STATION 1

Examine the X-Ray and answer following questions

1. What is the probable diagnosis?

Intestinal perforation
2. What is pre-operative management?
 IV fluids
 IV antibiotics
 NG aspiration
 NPO
 Urinary catheterization to monitor output
3. What is the definitive treatment?
 Laparotomy with washing of peritoneal contents with 4-6
liters saline
 primary closure of perforation or ileostomy with later
closure may be done
 post op antibiotics should be given

STATION 2
A 64 yrs. male presented with 2months h/o repeated episodes of
non-bilious vomiting, shortly after taking meals, containing
undigested food particles. O/E there is fullness in left
hypochondrium with visible peristalsis from left to right.

1. What is the most probable diagnosis?

Gastric outlet obstruction
2. Name the possible metabolic abnormality.
Patients with GOO have unique metabolic sequelae, namely hypochloremia,
hypokalemic metabolic alkalosis with paradoxical aciduria and hypocalcemia.

STATION 3
 A 16yrs old motorcyclist presents to ER with h/o RTA ½ hour
back, on arrival GCS 14/15, with h/o LOC at the scene.
BP=110/70, Pulse= 88/min, R/R= 18/min. after sometime
patient became unresponsive with a GCS of 3/15.

1. What is the probable diagnosis?

Epidural hematoma
2. Describe common site of injury?
Temporal
Parietal
3. What is the management?
Aspiration in emergency
Craniotomy with decompression of the extradural space is
definitive treatment

STATION 4

A 48yrs female presents with multiple episodes of vomiting upper

abdominal pain, and jaundice.
1. What is the above-mentioned pic and what does it show?
ERCP, narrowing of the Common bile duct.
2. What is the most likely diagnosis?
cholangiocarcinoma
3. What is the treatment?
 only when resectable
 Klatskin tumors
 Bismuth type I and II resected locally with removal of GB,
CBD, LN, and by performing roux en y hepatojejunostomy.
 Bismuth type III and IV require hepatectomy as well

Lower extrahepatic tumors

Wipple’s procedure

STATION 5

1. Identify the instruement.

2. What are the indications?
3. What are the contraindications?

STATION 6

1. Identify the suture.

2. After how many days it is absorbed?
3. What are its uses?
4. Is it monofilament or braided?
 STATION 7

An 18month old baby presents to ER with deformed arm

1. What is the diagnosis?

Supracondylar fracture
Distal humeral fracture

2. What important initial clinical examination must be performed?

 assessment of wrist drop (radial nerve)

 Assessment of distal ischemia
 assessment of flexors of fingers and thumb and sensory loss
(median nerve)
  assessment of claw hand deformity and sensory loss (ulnar nerve)
4. what structures are prone to injury?
brachial artery
radial, ulnar and median nerve
STATION 8

A 30yrs old lactating female came to ER with complaints of

painful lump on right breast that is hot and tender.

1.what is most probable diagnosis?

abscess

2.which organism is most common?

staph aureus

3.what is the management?

Antibiotics
incision and drainage
use other breast for feeding
STATION 9

A young male came to OPD with h/o repeated fractures after minor
trauma, also complains of lumbar pain. His serum Ca and PTH were
ordered that also came to be raised.

1.what is your diagnosis?

Hyperparathyroidism

2.what investigations are needed?

 Serum electrolytes
 Renal function tests
  serum phosphates
 urinary calcium
 ultrasound neck for parathyroid glands
 Technitium 99 scan

3.what is MEN 1 syndrome?

pituitary tumor usually adenoma
hyperparathyroidism due to hyperplasia
pancreatic endocrine tumor

STATION 10

A 26yrsmale presented with h/o blunt trauma to chest, followed by

decreased breath sounds on right side of chest with dull percussion,
patient’s BP=90/60, pulse= 120/min, R/R= 28/min. X ray chest shows
air fluid level.

1.what is most likely diagnosis?

Hemoperitoneum

2.how will you manage this patient?

emergency thoracotomy with chest tube intubation

3.what are the indications of thoracotomy?