OSCE-Revised PPT for University Exams.pptx

OSCE for University Exams

1. OSCE

2. 45 years old female presented with c/o dyspepsia, loss of appetite, vomiting, VGP + with sudden swelling in the umblicus for past 3 months QUESTIONS: What is the diagnosis ? What is the name of the lesion ? How does the lesion occur in the umblicus (pathway) ? SRD - 1

3. 45 years old female presented with c/o dyspepsia, loss of appetite, vomiting, VGP + with sudden swelling in the umblicus for past 3 months ANSWERS: Ca stomach, Sister joseph nodule, Hemetogenous spread. lesser omentum -> flciform ligament -> umblicus . SRD - 1

4. An 18 years old boy presented with c/o fever, gross loss of weight for past 2 weeks. Patient presented with cervical lymphadenopathy, X-ray chest shows mediastinal widening. Biopsy taken and cut section is homogenous. This is the HPE image. QUESTIONS: What is the pathognomonic cell called ? What is the diagnosis ? How will you manage ? SRD - 2

5. An 18 years old boy presented with c/o fever, gross loss of weight for past 2 weeks. Patient presented with cervical lymphadenopathy, X-ray chest shows mediastinal widening. Biopsy taken and cut section is homogenous. This is the HPE image. ANSWERS: Reed sternberg giant cells, Hodgkin’s lymphoma, Chemotherapy, radiotherapy. SRD - 2

6. A 50 years old male, a chronic alcoholic, presented in emergency department with h/o hemetomeisis , QUESTIONS: What is noted in anterior abdominal wall ? What is the diagnosis ? How does it occur ? SRD - 4

7. A 50 years old male, a chronic alcoholic, presented in emergency department with h/o hemetomeisis , ANSWERS: Engorged veins around the umblicus . Caput medusa. Due to portal hypertension, there occurs dilatation of porto -systemic circulation. SRD - 4

8. MRCP shows, gall stones found in Hartman’s pouch, patient presented with obstructive jaundice. QUESTIONS: What could be the diagnosis ? What is the management ? SRD - 5

9. MRCP shows, gall stones found in Hartman’s pouch, patient presented with obstructive jaundice. ANSWERS: Mirrizzi’s syndrome, Sub-total cholecystectomy - type 1, Sub-total cholecystectomy with T tube - type 2 & 3 sub totalcholecystectomy with biliary enteric anastomosis – type 4. SRD - 5

10. A 40 years old female post menopausal presented with lump involving all quadrants, freely mobile, no axillary lymph node with engorged veins. QUESTIONS: What is the diagnosis ? What is the management ? SRD - 6

11. A 40 years old female post menopausal presented with lump involving all quadrants, freely mobile, no axillary lymph node with engorged veins. ANSWERS: Cystosarcoma phylloides . Subcutaneous mastectomy with preserving of nipple and areola complex. SRD - 6

12. A 16 years old male, previously treated for Tuberculosis, presented with swelling in the right 2 nd ICS, the swelling is not warm, not tender, cough impulse +, on trial aspiration frank pus aspirated. QUESTIONS: What is the diagnosis ? How will you manage ? SRD - 7

13. A 16 years old male, previously treated for Tuberculosis, presented with swelling in the right 2 nd ICS, the swelling is not warm, not tender, cough impulse +, on trial aspiration frank pus aspirated. ANSWERS: Cold abscess with pleural communication. X-ray chest followed by intercoastal chest drainage. SRD - 7

14. PATIENT PRESENTED WITH LATE SECONDARY BLEEDING PILES. QUESTIONS: What is the treatment shown below ? What are the other modalities of treatment available ? SRD - 8

15. PATIENT PRESENTED WITH LATE SECONDARY BLEEDING PILES. ANSWERS: Rubber band ligation. Sclerotherapy . SRD - 8

16. A 30 YEARS A 30 YEARS OLD FEMALE PRESENTED WITH SWELLING IN THE UPPER LATERAL ASPECT OF THE NECK, LIFTING HE EAR LOBULE, OBLITERATES THE RETROMANDIBULAR GROOVE, WITH OUT AFFECTING THE FACIAL MUSCLE WEAKNESS. O/E OF ORAL CAVITY, A SMALL SOFT TISSUE BULGE WAS SEEN IN THE SOFT PALATE. THIS ABOVE PROCEDURE IS DONE ON THIS PATIENT . QUESTIONS: Name of the procedure done ? Name of the structure preserved ? How will you identify the preserved structure intra-operatively ? SRD - 9

17. A 30 YEARS A 30 YEARS OLD FEMALE PRESENTED WITH SWELLING IN THE UPPER LATERAL ASOECT OF THE NECK, LIFTING HE EAR LOBULE, OBLITERATES THE RETROMANDIBULAR GROOVE, WITH OUT AFFECTING THE FACIAL MUSCLE WEAKNESS. O/E OF ORAL CAVITY, A SMALL SOFT TISSUE BULGE WAS SEEN IN THE SOFT PALATE. THIS ABOVE PROCEDURE IS DONE ON THIS PATIENT . ANSWER: Total conservative parotidectomy . Facial nerve. Hamilton bailey technique, conley’s point, Nerve stimulator. SRD - 9

18. A POST MENOPAUSAL WOMEN PRESENTED WITH FUNGATING MASS IN THE RIGHT BREAST. QUESTIONS: How will you confirm the diagnosis ? Name the stage of the disease ? What is the preferred management for this disease ? SRD - 10

19. A POST MENOPAUSAL WOMEN PRESENTED WITH FUNGATING MASS IN THE RIGHT BREAST. ANSWERS: Biopsy from the fungating mass. Stage – 4. Palliative mastectomy. SRD - 10

20. A 30 YEARS OLD FEMALE PRESENTED WITH CHRONIC ABDOMINAL PAIN, NOT RELATED WITH MENSTRUATION, H/O TREATMENT OF TUBERCULOSIS IS PRESENT, USG SHOWS MINIMAL FREE FLUID, DIAGNOSTIC LAPAROSCOPE DONE. QUESTIONS: What is the diagnosis ? How will you confirm the disease ? SRD - 11

21. A 30 YEARS OLD FEMALE PRESENTED WITH CHRONIC ABDOMINAL PAIN, NOT RELATED WITH MENSTRUATION, H/O TREATMENT OF TUBERCULOSIS IS PRESENT, USG SHOWS MINIMAL FREE FLUID, DIAGNOSTIC LAPAROSCOPE DONE. ANSWERS: Abdomen tuberculosis . (KOCHS ABDOMEN) Peritoneal biopsy, Biopsy from tubercle, Mesenteric biopsy, Free fluid – Genexpert . SRD - 11

22. A YOUNG MALE PRESENTED WITH HUGE ENLARGEMENT OF BREAST. QUESTIONS: What is the diagnosis ? Eneumerate the causes ? Name of the procedure done ? SRD – 12

23. A YOUNG MALE PRESENTED WITH HUGE ENLARGEMENT OF BREAST. ANSWERS: gynecomastia , hormonal disturbances, chromosomal abnormalities , drug induced. 3. Websters procedure. SRD – 12

24. A 40 YEARS FEMALE PATIENT PRESENTED WITH BLACKISH LESION JUST BELOW THE MEDIAL CANTHUS OF LEFT EYE. NO REGIONAL LYMPH NODES ARE ENLARGED. QUESTIONS: What is the diagnosis ? What is the confirmation test ? What is the management for the above condition ? SRD - 13

25. A 40 YEARS FEMALE PATIENT PRESENTED WITH BLACKISH LESION JUST BELOW THE MEDIAL CANTHUS OF LEFT EYE. NO REGIONAL LYMPH NODES ARE ENLARGED. ANSWERS: Basal cell carcinoma. Biopsy. Mohs ’ procedure. SRD - 13

26. A 50 YEARS OLD MALE PATIENT PRESENTED WITH DILATED TORTUOUS VEIN IN THE LEG WITH CEAP CLASS 5 . QUESTIONS: Name of the procedure mentioned above ? What type of anaesthesia is given ? What are the content of the anaesthesia given ? SRD - 14

27. A 50 YEARS OLD MALE PATIENT PRESENTED WITH DILATED TORTUOUS VEIN IN THE LEG WITH CEAP CLASS 5 ANSWERS: Radiofrequency ablation. Tumusent . . SRD - 14

28. A PATIENT UNDERWENT LAP CHOLECYSTECTOMY 3 MONTHS BACK, NOW PRESENTED WITH FEATURES OF OBSTRUCTIVE JAUNDICE. ERCP SHOWS RADIOOPAQUE SHADOW IN CBD WITH DILATED CBD. QUESTIONS: What is the radiopaque shadow seen? What are the options available for relieving obstruction ? SRD - 15

29. A PATIENT UNDERWENT LAP CHOLECYSTECTOMY 3 MONTHS BACK, NOW PRESENTED WITH FEATURES OF OBSTRUCTIVE JAUNDICE. ERCP SHOWS RADIOOPAQUE SHADOW IN CBD WITH DILATED CBD. ANSWERS: Retained stone. ERCP – stone retrieval, Laparoscopic / open CBD exploration. SRD - 15

30. A 50 YEARS OLD MALE, A KNOWN DIABETIC FOR PAST 15 YEARS, PRESENTED WITH ULCER IN THE RIGHT FOOT. QUESTIONS: What is the etiopathogenesis of the above condition ? Write about WEGNER’S grading. SRD - 16

31. A 50 YEARS OLD MALE, A KNOWN DIABETIC FOR PAST 15 YEARS, PRESENTED WITH ULCER IN THE RIGHT FOOT. ANSWERS: Neuropathy, microangiopathy , secondary infection. GRADE 0 – intact skin, GRADE 1 – Superficial Ulcer Of Skin. GRADE 2 - ulcers involving the tendons, bone. GRADE 3 – deep ulcers with abscess. GRADE 4 – partial foot gangrene. GRADE 5 – whole foot gangrene SRD - 16

32. THE ABOVE PICTURE SHOWS THE SCHEMATIC REPRESENTATION OF SMA COMPRESSING DUODENUM. QUESTIONS: Name of the syndrome. What will be the clinical presentation ? Write about the management of the condition. SRD - 17

33. THE ABOVE PICTURE SHOWS THE SCHEMATIC REPRESENTATION OF SMA COMPRESSING DUODENUM. ANSWERS: SMA syndrome . Gastric outlet obstruction. Conservative management, Gastrojejunostomy , Duodenojejunostomy , Division of ligament o ftrietz . SRD - 17

34. A PATIENT PRESENTED WITH RIGHT INGUNAL HERNIA. PATIENT WAS PLANNED FOR LAPAROSCOPIC TAPP AND THIS SHOWS TAPP IMAGE OF CONTENT OF THE INGUINAL SAC. QUESTIONS: What is the name of the hernia ? What is the size of the mesh used ? SRD - 18

35. A PATIENT PRESENTED WITH RIGHT INGUNAL HERNIA. PATIENT WAS PLANNED FOR LAPAROSCOPIC TAPP AND THIS SHOWS TAPP IMAGE OF CONTENT OF THE INGUINAL SAC. ANSWERS: Amyand hernia. 15 * 13 cms . SRD - 18

36. QUESTIONS: Name of the procedure. What are the indications for this procedure ? DUODENUM CBD SRD - 19

37. ANSWERS: C holedochoduodenostomy . After CBD exploration, if duct is dilated > 1.3 cm. Multiple CBD stones , terminal CBD inflammatory stricture. higher up stones. DUODENUM CBD SRD - 19

38. QUESTIONS: What is the name of this tube ? What are the uses of this tube ? SRD - 20

39. ANSWERS: Sengstaken blakemore tube. Mechanical tamponade to control upper GI bleed. SRD - 20

40. QUESTIONS: Name the triangles seen in the image ? Name the boundaries of the triangle seen in the image. SRD - 21

41. ANSWERS: calot’s triangle & cystohepatic triangle. Cystohepatic triangle: superiorly –base of the liver, medially – CHD, laterally – cystic duct. callot’s triangle : superiorly – cystic artery, medially – CHD, laterally – cystic duct. SRD - 21

42. A PATIENT PRESENTED WITH CERVICAL LYMPHADENOPATHY WITH DISCHARGE FROM THE SWELLING. QUESTIONS: What could be the diagnosis ? Name the pathological stages of this disease ? SRD - 22

43. A PATIENT PRESENTED WITH CERVICAL LYMPHADENOPATHY WITH DISCHARGE FROM THE SWELLING. ANSWERS: TB sinus. stages of tubercular lymphadenitis: lymphadenitis, periadenitis , cold abscess, collar stud abscess, sinus. SRD - 22

44. A 40 YEARS OLD, A CHRONIC ALCOHOLIC PRESENTED WITH HEMETOMEISIS. THE ABOVE PROCEDURE WAS DONE. QUESTIONS: What is the name of the procedure. What is the advantage of this procedure SRD - 23

45. A 40 YEARS OLD, A CHRONIC ALCOHOLIC PRESENTED WITH HEMETOMEISIS. THE ABOVE PROCEDURE WAS DONE. ANSWERRS: TIPSS – transjugular intrahepatic portosystemic shunt. It reduces the portal hypertension. SRD - 23

46. A 45 YEARS MALE, FARMER BY OCCUPATION HAVING PET DOGS, CAME WITH C/O DIFFUSE SWELLING IN THE RIGHT HYPOCHONDRIUM, CT WAS TAKEN. QUESTIONS: WHAT COULD BE THE DIAGNOSIS ? WHAT IS THE MANAGEMENT ? WRITE WHO CLASSIFICATION OF CT PICTURE. SRD - 24

47. A 45 YEARS MALE, FARMER BY OCCUPATION HAVING PET DOGS, CAME WITH C/O DIFFUSE SWELLING IN THE RIGHT HYPOCHONDRIUM, CT WAS TAKEN. ANSWERS: Hydatid cyst. pericystectomy . Gharbi’s classification. SRD - 24

48. QUESTIONS: 1. Name of the procedure. SRD - 25

49. ANSWERS: 1. Devascularisation procedure. SRD - 25

50. SCREENING MAMMOGRAM PICTURE OF 40 YEARS FEMALE. QUESTIONS: What is the pathology noted ? How will you investigate further ? SRD - 26

51. SCREENING MAMMOGRAM PICTURE OF 40 YEARS FEMALE. ANSWERS: Microcalcifications . FNAC. SRD - 26

52. THE ABOVE PICTURE SHOWS CT IMAGE OF A HUGE THYROID SWELLING. QUESTIONS: 1. What is the complications expected ? SRD - 27

53. THE ABOVE PICTURE SHOWS CT IMAGE OF A HUGE THYROID SWELLING. ANSWERS: 1. Retrosternal extension – compression features, pressure symptoms, tracheomalacia . SRD - 27

54. PATIENT PRESENTED WITH ABDOMINAL PAIN. LAPAROTOMY SHOWED PATHCY GANGRENE. QUESTIONS: 1. What could be the diagnosis ? SRD - 28

55. PATIENT PRESENTED WITH ABDOMINAL PAIN. LAPAROTOMY SHOWED PATHCY GANGRENE. ANSWERS: 1. Mesenteric ischaemia . SRD - 28

56. AN MRCP PICTURE OF A PATIENT PRESENTING WITH OBSTRUCTIVE JAUNDICE. QUESTIONS: What is the diagnosis ? Name of the sign seen ? SRD - 29

57. AN MRCP PICTURE OF A PATIENT PRESENTING WITH OBSTRUCTIVE JAUNDICE. ANSWERS: Periampullary carcinoma. Double duct sign. SRD - 29

58. IT IS THE OPERATING PICTURE OF A NECK DISSECTION OF A PATIENT. QUESTIONS: What type of neck dissection is shown above ? Name the structure preserved in this type of neck dissection. SRD - 30

59. IT IS THE OPERATING PICTURE OF A NECK DISSECTION OF A PATIENT. ANSWERS: Modified radical neck dissection. Internal Jugular vein, spinal accessary nerve, sternocleidomastoid muscle. SRD - 30

60. A PATIENT PRESENTED WITH A HUGE SWELLING IN THE LEFT SIDE OF THE NECK, WITH TRANSILLUMINATION POSITIVE. QUESTIONS: What is the diagnosis ? Write about the management of the above condition. SRD - 31

61. A PATIENT PRESENTED WITH A HUGE SWELLING IN THE LEFT SIDE OF THE NECK, WITH TRANSILLUMINATION POSITIVE. ANSWERS: Cystic hygroma , Excision. SRD - 31

62. QUESTIONS: Name the procedure seen in the above image ? INDICATIONS FOR THIS PROCEDURE. SRD - 32

63. ANSWERS: 1. Marginal mandibulectomy . Oral malignancy with periosteum involvement. SRD - 32

64. A 20 years female psychiatric patient, who had clinical features of gastric outlet obstruction was operated. On gastrostomy, the above specimen found in the kidney tray was removed.

65. QUESTIONS: NAME THE RULE MENTIONED ABOVE ? WHAT ARE THE CAUSES FOR FISTULA IN ANO ?

66. A 27 YEARS OLD MALE CAME TO EMERGENCY DEPARTMENT WITH SEVERE SCROTAL PAIN, HE WAS DIAGNOSED TO HAVE TORSION TESTIS AND OPENED. THE ABOVE WAS THE INTRA-OPERATIVE FINDINGS. QUESTIONS: WHAT WILL YOU DO FOR LEFT TESTIS ? WHAT WILL YOU DO FOR RIGHT TESTIS ?

67. QUESTIONS: WHAT IS THE DIAGNOSIS ? WHAT IS THE DIFFERENTIAL DIAGNOSIS ? WHAT ARE THE OTHER TRANSILLUMINANT POSITIVE SWELLINGS ?

68. THIS IS THE CLINICAL PICTURE OF THE SWELLING. THIS PATIENT IS ALSO HAVING CERVICAL LYMPHADENOPATHY. FNAC REPORT WAS MALIGNANT PAROTID TUMOUR. QUESTIONS: 1. WHAT ARE ALL THE OTHER INVESTIGATIONS TO BE DONE ? .2. NAME OF THE SURGICAL PROCEDURE TO BE DONE ?

69. THIS IS THE CLINICAL PICTURE OF THE SWELLING. THIS PATIENT IS ALSO HAVING CERVICAL LYMPHADENOPATHY. FNAC REPORT WAS MALIGNANT PAROTID TUMOUR. ANSWERS: FNAC LYMPH NODE, CT, MRI. . TOTAL PAROTIDECTOMY.

70. THE SHADED PORTION SHOWS THE LESION IN THE STOMACH. QUESTIONS: What procedure is to be done ? How will you maintain the continuity ?

71. THE SHADED PORTION SHOWS THE LESION IN THE STOMACH. ANSWERS: TOTAL GASTRECTOMY. ROUX EN Y OESOPHAGO-JEJUNOSTOMY .

72. A 40 YEARS MALE PATIENT PRESENTED WITH AN ULCEROPROLIFERATIVE LESION IN THE FOOT ON CLINICAL EXAMINATION THERE WAS AN INGUINAL NODE WAS ENLARGED. QUESTIONS: 1. HOW WILL YOU TREAT THE PATIENT ? 2. IF THERE IS NO LYMPHADENOPATHY, THE INVESTIGATION OF CHOICE TO LOCATE THE METASTASIS ?

73. A 40 YEARS MALE PATIENT PRESENTED WITH AN ULCEROPROLIFERATIVE LESION IN THE FOOT ON CLINICAL EXAMINATION THERE WAS AN INGUINAL NODE WAS ENLARGED. ANSWERS: 1. WIDE LOCAL EXCUSION – REYE AMPUTATION OF 2 ND AND 3 RD TOE. 2. SENTINAL NODE BIOPSY..

74. A 40 YEARS FEMALE, PRESENTED WITH ABDOMINAL DISTENSION AND VOMITING. PLAIN X RAY ABDOMEN ERECT SHOWS COFFEE BEAN APPEARANCE. THE PATIENT IS PREPARED FOR EMERGENCY LAPAROMTOMY. THIS IS THE LAPAROTOMY FINDING. QUESTIONS: WHAT IS THE DIAGNOSIS ? HOW WILL YOU MANAGE ?

75. A 40 YEARS FEMALE, PRESENTED WITH ABDOMINAL DISTENSION AND VOMITING. PLAIN X RAY ABDOMEN ERECT SHOWS COFFEE BEAN APPEARANCE. THE PATIENT IS PREPARED FOR EMERGENCY LAPAROMTOMY. THIS IS THE LAPAROTOMY FINDING. ANSWERS: SIGMOID VOLVULUS. OPERATIVE PROCEDURES: resection end to end anastomosis and hartmann’s procedure.

76. A 60 YEARS OLD MAN, PRESENTED WITH MASS PROTRUDING THROUGH ANUS. LOCAL EXAMINATIONS SHOWS CIRCUMFERENTIAL DESCENT OF THE RECTUM. QUESTIONS: WHAT IS THE DIAGNOSIS ? WHAT ARE THE TREATMENT OPTIONS AVAILABLE ?

77. A 60 YEARS OLD MAN, PRESENTED WITH MASS PROTRUDING THROUGH ANUS. LOCAL EXAMINATIONS SHOWS CIRCUMFERENTIAL DESCENT OF THE RECTUM. ANSWERS: RECTAL PROLAPSE. ABDOMINAL PROCEDURE: Rectopexy , RECTAL PROCEDURE: altemeier procedure, Delorme procedure.

78. A 26 YEARS MALE, PRESENTED WITH SEVERE ABDOMINAL PAIN, VOMITING. A CLINICAL DIAGNOSIS OF ACUTE APPENDICITIS WAS MADE. ON LAPAROTOMY, THE APPENDIX WAS FOUND TO BE NORMAL. O/E OF THE TERMINAL ILEUM, 2 CM SIZE LESION WITH 2 CM CIRCUMFERENCE WAS FOUND IN THE ANTI -MESENTERIC BORDER 2 FOOT FROM THE ILEO-CAECAL JUNCTION. QUESTIOS: WHAT IS THE DIAGNOSIS ? WHAT IS THE MANAGEMENT ?

79. A 26 YEARS MALE, PRESENTED WITH SEVERE ABDOMINAL PAIN, VOMITING. A CLINICAL DIAGNOSIS OF ACUTE APPENDICITIS WAS MADE. ON LAPAROTOMY, THE APPENDIX WAS FOUND TO BE NORMAL. O/E OF THE TERMINAL ILEUM, 2 CM SIZE LESION WITH 2 CM CIRCUMFERENCE WAS FOUND IN THE ANTI -MESENTERIC BORDER 2 FOOT FROM THE ILEO-CAECAL JUNCTION. ANSWERS: MECKELS DIVERTICULUM. RESECTION AND ANASTOMOSIS.

80. A 40 YEARS MALE PRESENTED WITH MASS PROTRUDING PER ANUM, BLEEDING PER RECTUM. WHAT IS YOUR DIAGNOSIS ? HOW WILL YOU MANAGE ?

81. PROLAPSED PILE MASS, GLYCERIN MGSO4 DRESSING AFTER EDEMA SUBSIDED, HEMORRHOIDECTOMY.

82. IDENTIFY THE SPECIMEN ? WHAT IS THE USE OF IT ? WHAT SHOULD BE THE IDEAL CHARACTERISTIC FEATURES OF THE SPECIMEN ?

83. PROLENE MESH. HERNIOPLASTY. 1. INERT, NON-CARCINOGENIC, NON-ABSORBABLE, EASILY AVAILABLE, SHOULD NOT PRODUCE EXCESS FOREIGN BODY REACTION, EASILY STERILISABLE.