2016 Flashcards
50 year old female with a history of sigmoid cancer resected 2 years ago.
Q1: Describe the finding
Q2: Which tumor marker might help?
Q3: How to reach a definitive diagnosis?
- Multiple hypodense well-circumscribed lesions occupying both right and left liver lobes giving cannon-ball appearance suggestive of liver metastasis.
- CEA
- Colonoscopy/percutaneous biopsy?
- 45 year old female with this abnormality Mention 2 indications for surgery
- 8 hours post-op the patient developed severe difficulty in breathing and neck swelling. What should be done?
- Malignancy, compression symptoms, cosmetic reasons
- 1) Go to the OR
2) Open the wound, evacuate the hematoma and look for bleeding source and coagulate the vessel
3) Put a closed suction drain 4) Intubate
- Describe the abnormality
- What’s the intervention?
- Pneumothorax: Hyperlucency and loss of the lung markings caused by central line insertion.
(Tension pneumothorax??? It was not clear) - Remove the central line, insertion of a needle in the right second intercostal space then placement of a chest tube.
Patient underwent inguinal hernia repair, presented 3 days after with this
Q1: Describe the finding
Q2: Mention 6 risk factors for this complication?
Q3: Mention 2 signs and symptoms
Q4: What is the definitive management?
- Evisceration (protrusion of the bowel) and wound dehiscence
- 1) Wound infection
2) Anastomotic leak
3) Smoking
4) Uncontrolled diabetes mellitus
5) Connective tissue disorders
6) Poor closure technique
7) Increased intra-abdominal pressure 8) Steroids
9) Long operation time - 1) Gush of pink serous fluid. 2) Abdominal pain 3) Fever
- Provide analgesia and broad-spectrum IV antibiotics. Cover the wound in saline-soaked gauze and return to the OR for re-closure of the wound. If the sheath won’t come together then it’s necessary to manage the wound as an open abdomen and apply a vacuum dressing.
Q1: Describe the finding.
Q2: Mention 2 causative organisms?
Q3: Mention 4 risk factors?
Q4: Treatment?
- Erythema surrounding the incision suggesting wound infection.
- 1) Staphylococcus aureus 2) Group A streoptococcus
- 1) Smoking
2) Uncontrolled diabetes
3) Immunocompromised patients
4) Extremes of age - Remove clips/sutures to drain the pus, the wound is left open to be heal by secondary intention. Debride any non-viable tissue, send pus for culture. Pack with moist gauze with normal saline and cover with dressing. Systemic antibiotics in case of cellulitis.
Q1: Describe the findings of the right and left breast?
Q2: Mention 2 investigations.
Q3: What’s the likely diagnosis?
- Left breast: multiple ulcerated breast lesions with complete destruction of the breast architecture and nipple areolar complex.
Right breast: nipple retraction/inversion and skin puckering and visible mass in the upper inner quadrant. - Mammography, Skin punch biopsy
- Bilateral invasive breast cancer, most likely inflammatory type
Patient presented post open biopsy to investigate for a thigh mass
Q1: What’s the finding?
Q2: 2 factors that might cause this?
Q3: What other complication the patient might develop?
Q4: How will you manage this complication?
- Subcutaneous bleed (hematoma)
- 1) Bleeding disorders (Hemophilia)
2) Anti-coagulation drugs (Warfarin, heparin) - ???Infection or hemarthrosis???
- Cold or hot packs, investigate the cause?
Q1: Describe?
Q2: 4 risk factors
Q3: 4 investigations that would confirm the diagnosis and help with any operative procedure?
Q4: How will you manage the patient?
Q5: What advice would you give the patient post-op?
- Lump protruding from previous wound scar. (incisional hernia)
- 1) Obesity
2) Chronic cough/constipation
3) Connective tissue disorders
4) Ascites
5) Lifting heavy objects more than 5kg - CT scan
We’re not sure about the rest of the answers:
CBC, LFTs, RFTs, coagulation profile, type and match. - Open the wound, reduction of the hernia, reinforcement of the abdominal wall with a tension-free mesh repair.
- Don’t lift heavy weight more than 5kg for 2 months, stop smoking, lose weight.
Q1: In the same patient, what is the diagnosis?
Q2: List 4 complications of this condition
- Diverticulosis
- Massive painless lower GI bleeding Diverticulitis
Perforation
Large bowel obstruction
This was found during diagnostic laparoscopy.
Q1: What is the diagnosis?
Q2: If this was left untreated, mention 3 sequelae?
Q3: What should be assessed in histopathology during follow-up?
- Appendicitis
- Rupture and peritonitis Appendicular mass Appendicular abscess
- Presence of appendicular cancer. (Carcinoid)
Q1: Name the device labeled A and mention one indication for its use.
Q2: Name the device labeled B and mention one indication for its use.
- Incentive spirometry, it’s used to prevent post-op pulmonary complications, such as atelectasis
- intermittend pneumatic compression device, it’s used to reduce the risk of developing deep vein thrombosis.
30 year old diabetic patient presented with anal pain and fever.
Q1: What’s the diagnosis?
Q2: What is the most likely cause of this condition?
Q3: What’s the treatment?
Q4: What are the complications after the treatment?
- Perianal abscess
- Blockage of anal crypt with subsequent infection/inflammation and abscess formation
- Incision and drainage of the abscess, with systemic antibiotics.
- Fistula Sepsis Bleeding Recurrence
Patient with a history of change in bowel habits for 6 months, now noticed stool mixed with blood.
Q1: What is this study?
Q2: What’s the finding?
Q3: Mention 4 investigations?
Q4: How do you confirm diagnosis?
Q5: Mention 2 treatments you can offer the patient?
- Barium enema
- Apple core sign and filling defect, with irregular narrowing of the lumen.
- 1) CBC, LFTs, CEA
2) CT scan
3) Colonoscopy with biopsy
4) Metastatic work up (abdominal CT, chest x-ray, bone scan) - Colonoscopy with biopsy
- 1) Surgical resection
2) 5-fluorouracil based chemotherapy
Patient presented to the ER with severe epigastric pain. Patient gave a history of similar but less severe pain especially when hungry over the last 2 years.
Q1: Describe the finding on X-ray.
Q2: What’s the diagnosis?
Q3: List 2 etiologies for this diagnosis.
Q4: List 4 investigations.
Q5: List 4 interventions you will perform.
- Air under the diaphgragm (pneumoperitoneum)
- Perforated duodenal ulcer.
- Helicobacter Pylori
Zollinger-Ellison syndrome - CBC, coagulation profile, RFTs, CT scan.
(We’re not sure about the correct answers)
5.
1) Resuscitate with 2 large IV bores
2) administer analgesics
3) Antibiotics
4) Graham patch (omental patch) procedure
5 year old had a car accident and presented with this.
They put 1 more lateral X-ray of the forearm with fracture in both to ulna and radius, and 1 picture of the patient’s arm with defomity.
Q1: What’s the deformity? (angulation)
Q2: Describe the fracture on X-rays.
Q3: What is the definitive treatment of the fracture?
Q4: Name 2 complications other than bleeding and infection.
- Varus deformity?
- Transverse fractures on both ulna and radius, no displacement, no rotation, no shortening.
- ORIF with plate and screws.
- 1) Compartment syndrome 2) Non/mal-union.
30 year old female with diabetes, asthma and sickle cell anemia.
Q1: What’s the name of this surgery?
Q2: What’s the reason for performing this surgery in the patient?
- Bilater total hip replacement
- Bilateral avascular necrosis of the femoral head because of bone crisis.
27 year old male with a knee twisting injury during soccer game presents to you 2 days later with knee pain, swelling and difficulty walking.
He had positive tests in the following examinations:
Q1: Name the three tests:
Q2: What’s the tested structure in each test?
Q3: What symptom do you expect this patient to have that indicates instability?
- A: Valgus stress test
B: Lachman’s test
C: Anterior drawer test - A: Medial collateral ligament
B: Anterior cruciate ligament C: Anterior cruciate ligament - Giving away the knees.
The patient is standing on the left hip after hip fracture surgery
Q1: What’s the name of the gait?
Q2: Which picture is abnormal: A or B?
Q3: Name the affected muscle.
- Trendelenburg’s gait
- B
- Gluteus medius and minimus
Q1: What is the implant used in each bone?
A:
B:
A: Intramedullary nail in the tibia
B: Plates and screws in the fibula
This patient had a right elbow trauma 6 months ago.
Q1: Which nerve is affected?
Q2: Where does this nerve cross at the elbow?
Q3: List 1 movement affected?
Q4: Which skin surface area will be numb?
- Ulnar nerve
- Over the medial epicondyle
- Thumb adduction (adductor hallucis longus)
- Palmar and dorsal surface of the last two digits
23 years old pedestrian hit by a car on his right leg. Q6: What is the diagnosis?
Transverse fracture of the right tibia and fibula, with no displacement, no shortening, no rotation, no angulation. + communited fracture of the fibula.
Q1: Which grade based on Gastillo-Anderson classification?
Q2: Which implant is used to fix the fracture?
Q3: What’s the treatment of compartment syndrome?
- Grade 3a (it was a comminuted fracture)
- Intramedullary nail
- Immediate fasciotomy of the affected compartment.
Q1: What’s the name of the instrument shown in the picture?
Q2: Mention 3 uses for it.
- Rigid cystoscope
- 1) Management of bladder stone
2) Resection of bladder tumor
3) Management of bladder contracture
23 year old with scrotal mass undergone right radical orchiectomy.
Q1: Where was the surgical incision performed for this case?
Q2: Other than CBC, coagulation profile and renal function tests, mention three important blood tests performed in case of radical orchiectomy.
- Inguinal ligament
- 1) Alpha-feto protein 2) B-HCG
3) LDH
Q1: What’s the name of the device?
Q2: Mention 3 uses for it.
- Flexible ureteroscopy
- 1) Visualization of the ureter
2) Retraction of ureteric stone
3) Lithotripsy of renal stone
45 year old male presents with symptoms pf weak urinary stream and you perform this test.
Q1: What’s the name of the test?
Q2: Name the labelled components.
a) Top Y-axis?
b) Bottom Y-axis?
c) Bottom X-axis?
- Uroflowmetry
- a) Urine volume
b) Urine flow rate
c) Time
This is a 25 year old lady with history of right renal stone who had undergone a surgical procedure.
Q1: What’s the name of this device and what surgery did she have?
Q2: Mention 4 possible complications from this procedure.
- Nephrostomy tube, percutaneous nephrostomy
- 1) Infection
2) Injury to the ureter 3) Hemorrhage
4) pneumothorax
Name the following retroperitoneal lymph node groups.
1:
2:
3:
5:
1: Paracaval
2: Precaval
3: Interaortocaval
5: Paraortic
Q1: what is the diagnosis?
Q2: mention two possible complications if the condition is left untreated.
- Diverticulosis
- Massive painless lower GI bleeding
Diverticulitis
Perforation
Large bowel obstruction
This was found by the surgeon during laparoscopy
Q1: what is the diagnosis?
Q2: mention two complications if it was left untreated.
- Appendicitis
- Rupture and peritonitis
Appendicular mass
Appendicular abscess
Q1: what is the diagnosis?
Q2: what is the treatment?
Q3: name one possible complication after the treatment.
- Perianal abscess
- Incision and drainage of the abscess with antibiotics
- Fistula
Sepsis
Bleeding
Q1: what is the use of this device?
Q2: what drug should be given perioperatively to increase the Efficiency of the device?
Q3: mention two side effects of the drug.
- Intermittent pneumatic compression device
- Low molecular weight heparin
- hemorrhage
- Osteoporosis with prolonged use.
- Heparin induced thrombocytopenia
Q1: what is the name of the test shown?
Q2: describe the image.
Q3: what is the diagnosis?
Q4: how can you confirm the diagnosis?
Q5: mention two treatment options for this condition
- Barium swallow test
- Narrowing at gastroesophageal junction
Bird beak appearance
Dilated esophageal lumen ( megaesophagus ) - Achalasia
- Esophageal Manometry
- Medical: calcium channel blockers
Endoscopic :dilation of LES using pneumatic ballon iniection of botulinum toxin
Surgical - Division of the muscle at lower end of esophagus
- A patient had a car accident
Q1: what is the diagnosis?
Q2: How will you manage this patient?
- Tension pneumothorax
- Chest decompression with a needle at the right 2nd intercostal space midclavicular line followed immediately by chest tube placement in The 5th intercostal space anterior or mid-clavicular line.
The patient presented with anal discharge
Q1: what is the diagnosis?
Q2: what is the treatment?
- Pilonidal sinus
- Pilonidal cvstotomy: excision of the entire sinus tract with either primary closure of the wound, keeping it open or marsupialization
” the picture was different but similar to this one”
Q1: what is diagnosis?
Q2: mention two treatment options.
- Perianal fistula
- 1 - Fistulotomy
2- Seton placement
Female patient with a history resected sigmoid cancer.
Q1: describe the finding.
Q2: What tumor marker may help in the diagnosis?
Q3: what investigations will help in the diagnosis?
Q4: how can vou reach a definitive diagnosis?
- Multiple hypodense well-circumscribed lesions occupying both right and left liver lobes giving cannon-ball appearance suggestive of liver metastasis.
- CEA ( carcinoembryonic antigen ).
- Colonoscopy/ sigmoidoscopy
-CT of abdomen and pelvis to check for metastasis - Chest x-rays for lung metastasis
- CBC, LFTs, liver enzymes etc..
- Colonoscopy/ sigmoidoscopy
- Colonoscopy with biopsy
A Patient presented with severe abdominal pain and obstipation.
Q1: what is the diagnosis?
Q2: what is your initial step in managing this patient?
Q3: name two options for treating this patient.
- Sigmoid volvulus
- Decompression by flexible sigmoidoscopy
- We’re not sure of the answer as The picture wasn’t clear, but if it showed an enterovesical Fistula then the treatment is resection of the affected
Intestinal segment
Q1: what are the signs shown?
Q2: Mention two conditions can cause them.
- Cullen sign
Grey turner’s - Hemorrhagic pancreatitis
Retroperitoneal hemorrhage
A 65 y/o female with this presentation:
Q1: identify two abnormalities
Q2: mention three investigations that can aid in the diagnosis
Q3: What is the diagnosis?
Q4: mention 2 modifiable and 2 non-modifiable risk factors for this Condition
Q5: mention two treatment options.
- Nipple retraction/inversion
visible mass above nipple areolar complex (NAC) - Mammogram
FNAC
Core needle biopsy - Breast cancer
- Modifiable: obesity, alcohol, Hormone replacement therapy, exposure to radiation.
Non-modifiable: age, gender, family history, genetics. - 1- breast conservative Lumpectomy with sentinel lymph node biopsy and radiation
2- Modified radical mastectomy
Q1: what is this condition called?
Q2: mention two causes for it.
- Gynecomastia
- Drug use (cimetidine, sprinolactone)
Cirrhosis
Chronic renal insufficiency
Q1 what is the device shown in the first picture? Mention one indication For it.
Q2: What is shown in the second picture? Mention one indication for it.
- Sengastaken-blakemore tube
indication: rebleeding due to esophageal or gastric varices that does not respond to endoscopic therapy. - Percutaneous gastrostomy tube
Indication: gastric feeding in the case of proximal Gl pathology
Q1: mention three differential diagnoses.
Q2: mention three investigations
Q3: What are the indications for surgery?
Q4: after the surgery, the patient developed difficulty breathing with Swollen neck. What is your next step?
- Thyroid nodule or malignancy
Thyroglossal duct cyst
Branchial cleft cyst
Lipoma
2.
CBC, LFTs, RFTs, coagulation profile for any surgical operation.
Thyroid function test, US and FNA for this case. - Malignancy
Airway obstruction
Patient’s cosmetic concern - Surgical evacuation: open wound by removing sutures, evacuate the hematoma and look for bleeding source and coagulate the vessel, then put a closed suction drain.
A Patient came complaining of right upper quadrant pain after ingestion
Of fatty meals.
Q1: describe the finding.
Q2: List four possible complications.
Q3: what is the definitive management?
- Gallbladder stone with posterior acoustic shadow
- Acute cholecystitis
Choledocholithiasis
Biliary pancreatitis
Gallstone ileus
Ascending cholangitis - Laparoscopic cholecvstectom
This patient presented to the ER with severe abdominal pain, vomiting and obstipation. She has a history of appendectomy 5 years ago and mesh Hernia repair.
Q1: List two abnormalities on the x-rays.
Q2: what is the diagnosis?
Q3: what are the possible causes in this patient?
Q4: What is your initial management?
- Multiple air-fluid levels
Dilated bowel with prominent plica circularis - Small bowel obstruction
- Adhesions ( due to appendectomy ) and incarcerated/ strangulated hernia
- NPO, IV fluid resuscitation, electrolytes replacement and IV antibiotics
A male patient presented with severe abdominal pain, obstipation and Vomiting
Q1: what is the diagnosis?
Q2: list four initial investigations that will aid in the diagnosis
Q3: what is the treatment?
- SBO due to incarcerated (possibly strangulated) inguinal hernia.
- KUB erect x-ravs: bowel dilatation and multiple air-fluid levels.
- CT scan with contrast
- US of abdomen
- Electrolytes, lactic acid, etc..
- Herniorrhaphy with possible resection of the strangulated bowel segment.
- 22 y/o sustained an injury to his knees while playing soccer, he has valgus hyperextension of his knees, with clicking and giving away.
Q1: what knee structures are possibly injured?
Q2: what will be your initial management if you were the team Doctor?
- Anterior cruciate ligament
- Medial collateral ligament
2. - protect the knee from further trauma by using crutches and limit weight-bearing
- Manage the swelling with ice and compression
- what is the name of the test shown in figure A?
- when is the test considered positive
- what is the name of the test shown in figure B?
- When is the test considered positive?
- Lachman test
- increased anterior translation of the tibia by pulling It forward ( no discrete end point ) indicating damage Of ACL.
- Valgus stress test
- Excessive gapping or pain at the medial aspect of the knee when pushing against the lateral side, indicating
A tear of MCL.
Q1: What is the name of the test shown in figure C?
Q2: What constitutes a positive test?
- Patellar ballottement (patellar tap)
- Rapid rebound upon compressing the patella posteriorly
Indicating increased fluid pressure
A guy fell from a buggy and sustained an open fracture of his leg. The wound was 10×5 cm in size. On exam, the vessels and nerves Were intact.
Q1: Based on gustilo-Anderson classification, what is the class of his injury?
Q2: Describe what you see on the x-rays.
Q3: what is your initial management for this patient?
Q4: what is the definitive management for this patient?
Q5: if the patient has pain when you stretch his toes passively, what did he develop and how will you manage it?
- Grade 3C (In the exam, the fracture was severely Comminuted).
- -Severe comminuted fracture of the tibia with posterior translation.
-Medial malleolar fracture.
-Segmental fracture of the fibula - Initiate the ATLS protocol, resuscitate with IV fluids, IV antibiotics, tetanus booster, compress the wound to stop bleeding with sterile saline wet gauze, assess NVS, apply external fixator or splint, rush to OR for surgical debridement of non-viable tissue.
- Open reduction internal fixation with intramedullary nail
- The patient developed compartment syndrome, immediate decompression by fasciotomy is indicated.
A 30 y/o female presented with chronic groin pain and painless limping
Q1: describe the radiological findings on the x-rays.
Q2: what is the diagnosis?
Q3: what on the physical examination could explain her limping?
Q4: what is the definitive management at her age?
- Disrupted shenton line, acetabular dysplasia, dislocated hip, irregular femoral head architecture.
- Developmental dysplasia of the hip joint ( possibly complicated by AVN or OA)
- Leg length discrepancy and Trendelenburg gait on inspection
ROM: restricted adduction and internal rotation. - Total hip replacement.
Q1: Describe the radiological findings of both hip joints.
Q2: What two nerves could be injured in each hip?
- right hip: anterior dislocation of the hip joint
- left hip: posterior dislocation of hip joint.
- femoral nerve with the anterior dislocation of the right
Hip joint - sciatic nerve with the posterior
Dislocation of the left hip joint
- femoral nerve with the anterior dislocation of the right
Q1: Name the injury.
O2: what is the method used to treat it?
- Galeazzi fracture
- open reduction internal fixation with plate and screws
Q1: what is the name of the machine?
(without using abbreviations)
Q2: what is the size of stones treated with this machine?
Q3: list two contraindications for it.
Pregnancy
- extracorporeal shockwave lithotripsy
- 0.5-2 cm
- UTI bleeding disorders.
Q1: What is the name of the test?
Q2: What is the diagnosis?
Q3: what causes this condition in children?
- Transillumination test
- Hydrocele
- Patent processus vaginalis
A young man presented with a hard scrotal mass. He underwent Orchidectomy.
Q1: Name two anatomical structures in the picture.
Q2: Where should the surgeon make the incision for this
Procedure?
Q3: What investigations will you order to confirm the diagnosis?
- testis
- spermatic cord
- Inguinal ligament
- ultrasound of testis
- CT scan
- tumor markers: AFP, HCG, LDH
In the exam we had a video, attached picture shows the exact steps of The video.
Q1: What is the diagnosis?
Q2: What is the name of the procedure?
- Ureteral stone
- Ureteroscopy with laser lithotripsy
Q1: list two risk factors for this condition
Q2: Name two investigations will aid in staging the
disease.
- Smoking
Schistosomiasis
Chronic irritation
Aromatic amines
2.
CT urography
US
Metastatic workup: CT chest, abdomen and pelvis
Q1: List two differential diagnoses
Q2: mention two familial conditions associated with this presentation.
- Renal cell carcinoma
Adenoma oncocytoma
2.
Von Hippel Lindau
Hereditary papillary cell carcinoma
Hereditarv leiomvomatosis with RCC
Birt Hogg Dube
” in the exam we had a different picture”
Q1: What is the diagnosis?
Phimosis
57-year-old male presented with diffuse abdominal pain, constipation and wight loss
Q1: Name the study shown in the image
Q2: From the image, what is the diagnosis
Q3: List 2 investigations to confirm the diagnosis
Q4: What is the best next step for treatment
- Barium enema
- Colon cancer of the proximal transverse colon
- 1- Colonoscopy with biopsy
2- Metastatic workup: abdominal CT, chest X-ray, bone scan - Stabilize the patient with IV fluids, analgesia. Administer antibiotics, and shift urgently to surgery (extended right hemicolectomy)
40-year-old female with previous history of hysterctemy presented with abdominal pain, nausea, vomiting and obstipation
Q1: Name the modality of imaging
Q2: Describe the findings shown in the image
Q3: What is the diagnosis
Q3: List 2 important risk factors
Q4: What is the immediate management
- Contrast enhanced CT scan
- Multiple dilated small bowel loops with air fluid level and prominent plica circularis
- Small bowel obstruction most likely secondary to adhesions
- 1-Adhesions
2- Incarcerated hernia
1- Admit the patient, draw blood and administer IV fluids, analgesics, anti-emetic
2- Insert nasogastric tube for decompression
3- Obtain full history and physical examination, get COVID swab and send the blood for CBC, RFT, Lactate
4- Monitor any worsening symptoms or distortion in laboratory parameters indicating mesenteric ischemia
43-year-old male presented with this finding, he has no relevant medical or surgical history
Q1: What is the diagnosis
Q2: What is treatment
Q3: What will happen if left untreated, list 2.
- Spigelian hernia (the picture is very close to what we got in the exam, not sure of the answer)
- Hernioplasty, tension free mesh repair
- 1- Incarceration and bowel obstruction
2- Strangulation and mesenteric ischemia
52-year-old female presented with a mass in the right breast
Q1: Name the investigation used
Q2: List 2 investigations to confirm the diagnosis
Q3: List 4 differential diagnoses (in the exam the mass was hyperdense well circumscribed, not speculated, no microcalcifications, no cystic changes)
Q4: List 4 risk factors for breast cancer
Q5: Mention 2 treatment options
- Mammography
2.
1- Core needle biopsy
2- Metastatic workup: abdominal CT, chest X-ray, bone scan
3- If palplable axillary lymph nodes, fine needle aspiration
3.
1- Breast carcinoma
2-Fibroadenoma
3-Phyllodes tumor
4- Paget disease of the breast
4.
1- Advancing age
2- Family history
3- Obesity
4- Early menarche, late menopause
5- Genetic predisposition, BRCA1/ BRCA2 genes
5.
1- Wide local excision, with lymph node excision if palpable and sentinel lymph node biopsy if not, flowed by adjuvant radiation therapy.
2- Simple mastectomy , with lymph node excision if palpable and sentinel lymph node biopsy if not.
Possible adjuvant hormonal or chemotherapy depending on the tumor dimension, lymph node status, estrogen and progesterone receptor status, and
HER2 expression
66-year-old male, with 20 years history of neck swelling
Q1: What is the most likely diagnosis
Q2: List 4 methods to confirm the diagnosis
Q3: List 2 indications of surgery
Q4: List 3 common complications of the surgery
Q5: After 1 moth of the surgery, the patient had voice fatiguability and could no extend his voice, what is the injured nerve
- Multinodular goiter
2.
1- Thyroid function test
2- Neck ultrasonography
3- Fine needle aspiration
4- Thyroid scan and radioiodine uptake
3.
1- Airway compression
2- Malignancy
4.
1- Neck hematoma
2- Hypocalcemia
3- Recurrent laryngeal nerve injury and hoarseness of the voice
5.
The external branch of the superior laryngeal nerve
4: 35-year-old male presenting with this picture
Q1: Name the finding
Q2: List 3 causes
- Gynecomastia
- 1- Drugs: spironolactone, marijuana
2- Liver cirrhosis
3- Hypogonadism: Klinefelter syndrome
Q1: Name the instrument A, B, C
Q2: Mention 1 indication for each
- A: Two-way latex foley catheter
B: Two chamber underwater seal chest drain
C: Central venous catheter
2.
A: Management of urinary retention
B: Pneumothorax
C: Hemodynamic monitoring of the central venous pressure
Q1: Name the instrument A, B
Q2: Mention 1 indication for each
- A: Suction drain
B: Endotracheal tube
2.
A: Prevent fluid collection after surgery
B: Secure a definitive airway, such as respiratory failure with facial or mandibular fractures
30-year-old female presented with RUQ pain
ME
Q1: Describe the image
Q2: List 4 risk factors
Q3: List 4 complications
- Hyperechoic stone with posterior acoustic shadow, with thickening of the gall bladder wall
- 1- Female gender
2- Obesity
3-Crohn disease
4-Pregnancy
5- Rapid weight loss
6- Drugs: OCP, somatostatin analogs
3.
1-Choledocholithiasis
2- Ascending cholangitis
3- Gall stone pancreatitis
4- Gall stone ileus
Q1: Name structure A
Q2: Name structure B
- Cystic duct
- Cystic artery
Q1: Name A
Q2: Name B
- Hypertrophic scar
- Keloid scar
Patient presented with fever, jaundice, abdominal pain
Q1: Name the modality used in the image
Q2: Mention 2 abnormal findings
Q3: After 12 hours, the patient had severe epigastric pain, fever, leukocytosis and his BP was 90/80,
List 2 differential diagnoses
Q4:How would you confirm the diagnosis
- Endoscopic retrograde cholangiopancreatography
- 1- Filling defect of the common bile duct
2- Dilated common bile duct
3.
1- Acute pancreatitis
2- Bleeding
4.Serum amylase and lipase
60 -year-old female known to have atrial fibrillation presented with diffuse abdominal pain with tenderness, she passed blood mixed with stool and blood clots
Q1: list 3 differential diagnoses
Q2: list 4 investigations
Q3: what is your initial management
Q4: if the initial management failed, what would be the management
Q5: describe the image
- 1- Acute mesenteric ischemia
2- Sigmoid volvulus
3- Colorectal cancer
2.
1- Complete blood count
2- Renal function test
3- Lactate
4- CT scan of the abdomen
5-ECG
3.
1- Admit the patient, draw blood and
administer IV fluids, analgesics, and antibiotics
2- Insert nasogastric tube
3- Obtain full history and physical examination, get COVID swab and send the blood for typing and crossmatching, CBC, RFT, Lactate
4.
Urgent exploratory laparotomy with possible bowel resection
5.
Multiple gangrenous small bowel loops
57 presented with abdominal pain, constipation and vomiting
Q1: What is the diagnosis
Q2: List? investigations that will help you in the diagnosis
Q3: List 3 treatment options in order (this is the exact wording in the exam)
- Small bowel obstruction secondary to incarcerated inguinal hernia
- 1-CT scan of the abdomen and pelvis
2- Lactate
3.
1- Admit the patient, draw blood and administer IV fluids, analgesics and keep the patient NPO and get COVID swab
2- Hernioplasty open method tension free mesh repair
3- Laparoscopic total extraperitoneal or transabdominal pre-peritoneal (not sure of the answer)
Q1: What is the finding shown
Q2: What is the diagnosis
Q3: What is the surgical management
- Creeping fat
- Crohn disease
- Strictureplasty or bowel resection
Q1: Name the elements used to make a cast:
Q2: Mention the order in which they are used to make a full cast.
- A. Cotton padding/Webrill
B. Plaster of paris bandage roll
C. Fabric stockinette/tubular bandage
D. Elastic bandage - 1) C
2)A
3) B
4) D
Q1: Mention eight steps in the initial management of this patient
Q2: Mention 2 abnormalities.
- image
- 1) Fracture of the right superior ramus
2) Diastasis of the pubic symphysis (Open book fracture)
3) Disrupted sacroiliac joint (this wasn’t present in the exam but it’s there in the attached photo)
Q1: What’s the motor and sensory function of the nerve at risk of injury?
Q2: What clinical test will be positive?
Q3: Injury to what structre lead to repeated presentation of dislocation/instability?
- Sensory: Responsible of the sensation of the skin over the shoulder.
Motor: Abduction of the arm beyond the first 15 degrees. - Apprehension/relocation test
- Injury to the labrum leads to instability of the glenohumeral joint.
Q1: What’s the name of the device?
Q2: Give 4 indications to use this.
- External fixator
- 1) Severely contaminated fracture
2) Open fractures
3) Pelvic fractures
4) Infected nonunions
30 year old diabetic male presented with elbow pain that radiates to the forearm. The pain is worse with movement and wrist rotation, relieved by rest and NSAIDs. There was no history of trauma, recent infection or malignancy.
Q1: What’s the most likely diagnosis?
Q2: What is your initial management?
- Osteoarthritis/Tendonitis/Lateral epicondylitis
(It’s one these three, we don’t know…) - Conservative management by NSAIDs, physiotherapy, cold packs (if tendonitis/epicodylitis), analegics, limit physical activity by a sling.
mention type of healing, type of stability, type of fracture nd name instruments used for patient A and B
Q1: Define the following terms:
- Frequency:
- Nocturia:
- Intermittency:
- Hesitancy:
- Frequency: The tendency to urinate more than 8 times during the day.
- Nocturia: Waking up from sleep to void more than one time, and this episode is perceeded and followed by sleep.
- Intermittency: Complaints of urine flow that stops and starts on one or more occasions during one voiding episode
- Hesitancy: Difficulty in initiating urination resulting in a delay in the onset of voiding.
Q1: What’s the name of the device?
Q2: What is the size of stones treated with this machine?
Q3: List two contraindications to use this device:
- Extra-corporal shock wave lithotripsy
- 0.5cm to 2cm
- Pregnancy
Bleeding disorders
UTI
Q1: What’s the name of the device?
Q2: What is the size of stones treated with this machine?
Q3: List two contraindications to use this device:
Q4: If the above treatment failed and the stone size was more than 2cm at the renal pelvis, mention 2 other ways to treat it.
Q5: Give 2 indications for urgent surgical intervention.
Q6: If the patient developed hydronephrosis and fever, mention 2 ways to treat.
- Extra-corporal shock wave lithotripsy
- 0.5cm to 2cm
- Pregnancy
Bleeding disorders
UTI - 1) Percutaneous nephrolithotomy
2) Flexible ureteroscopy with lithotripsy
5.
1) Solitary kidney
2) Renal impairment
3) Urosepsis
6.
1) Double J stent
2) Nephrostomy tube
A 68 year old male came to the clinic complaining of frequency, nocturia and drippling at the end of micturition.
Q1: What’s the name of the test?
Q2: Write down the results of each while making sure to write the units.
Qmax =
Voided volume =
Residual volume =
(they just wanted us to copy the numbers down)
Q3: What 2 medications you would prescribe to this patient?
(use scientific names not generic names)
- Uroflowmetry
- -
- 1) Alpha-adrenergic blockers, e.g. Alfuzosin
2) 5 Alpha reductase inhibitors, e.g. Finasteride
A hard mass was found in the right testis of this patient.
Q1: Describe what you see in radiolocial terms.
Q2: Where is the incison made to perform radical orichdectomy?
Q3: Explain why you would approach the removal from here?
Q4: What is the lymphatic drainage of the testis?
- 2 well-circumscribed hypochoic masses occupying the right testis.
- Inguinal ligament
- To prevent seeding of cancer cells
- Right testis -> Interaortocaval lymph nodes
Left testis -> Left para-aortic lymph nodes
A paient presented with severe abdominal pain and obstipation.
Q1: what is the diagnosis?
Q2: what is your initial step in managing this paitent?
Q3: mention two surgical treatment for this complication?
- Sigmodal valvulus
- Decompression by sigmoidoscopy
- Fistulectomy
Seton placement
(not sure if it was fistula)
- What do you see?
- What is your diagnosis?
- Mention Two causes that can lead to this?
- Mention Two managements for this patient ?
- -Multiple air- fluid levels
-Distention of the small bowel with promenant circularis - -Small bowel obstruction
- -Adhesions, herina
- -NPO, Iv fluid and electrolytes correction, NG tube and foly cath placment -If the area is ischemec; resection / surgery ( lysis of adhesion, hernia repair)
Diabetic Patient presented with recurrent anal pain and did many surgeries before
1. what is the diagnosis ?
2. How will you treat this paient?
3. mention two causes?
- Perianal abscess
- Drainage then antibiotics
- History of perianal abscess IBD
immunocompromise
- What is the diagnosis?
- Give two radiological investigations?
- Appendisitis
- CT scan and ultrasound
During morning round, 16 YR old male, perviously healthy , three days postoperative complained of lower abdominal pain, diahrea, and fever.
1. What 4 tests would you order?
2. Why did this happen (mention three causes)?
- CBC ,RFT, X-ray, US
- Peritonitis Bleeding Sepsis Perforation
- What is the findings?
- What is the structure labeled with the arrow?
- What are the complications for this procedure?
- CBD dilation
Distraction of the filling
(Our exam had obvious stones in CBD) - CBD
- Pancreatitis Ascending cholangitis Perforation Hemorrhage
- What is the diagnosis?
- List two management options?
- Superficial Thrombophlebitis
- Remove the cannula, alternate hot/ cold compresses, NSAIDs
Change the area for IV cannula to the other hand
43 year old female non-diabetec presented again to the ER with the same complaint; redness and pain on the breast. On examination yellowish stain was found b/w her fingertips.
1. What is the diagnosis?
2. How you will treat it?
3. What is the main risk factor in this patient for this condition
- Mastitis complicated with abscess
- Antibiotics and Drainage
- Smoking
- What is the diagnosis in A?
- What is the diagnosis in B?.
- Hypertrophic scar
- Kaloid scar
- What is the structure labeled in A?
- What is the structure labled in B?
- Cystic duct
- Cystic artery
- Discribe the pic ?
- What investigation you would do?
- What is the diagnosis?
- Mention two modifiable and non modifiable risk factors?
- Give two treatment options
- Nipple retraction and lump above the nipple at 12 o clock position
- Mammogram and ultrasound , tissue biopsy
- Breast cancer
- Modifiable: radiation exposure, smoking
Non modifiable: family history, early menarche, age - Simple mastectomy
Radical mastectomy
Lumpectomy + setinnel LN biopsy
- What can you see in this pic?
- What is the diagnosis?
- What is the surgical treatment for this condition?
- Creeping fat
- Crohns disease
- Sugrical resection of the affected area if there is complication (Surgery is done as a last option if the medication therapy failed).
-If the patient has stricture, fistula.
Patient presented with anal pain and bleeding, proctoscopy was done:
1. What is the diagnosis?
2. Mention the nonsurgical treatments?
3. If surgical management failed, what the surgical option?
- Internal hemorroids
- Sitz bath, stool softeners, rubber band ligation
- Hemorrodectomy
- What is the diagnosis?
- Mention two causes?
- Gynacomastia
- Medication (spirolactone)
Hermonal imbalance ( high estrogen) Cushing syndrome
Klinfilter syndrome
35 yr female came with right upper quadrant pain ,vomiting and fever
1. What is your 3 differential
2. What investigations will help you in diagnosis:
3. What is the defenitive treatment?
4. What are the complication for this treatment?
- Asending cholangitis, pancreatitis, sclerosing cholangitis
- CBC, LFT, US , amylase and ERCP
- Decompression using ERCP
- Pancreatitis Ascending cholangitis Perforation Hemorrhage
- Give three differentials
- What investigations you would do
- What are the indications for surgical intervention?
- The patient underwent surgery. Later in the ward, he developed cyanosis with dypnea and swollen neck. What is your next step?
- Thyroid lesions
Sebaceous cystslipoma Cervical lymphadenopathy - TFTs, ultrasound, fine needle aspiration
- Malignancy
Cosmetic concern
Compression symptoms (airway obstruction) - Surgical evacuation ( hematoma evacuation)
Name the following retroperitoneal lymph node groups
1
2
3
5
- paracaval
- precaval
- interaortocaval
- paraortic
45 Yr male presented with vomiting and abdomenal pain
1. What is the diagnosis?
2. What is the treatment?
- Inginal hernia complicated with SBO
- Herniorraphy and hernioplasty
- What is this test?
- What is A:
- WHAT IS B:
- WHAT IS C:
- Uroflowmetery
- urine volume
- urine flow
- time
- What is the diagnosis?
- Mention the three steps of management ?
- Testicular torsion
- Surgical exploration with scrotal insesion Detorsion of the affected testis with orchidopexy Bilateral orchidopexy
This is gross sample of a kidney removed from a 50 YO male?
1. What is your differencial?
2. Give three familial causes?
- Renal cell carcinoma, adenoma, oncocytoma
- Von hippel lindau
Birt hogg dube
Hereditary papillary cell carcinoma
A 4-year-old boy presented with this.
1. What is this test
2. What is the cause at this age group and what is the diagnosis?
- Transillumination test
- Patent processus vaginalis / hydrocele
This is a 25 year old lady with history of right renal stone who had undergone a surgical procedure.
Q1: What’s the name of this device and what surgery did she have?
Q2: Mention 4 possible complications from this procedure.
- Nephrosotmy tube, percutaneous nephrostomy
- 1) Infection
2) Injury to the ureter 3) Hemorrhage
- Describe what you see in this xray ?
- What is the definitive treatment option?
- Radiopaque lesion ( most likely a stone) in the rt kidney occupying the renal pelvis
- Since the stone is big; precoutanuce nephrolithotripsy
- What is the diagnosis ( donot write the appreviatiuon)
- Mention 4 signs in this x ray
- What is the definitive treatment ( the pt is 2 years)
- Developmental dysplasia of the hip
- Disrupted shenton line, acetabular dysplasia, dislocated of the femur in the upper outer quadrant, small femoral head
- Open reduction with or without femoral osteotomy then. Spica
40 year old male presented with 3 months history of low back pain that radiates to both legs associated with weakness and paraperesis.
1. Give 3 more questions you would ask the patient?
2. What is this test ( do not use appreviation)?
3. What is the finding ?
4. Give diffrentials
- If the patient have any urinary incontinence
If the patient experience any weight loss or fever
If the patient had history of trauma - magnetic resonance imaging
- Disc herniation between L4 and L5
- Disc herniation, direct trauma to the area
Patient presented with neck pain that radiates to the left shoulder with reduction in the apility to flex the elbow and etend the wrist and weakness in the thumb
1. Which nerve root is affected ?
2. Where is the lesion?
3. What is your differential?
4. What reflx will be reduced?
5. Discibe the test and mention its name?
- C6
- Between C5 – C6
- Disc herniation and trauma
- Brachioradialis
- Spurling sign, the examinar turns the patients head to the affected sinde with slight extention aalying downward pressure to the top of the patients head. The pain arising in the neck radiating to the ipsilateral shoulder
- What is the lesion?
- What is the treatment that is used?
- Intertrochanteric fracture
- ORIF and Gamma nail
- What is the fructure?
- Discribe the fracture?
- Humeral Fx
- Rt Distal humeral shaft fracture, transverse fx with shortening and varus angulation
- There was gross photos of the arm (of the same pt), we belive that the muscle that he pointed at was the biceps ( not sure)
- And another photo of a structure behind the muscle; it could be a nerve or an artery but most likely the radial nerve.
What is the physical sign?
Drop wrist
What is the treatment procedure that is done ?
ORIF with plates and screw
- What is this test ?
- If it is positive, what does that mean?
- Patrick test (FABER)
- Instability of the sacroiliac joint
