How to prepare for a pathology viva

To prepare for a pathology viva, learn each topic in a fixed order you can say out loud, then practise answering questions aloud, not just reading. Examiners often start with an open question and push harder with each follow-up, so you need to speak in full sentences under pressure.

What is a viva voce examination?

A viva voce is an oral exam: an examiner asks you questions and marks what you say. Formats vary by school. In a traditional viva, the examiner picks the questions as they go. In a structured viva, the questions are set in advance, often on cards, so every student gets a similar test.

Structured vivas are more reliable than traditional ones, where marks can differ between examiners (Abuzied and Nabag, 2023).

Ask your lecturers which type you'll sit and how long it lasts.

What does a pathology viva test?

A viva tests how well you understand a topic and whether you can explain it clearly. You can't hide behind a list. If you've memorised words without the meaning, the second question often shows it.

How do examiners build their questions?

Many vivas move from an open question to harder follow-ups. A common pattern:

1. Name it. "Tell me what you know about…"
2. Explain it. "Why does that happen?" or "What would you see under the microscope?"
3. The exception. "Is that only seen in tuberculosis?"

In one structured pharmacology viva, the harder part of a question was asked only if the student got the first part right (Dhasmana et al., 2016). So get the first part right, or you won't be asked the harder part.

How should you structure a pathology viva answer?

Start with a definition, then follow the same order every time:

You won't always get through all six. The examiner may stop you after the morphology and move on. That's fine. A fixed order means you don't waste time deciding what to say next, and the examiner can follow you.

Example: caseous necrosis

"Tell me what you know about caseous necrosis."

Start with the definition: it's a pattern of tissue death (necrosis) in which the dead tissue has lost its structure. Then the morphology: grossly, it's soft and looks like cheese. Under the microscope, you can't see nuclei or the normal tissue pattern.

Example: the Ghon complex

"What's the Ghon complex?"

It's the Ghon focus in the lung plus the lymph node that drains it. Say both parts. Naming only the focus is half an answer.

Example: the Langhans giant cell

"Describe a Langhans giant cell."

It's made of epithelioid macrophages that have fused. Its nuclei sit in a horseshoe shape at the edge of the cell.

Expect the exception next: "Is it only seen in tuberculosis?" No. It's seen in immune granulomas of any cause. The examiner may then ask how it differs from a foreign body giant cell. In a foreign body giant cell, the nuclei are scattered through the cell, not set out in a horseshoe.

How do you practise for a viva?

Practise out loud, and test yourself instead of rereading. A large review of study methods rated practice testing and spaced practice as highly useful, and rated rereading and highlighting as low (Dunlosky et al., 2013). Saying an answer aloud from memory is practice testing.

Among six Nigerian medical students we interviewed in October 2026, each prepared in a different way:

• One made audio viva practice with Grok: a question, then a 10-second pause before the answer.
• One rereads her written answers.
• One explains topics aloud to friends, in the same order as a written answer.
• One asks classmates who went in first what they were asked.

The first and third come closest to the real exam, because you have to produce the answer yourself. Rereading feels useful but doesn't make you speak. Asking classmates can help you guess the topics, but examiners may use several sets of questions (Dhasmana et al., 2016), so don't count on getting the same one.

A simple plan:

• Pick one topic a day and spread your topics out over the weeks before the exam.
• Say the full answer aloud, in the six-step order, without notes.
• Have a friend ask the follow-ups: "Why?", "What does it look like?", "Is it only seen in…?"
• Check what you missed, then try again a few days later.

What should you do when you go blank in a viva?

Say what you can, even if it's only the definition or one feature. One of the students went blank during our test viva and said, "I can't think of anything." Silence earns nothing. A single correct point gives the examiner something to build on.

• Go back to your order. Start at the definition and walk forward. The next step often comes back once you're talking.
• Say what you do know. "I know it's a type of necrosis seen in tuberculosis" is better than nothing.
• Listen for the next question. If you can't answer, the examiner may ask it another way or move on. Take the new question as a fresh start.

Where can you find pathology viva questions and answers?

Your lecture notes and seniors' past questions show what your school asks. Use them to build your list of topics, then practise each one out loud using the structure above.

Practise it

The tuberculosis module has a viva simulator: an examiner voice asks "Tell me what you know about…" and follow-ups, and a coach marks the points you made.