PRE FINAL MBBS

OSCE/PICTURE TEST DEMO

GENERAL SURGERY
1• List 5 causes of
obstructive jaundice
• Ca head of pancreas
• Choledocal cyst
• Cholangiocarcinoma
• Biliary atresia
• Choledocolithiasis
• Cholelithiasis
• PLCC
• PeriAmpullary Carcinoma
• Sclerosing Cholangitis
2
a. List 3 differentials
b. Define goitre
c. List the components of
thyroid function tests
Differentials • TSH, T3, T4
• Multinodular goiter
• Hodkins lymphoma
• Rhabdomyosarcoma
• Thyroid Cancinoma

• Goitre is any enlargement

of the lateral lobes of the
thyroid gland larger than
the phalanx of the thumb
of the patient
 3
a. List any 6 important points while counselling a
patient for thyroidectomy

b. List any 5 eye signs of thyrotoxicosis

• Life long thyroxine Eye Signs
• Damage to the • Proptosis
recurrent laryngeal • Upper lid retraction
nerve • Lid lag
• Euthyroid before • moebius sign
surgery
• Diplopia
• Chemosis
• Opthalmoplegia
 4
a. List 2 major important nerves during
thyroidectomy
b. Name two antithyroid medications
• Recurrent laryngeal
nerve and External
laryngeal branch of
superior laryngeal nn

• Carbimazole,
Propylthiouracil,
Methimazole, Na
Perchlorate
 5
a. List 4 classical clinical features of obstructive
jaundice
b. List the clinical problems in a jaundiced
patient
• Yellowness of eyes • Overwhelming sepsis
• Pruritus • Bleeding problems
• Dark Urine • Dehydration resulting
• Pale bulky stool from hepatorenal
syndrome
• Liver failure
6
a. Identify the object
b. List its 3 uses
c. List 5 complications of
iv infusions
• Size 20G intravenous • Thromophlebitis
cannula • Infection
• Bleeding
• For intravenous access • Air embolism
• For Giving drugs • Arterial cannulation
• For giving fluids • Haematoma
• For blood • pain
7
a.Identify the object
b.List its 5 uses
c. List 5 complications of
its use
• Rubber Foley’s catheter Complication
• Urinary tract infection
Uses • Crust formation
• For Draining of urine • Urethra rupture/stricture
• For protecting the bladder • Urosepsis
after surgery
• Urethritis
• To instill urograffin dye
• Cystitis
• For Instilling Drug
• For monitoring Urine input
• Allergic reaction to
and output catheter material
• For draining Wounds • Bleeding
 8
Highlight the components of the ATLS protocol
Primary Survey
• ABCDE
• AMPLE Hx
Secondary Survey
• Full HX
• Full Physical
Examination
• Other Examination
9

a. Identify the object

b. List 5 of its uses
c. List 4 complicatons
associated with its use
• NasoGastric tube Complications
• Tracheal intubation
Uses • Bleeding
• For decompression • Allergic rxn
• Application of drug • Fistulous communication
• Gastric lavage • Esophageal fibrosis
• Diagnosis of upper GI leading stenosis
bleeding • Rupture of esophageal
• For enteral feeding varices
10
A. List 5 differentials of a
groin swelling
B. Define a hernia
C. Which is the
commonest type of
hernia?
D. Which is the
commonest type of
hernia in females?
• Lymphoma, Inguinal • Inguinal Hernia
hernia, femoral hernia,
lymphadenopathy, • Femoral hernia
Rhabdomyosarcoma

• Hernia is the abnormal

protrusion of a viscus
tru a defect in its
containing wall
 .
11. List 4 causes of upper GI bleeding

• Mallory Weiss tear

• Bleeding Peptic Ulcer
• Esophageal varices
• NSAIDs/Steroid induced Gastritis
• OWR
• Prolonged Anrocoagulation
12. List 5 causes of lower. GI bleeding

• Diverticulosis
• Thrombosed Haemorrhoids
• Colorectal Cancer
• Thyphoid perforation
• Massive UGIB
• Trauma
• Anal polyps
• Ulcerative Colitis
13
a. List 3 differentials of a
breast lump
b. List 3 risk factors for
breast cancer
c. List 3 treatment
options of breast
cancer
d. List 3 complications of
mastectomy
• Breast CA, Fibroadema, Treatment
• Surgery
Cystasarcoma Phylloides, • Chemotherapy
Breast Abscess, • Immunotherapy
Galactocele, Breast • Radiotherapy
• Hormonal therapy
Papiloma, Paget dx Complications
• Damage to Nerves
• Bleeding
• Prolonged Exposure to • Infection
Estrogen, Family Hx, Age, • Flap Necrosis
• Stiffness
Femal Sex, Alcohol, Race • Depression
• Phantom breast
• Depressionn
 14

List any 6 important statements during

counselling for mastectomy

• Blood loss
• No Breast
• Brest reconstruction option
• Complication (nn damage)
• Recurrence possibility
• Hand hanging
 UROLOGY
15. a. List 3 differentials
b. Define hydrocele
c. List 3 types of
hydrocele
d. List 2 surgical options
for hydrocelectomy
• Inguinoscrotal hernia • Congenital, follicular,
• Hydrocele infantile, cystic
• Testicular ca
• Tapping, Inversion of
• Hydrocele is the the sac (Jaboulays
abnormal collection of operation), Insertion of
fluid in the turnica a sclerosant and Lord’s
varginalis of the testis Operation
 .
16a. Define urethral stricture
b. list 3 causes
c. list 3 treatment options
d. list 4 sources for urethral substitute

17. List 5 causes of bladder outlet obstruction

18. List 5 non-malignant causes of hematuria

• Urethral stricture is a Treatment Option
narrowing or lack of • Dilatation
distensibility of any part of
• Urethroplasty
the urethral as a result of
fibrosis from trauma or • Direct visual internal
inflammation urethrotomy
Causes Sources
• Trauma • Prepuce
• Post Gonococcal Urethritis • Buccal mucosa
• Instrumentation • Scrotal skin
• Congenital • Penile obstruction
BOO Non Malignant causes of
• BPH haematuria
• Bladder stone • Renal stone
• Prostate Ca • Pyelonephritis
• Urethral stricture • Bladder stone
• Bladder cystitis
• Schisostomiasis
• Ureteritis
• Schisostomiasis infection
• Urethral Trauma
 .
19. List 5 causes of male infertility

20. Give normal ranges of urea,creatinine and

any 3 electrolytes
• Mumps Orchitis
• Hypogonadism
• Hypopituirism
• Deficiency of germ cells
• Obstruction of
conduction sytem
• Varicoceles
• Mump Orchitis • Urea: 15-45
• Varicocele • Na: 135-145
• Untreated Testicular • HCo3: 20-30mmol/l
torsion • Cl: 90-110
• Cancer Cheme • Ca: 9-11
• Radiation • Creatine: 0.5-1.5
• Chronic
Epididymoorchitis
ORTHOPEDICS
21a.What is the diagnosis?
b.List 5 complications
of fractures
c.List the ′rules of 2′ in
fracture imaging
• Complete closed Rule of 2s
tranverse fracture of the • 2 views
left femoral mid-shaft • 2 limbs
• 2 joints
• Damage to Nn, vv, Pain, •
2 times
Haematoma, Fat
• 2 weeks
embolism, Shock,
Hypovoleamia,
Volkman’s contracture,
Osteomyelitis,
22.
a.List the 3 types of
shoulder dislocation
b.Which is the
commonest?
c. List 3 methods of
reducing shoulder
dislocation
• Anterior, Posterior and
inferior

• Commonest is Anterior

• Hippocratic, Kocher’s,
Prone method
23.
a. List 2 differentials
b. Which mineral
deficiency is
associated?
c. The pathology in
adults is called?
• Blount and Ricket

• Calcium

• Ostemalacia
 24.
. a. What is the diagnosis?
b. List the 4 components
c. name one scoring
system
• Congenital talipes euinavarus • Pirani Scoring
• Tibial torsion
• Shortening TendoAchilles and Treatment
hypodevelopment of calf mm
• Reassure the parent
• Contracture of posterior capsule
of ankle joint • Teach mother on leg
• Contracture of the Thomas heart manipulation
muscles.
• Medial inclination of • After
Talonavicular
• Contracture of subtalar jt
• Forefoot adduction
CTSU
25a.What is the diagnosis?
b. What are the features
on the radiograph?
c. List 3 complications
d. What is the surgical
treatment?
• Esophageal Ca • Malnutrition
• Aspiration pneumonitis
• Mucosa irregularities • Lung Abscess
• Bilateral shouldering • Pneumonia
• Narrowing of the
mucosa • Orringer’s procedure
• Pre stenotic dialation (Transhiatal
• Tappering of the distal esophagectomy, Ex Lap,
part Cervicoesophagogastric
anastomosis)
26.
a. What is the diagnosis
b. What are the
radiographic features
c. What is the surgical
treatment?
• Achalasia • Modified Hellers ( Left
Thoracotomy plus
• Structureless dilatation Esophagocardiomyotom
of the esophagus, y)
smooth tapering of the
esophagus into a bird
beak, Contrast hold up
27
a. What is the diagnosis
b. What is the immediate
treatment?
• Tension Pneumothorax

• Wide incision with a

needle in the rt 2nd ICS
MCL to convert it to
Simple Pneumothorax
 28
List 5 indications for CTTD

• Haemothorax
• Pneumothorax
• Chylothorax
• Empyema thoracis
• Hydropneumothorax
29
a. Define an ulcer
b. List 4 types of ulcer
c. Chronic ulcer with
malignant changes is
called?
d. List 4 types of
debridement
• An Ulcer is a • Manjoli’s ulcer
discontinuity in the
epithelial surface • Mechanical, autolytic,
Types Biological, Chemical,
• Tropical Enzymatic
• Buruli
• Vascular
• Pressure
• Neuropathic
 PAEDIATRIC SURGERY
30. List 5 causes of abdominal distension in a
5year old child

31. List 3 causes of delayed passage of

meconium
30. 31.
• Neuroblastoma • Hirshsprung
• Wilm • ARM
• Hepatoblastoma • Meconium Ileus
• Intussusception • Meconium plug
• Volvulus syndrome
• Hirshsprung
33
a. List the problems in a
child with cleft lip and
palate
b. When would you like
to operate on the
child?
Problems • 10 weeks
• Speech • 10pds
• Feeding problem • Hb of 10g/dl
• Psychological
• Aspiration Pneumonia
• Hearing problem
• Recurrent ear infection
• Mal-alignment problem
• Aesthetic problem
34
a. List 2 differentials
b. List possible locations
of an undescended
testis
c. List 4 possible
complications of
undescended testis
d. When will you like to
operate on the child
• Cryptorchidism, • After one year
Retractile testes

• Abdominal, Inguinal
canal, Upper Scrotum

• Tortion, trauma,
Subfertility, malignant
transformation
 35
a. List 5 indications for circumscision
b. List 3 methods of circumscision
c. List 5 possible complications of
complications
Indication Complications
• Phimosis • Balanitis of the glans
• Paraphimosis
• Phostitis
• Balanitis
• Religious purpsose • Excessive rxn
haemorrhage
Methods • Urethrocutaneous
• Plastibel method fistula
• Bone cutter method • Amputation
• Dorsal slit
• Free hand
36
a. What is the diagnosis
b. What are the
components
c. What are the likely
problems in the
patient
d. List the components of
the surgery
• Distal penile Problems
Hypospadias • Subfertility
• Psychological
Component • Urine splaying
• Ventrally located meatus Surgery
• Ventral chordae • Orthoplasty
• Hooded prepuce on the • Urethroplasty
dorsal penis • Meatoplasty
• Spatulated glans • Glanduloplasty
• Scrotoplasty
NEUROSURGERY
37a. List 4 differentials
b. List 3 risk factors for
neural tube defects
c. List 3 possible
clinical features in the
patient
DDx Clinical Features
• Meningocele • Sphinteric incontinence
• Meningomyelocele • Club foot
• Sacrococcygeal teratoma • Paralysis
• Dermoid cyst
• Paraplegia
• Hydrocephalus
Risk Factors
• Maternal FA def • Hypotonia
• Radiation • Patulous anus
• Maternal drug ingestion
 38
. a. What is the diagnosis
b. List 5 possible
complications
c. List 4 indications for
surgery
• Depressed Skull fracture Indications for surgery
• Raised ICP
Complications • Epidural haemorrhage
• Epidural haemorrhage • Subdural
• Subdural haemorrhage
• Brain Contusion
• Brain Concussion
• Raised ICP
• Meningitis
• Paraplegia
 39
. List 5 possible causes of coma following trauma

• Hypoxia
• Hypotension/ Hypertension
• Raised ICP
• Hypo/Hyper glycemia
40.
a. Describe the finding
b. What is the diagnosis
c. Which vessel is mostly
involved
• A biconvex shape
hyperdense lesion at
the parieto occipital
cortex, Midline shift,
Effacement of the gyra

• Epidural h
• mma
PLASTIC SURGERY
41a. List 4 types of
hemangioma
b. List 4 associated
syndromes
• Capillary (potwine) Syndromes
• Carvenous (Strawberry) • Sturge weber
• Mixed • Von hippel landau
• Herpatic • Maffucci
• Kassabach-mersitt
 42
. a. List 2 differentials
b. List 5 ways of
differentiating them
c. List 3 options of
treatment
• Keloid and Hypertrophic Tripple
scar • Intralesional
• For Differences, check Triamcinilone
your Badoe • Surgery
• Radiotherapy
43
a. List 3 differentials
b. Classify lymphedema
c. List 3 possible
complications of
lymphedema
d. List 3 surgical options
of management
e. Lymphangiosarcoma
resulting from chronic
lymphedema is called?
• Lymphoedema, Cellulitis, Surgical mgt
Trauma, Tuberculous • Homans Operation
lymphangitis • Charles Operation
Classification
• Thompson’s Operation
• Primary and Secondary
Complications
• Stewart treves
• Recurrent cellulitis
Syndrome
• Lymphangiosarcoma
• Lymphorrhea
 .
• THANK YOU

• Please turn over one more time!

 FOR THE ROAD
• Define amputation
• List 6 types of amputation
• Counsell a patient for amputation
• Discuss bowel preparation
• How will you resuscitate a patient in shock
• Calculate daily fluid and metabolic needs of an average
surgical patient
• How do we catheterise a patient?
• Teach steps to IV cannulation
• Dicuss intestinal obstruction
 .
• Best of luck insha Allah.