PROF - SURGERY OSCE 2013
2ND OCTOBER
1.Patient vd H/O trauma 3 yrs back, now presented vd diff in micturition...pic of
urethrogram stricture, management, another inv was done, identify (most probably
urethroscopy), complications.
2.CT of inflammed gallbladder vd stones, identify, ERCP identify, findings,
complications
3.xray gas under diaphragm, 3causes, another fig (which nobody is sure what it was) its
complications, management.
4.Knee joint exam+ xray OA
5. sutures, 6.pt. Vd upper limb weakness examine.
7. Inguinal hernia short case examination + viva vd external- tht pt.also had a
nevus/hemangioma on face.cud b asked to examine tht
8. lump in neck examine + viva dr aamir.(do transillumination even if u dont find it to b
cystic!)
9.inguinal hernia surgery incision, steps , anatomy vd dr tahir.
10.viva dr iqbal imperofrate anus, hirschburg disease etc( congenital anomalies basically)
11.Councel pt vd woun inf after appendicectomy
3RD OCTOBER
Station 1 :viva wid Dr iqbal urinary obstruction in 2 yrs old,
umblical hernia wid external,
counseling on cbd injury after cholecystectomy ,
hip joint eman + x ray fracture neck of femur,
exploratory laprotmy incision wid Dr tahir,
short case on multinodular goiter Dr amir,
lower limb n back exam,
pics barium meal outlet obstruction d/d,
endoscopy ca stomach treatment,
x ray intestinal obs d/d ,
colonoscopy mass, management,
xray kub renal stone,
Pcnl pic management
4TH OCTOBER
1. Examine knee, xray of right knee with fracture of head of fibula and valgus
displacement of the head, asked complications, foot drop, why, relation of nerve to bone
ect, treatment
2. Static image of IVY bladder tumor another picture of cystoscopy and 5-6 follow up
easy questions like diagnosis management
3. Rest
4. Dr tahir- incision and steps of MRM, asked levels of lymph nodes, where they are,
axillary nodes and how many groups, also where long thoracic and thoraco dorsal nerves
are
5. Static station x ray of intestinal obstruction- D/D volvulus, colon cancer, complications
– gangrene, image B of open abdomen with large mass an omentum ect- what is this
procedure on the same pt ie laparotomy. Can you tell if the feared complication
(gangrene) has occurred or not from this image and if so then explain.
6. Dr amir short case child with small multiple swellings in the right axilla, you can take
a history if you want, examine, asked what it is , what is the while like ( was a scar from
prev surgery), what is the treatment – surgery, why is it difficult, cuz theres multiple
small swellings that will be hard to remove so the entire skin needs to be removes, what
will you have to do then – skin graft
7. Sutures
8. Examine upper limb motor and sensory both
9. Dr iqbal viva on choledochal cyst
10. Static station- mammogram image – list 3 findings, what is your diagnosis, what is
image B (tru cut biopsy) what are the possible complications of this procedure and 3
other questions I cant remember but related to breast imaging
11. External viva varicose veins examine and answer questions
12. Counsel patient with toxic multinodular goitre
5th OCTOBER
1. Appendectomy incision with questions. Dr tahir
a. Where is incision given on dummy? (mcburney point) junction of lateral 1/3rd and
medial 2/3rd, at right angle to the line
b. What is this incision called? (grid iron)
c. Why at mcburney point? (b/c base of appendix lies here)
d. Layers dissected? (tell which layer incised & which retracted)
e. Further steps (remember ligation of mesoappendix)
f. Till reclosure of skin
2. viva on pleomorphic adenoma: there was a patient with pleomorphic adenoma,
command: examine the patient (do examination of swelling and facial nerve rapidly).
Why should oral cavity be examined? It’s investigation (FNAC). It’s treatment. What if
not removed?
3. hydatid cyst. There was this CT scan of hydatid cyst and this pic A. B.
A
what is seen in the picture?
What is the diagnosis?
B
What investigations will be carried out?
What are the non-invasive methods of it’s treatment?
What is the definitive treatment?
What complication can occur during surgery?
How to prevent this complication?
4. lower limb exam: do inspection, palpation, active and passive movements, power, tone,
reflexes.
What is this position of arm pronated (sir made the position of hand, it was erb’s palsy).
Why does it occur? (upper brachial plexus injury). Root values? (C5, C6) what is lower
brachial plexus injury called? (klumpke palsy) how does it occur and manifest?
Demonstrate the location of dermatomes of lower limb. Where are s3, s4 and s5
(perineum) what is root value of ankle jerk, knee jerk, biceps jerk and triceps jerk. What
are signs and symptoms of upper and lower motor neuron injury?
5. chest tube insertion (should know all steps, from consent till post-operative
instructions, should know the water chamber and working of chest tube, mam specifically
ask about working and what advice to give to patient post-operatively)
6. a person had road traffic accident. Chext xray and abdomen ct shown
A.
What are the findings in the above picture?
Diagnosis? (tension pneumothorax)
What immediate treatment will you give?
B.
Name two findings in the picture.
What is the diagnosis?
What treatment will you provide to this patient in the emergency room?
7. viva with dr iqbal: he had a picture of breast cancer infiltrating skin, patient also had a
lump in axilla. What it can be? (ans. It can be accessory breast tissue or might be lymph
node) what will you do now? (don’t say FNAC, we will do core
biopsy in this case). He asked will we do mammography? Ans no, because
mammography is done to check for lump, if malignancy is obvious there is no need to do
mammogram. He asked what is the diagnosis? Breast carcinoma. What does T mean?
(tumor size) what is the T in this case? (4) what is T4 (carcinoma infiltrates skin or chest
wall). what is the stage supposing there is one lymph node involved and no mets. Role of
neoadjuvant chemotherapy????
8. bilateral hydrocele viva with dr amir. There was a patient who had bilateral hydrocele.
Exam the patient (remember to do transillumination with a cylinder already placed there
or ask sir for it or indicate need for dark room for transillumination)
9. examine hip joint (remember to do all specific tests too) there was an xray of avascular
necrosis of head of femur placed on this station. After examination of hip joint sir asked
to describe the xray (the xray there was not the same but a bit similar to this one and was
more prominently showing erosion type features of head of femur i.e. the head of femur
was a bit irregular and destructed)
(describe which xray: pelvis xray, over exposed or underexposed etc. should know how
to describe an xray)
10. counsel a patient with rectal carcinoma with levator ani muscles infiltration regarding
the treatment options. (counsel that resection w/ colostomy is needed). He asked why
colostomy? I don’t want to walk around with this bag attached, is there any other option
like attaching the colon to anus? (yes, but there will be anal incontinence then, so we
need to do colostomy) why anal incontinence? (I think because levator ani muscles
involved, but confirm). He then asked about what are the long term complications?
Confirm this entire counseling from some teacher.
11.
make three D/Ds on this xray
what diagnostic test will you order?
pic given at station was similar to it but not same this one.
What is the specimen in the above picture?
What is the diagnosis? (renal cell carcinoma I thin k)
What is the treatment?
Miscellaneous (if anything missed in the above)
SURGERY :
05-10-2013
: Hydatid cyst, hip exam, lower limb, appendectomy incision, inguinal hernia,
pleomorphic adenoma v, inguinal hernia v, inflammatory ca of breast, levator ani ca
counselling viva, Station of kidney tumor with mets.
04-10-2013
: Station 1 . Procedure name Mammography.. findings. F n a procedure pic.
Complications. Contraindications station 2. Varicose vein exam and viva wit external 3.
Knee exam wit x ray of fracture of tibia and fibula. 4. Counselling of toxic multimodular
goiter 5. transitional cell ca. Treatment. Procedure name. Findings in pic 6. Rest 7.
Radical modified mastectomy . Incision sites 8. Sigmoid volvulus pic. Findings in pic 9.
Viva wit internal on haemangioma 10. Upper limb exam 11. Choledococal cyst viva wit
internal.
03-10-2013
: Examination Thyroid-mng dr amir Lower limb exam plus back Hip joint exam +
fracture neck of femur x ray management options Counseling on pt with stricture post
chole Viva with dr tahir on laparotomy incision n steps Dr iqbal viva -baby has not
passed urine (phimosis, meatal stenosis,post urethral valve) External -umbilical hernia
exam n related ques Static- pyloric stenosis identify n management -acute obstruction
findings identify n manage -renal stone identify findings n procedure done other
management options
LONG CASES
: Liver abcess/hydatid cyst, varicose ulcer, hydrocele, recurrent hemangioma,
cholecystitis, incisional hernia, obs jaundice+chole+HCV, pleomorphic adenoma,
lymphedema, thyroid CA, CA breast.
INTERNAL OSCE CLASS 2013
Surgery
Group 2:
1. Procedure for appendectomy, incisions, mini viva
2. Hernia examination, ring occlusion test, 3 important questions to ask in the history of
the patient – Dr Amir
3. Breast CA, examination and viva, Dr Iqbal
4. Periphral nerve testing, radial and ulnar, Dr Shahid
5. Hip joint testing, Dr Humaira
6. Chest tube insertion for thorcostomy, insertion procedure labeling of intruments and
mini viva – Plastic surgery pg
7. CT scan of abdomen, patient who develops sharp abdominal pain over a very short
time, vague history – pancreatic pseudo cyst
8. X ray – fracture of femur – ER management
Group 1:
1. Counseling CBD stricture
2. Procedure hernioplasty
3. Exam and viva on paraumbilical hernia
4. Neurological examination of lower limb
5. Thyroid examination and viva
6. Varicose veins examination
7. Sutures
8. Xray osteoporosis
9. Imaging study- diverticulosis
10. Esophagoscopy stricture/barret’s esophagus
Group 4:
1. Counseling- patient with seroma after undergoing MRM
2. Mark laparotomy scar, ileostomy viva
3. Inguinoscrotal Hernia examination + viva
4. Cushing’s syndrome patient, viva
5. Neurological examination of lower limb
6. Neurological examination of upper limb
7. Imaging study- diverticulosis
8. Sutures
9. Osteoarthritis XRAY
10. Endoscopy image of Barret’s esophagus.