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2015 Flashcards

1
Q
  1. What is the instrument shown called?
  2. Name three indications for use:
  3. Name two complications
A
  1. Central line/catheter
    • Fluid resuscitation and hemodynamic monitoring
    • Parenteral feeding
    • Measurement of central venous pressure
    • Inability to establish peripheral venous access
    • Administration of irritant drugs
    • Pneumothorax
    • Central line infection
    • Hematoma formation
    • Internal jugular vein thrombosis
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2
Q

A diabetic patient presented with following (it was painless)
Describe what is shown and how you manage?

A
  1. Perianal fistula and abscess that is gangrened
    Fistulotomy and seton placement
    Debridement of the gangrened tissue
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3
Q

A 45-year old male presents with vomiting, constipation, and abdominal pain (Figures show hernia extending to scrotum)
1. What is most likely Diagnosis?
2. What is the treatment?

A
  1. Small bowel obstruction due to incarcerated (and possibly strangulated) inguinal hernia
  2. Herniorrhaphy, with possible resection of the strangulated bowel, after the stabilization of the patient.
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4
Q
  1. What is the diagnosis (describe the picture)?
  2. What are 2 risk factors?
  3. How would you manage?
A

1.Abdominal wound dehiscence/ wound infection

2.
* Extremes of age
* Poor nutritional state
* Diabetes mellitus, renal failure, or immunosuppression
* Current smoker

  1. MANAGEMENT OF SUPERFICIAL WOUND DEHISCENCE
    * Washing out the wound with saline
    * Simple wound care (e.g. packing the wound with absorbent ribbon gauze).
    * More extensive wounds - Vacuum-Assisted Closure device to speed healing
    MANAGEMENT OF WOUND INFECTION
    * Any sutures or clips present should be removed allowing for the drainage of any pus and the opportunity for wound packing if required.
    * Empirical antibiotic should be started, then giving specific antibiotic based on culuture and sensitivity

https://teachmesurgery.com/periopera tive/skin/wound-dehiscence/
Info about wound dehiscence
https://teachmesurgery.com/periopera tive/skin/surgical-site-infections/
Info about surgical site infection

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5
Q

A procedure had been performed for this patient
1. What has been inserted into this patient?
2. List two indications for such use
3. What complication can be seen in this x-ray?

A
  1. Central line
  2. Fluid resuscitation and hemodynamic monitoring
    * Parenteral feeding
    * Measurement of central venous pressure
    * Inability to establish peripheral venous access
    * Administration of irritant drugs
  3. Pneumothorax
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6
Q

his 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 managed?

A
  1. Pressure (bed) sore (ulcer)
    • Minimize pressure by repositioning the patient
    • Wound debridement, irrigation, and dressing
    • Topical antibiotics
    • Surgical reconstruction of the ulcer
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7
Q
  1. What’s the diagnosis?
  2. What’s the most likely etiology?
  3. How would you manage?
A
  1. Carbuncle
  2. Staph aureus
  3. Saucerization of the carbuncle (excision of the whole infected and dead tissue leaving a large clean cavity)
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8
Q
  1. What is the name of the sign shown?
  2. What is the cause?
A
  1. Trousseau sign
  2. Hypocalcemia
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9
Q
  1. What is this instrument?
  2. When do we use it?
  3. Mention a complication?
A
  1. Sengastaken-Blackmore tube
  2. In cases of variceal bleeding not responding to endoscopic therapy
  3. Mucosal ulceration and necrosis, Esophageal perforation.
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10
Q

A patient presented with cheek swelling for the past 2 years
1. Mention two differential diagnoses.
2. Mention two investigations to help establish the diagnosis.
3. Which structure is at risk of injury during operation?

A
    • Polymorphic Adenoma/Adenoid Cystic Carcinoma
      * Cervical lymphadenopathy
      2.
      * Ultrasound/CT scan
      * Fine needle aspiration cytology (FNAC)
    • Facial nerve
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11
Q
  1. What is the diagnosis?
  2. Give 2 indications for surgery
  3. Give 4 complications specific to this surgery
A
  1. Multinodular goiter
  3. Malignancy (suspected or confirmed)
  4. Compression of airways
  5. Cosmetic concerns

3.
1. Neck (compressing) hematoma
2. Hypocalcemia
3. Hypothyroidism
4. Unilateral (hoarseness) and bilateral (choking fits/obstruction) recurrent laryngeal nerve injury
5. Thyroid storm

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12
Q

This finding is in a lactating female
1. What is the diagnosis?
2. How will you manage?

A
  1. Breast abscess
    • Incision and drainage
    • Give antibiotics
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13
Q
  1. What is shown in the picture ?
  2. What is the complication if you don’t treat it?
A
  1. Thyroglossal duct cyst
    • Infection
    • Thyroglossal duct fistula
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14
Q
  1. What is shown
  2. What are the indications?
A
  1. Vacuum assisted wound closure
    • Large open contaminated wounds
    • Degloving injuries
    • Chronic nonhealing wounds
    • Surgical dehiscence
    • Infected wound after debridement
    • Diabetic foot with large wounds
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15
Q
  1. What do you see?
  2. Mention FOUR causes that can lead to this condition?.
A
  1. Multiple air-fluid levels
    Dilated bowel with prominent plica circularis
  2. Adhesion Hernia Gallstone ileus Intussuception
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16
Q

A patient presented with acute right upper quadrant pain and fever of 1 day duration
1. What is shown? What is the diagnosis?
2. What is the definitive treatment?

A
  1. Hyperechoic stone with posterior acoustic shadow Pericholecystic fluid
    Wall thickening
    Dx: acute cholecystitis
  2. Early laparoscopic cholecystectomy
    (After giving IV fluids, IV antibiotics, analgeisia, lap chole within 72 hours)
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17
Q

A patient presented post lap chole after noticing yellowing of his skin and eyes with the following labs:
1. What are 2 investigations you would like to order?
2. What are 4 differentials?

A
  1. CT scan
    MRCP/ERCP
  2. Biolma Cholangitis/choledocholithiasis Bile duct injury
    Tumor
    Stricture
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18
Q
  1. What is the diagnosis?
  2. What 2 symptoms would this patient would present with?
  3. What are 2 signs the patient will have?
  4. What is the management?
A
  1. Pneumoperitoneum
  2. Severe sharp abdominal pain
    Vomiting
    Malaise
  3. Rigid abdomen
    Guarding
    Patient will be lying completely still
    Tachycardia?
  4. IV fluid resuscitation
    IV broad-spectrum antibiotics
    Exploratory laparotomy with irrigation and debridement
    (If duodenal ulcer, perform omental patching. If gastric ulcer, do omental patching if the patient is unstable or wedge resection if they’re stable and take multiple biopsies. Discharge the patient on triple therapy)
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19
Q

A patient presented with multiple episodes of hematemesis, shown in the picture
1. Give 2 differentials?
2. What is the immediate management?
3. She is now well, give 4 questions you would ask in the history?

A
  1. Mallory Weiss tear
    Bleeding esophageal varices
    Bleeding Peptic ulcer
  2. Insert 2 large bore IV cannulas, resuscitate with RL, start IV PPI (if suspecting PUD)/ or IV octreotide (if suspecting varices), then perform urgent endoscopy to identify the source of bleeding and preform specific therapies depending on the cause (banding, sclerotherapy, thermal coagulation etc.)
    • Past history of liver disease, cirrhosis
    • Past history of dyspepsia, or known peptic ulcer
    • History of alcohol use
    • Drug history – especially steroids and NSAIDs
    • History of binge drinking the night before, with vomiting and retching (or history of vomiting and retching for any other reason)
    • History of prior GI bleed
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20
Q
  1. A 32 year old female who presents as a case of ruptured ectopic pregnancy was found to have a HR of 117 beats/min, a BP of 93/69 mmHg and a Hb of 6.5 mg/dL.
  2. A middle-aged male present to the casualty with severe vomiting. His HR was 123 beats/mins and BP was 98/71.
  3. A young lady who is going to undergo a laparoscopic cholecystectomy the next day. Her HR is 88 beats/min, BP is 117/81.
  4. A male patient who fell from height reports only lower limb pain. He has a HR of 153 beats/min, BP of 87/59, Hb of 14.2 and INR of 0.96.
A
  1. Packed RBCs
  2. 5% dextrose in normal saline and KCL
  3. Ringers lactate
  4. Normal saline (or ringers lactate NOT SURE)
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21
Q

A 42 year old male presents with hematemesis. Upper endoscopy was performed and is shown below
1. What is the diagnosis?
2. Mention four options that can be used in the management of this patient

A
  1. Bleeding peptic ulcer
    • IV PPI infusions
    • Therapeutic endoscopy using clips
    • Therapeutic endoscopy using thermal coagulation with or without epinephrine injection
    • Suture ligation of bleeding ulcer
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22
Q
  1. Name this device
  2. Indications
A
  1. Gastrostomy tube
  2. Feeding \ irrigations
    Gastric feeding in the case of proximal GI pathology
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23
Q

This view was obtained during a laparoscopic cholecystectomy.
1. Name the structure A
2. Name the structure B

A
  1. Cystic duct
  2. Cystic artery
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24
Q

patient came to you with very severe pain in his perianal area
1. What is your diagnosis?
2. List 2 methods of treatment?

A
  1. Anal fissure
    • Sitz bath
    • GTN ointment and nitroglycerin
    • Stool softeners
    • Lateral internal sphincterotomy
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25
Q

A patient presented with a one-day history of server right flank pain, fever and chills

  1. Describe what is shown? What is the imaging modality?
  2. What is the most likely diagnosis?
  3. Who is at most risk for this condition classically?
  4. Name 2 organisms that commonly result in this condition?
  5. What are the 2 initial steps of management?
  6. If these fails what are the next steps of management?
A
  1. Axial CT scan. Gas seen within the right kidney substance
  2. Emphysematous pyelonephritis
  3. Diabetics
  4. E.coli, Klebsiella
  5. Admit to hospital, give IV fluids and Start empiric IV antibiotics
  6. Drain obstructed kidney.
    Drain perinephric collection if present
    Consider nephrectomy if all above measures fail to save patient life.
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26
Q
  1. What is the name of the imaging modality?
  2. What is the finding?
A
  1. Retrograde urethrogram (RUG)
  2. Narrowing of the urethra- urethral stricture
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27
Q

A patient presented with intermittency, weak stream, hesitancy and incomplete emptying. Urethroscopy was done and shown below
1. What are two causes of this condition?
2. What is the endoscopic treatment?
3. What is the surgical treatment option if this fails?

A
  1. Trauma
    Iatrogenic- urethral catheterization
    Infection (recurrent urethritis) (e.g. Gonorrhea)
  2. Urethral (balloon) dilation or
    Internal urethrotomy
  3. Urethroplasty (anastomotic/substitution)
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28
Q
  1. What is the imaging modality?
  2. What is shown?
  3. What is the management? Mention 2 options
A
  1. X-ray KUB
  2. Staghorn (struvite) stone in the right kidney
  3. Antibiotics
    PCNL
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29
Q
  1. What is the composition of this stone?
  2. What is characteristic of organisms causing this?
A
  1. Struvite - magnesium ammonium phosphate
  2. Urease producing bacteria
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30
Q

A patient was injured in the lateral part of his knee. The patient presented with high steppage gait
1. What is the nerve damaged?
2. What is a muscle supplied by this nerve?
3. What deformity will the patient have?
4. Which part of the foot will he lose sensation from? (or where would he lose sensation)

A
  1. Common peroneal nerve
  2. Tibialis anterior
  3. Foot drop
  4. Dorsum of the foot
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31
Q

A patient suffered from a road traffic accident, his x-ray is shown below. The patient is hypotensive and is tachycardia. They conducted FAST and it was negative. The patient had a pneumothorax
1. What is the initial assessment you would preform?
2. How would you manage the pneumothorax?
3. How would you resuscitate the patient?
4. Give 2 disrupted joints?

A
  1. You would preform ATLS, so you would first perform the primary survey, and check that the airways is patent (and place a c-spine collar)
  2. Immediate insertion of a needle in the right 2nd intercostal space midclavicular line followed by chest tube insertion in the 4th intercostal space anterior axillary line (if it is a tension pneumothorax)
  3. Two peripheral large bore IVs, Two litres of Ringers Lactate. If there is no response, then severe hemorrhage has occurred, and immediate blood is needed.
    Monitor: blood pressure, urinary output and base deficit.
  4. Sacroiliac joint Pubic symphysis Hip joint
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32
Q

A patient presented with pain and swelling in his knee that gets better with activity and is worse on rest. The patient also has one hour of stiffness in his knee when he wakes up.
1. What type of pain is this?
2. What are 2 things that support your answer?

A
  1. Inflammatory pain
  2. Morning stiffness
    It gets better with activity and is worse on rest
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33
Q
  1. What is this test?
  2. What structure is it testing?
  3. What is the function of the structure being tested?
A
  1. Speed’s test
  2. Bicipital tendon
  3. Flexion of the elbow and supination of the forearm
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34
Q

Name the test and the structure being tested:

A

A
Name of test: Neer’s impingment test
Structure being tested: to see whether greater tuberosity impinges against acromion or not.
B
Name of test: Empty can/jobe’s test Structure being tested: supraspinatus tendon

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35
Q

A patient fell while gardening and suffered the injury shown below. There was gross contamination of the wound. The pulse were all intact
1. Describe the x-ray
2. What is the classification based on gusitillo Anderson classification?

A
  1. Fracture of the radius and the ulna
  2. 3b
    (in the exam I think there was enough skin to cover the wound but I’m not sure – according to this picture I provided, there in not enough skin to cover the wound but there are pulses so it must be 3b)
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36
Q

The patient was managed as shown below
1. What is the device shown?
2. Mention 2 other uses of this device (other than the scenario)?

A
  1. External fixator
  2. Pelvic fractures
    Unstable knee, elbow and ankle dislocation Infected nonunion
    Initial stabilization of soft tissue and bony disruption in polytrauma patient
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37
Q
  1. What is shown in the picture ?
  2. What is the complication if you don’t treat it?
A
  1. Thyroglossal duct cyst
    • Infection
    • Throglossal duct fistula
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38
Q
  1. What 2 symptoms would this patient present with?
  2. What are you 4 findings you would find on the CBC?
A
    • Pale stools, tea colored urine, yellow sclera * Right upper quadrant pain
    • Leukocytosis
    • Increased direct bilirubin
    • Increased ALP
    • Slightly increased amylase, AST, ALP (???)
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39
Q
  1. What is the diagnosis?
  2. List two management options.
A
  1. superficial thrombophlebitis (IV site infection)
  2. Remove cannula, alternate hot/ cold compresses, NSAIDs
    Change the area for IV cannula to other hand
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40
Q
  1. What is the diagnosis?
  2. Give 2 indications for surgery
  3. Give 4 complications specific to this surgery
A
  1. Multinodular goiter
  3. Malignancy (suspected or confirmed)
  4. Compression of airways
  5. Cosmetic concerns

3.
1. Neck (compressing) hematoma
2. Hypocalcemia
3. Hypothyroidism
4. Unilateral (hoarseness) and bilateral (choking fits/obstruction) recurrent laryngeal nerve injury
5. Thyroid storm

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41
Q
  1. What is the diagnosis?
  2. How will you manage?
A
  1. Breast abscess
    • Incision and drainage * Give antibiotics
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42
Q
  1. What is this device?
  2. What is it used for?
A
  1. Incentive Spirometry
  2. To prevent post op respiratory complications e.g. atelectasis
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43
Q
  1. What’s the diagnosis?
  2. What’s the most likely etiology?
  3. How would you manage?
A
  1. Carbuncle
  2. Staph aureus
  3. Saucerization of the carbuncle (excision of the whole infected and dead tissue leaving a large clean cavity)
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44
Q
  1. What is the diagnosis?
  2. Give 2 complications?
  3. What would be the immediate management (4 marks)?
A
  1. Open comminuted fracture of the fibula with anterior dislocation of the tibia
  3. Compartment syndrome
  4. Mal-union
  5. Common peroneal nerve injury
    • Conduct initial trauma survey to check
      for serious injuries
    • If hemodynamically unstable resuscitate and control bleeding
    • Initiate IV antibiotics as early as possible for 72 hours
    • Check tetanus +/- booster
    • analgesia
    • Conduct neurovascular exam
    • Remove gross debris and place sterile saline-soaked dressing on wound
    • Stabilize with a splint
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45
Q

An 18 month girl presented with painless limping
1. What is the initial screening test for this condition?
2. List 4 abnormalities seen in this X-ray
3. What are the treatment options for this patient?
4. What are the complications if it isn’t treated?

A
  1. Barlow and Ortolani
  3. Broken right shenton line
  4. Shallow dysplastic right acetabulum
  5. Femoral head in the right upper outer quadrant
  6. Small right femoral head

3.
Open reduction with femoral osteotomy and Spica cast Or
Closed reduction, confirmation with hip arthrogram and then immobilization with Spica cast (cuz 18 months is borderline)

  1. Hip osteoarthritis
    AVN of femoral head Leg length discrepancy
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46
Q
  1. What are 2 possible causes for this abnormality?
  2. What gait would he present with?
  3. Name one muscle used in dorsiflexion?
A
  1. Injury to peroneal nerve, fibular head fracture, direct muscular or tendon injury, compartment syndrome
  2. High steppage gait
  3. Tibialis anterior
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47
Q

Mention the name of the approach used

A

a. Gamma nail and compression screw
b. K wires
c. Intramedullary nail
d. Plate and Screws

48
Q

Patient came to you with very severe pain in his perianal area
1. What is your diagnosis?
2. List 2 methods of treatment?

A
  1. Analfissure
    • Sitz bath
    • GTN ointment and nitroglycerin
    • Stoolsofteners
    • Lateral internal sphincterotomy
49
Q

Patient with perianal discharge with no pain
1. Diagnosis?
2. Treatment?

A
  1. Perianal fistula
    • Placing a soft seton permits resolution of surrounding inflammation (if fistula
    • Fistulotomy
    • Marsupialization of fistula tract + routine sitz bath and dressing change
50
Q
  1. What is this procedure?
  2. What are 2 physical exam finding in this patient
  3. What are the post surgical complications?
A
  1. Laparoscopic appendectomy
    • Rebound tenderness
    • Rovsing sign
    • Psoas sign
    • Guarding
      3.
    • Wound infection
    • Bleeding
    • DVT
    • Atelectasis
51
Q

Female came in complaining of one day history of abdominal pain with fever
1. What are 2 findings you can see on the US?
2. What is the most likely diagnosis?
3. How would you treat this patient?
4. Complications specific to this surgery?

A
    • Hyperechoic stone with posterior acoustic shadow
      * Pericholesystic fluid
      * Wall thickening
  2. Acute cholecystitis
  3. NPO, IV antibiotics, bowel rest, IV fluids, lap cholecystectomy
    • Injury to cystic artery
    • Injury to CBD
    • Duodenal injury
    • Liver injury
52
Q
  1. What test is the patient doing in picture 1?
  2. identify the labeled letters for each axis A, B, and C?
A
  1. Uroflowmetry
    • Urine volume
    • Urine flow rate
    • Time
53
Q
  1. What is diagnosis?
  2. What are 2 sequelae?
  3. Mention 2 abnormalities in the semen analysis of this patient
A
  1. varicocele
    • Infertility
    • Dull Pain
    • Further increase in scrotal size
    • Oligospermia – low count
    • Asthenospermia – low motility
    • Teratospermia – abnormal forms
54
Q

A patient presented with painless hematuria. The urologist did him a cystoscopy which revealed the shown abnormality.
1. What is the diagnosis?
2. What are 4 risk factors for this condition?
3. What 4 things would you do next?

A
  1. Bladder carcinoma
    • Smoking
    • Aniline dyes (working in rubber and dye industries)
    • Cyclophosphamide
    • Schistosomiasis
    • Aromatic amines
    • Chronic bladder irritation
    • Resect and stage by TURBT
    • Urine cytology
    • Metastatic work up
    • CT urogram
    • Kidney ultrasound for hydronephrosis
55
Q

Identify 2 abnormalities?

A
  • 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
56
Q
  1. What do you see?
  2. Mention FOUR causes that can lead to this condition?.
A
    • Multiple air-fluid levels
      * Dilated bowel with prominent plica circularis
    • Adhesion
    • Hernia
    • Gallstone ileus * Cecal volvulus
57
Q

This is an x-ray of a patient with hip pain. He is a known case of IBD and is on steroids.
1. What is the Dx?
2. How will you treat?

A
  1. Avascular necrosis of the femoral head
  2. Core decompression with or without bone grafting / Total hip replacement in severe cases
58
Q

This is an x-ray of a patient who presented to the ER after a motorcycle accident. Vasculature was intact with no major damage.
1. Describe what you see?
2. Classify this fracture according to Gustillo- Anderson classification?
3. Management?
4. Mention four complications.

A
  1. An open displaced fracture of the left ulna (spiral) and left radius (transverse) with a dislocation of the elbow (humero-ulnar) joint.
  2. IIIB.
  3. General assessment followed by antibiotics, analgesia, debridement, and external fixation.
  4. Infection, compartment syndrome, neurovascular injury, sepsis
59
Q
  1. What is shown in the picture?
  2. What is the rationale of using it?
A
  1. Skin traction
  2. Maintain bone alignment and decrease muscle spasms
60
Q
  1. What is shown in the picture?
  2. What is the rationale of using it?
A
  1. C arm Fluoroscopy
  2. Capturing radiograph in mid-surgery and assessing procedure efficacy
61
Q
    • Mention two findings shown in the picture?
  2. How should this patient be treated?
A
    • Fungating mass in the bladder wall
      * Surrounding healthy mucosa
      2.
      Depending on staging:
      Superficial (Tis, Ta, T1) -> TURBT ± intravesical chemotherapy
      Invasive (T2a, T2b, T3) -> Radical cystectomy + lymphadenectomy + urinary diversion Metastatic (T4, N+, M+) -> combination of chemotherapy, irradiation, surgery
62
Q

The picture on the right was shown in
video form. A similar one: https://www.youtube.com/watch?v=RrXSIycfoqc
1. What is the Dx?
2. What is the name of this procedure?
3. Mention three types of this condition.

A
  1. Ureteral stone
  2. Ureteroscopy w/ laser lithotripsy
  3. Cysteine, uric acid, calcium oxalate
63
Q

This is an investigation done for a patient who presented to the ER after an accident.
1. What is the name of the procedure?
2. Mention two findings?
3. What is the diagnosis?

A
  1. Urinary cystogram
  2. Contrast seeping outside of bladder Pelvic fracture
  3. Bladder rupture
64
Q

This picture is of a testicular pathology in 25-year-old male that presented with a painless scrotal swelling.
1. What is the Dx?
2. What is the treatment?
3. How will you approach surgically?

A
  1. Testicular cancer.
  2. Radical orchidectomy, consider sperm banking, and adjuvant therapy.
  3. Through the inguinal ligament.
65
Q
  1. What is shown in the top picture + mention an indication of it
  2. What is shown in the bottom picture + mention an indication of it?
A
    • Sengstaken blackemore tube
      - Upper GI bleeding intervention after failure of medical / endoscopic therapy
    • Percutaneous endoscopic gastrostomy
    • Gastric feeding in the case of proximal GI pathology
66
Q
  1. Describe what is seen on the X-ray
  2. What is the Dx?
  3. Mention two causes.
  4. What is your initial management?
  5. What is your next step in case of Rx failure?
A
    • Dilated bowel loops
      - multiple air fluid levels
  2. Small bowel obstruction
  3. Adhesions and incarcerated hernias
  4. NPO, IV fluids, electrolyte correction, NGT, Foley’s (monitor urine output)
  5. Surgery
    (Lysis of adhesions, hernia repair, etc)
67
Q
  1. What is the Dx?
  2. What is your management?
A
  1. Tension pneumothorax
  2. Chest decompression with a large bore needle (2nd intercostal space in the midclavicular line) followed immediately by chest tube placement.
68
Q
  1. What is the name of the test in the picture?
  2. Describe what you see?
  3. What is the Dx?
  4. How to confirm the Dx?
  5. How would you treat this patient?
A
  1. Barium swallow test.
  2. Narrowing at the gastroesophageal junction with bird beak appearance as well as dilated esophageal lumen proximally.
  3. Achalasia
  4. Esophageal manometry
  5. Medical therapy (GTN, CCB, lifestyle)èshort-term
    Botox injection into sphincter / forceful dilation / Heller myotomy
69
Q
  1. What is the Dx?
  2. What are the possible complications?
A
  1. Diverticulosis
  2. Painless GI Bleeding
    Diverticulitis and its complication:
    - Perforation
    - Abscess
    - Fistula
    - Obstruction
70
Q
  1. What is the Dx?
  2. What would happen if this was left
    untreated?
A
  1. Appendicitis
  2. Rupture or abscess formation
71
Q

This CT scan was done for a patient who has recovered from colorectal cancer 2 years ago.
1. What is the Dx?
2. What tests should be ordered?
3. What tumor marker will confirm the Dx?

A
  1. Liver metastasis
  2. LFTs, CBC, coagulation profile
  3. Carcinoembryonic antigen (CEA) - used to monitor recurrence of CRC especially w/ the cannon ball appearance.
72
Q
  1. What is the differential diagnosis?
  2. Mention two tests to be performed.
  3. What are the indications for surgical intervention?
  4. The patient underwent surgery. Later in the ward, he developed cyanosis with dyspnea and a swollen neck. What is your next step?
A
  1. Thyroid lesion
    Sebaceous cystslipoma lymphadenopathy (infective / malignant)
  2. TFTs, US, and FNA.
  3. Patient’s cosmetic concern / Malignancy Medication failure / Airway obstruction
  4. Hematoma evacuation.
73
Q

Patient Had history of sigmoid diverticulitis, presented 3 weeks later with leukocytosis and spiking fever
1. What Is the most likely diagnosis?
2. How will you manage this patient

A
  1. Hepatic pyogenic abscess
  2. Percutaneous drainage of the abscess with antibiotic administration. Surgery is indicated if multiple percutaneous attempts fail
74
Q

Patient was admitted with fever and leukocytosis
1. Mention what you see in the picture
2. Mention One investigation that will help you in the management
3. What is the most SURGICAL appropriate treatment for this patient

A
  1. Gangrenous big toe with skin yellow discoloration and onychomycosis
  2. Swab of skin? Doppler Ultrasound? ABI?
  3. Surgical debridement and amputation?
    (Note: in the exam the picture only showed gangrene of the big toe with no calluses or ulcers)
75
Q

Patient came to the hospital with severe Anal pain
1. Mention the diagnosis

  1. Mention Two treatment options
    Hemorrhoidectomy
A
  1. Thrombosed external hemorrhoids
  2. Conservative: Topical corticosteroids / lidocaine, stool softeners, sitz baths, high fiber diet.
76
Q
  1. What is the likely diagnosis
  2. Mention Two treatment options
A
  1. Perianal fistula
  2. Fistulotomy
    Seton placement if fistula transects the sphincteric complex
    Mursipulization of the tract with good anal hygiene and sitz baths
77
Q
  1. What is the diagnosis?
  2. What is the definitive treatment?
A
  1. Pilonidal sinus
  2. Excision of the sinus tract with primary closure, or leaving the wound open.
78
Q

48 year old patient was came to the ER with abdominal pain and obstipation, she is hemodynamically stable
1. What is the diagnosis?

  1. What is the management?
A
  1. Sigmoid volvulus
  2. Reduction with sigmoidoscopy
79
Q
  1. What is the diagnosis
  2. What is the treatment
  3. Mention one complication that can develop after treatment
A
  1. Perianal abscess
  2. Incision and drainage with antibiotic treatment
  3. Perianal fistula
80
Q
  1. What is the finding
  2. Mention the structure pointed at
  3. What is the procedure the patient goes prior to this procedure
  4. Mention Four complications of this procedure
A
  1. Dilated CBD with multiple filling defects(in the exam the picture showed that)
  2. CBD
  3. cholecystectomy
  4. Acute pancreatitis / perforation / bleeding / cholangitis
81
Q

Patient who had a previously resected colorectal cancer underwent a CT scan
1. What is the likely diagnosis

  1. How will you confirm the diagnosis
    CEA for recurrence of colon cancer
A
  1. Metastasis of the liver
  2. Colonoscopy
82
Q

Patient previously had an attack of acute pancreatitis came to the hospital 8 weeks later with epigastric pain and vomiting
1. What is the likely diagnosis

  1. Mention one treatment option for this patient
A
  1. Pancreatic Pseudocyst
  2. Endoscopic cyst drainage with cyst gastrostomy Operative drainage
    Percutaneous drainage
83
Q

This patient presented with swelling of her left leg after surgery.
1. List the two most probable differential diagnoses.

  1. What is the most appropriate investigation that should be done
    in this case?
A
  1. Deep vein thrombosis
    Cellulitis
  2. Compression Ultrasonography
84
Q
  1. Name the device shown in the figure
  2. What is it used for?
A
  1. Incentive spirometer
  2. To prevent post-operative pulmonary complications e.g. atelectasis and pneumonia
85
Q

What is this tool?

A

Clip/Staple remover

86
Q
  1. What is this procedure.
  2. Mention two complications.
A
  1. Ileostomy
  2. Infection
    Stenosis
    Parastomal herniation Skin irritation Necrosis
87
Q
  1. What is the name of the physical findings in this patient’s abdomen?
  2. List two conditions associated with this finding.
A
  1. Cullen’s sign and Grey turner sign
  2. Hemorrhagic pancreatitis, trauma, retroperitoneal hemorrhage
88
Q
  1. What is the diagnosis?
  2. Mention two risk factors
A
  1. Ventral incisional hernia
  2. Wound infection smoking
    Steroids
    high intraabdominal pressure chronic constipation
    chronic cough
89
Q
  1. What is the diagnosis?
  2. List two management options.
A
  1. superficial thrombophlebitis (IV site infection)
  2. NSAIDs
    Change the area for IV cannula to other hand
90
Q
  1. Identify Two abnormalities?
  2. Mention three investigations
  3. What is the diagnosis
A
    • Nipple retraction/inversion
      - Visible mass above nipple areolar complex (NAC)
    • Mammogram
    • FNAC
    • Core needle biopsy
    • Metastatic workup
  3. Breast cancer (most likely ductal)
91
Q

Female complaining of abdominal pain after ingestion of fatty meals
1. Mention findings in the Ultrasound

  1. Mention four complications
A
  1. Gallbladder stone and acoustic shadow
    • Cholecystitis
    • Choledocholithiasis - Acute pancreatitis - Gallstone ileus
92
Q

Patient Underwent appendectomy 1 year ago and comes to you with this scar
1. What is the diagnosis

  1. Mention two treatment options
A
  1. Keloid scar
    • Corticosteroid injection
    • Cryotherapy
    • Laser therapy
93
Q

30 year old lactating mother presented as shown:
1. What is the diagnosis?

  1. How will you manage?
A
  1. Mastitis complicated by abscess
  2. Use breastfeeding pumps, antibiotics, incision and drainage of the abscess
94
Q
  1. Mention Two abnormal findings
  2. What is the next step ?
A
    • Irregular mass - Calcification
  2. Tissue biopsy: Core needle biopsy
95
Q

Patient came RUQ quadrant pain. Physical examination and labs show the following
1. What is the likely diagnosis

  1. How will you manage this patient
  2. What is the cause of this condition (or more likely cause)?
A
  1. Cholangitis
  2. Decompression of the biliary tract with ERCP after stabilization of the patient with IV fluids and IV antibiotics
  3. Obstruction of the common bile duct by stones
96
Q
  1. What is the likely diagnosis
  2. Mention Four causes of this diagnosis
  3. Mention Four complications
  4. Mention Two Investigations that you would order for this patient
A
  1. Acute pancreatitis
    • Stones - Alcohol
    • ERCP - Trauma
    • Hemorrhagic pancreatitis and shock
    • Multiorgan failure
    • Pseudocyst formation - Sepsis
    • CT scan
    • X-ray to rule out perforated peptic ulcer
97
Q
  1. Name this device
  2. What is the indication
A
  1. Intermittent pneumatic compression device
  2. Reduce risk of post-operative risk of deep vein thrombosis.
98
Q

45 year old male presents with vomiting, constipation, and abdominal pain. (Figures Show hernia extending to scrotum)
1. Most likely Diagnosis

  1. What is the treatment ?
A
  1. Small bowel obstruction due to incarcerated ( and possibly strangulated ) inguinal hernia
  2. Herniorrhaphy, with possible resection of the strangulated bowel, after the stabilization of the patient
99
Q

A 61 year old female developed this condition
1. What is the original diagnosis?

  1. What is the pathophysiology underlying this complication?
A
  1. Treatment of breast cancer with modified radical mastectomy with axillary lymph node dissection
  2. Lymph node dissection leads to disruption of the lymphatic system and hence, decreased lymphatic drainage of the upper arm resulting in accumulation of lymph
100
Q

A 32-year old Patient with weight of 80 KG and height of 171 came to you with repeated vomiting with gastric outlet obstruction
1. Calculate her maintenance fluids within 24 hours

  1. What are the expected electrolyte abnormalities
  2. What is the most appropriate fluid to be given
  3. How do you monitor the patient’s fluid status (Mention four ways)
A
  1. 2880 ml/ 24 hours
  2. Hypokalemia
    Hypochloremia
    Metabolic alkalosis
  3. 0.9% normal saline and KCL
    1. Urine output 2. Vital signs (HR and BP) 3. Skin turgor 4. Mucous membranes
101
Q

A patient underwent a thyroidectomy
1. What is the diagnosis

  1. What is your next step
A
  1. Hematoma ( complication of thyroidectomy)
  2. Remove sutures, pack wound open, Clot at bedside
102
Q

Patient presented with painless hematemesis, he underwent endoscopy
1. Mention the cause

  1. Mention one Endoscopic treatment option
A
  1. Ruptured esophageal varices
  2. Endoscopic band ligation of the varices or injection with sclerosing agent
103
Q
  1. What is shown in the bottom picture ?
  2. Mention one indication of it?
A
  1. Percutaneous endoscopic gastrostomy
  2. Gastric feeding in the case of proximal GI pathology
104
Q

fever
1. What are the two differential diagnoses we should consider

  1. What is the imaging modality and what is the finding
  2. how will you manage the patient
  3. Mention two complications of this condition
  4. Mention Two congenital abnormalities that lead to this condition
A
  1. Testicular torsion
    Other diagnosis?
  2. Color doppler ultrasound showing reduced blood flow to the testes
  3. Emergency surgical exploration with bilateral orchidopexy and possible orchidectomy if non-viable testes
  4. Infertility
    Testicular atrophy
    Infection of necrotic testes
  5. Cryptorchidism
    Bell clapper deformity
105
Q

Patient presents with a history of painless hematuria, CT scan was done.
1. What is the Imaging modality and describe what you see

A

Contrast enhanced CT scan showing irregular mass occupying the wall of the bladder most likely a bladder carcinoma

106
Q

Same patient underwent cystoscopy
1. Describe what you see
2. What is the diagnostic test that should be done in urinalysis

  1. What is the next step
  2. Mention two intravesical treatments given
  3. Mention Two risk factors for this condition
A
  1. Papillary mass occupying the wall of the gallbladder most likely bladder carcinoma
  2. Cytology
  3. Transurethral resection of bladder and staging of cancer
  4. Mitomycin C and BCG
  5. Smoking and chronic irritation (cystitis), cyclophosphamide
107
Q
  1. What is this device
  2. Mention the steps of insertion
  3. Mention two indications
  4. Mention Two complications
A
  1. Two-way foley catheter
  2. ( you should write the steps accordingly)
  3. To relieve urinary retention in patient without flow obstruction
    - Peri-operatively or during surgical procedures
    - To obtain sterile specimens for urine analysis and culture and staining
    • Urethral stricture
    • UTI
    • Rupture of urethra due to inadequate catheterization
108
Q

Elderly fell down from using his walker, he is now complaining of left groin pain
1. What is the diagnosis

  1. Mention one complication that is common with this condition
  2. What is the treatment of choice
  3. Mention two post-operative complications
A
  1. Fracture of the femoral neck
  2. Avascular necrosis of the femoral head
  3. Hemiarthroplasty ( patient is not active using a walker )
  4. Neurovascular injury Infection of the prosthesis
109
Q

Elderly patient fell down from his walker and is now complaining of left groin pain
1. What is the diagnosis

  1. Mention one treatment option for this patient
  2. What gait will she present with after 3 months
A
  1. Intertrochanteric fracture
  2. Dynamic hip screw? Intramedullary nail?
    Note: In the lecture the doctor said for a stable fracture you choose dynamic hip screw, for an unstable fracture you use intramedullary nail.
  3. Trendelenburg gait
110
Q
  1. What is the name of this test?
  2. What structure is being tested?
A
  1. FABER (Patrick test)
  2. Sacroiliac joint
111
Q

After performing this test to a patient who fell with his arm extended, externally rotated and abducted, patient felt pain, and upon applying an anterior force patient felt more relieved
1. What is the name of the test

  1. What is the structure that is tested
  2. What is the structure that is torn ?
A
  1. Shoulder apprehension test
  2. Glenohumeral joint
  3. Anterior dislocation of the shoulder joint that might result in axillary nerve injury
112
Q

Patient fell and obtained a fracture to his lumbar spine
1. What root is affected

  1. What reflex is lost
  2. What muscle movement will be weak
A
  1. L4
  2. Knee jerk reflex
  3. Ankle dorsiflexion and knee extension (tibialis anterior will be affected)
113
Q

Patient obtained a fracture to his ankle, there was gross contamination and it’s the size of 5cm, can be covered with soft tissue ( this was written in the question)
1. What is the diagnosis

  1. How will you initially manage the patient
A
  1. Trimalleolar (Or Bimalleolar) open fracture of the ankle with gustillo Anderson class IIIA?
  2. Conduct initial trauma survey to check for serious injuries
    If hemodynamically unstable resuscitate and control bleeding Initiate IV antibiotics as early as possible for 72 hours
    Check tetanus +/- booster
    analgesia
    Conduct neurovascular exam
    Remove gross debris and place sterile saline-soaked dressing on wound
114
Q

The fracture has been contaminated with grass 1. Now how will you treat this patient

  1. Mention some complications of this fracture
A
  1. External fixator
  2. Compartment syndrome
    Neurovascular injury
115
Q
  1. What is this test
  2. What structure is being tested
A
  1. Varus stress test
  2. Lateral collateral ligament

Surgery ELOOPs (9 decks)

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