OSCE Y4 – Non-intereactive

1.A 19-year-old man presents with a 2-day history of abdominal pain. The pain
started in the central abdomen and has now become constant and has shifted to the
right iliac fossa. The patient has vomited twice today and is off his food. The patient
has a temperature of 37.8°C and a pulse rate of 110/min. On examination of his
abdomen he has localized tenderness and guarding in the right iliac fossa.
Q1 What is the likely diagnosis?
A Ac appendicitis

Q2 What are the differential diagnoses for this condition?

A Mesenteric adenitis/colitis/R ureteric colic/Psoas abscess/Mekel’s diverticulitis

Q3.What investigations will you request for this patient?

A FBC,Urine analysis,Ultrsound scan
.
Q4 How would you manage this patient?
A Iv fuids/antibiotics/NBM/analgesics/Appedicectomy

Q5 What are the complications of any surgical intervention that may be required?
A Wound infection/pelvic abscess/paralytic ileus/stump leakage/peritonitis

2. 32-year-old factory worker presented with swelling in the R. groin for 5 months

a. What is your provisional diagnosis?

R inguinal hernia
b. Name 3 differential diagnosis
Inguinal lympadenitis,Lipoma ingunal region,encysted hydrocoele
c. What are the common complications of this condition?
Irreducibility, obstruction, strangulation of bowel, Intestinal obstruction
3. A 68year old woman presented with a history of pain at her left iliac fossa for
1week.This was associated with fever, nausea and vomiting but diarrhoea and no
urinary symptoms. There was tenderness and guarding at the LIF but no mass
palpable

a. What is the most likely diagnosis?

Colonic diverticulitis
b. What investigation will you do for her to confirm the diagnosis?
Colonoscopy
c. What is the definitive treatment
IV antibiotics – cephalosporin + metronidazole
Left hemicolectomy /Hartmann’s procedure

4.This is the picture of a 53year old man with painful swelling around the anus for 5
days, associated with fever and difficulty in passing urine.He is a known case of
diabetes for 5 years.

a. What is the diagnosis?

Perianal abscess
b. What is the treatment for this condition?
Broad spectrum antibiotics/analgesics/EUA + incision & drainage
c. What are possible complications of this condition?
Rupture,Fistula in ano,septicemia,Fournier’s gangrene(necrotising fasciitis)
5.This 30 year old man presents with a lump on the right side of his neck for the last
3weeks.It is painless and has grown slightly over the 3 weeks.

a. What is most likely diagnosis?

Solitary thyroid nodule
b. Name the investigations for this patient.
TFT,Ultrasound,FNAC
c. What the definite treatment for this condition if confirmed benign?
Right lobectomy