Surgery OSCE for post graduates..powerpoint

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1. 1. What is the diagnosis? What are the types? Management of this condition

2. ANSWER Tension Pneumothorax Types- open, closed, tension Management- Nasal O2 Intercostal drainage tube insertion IPPV if needed Analgesics & antibiotics

3. 2. What is the diagnosis? What are the types? Treatment of this condition

4. ANSWER Leukoplakia Types-homogenous, speckled, nodular Treatment- Excision with or without skin grafting Local application of isotretinoin , tocoferol CO2 laser excision Regular follow up

5. 3. Name of the procedure What is the appropriate level at which this surgery is done? Indications for this procedure

6. ANSWER Burgess technique of below knee amputation Appropriate level- Tibia – 8.5 to 12.5 cm below knee joint line Fibula 1 to 1.5 cm above tibia Long posterior flap of length 12 to 15cm Indications- Dead limb- Gangrene, Embolism, DM Dangerous limb – Crush injury, Osteosarcoma Damn nuisance – Congenital malformations, severe contracture, paralysis

7. 4. What is this diagnosis? What are the types? What are the complications of this condition?

8. ANSWER Cholelithiasis Types of stones- cholesterol, pigment, mixed Complications – acute/chronic cholecystitis , empyema gb , perforation of gb , mucocoele of gb , carcinoma

9. 5. What is the name of this investigation? What is the diagnosis? How will you treat this condition?

10. ANSWER MRCP Cholelithiasis with choledocholithiasis Treatment- Antibiotics & analgesics ERCP guided sphincterotomy with stone extraction and CBD stenting followed by Laparoscopic/open cholecystectomy If ERCP guided procedure fails- open choledochotomy with T tube placement

11. 6. What is this a picture of? What are the indications for this procedure? What are its complications?

12. ANSWER ileostomy indications- typhoid ileal perforation, TB abdomen, mesenteric ischemia, trauma, CA colorectum , anastomotic leakage complications- Prolapse, retraction, Parastomal hernia, bleeding, necrosis with gangrene, electrolyte imbalance, skin excoriation

13. 7. What is the diagnosis? What is Monroe-Kellie Doctrine? How do you treat this condition?

14. ANSWER EDH Monroe Kellie doctrine- an increase in the volume of any one of the 3 components- brain, blood, CSF, must be at the expense of the other two components beyond the auto-regulation Treatment- An EDH >30ml must be surgically evacuated regardless of GCS--- Craniotomy with clot evacuation + hitch stitches between dura and galea EDH <30ml or <15mm thickness or <5mm midline shift with GCS>8 and no focal deficit may be managed conservatively with serial CT monitoring

15. 8. What is the diagnosis? What are the causes for post operative stridor? How will you manage stridor?

16. ANSWER Goitre Causes for stridor- Haematoma , laryngeal edema, hypoparathyroidism , tracheomalacia , RLN palsy Management of stridor- delayed extubation Video laryngoscopy to look for position Elective tracheostomy Speech therapy with/without thyroplasty

17. 9. What is the diagnosis? Name the sign shown in the image How will you manage walled-off necrosis?

18. ANSWER Acute haemorrhagic pancreatitis Cullens sign Treatment of WON – Percutaneous drainage Endoscopic drainage Open necrosectomy

19. 10. What is this diagnosis? What is its composition? How will you manage this condition?

20. ANSWER Staghorn calculus Composition- Magnesium ammonium phosphate hexahydrate with or without calcium phosphate Management- CT urogram to confirm diagnosis Percutaneous Nephrolithotomy / open pyelolithotomy Low phosphorous, low calcium diet