Title 2013.pdf ✅

what caught my attention in this exam was that there was no need to memorize normal values for lab tests. they were all given. & no need to memorize staging for cancers. they didn't ask. ASSCC - Jaundice. Causes of jaundice. Pre-hepatic /hepatic /post-hepatic. enterohepatic circulation of bile. How does bile help with fat digestion /absorption ASSCC - surgery in pregnant patient – preload – how to increase preload in this instance. Generally how is blood pressure controlled when you stand up. Where to admit patient after surgery – obstetric HD ASP - breast CA -pathology report. What to look out for. Size, mitosis, estrogen receptor. Most common type of breast CA, then you’ll be presented with the report & ask how to manage next – tumor board. Referrals to make. ASP - gallbladder CA complicated by necrotising fasciitis & pseudomembranous colitis. Most common gallbladder CA, risk factors for this. Microbiology of wound infection in a patient post surgery for gallbladder CA. then Necrotizing fasciiitis. Organisms, treatment. Then pseudomembranous colitis. Must know scope findings – what it looks like. & explain how C. diff forms the pseudomembrane. CPS - insert foley catheter & what to do if no urine comes out. Flush, if able to flush & aspirate same volume out then inflate balloon. Don’t forget to give analgesia after. ASP - stab wound through chest & upper abdomen. structures injured based on trajectory. identify /point out parts on heart, lung (what is the pulmonary ligament), liver (ligaments supporting liver, diaphragm (origin /attachements, what goes through & which part of the diaphragm each goes through – eg IVC & phrenic thru central tendon..). ASP - skeleton. point origin & insertion – shoulder /rotator cuff. Radial nerve injury – where to test for sensation, explain what happens to grip when radial nerve injured. ulnar nerve – sensation – where to check. Which muscle of the thumb innervated by ulnar nerve. Then origin /insertion around hip joint – names of tubercles. What to expect when gluteus medius injured. What does gluteus medius do in walking. ASP - cadaver posterior thigh & leg – sciatic nerve path. Hamstring muscles – origin /insertion. Contents of popliteal fossa. What can give rise to a lump in popliteal fossa – name one lump per tissue – skin, artery, vein, nerve, muscle, joint.. ASSCC - pancreatitis & ARDS – why is there hyperglycemia & hypocalcemia in pancreatitis. How to diagnose pancreatitis. ARDS – what is it. How to manage it. Where to manage it. CPS - knot tying 2 rubber bands, hook in cylinder & overrun bleeding spot. Advantage of braided suture vs monofilament. What type of knot you made. Name other knots you know. Vicryl – what is it, how long does it last. CSH - patient with new onset fits – SOL in brain. DDX. Investigation, how to manage. CPE - CVS -heart murmur in patient for lap chole – pre-op who to refer patient. Investigations. What cardio will ask for. What anesthesia will ask for. Can surgery proceed? CPE - claudicating lower limb – arterial exam. Investigations aside from angiogram. Management. CPE - knee OA – differentials. Investigations. Management. If for knee replacement, What if patient is taking clopidogrel. CPE - thyroid lump – differentials. Investigation – US, FNA /core. For thyroidectomy if obstructing - dysphagia /dyspnea CSI prep - referring patient with critically ischemic leg for transfer. Patient admitted for diverticulitis.
Abdo pain now better. Now got ischemic leg. Had irregular pulse & ECG which had p waves so don’t know if AF or not. CSI - call vascular surgeon for transfer – convince him that it is not ischemic bowel. Then convince him that patient needs to see him first rather than cardiologist CSI prep - patient going for OGB , dilatation & biopsy. Patient went for barium swallow then heard nothing from any doctor till you see him on day of OGD. Anxious ++ re: cancer. Whether he can go home right after procedure CSI - talk to above patient, counsel re: risk of procedure. Advise re: risk of dilatation – risk of rupture. Can die on table. May need open surgery. CSH - abdo pain – gallstones on US but actually IBD – other differentials investigation.
1) Counselling and consenting a patient for an oesophagoscopy. Needs smooth talk and the patient will interrupt with questions like, will you give me an anaesthesia? how painful is it? etc. Do mention the complications to him while you talk him through it. 2) Thyroid examination 3) Knee examination 4) CVS exam: murmur in a kid (this was a real patient who did have a murmur) 5) Reading station with case notes, a pen etc informing and discussing with consultant an young adult patient who has had a RTA with fracture of the tibia and fibula. Don't forget C-spine stabilization first (I forgot that!!) 6) History taking in Impotence 7) History taking in a case of headache. Turned out the patient had a SDH. Questions towards the end were," what are the signs and symptoms in a patient with an SDH?" 8) Inguinal hernia examination. He also asked me about skin preparation before surgery. 9) Skill station: suturing a lacerated wound. 10) Microbiology: Gas gangrene, necrotising fascitis, causes of post operative diarrhoea in a hospital. 11) The physiology of adrenal gland and signs/symptoms of Cushing's syndrome 12) A station on Tuberculosis. Tuberculoid granuloma picture was shown. Culture/ how to grow the organism was asked. (this station came one day previously. I appeared on the second day). 13) Make an operative list and prioritize the patient. (One was a diabetic so I put him first on the list.) Cautery with a patient plate electrode was shown and questions were asked about monopolar and bipolar cautery. 14)a 3D model of heart; blood supply to the brain; cervical vertebra; identify the azygous vein, brachiocephalic trunk and the sympathetic chain on a picture of a cadaver. 15) Klumpkes paralysis and a volley of questions on upper limb anatomy. Examiner had a whole skeleton in front of him; muscle attachments, nerve supply of muscles and root value of nerves (i remember suprascapular) 16) pH and buffer system of blood.
1. comms- - barium swallow shows ?benign stricture, counsel for OGD and dilatation - but they gave like 10 pages of info - alcohol/smoking history + bloods all screwed up hb low, ldh high, bilirubin high - so i ended up counselling for ogd + biopsy + dilatation, counsel for likely blood transfusion, and advise management of smoking/alcohol 2. patho- - lump in neck of woman who went saudi arabia - 2 diagnoses - what’s granuloma - 3 causes of granuloma - patho test for tb - what other organisms can cause - etc 3. skills- - iv drip station - fluid management - management of trauma patient 4. history taking- - first seizure - turned out to be brain tumour - management 5. skills- - trauma patient motorcyclist hit by car - ATLS principle - got oropharyngeal airway, got c-collar - machiam ATLS course station 6. comms- - patient likely perf viscus - need pre-op advise from icu reg and need to book bed - call on phone and speak to reg - *damn sneaky he’ll ask you to do invx/procedure for patient at the end, and just before you put down, he’ll ask you to repeat all the stuff he ask you to do, so better copy down everything 7. history taking- - patient here for pre op assessment for cholecystectomy - has shortness of breath - just go thru cardiac/respi - den ask stressor - turned out to be anxiety - management 8. patho- (totally died for this station) - show picture of colon with numeous polyps - what condition? FAP - what behaviour/lifestyle modification will you advise his siblings????