2014 Flashcards
Case: RTA, Right femoral shaft Fx; vitals were provided.
Q1: Pattern of Fx?
Q2: Temporary stabilization?
Q3: Definitive management?
Q4: 2 FATAL complications?
Q5: How long does it take for hard callus formations?
- Segmental
- External fixator
- ORIF with intramedullary nail
- Bleeding & hemorrhagic/hypovolemic
shock
Fat embolism & ARDS - Around 3 months
- Dx?
- Management?
- Right shoulder (glenohumeral) joint dislocation; most likely anterior.
- Closed reduction under IV sedation + stabilize/immobilize with sling.
N.B: READ HX AND QUESTIONS CAREFULLY.
Case: Hx of ATRIAL FIBRILLATION.
Q1: Pathophysiology?
Q2: How to decrease recurrence rate?
- The patient suffers from atrial fibrillation, which predisposes to arterio-embolization, leading to mesenteric ischemia of the affected bowel segment, undergoing gangrenous necrosis due to vascular compromise.
- Anticoagulation therapy.
Q1: 4 biochemical abnormities?
Q2: 2 presenting Sx?
- Elevated direct/conjugated bilirubin Leukocytosis
Elevated liver enzymes (AST/ALT) Elevated ALP - RUQ pain
Jaundice; dark urine, pale stool, and yellow sclera (scleral icterus)
Q1: Identify?
Q2: One indication?
- Percutaneous Endoscopic Gastrostomy (PEG) tube
- Feeding/nourishment, medication.
Q1: Identify?
Q2: Indication?
- Intermittent pneumatic compression device
- Reduce risk of post-operative risk of deep vein thrombosis.
Q1: 2 DDx?
Q2: How to confirm Dx?
Q3: 2 complications if left
untreated?
- PUD
Gastric malignancy - Biopsy of ulcer (to R/O malignancy)
- Bleeding
Pneumoperitoneum and peritonitis due to perforation.
Q1: Identify?
Q2: Rx?
- Breast abscess
- Incision & drainage + antibiotics
Case: 40 y/o female
Q1: Identify 2 abnormalities?
Q2: 3 investigations?
Q3: Dx?
- Nipple retraction/inversion
Visible mass above nipple areloar complex (NAC) - Mammogram
FNAC
CNB - Breast cancer (most likely ductal carcinoma)
Case: 45 y/o male presents with vomiting, constipation, and abdominal pain. (Figures show hernia extending to scrotum)
Q1: Most likely Dx?
Q2: Rx?
- nguinal hernia [incarcerated (key)/strangulated – due to development of Sx]
- Herniorrhaphy with mesh [Lichtenstein open (tension-free) mesh hernia repair]
Case: Female complaining of abdominal pain after ingestion of fatty meals
Q1: 4 complications?
Q2: Definitive Rx?
- Acute cholecystitis
Choledocholithiasis
Ascending cholangitis Biliary pancreatitis
Gallstone ileus - Laparoscopic cholecystectomy
Q1: Identify?
Q2: 2 Complications?
- Perianal abscess
- Fistula formation
Bleeding
Infection
Q1: Identify 2 abnormalities?
Radiopaque shadow opposite to left transverse process of L4 vertebra; most likely (upper) ureteric calculus
2 small radiopaque shadows in the pelvis region; most likely bladder stones
Q1: Most likely Dx?
Q2: 2 tests to order aside from blood tests?
- Bladder cancer
- Urine cytology
CT urography
Q1: 2 findings?
Q2: 2 causes?
Q3: 3 Sx?
- Dilated bowel loops with prominent plica circularis Multiple air fluid levels
- Post-operative adhesions Hernias
Pain - Constipation Vomiting
Q1: Dx?
Q2: 2 sequelae?
- Varicocele
- Infertility
Further increase in testicular/scrotal size
NO Hx WAS PROVIDED
Q1: Describe image?
Q2: Rx?
Q3: 2 investigations other than blood tests?
Q4: 3 Sx?
- Axial non-contrast enhanced CT showing heterogenous mass located at the right renal pelvis
- Radical nephroureterectomy
- Urine cytology
Ureteroscopy
CT urography - Total hematuria
Right flank pain
Right flank mass (or Sx of mets)
Q1: Describe imaging study WITHOUT abbreviations?
Q2: Which level/s is/are affected?
Q3: 4 Sx; OTHER THAN PAIN
- Sagittal Magnetic Resonance Imaging (MRI) of lumbosacral spine (T2-weighted)
- L5 – S1 disk herniation
- Bilateral lower limb weakness, numbness, parasthesia
Case: fever
Q1: 3 DDx?
Q2: Which test to confirm Dx?
Q3: 4 positive signs in clinical examination?
- Right knee joint osteoarthritis Right knee joint septic arthritis Right knee joint gouty arthritis
- Knee joint synovial fluid aspiration and analysis
- Joint line tenderness
Limitation of ROM
Inability to bear weight
Positive patellar tap test for knee joint effusion
Q1: Dx?
Q2: 4 complications SPECIFIC for this surgery?
Q3: 2 indications for surgery?
- Multinodular goiter
- Bleeding/hematoma
Hypocalcemia/hypothyroidism
Unilateral (hoarseness) and bilateral (choking fits/obstruction) recurrent laryngeal nerve injury - Malignancy (suspicion/confirmed) Development of aerodigestive Sx Cosmetic purposes
Q1: Dx?
Q2: Rx?
- Sigmoid volvulus
- Flexible sigmoidoscopy
A 27 year old female with watery diarrhea
1. What is this?
2. What is your diagnosis?
- Creeping fat (onto the antimesentic border of small bowel) wall could also be thickened
- Crohn’s disease
- What is this instrument?
- When do we use it?
- Mention a complication?
- Sengastaken-Blackmore tube
- In cases of variceal bleeding not responding to endoscopic therapy
- Mucosal ulceration and necrosis, Esophageal perforation.
A 37 year old male went for surgery, he had epigastric pain. This was noticed in the surgery.
1. What is the diagnosis?
2. What is a classic finding on physical exam?
3. What other procedure should be done during the
surgery?
- Perforated duodenal ulcer (in batch 2013 exam it said gastric ulcer but I found the exact picture on the internet stating duodenal ulcer) http://www.gastrohep.net/images/image.asp?id=1149
- Rigidity
- Graham omental patch and highly selective vagotomy. (forgot what I wrote exactly but you can check the management of duodenal ulcer)
A 45 year old female was diagnosed with breast cancer and this procedure was done during surgery
What is this procedure called?
Sentinel lymph node biopsy
- What is the diagnosis?
- List two management options.
- superficial thrombophlebitis (IV site infection)
- Remove cannula, alternate hot/ cold compresses, NSAIDs
- Change the area for IV cannula to other hand
This is an ERCP film of a 35-year-old patient.
1. List two abnormal findings.
2. List two symptoms this patient might present with.
3. List three potential complications specific for this procedure.
- Dilation of the common bile duct
* multiple filling defects within the common bile duct
- Dilation of the common bile duct
- Right upper quadrant pain
* Dark urine, Pale stool, yellow sclera
- Right upper quadrant pain
- Pancreatitis
* Infection [ascending cholangitis]
* Bleeding
* Perforation
- Pancreatitis
- What is the Diagnosis?
- What Nerve is at risk of injury?
- How would you asses the nerve function (motor and sensory)?
- What is the management for this condition?
- Posterior hip dislocation
- Sciatic nerve
- You should mention the general measures and then most importantly say urgently perform closed reduction under IV sedation or general anesthesia within 6 hours
This patient presented with pain after eating but
no fever
1. What is your diagnosis
2. List 4 complications
- Gallstones causing biliary colic
- acute cholecystitis
- Choledocholithiasis
- Biliary pancreatitis
- Gallstonee ileus
What is the abnormality?
A: hypertrophic scar
B: keloid scar
- What test is the patient doing in picture 1?
- Identify the labeled letters for each axis A, B, and C?
- Uroflowmetry
- Urine volume
- Urine flow rate
- Time
It was a scenario of testicular pain:
1. Mention 2 differentials that can lead to this with the one most probable mentioned first?
2. What abnormal findings would you find on semen analysis? (they showed us similar picture to the one here with the normal reference range and asked to mention 2 abnormalities)
- 1- varicocele
2- testicular torsion - -
A 59 year old male reports a history of painless hematuria. The urologist did him a cystoscopy which revealed the shown abnormality.
1. Describe the finding seen on cystoscopy
2. Based on this finding, what’s your next step?
3. Mention two investigations to be conducted other than blood and urine tests?
4. Name four histological types of such lesion
- A papillary lesion in the bladder wall most likely to be bladder carcinoma
- I will resect the tumor during cystoscopy looking for muscle invasion and hence, staging the carcinoma
- CT urogram
- Kidney ultrasound for hydronephrosis
- Metastasis work up
- Transitional cell carcinoma
- Squamous cell carcinoma
- Adenocarcinoma
- Sarcoma
- Small cell carcinoma
- What is this device?
- What is it used for?
- Incentive Spirometry
- To prevent post op respiratory complications e.g. atelectasis
- What’s this device called?
- Mention two surgeries where its commonly used?
- Closed suction drainage device
- Thyroidectomy
- Abdominoplasty
- Ruptured appendix
This finding was noticed in a 64 year old lady which has been admitted to the ward a long time ago
1. Name the finding
2. How should this lesion be treated?
- Pressure (bed) sore (ulcer)
- Minimize pressure by repositioning the patient
- Wound debridement, irrigation, and dressing
- Topical antibiotics
- Surgical reconstruction of the ulcer
- What’s the diagnosis?
- What’s the most likely etiology?
- How would you manage?
- Carbuncle
- Staph aureus
- Saucerization of the carbuncle (excision of the whole infected and dead tissue leaving a large clean cavity)
Patient with perianal discharge with no pain
1. Diagnosis?
2. Treatment?
- Perianal fistula
- Placing a soft seton permits resolution of surronding inflammation + Fistulotomy
30 year old lactating mother presented as shown:
1. What is the diagnosis?
2. How will you manage?
- Breast abscess
- Incision and drainage
- Give antibiotics
- Name this device
- What is it used for?
- intermittent pneumatic compression device
- To prevent or reduce the risk of lymphedema and deep venous thrombosis
- What is the diagnosis?
- how would you treat this patient?
- Perianal abscess
- Incision and drainage and antibiotics
Patient presenting with this finding in the natal cleft
1. What is the diagnosis?
2. Treatment:
- Pilonidal sinus
- remove the tract with the hair that is trapped inside
- What is the diagnosis ?
- Mention two complications?
- Diverticulosis
- Diverticulitis
- Perforation and peritonitis
- Describe the finding?
- How to manage?
- Testicular torsion
- Surgical distorsion + bilateral orchidopexy if the testis is viable Remove testes and orchidopexy for the other testis
- What is the name of the machine?
- Contraindication?
- ESWL
- Pregnancy and bleeding disorder and acute UTI
- What do you see?
- What is your diagnosis?
- Mention TWO causes that can lead to this condition?.
- Mention briefly how you would manage this patient in the emergency room
- Multiple air-fluid levels
* Dilated bowel with prominent plica circularis
- Multiple air-fluid levels
- Small bowel obstruction
- Adhesion, hernia, Gallstone ileus, Volvulus
- NPO, fluid and electrolyte resuscitation, NG tube
- Inseration and foley’s catheter insertion
Patient came to you with very severe pain in his perianal area
1. What is your diagnosis?
2. List 2 methods of treatment?
- Anal fissure
- Sitz bath
- Stool softeners * GTN ointment
This is a 63-year-old woman with a 3 week history of a breast mass that is not responding to antibiotics.
1. List two abnormal findings.
- List two investigations that you would order to help establish the diagnosis.
- What is the most likely diagnosis?
- Ulceration and necrosis/destruction of the nipple-areola complex
* Skin erythema and dimpling (Peau d’oragne)
- Ulceration and necrosis/destruction of the nipple-areola complex
- Mammography
- Skin punch biopsy
- Inflammatory breast carcinoma
- What is the Salter Harris classification of the following fracture?
- Mention 2 complications of such a fracture.
- Salter Harris Class II
- Growth arrest causing deformities e.g. angulation, genu valgus or varus, and leg length discrepancy.
Mention 2 findings from this picture.
Fracture blisters and bruises
Mention 2 findings from this picture.
Open fracture (grade III) and external fixator
Mention 2 findings from this picture.
Tibial plateau fracture
(This wasn’t the exam’s picture, the one in the exam was a lateral view and the other finding was not obvious I couldn’t see.)
- Describe the fracture pattern.
- Can this fracture be caused by a high energy trauma, low energy, or both?
- What 2 fracture complications are specific to this fracture?
- What is the definitive management of this fracture?
- Comminuted fracture of the left tibia with oblique fracture of the left fibula
- High energy
- Compartment syndrome, common peroneal nerve injury, fracture blisters, non/mal-union
- ORIF with IM nail
A 20 years old male fell on his right arm while he was playing football. He reports pain in his right shoulder.
1. What is the diagnosis?
2. How would you manage?
- Right acromioclavicular joint dislocation
- Analgesics, assess neurovascular status, immobilizing with arm sling and physiotherapy.
(Not sure if closed reduction under sedation or anesthesia)
- In which stage of healing process is this child’s bone fracture after 7 days?
- In which stage of healing process is this child’s bone fracture after 6 months?
- Inflammatory
- Remodeling
- What is the name of this implant?
- Mention 2 sites that we use such an implant in other than the femur.
- Intramedullary gamma nail
- Tibia and humerus fractures
This is a gross sample of a kidney removed from a 50 years old male.
1. What is the differential diagnosis
2. What 2 hereditary syndromes are associated with such condition?
- Renal cell carcinoma: Clear, papillary,
chromophoic
Adenoma, oncocytoma, angiomyolipoma - Von Hippel Lindau
Hereditary papillary cell carcinoma Birt Hogg Dube
This is a picture from a patient who presented with acute scrotal pain.
1. What is the diagnosis?
2. Mention 3 examination findings before taking the patient to OT.
3. Mention 3 operative steps you will do during the surgery.
- Testicular torsion
- Diffuse tenderness of scrotum, transverse high riding testis, negative Prehn’s sign and negative cremasteric reflex.
- Surgical detorsion.
Fixing this testis (orchidopexy) Orchidopexy of the contralateral testis. (The testis looked viable)
-You can also write: Assessing the viability of the testis, if viable detort it and bilateral orchidopexy. If not, remove the dead testis and fix the other.
- What is the name of test?
- What is the diagnosis?
- What is the underlying cause in pediatric population?
- Transillumination test
- Hydrocele
- Patent prossesus vaginalis
A 35 years old female presented with severe right flank pain, fever, nausea, and vomiting. Her WBC count was 20.
1. Describe the abnormality.
2. How will you manage the case after admitting her, administering IV fluids and antibiotics?
- A radiopaque shadow in the right kidney - staghorn stone
- Insert double J stent or percutaneous nephrostomy.
Analgesics.
Definitive treatment later on with PCNL, or open surgery + antibiotics.
A patient presented with hematuria.
* What are the risk factors for this condition?
Smoking, aromatic amines, aniline dyes, cyclophosphamide, schistosomiasis, chronic cystitis.
A patient came to the ER after he had a RTA. Chest X-ray showed the following.
1. What is the diagnosis?
2. What is the most important step in management?
- Tension pneumothorax
- Needle thoracostomy at the right 2nd intercostal space mid clavicular line
A 34 year old male came with the following. He didn’t notice it until it smelled.
1. What is the condition he has?
2. How would you manage such case?
- Neuropathic ulcer most likely due to
diabetes mellitus, with overlying infection. - Debride the ulcer, proper wound dressing, pressure/weight off loading, antibiotics. Amputation is the last resort.
Proper glycemic control. Good care of the feet.
A patient came with a sudden acute epigastric pain. Upon examination the patient had generalized tenderness and rigidity.
1. What is the most likely cause?
2. How will you manage such case?
- Perforated PUD
- NPO, resuscitate with IV fluids, correct electrolytes, IV antibiotics and PPI. Graham (omental) patch.
- What is the name of the physical findings in this patient’s abdomen?
- List two conditions associated with this finding.
- Cullen’s sign and Grey turner sign
- Hemorrhagic pancreatitis, trauma, retroperitoneal hemorrhage
A 48 year old woman presents with two days history of abdominal pain, distension, vomiting and constipation. Her past history is significant for hysterectomy 5 years ago.
1. Describe two abnormal findings shown in the abdominal x-ray.
2. What is the most likely diagnosis?
3. List 2 possible causes that can lead to this presentation.
?
- What is the diagnosis?
- List 2 symptoms the patient might present with.
- Intussusception
- Abdominal pain, nausea, vomiting, obstipation/constipation
A 50 years old male had cholangitis. One week after, he presented with RUQ pain and fever
1. What is the diagnosis?
2. What is the management?
- Liver abscess
- Percutaneous drainage and antibiotics
- What is the diagnosis?
- What is the management?
- Perianal abscess
- Incision and drainage, antibiotics
A 30 years old male presented with bleeding per rectum. Proctoscopy showed the following.
1. What is the diagnosis?
2. Mention 2 treatment options.
- Hemorrhoids (internal)
- High fiber diet, stool softners, sitz bath
Rubber band ligation, hemorrhoidectomy
This patient underwent total gastrectomy 4 days ago.
1. List 2 differential diagnoses.
2. What is the most appropriate investigation?
- DVT, Cellulitis
- Compression/ Doppler US
- What is shown in this picture?
- What is the indication for its use?
- Mesh
- Hernia repair to prevent recurrence
What is this surgical instrument?
Staple remover
- What is the diagnosis?
- What is the management?
- Pressure ulcer
- Debridement and antibiotics, wound dressing, repositioning the patient, reconstruction.
This is a picture of a wound in a patient who had fever after undergoing colectomy.
1. What is the diagnosis?
2. How will you manage?
- Wound infection
- Open, drain, swab culture and antibiotics. Proper wound dressing.
- What is the diagnosis?
- What are the risk factors?
- Ventral incisional hernia
- Wound infection, smoking, steroids, high intra abdominal pressure, chronic constipation, chronic cough
What is A and B?
A: Cystic duct
B: Cystic artery
