2010 Flashcards
Q1: What is the diagnosis?
Q2: List two management options.
- thrombophlebitis
- 1- Remove cannula, alternate hot/
cold compresses, NSAIDs.
2- Change the area for IV cannula to other hand.
Q1: What is this tube?
Q2: In which clinical situation is this tube utilized?
Q3: List two possible complications.
- Sangestaken-blakemore tube
- Bleeding esophageal varices
- 1- esophageal perforation
2- pressure necrosis
This is a 63-year-old woman with a 3-week history of breast problem that is not responding to antibiotics.
Q1: List two abnormal findings.
Q2: List two investigations you will order to help you establish
the diagnosis.
Q3: What is the most likely diagnosis?
- 1- Skin ulceration with destruction of the nipple areola complex
2- skin erythema with peau d’orange [dimpling of the skin] - 1- Imaging [mammogram] 2- core needle biopsy
- Inflammatory Breast cancer
Q1: Name the device.
Q2: What is the indication for the use of this device?
- Pneumatic compression device
- This device is used to reduce the risk of deep venous thrombosis and reduce edema by improving venous circulation
This is an ERCP film of a 35-year-old patient.
Q1: List two abnormal findings.
Q2: List two symptoms this patient might present with.
Q3: List three potential complications specific for this procedure.
- 1- Dilation of the common bile duct
2- multiple filling defects within the common bile duct - 1- Right upper quadrant pain
2- Dark urine, Pale stool, yellow sclera - 1- Pancreatitis
2- Infection [ascending cholangitis]
3- Bleeding
4- Perforation
This is an operative procedure done on the axilla of a 55 year old woman
Q1: What is this procedure?
Q2: What is the likely pre-operative diagnosis?
- Sentinel Lymph node biopsy
- Nodal positive breast cancer
A 55 year old insulin requiring diabetic gentleman presents with this finding. He was otherwise stable other than a temperature of 38.1°C.
1. Describe what you see.
2. How will you manage this patient?
3. How will you asses the severity of this disease?
- 1- Erythema of the skin of the foot with striations
2- Black discoloration of the first and second toes - 1- Antibiotics and radiograph of the foot
2- Removal of necrotic tissue
3- Amputation as a last resort
4- Proper control of glycemia
5- Patient Education on proper foot care [inspect daily, don’t wear tight shoes, don’t walk barefoot, don’t cut toe nails across] and to quit smoking if patient is a smoker - Based on the impairment of sensation of the foot and the blood flow to the foot [pulses] [NOTE SURE]
What is the diagnosis?
Ingrown toenail
A 52 year-old male presents with sudden abdominal pain and fever. Previous history of off and on epigastric discomfort. He has board-like rigidity on examination.
1. What is the most likely diagnosis?
2. How will you manage this patient initially?
3. After stabilizing the patient, how would you manage him?
4. On discharge, what should his oral medication include?
- perforated viscus most likely an anterior duodenal ulcer
- Resuscitation to stabilize the patient: keep the patient NPO and place a nasogastric tube, administer IV fluids and place a foley catheter, give him antibiotics, analgesia, and proton pump inhibitors.
I would also order a type and cross and other lab investigations [coagulation profile, renal function, Complete blood count] - Surgery: graham patch [omental patch]
- Triple therapy- PPI, amoxicillin, clarithromycin to treat his peptic ulcer disease.
- Describe the cystoscopic image.
- Mention three work up tests other than cystoscopy you would perform for this patient.
- Mention three risk factors for the above condition.
- Mention two histological types of the above condition.
- Cystoscopy shows a Papillary mass in the wall of bladder growing in finger-like projections into the bladder
- 1-urinalysis
2-CT scan
3- biopsy of the mass - 1- Smoking
2- cyclophosphamide
3- Radiation exposure
4- Schistosoma Hematobium infection
5- Aromatic amines
6- chronic irritation: cystitis, bladder stones, chronic catheterization - 1- Transitional cell carcinoma
2- Squamous cell carcinoma
3- Adenocarcinoma
Plain X-ray KUB of a 51 year old man complaining of left loin pain of 6 months duration.
1. What is the correct diagnosis?
2. List two possible treatment options.
3. Name one test that will enable you to determine the percentage of left renal
function.
- Large Left renal stone taking the shape of the renal pelvis and calyces most likely a struvite stone
- 1- Percutaneous nephrolithotomy
2- Open surgery - Renal nuclear scan [Renogram- IV DTPA]
Radiological imaging of a 32 years old lady presenting with total painless haematuria of 3 months duration.
1. What is the full name of the study shown?
2. List two possible differential diagnoses.
3. List two contraindications for requesting this study.
- Coronal reconstruction CT urography
- 1- Renal cell carcinoma
2- Transitional cell carcinoma of the renal pelvis - 1- Allergy to the contrast material [anaphylaxis]
2- Pregnancy
3- impaired renal function
A 72 years old gentleman presented to the Urology OPD with lower urinary tract symptoms. He was requested to bring the report of the attached test to the OPD 2 weeks after his initial visit.
1. What is the full name of the test?
2. List two possible differential diagnoses.
- uroflowmetry [a urodynamic study]
- 1- Benign prostatic hyperplasia 2- Urethral stricture
The parents of this 2 year old uncircumcised male child brought him to the Emergency Room because of painful, swollen and non-retractable foreskin as shown in the figure.
1. What is the correct diagnosis?
2. List two possible treatment options for this patient.
- Phimosis
- 1- Medical: topical corticosteroids
2- Surgical: dorsal slit or circumcision
A 45 year old female drug addict presented to the casualty with exposed right tibia discharging pus and low grade fever for the past 7 months.
Q1: What is your diagnosis?
Q2: What are the possible complications of this disease?
- Chronic osteomyelitis
- 1- Sepsis
2- cellulitis
3- Squamous cell carcinoma of the skin from a draining sinus tract [Marjolin’s ulcer]
4- Pathological fracture
5- Septic arthritis
- Based on the provided image, what will be your diagnosis?
- Which muscle is responsible for displacing this fracture?
- Comminuted displaced fracture of the patella on the right
- Quadriceps Femoris
- What is the name of this device?
- Give two indications to use this device in the elbow.
- External fixator
- 1- Open fracture with significant contamination or inadequate soft tissue coverage
2- Infected fracture
- Name the demonstrated clinical test.
- What is the function of the tested anatomical structure?
- Jobe’s test [empty can test]
- The structure is the supraspinatus muscle
Function: responsible for initiation of abduction
A 25 year old male met with a motor cycle accident.
1. What is your diagnosis?
2. Which nerve is at risk at this level of injury?
- Complete Oblique Fracture of the proximal humerus involving the surgical neck on the left
- Axillary nerve
- What is the diagnosis?
- What is the immediate management?
- dislocation of the right glenohumeral joint [shoulder joint] most likely an anterior dislocation
- Closed reduction and immoblization with a sling
Figure 1A is a photograph of the duodenum and pancreas obtained at post mortem from a 55- year-old man. Figure 1B is a microscopic section from the specimen.
1. Describe the features present in Figure 1A.
2. Describe the features present in Figure 1B.
3. What is the most likely diagnosis?
4. Give three risk factors associated with the diagnosis in the present case.
- Irregular, poorly delineated, white, hard mass involving the head of the pancreas
- Gland-forming tumor with glandular spaces lined by atypical cells with nuclear crowding. desmoplasia is evident.
- Pancreatic Adenocarcinoma of the head of the pancreas
- 1- Smoking 2- Chronic pancreatitis 3- Age 4- Alcohol 5- Diabetes mellitus
A 60 year old male, diabetic on Glucophage 850mg twice daily, well controlled with no complications. His past surgical history includes appendectomy 40 years ago. The patient presents with documented history and physical examination of non resolving small bowel obstruction confirmed by CT abdomen findings. The patient’s weight is 110kg, height is 160cm and BMI = 42.9
Your senior registrar has asked you to write the patient’s pre-operative orders. Please note the patient will be undergoing laparotomy-adhesiolysis with possible bowel re-section.
- Date and Time
- Pre-op. Diagnosis: Small bowel obstruction due to adhesions
- Procedure: laparotomy-adhesiolysis with possible bowel re-section.
- Pre-op. Orders: Please keep the patient NPO and discontinue his oral diabetic medication at least 8 hours before the surgery or after midnight the night before the surgery. IV Fluid replacement should be at a rate of 150 ml/hr of 1⁄2 normal saline+ 5% dextrose in water for maintenance and administer extra fluid according to the patient’s fluid losses if they exceed the maintenance. Administer IV antibiotics an hour before the surgery.
- Labs to be ordered: Complete blood count, renal function test and electrolytes, liver function test, coagulation profile, urinalysis.
- Blood: type and cross and screen.
- Order Chest x-ray: note any abnormalitites
- Order ECG [Any patient over 40]: note any abnormalities
- Take consent from the patient and explain to him the risks of the procedure: bleeding, infection, anesthesia, scar [MI, CVA, death if CV disease present]; and any risks specific to the procedure.
