 Students,

Those of you who will be sitting for Distinction Viva, please read up on recent developments in Medicine, especially on Biochemistry. Please take note that viva will cover beyond what was taught in the lecture hall. You really have to read up, know and understand and be able to tell the Viva Panel what you really know to pass and get a distinction. There's no point in giving a distinction to mediocre students. So, if you think you stand a chance at Distinction Viva, then read up. Come prepared to answer our questions. We will challenge you and you can judge whether you will get a distinction or not.

What areas to read up on? Well, look at what's current in Biochemistry. These will include (but not necessarily related to the viva per se though) glucose metabolism and factors that control/regulate blood glucose levels; the central role of hormones in glucose metabolism and how that can tip the balance towards hyperglycaemia; what underlying mechanisms are responsible for hyperglycaemia; hyperglycaemia & hyperlipidaemia co-exist in most chronic diseases wrt diabetes and CVD; what happens to proteins in prolonged hyperglycaemia; what happens to lipoproteins in prolonged hyperlipidaemia as that prevails in diabetes; what are some abnormal products of metabolism in the hyperglycaemic state as occurs in long standing diabetes; what is the commonality (common basis or common element) underlying chronic diseases; what are the hazardous effects of in vivo oxidation that does not lead to ATP production; what are the roles of the antioxidant systems in our bodies; why are peroxides dangerous to our health; what are the body's defense mechanism against oxidative stress: how does the body defend itself against rampant and rapid hazardous oxidation; what are the mechanisms that are protective against reactive oxygen species (ROS); what are the harmful effect of ROS on DNA structure and function; how does the body protect its DNA against damage; if we cannot protect our DNA for lack of some repair systems, what will happen; what happens in the case where repair is sufficient; what happens in the case where repair is insufficient and cannot cope; what are the biochemical mechanisms in cancers we see today; can cancers be stopped and cured; if yes, why; if no, why.

I think I have guided you sufficiently to be able to read up on your own. These areas I think are quite important and relevant to medicine (not only for viva) so you should read, read for knowledge, not just to pass your viva. Remember viva is about test of comprehension, not just what you know. Even if you know a lot, it doesn't mean you can easily pass because we will test your understanding (comprehension) which means you will need to assimilate and understand what you know.

Good luck to those you will be taking the Distinction Viva. May you have a good time at the viva. Remember, if you read widely, you will be able to answer meaningfully. Don't try to memorise without understanding. You will be dead in 5 minutes and won't last 20 minutes.

Take care!

Prof Faridah