National University of Singapore Department of Surgery OSCE

National University of Singapore Department of Surgery OSCE 24 January 2005 Begin Warning! Begin only when told to do so

OSCE Question 01 24 Jan 2005 Question Number A 37 -yr old man noticed that his left scrotum was getting bigger over the past 2 months. 1 2 3 4 5 6 7 8 9 This picture is taken with the patient lying down. 10 11 12 13 14 15 16 17 18 a. Give 3 differentials based on just inspection alone. (3 marks) b. On examination, the left testicle is hard, non-tender and enlarged. Give 3 relevant serum tests you would do. (3 marks ) c. What is the surgical management and the appropriate incision to remove this testicle? (4 marks)

OSCE Question 02 24 Jan 2005 Question Number 1 6 8 9 10 11 12 13 14 15 16 c. What is the most appropriate immediate treatment for this patient? (3 marks) 5 7 b. Give your likely diagnosis & 2 differential diagnoses? (3 marks) 3 4 a. Describe the abnormalities seen on this X-ray. (4 marks) 2 17 18

OSCE Question 03 A 70 year old lady presented to hospital with vomiting and epigastric discomfort for 1 month. Examination revealed that she was mildly dehydrated. A vague swelling was palpable at epigastrium. Blood investigation showed that she had microcytic anemia. A gastroscopy was performed and revealed an ulcerating lesion at atrium. a. What is your diagnosis? (2 marks) b. What is the most useful staging investigation at the time this picture was taken? (2 marks) c. What are the common complications of this lesion? (3 marks) d. List the modes/routes of spread of this disease. (3 marks) 24 Jan 2005 Question Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

OSCE Question 04 24 Jan 2005 Question Number 1 9 11 12 14 15 16 (2 marks) 8 13 d. If conservative treatment fails, name an operation to treat this. 6 10 c. What predisposing conditions may result in this lesion? (2 marks) 5 7 b. What would this patient complain of before presenting to the Emergency Department? (3 marks) 3 4 a. Describe the lesion seen & give your diagnosis. (3 marks) 2 17 18

OSCE Question 05 24 Jan 2005 Question Number 1 8 9 11 12 13 14 15 16 c. In the context of the diagnosis you are considering, name 4 other findings that the investigator should look for. (4 marks) 6 10 b. What does it show? (3 marks) 5 7 a. What is this investigation called? (3 marks) 3 4 This patient presented with right sided abdominal pain and fever. This investigation was done. 2 17 18

OSCE Question 06 24 Jan 2005 Question Number A 38 year old lady presented to the outpatient clinic with a swelling over the right preauricular region. Excision of the lesion was performed. The picture shows the appearance a week after the surgery. b. Explain the phenomenon seen in the right eye? (2 marks) c. What is the probable cause of this lesion? (2 marks) d. What is the best immediate management? (2 marks) e. What long-term complications may result from this if left untreated? (2 marks) 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 a. What is this sign called? (2 marks) 1 17 18

OSCE Question 07 24 Jan 2005 Question Number 1 b. What diagnoses would you consider? (3 marks) c. How would you establish the diagnosis? (2 marks) d. What are the principles of surgical management of this condition? (2 marks) 4 5 6 7 8 9 10 11 12 14 15 16 a. What would you like to ask during history-taking? (3 marks) 3 13 This 84 yr old Chinese lady complained of a nodule growing on the skin of her right forehead. 2 17 18

OSCE Question 08 24 Jan 2005 Question Number 1 6 8 9 10 11 12 13 14 15 16 c. What treatment would you recommend. (3 marks) 5 7 b. Name a simple test to confirm the diagnosis. (3 marks) 3 4 a. Give 2 differential diagnoses of this lesions. (4 marks) 2 17 18

OSCE Question 09 24 Jan 2005 Question Number 1 a. What is the abnormality seen? (3 marks) b. How would you treat this condition? (3 marks) c. What surgical treatments are available for this condition? (4 marks) 3 4 5 6 7 8 9 10 11 12 13 14 15 16 A 23 year old female complaints of sudden onset pleuritic chest pain on the right-hand side and shortness of breath. The Chest X-Ray in A&E is shown. 2 17 18

OSCE Question 10 24 Jan 2005 Question Number 1 c. List 2 investigations you would order. (2 marks) d. What operation would you perform? (1 mark) 6 7 8 9 10 11 12 14 15 16 b. List 4 areas you would examine. (4 marks) 5 13 a. Name 3 possible conditions. (3 marks) 3 4 This patient presented with a mass in the left neck. 2 17 18

OSCE Question 11 24 Jan 2005 Question Number 1 8 9 10 11 12 14 15 16 c. Name the definitive treatment for her current condition. (3 marks) 6 13 b. What is the cause of the abdominal distension? (3 marks) 5 7 a. What is the likely condition of the liver now? (4 marks) 3 4 This child was diagnosed to have biliary atresia at birth. 2 17 18

OSCE Question 12 24 Jan 2005 Question Number a. What are the abnormalities seen on this ERCP? (4 marks) 1 2 3 b. How would these patients present normally? (2 marks) 4 5 6 7 8 9 c. Name 2 long term complications of this condition? (4 marks) 10 11 12 13 14 15 16 17 18

OSCE Question 13 24 Jan 2005 Question Number 1 b. What is the treatment for this chest condition? (4 marks) c. Name three methods to obtain histological diagnosis of the right breast mass. (3 marks) 4 5 6 7 8 9 10 11 12 14 15 16 a. Describe the Chest X-Ray findings? (3 marks) 3 13 A 50 year old lady presented with breathlessness and was found to have a hard mass in the right breast. 2 17 18

OSCE Question 14 24 Jan 2005 Question Number 1 c. What is the long term prognosis and likely neurological deficit? (3 marks) 6 7 8 9 10 11 12 14 15 16 b. What is the treatment for this condition? (3 marks) 5 13 a. What are the likely neurological signs of this patient? (4 marks) 3 4 A 50 year old man was found unconscious on the floor. An urgent CT scan was done. 2 17 18

OSCE Question 15 24 Jan 2005 Question Number 1 (4 marks) 8 9 11 12 13 c. Creatinine is raised at 288 mmol/l. A renal ultrasound confirmed bilateral hydronephrosis. What do you do next? 6 10 b. After catheterisation, give 3 investigations you would do in the ward. (3 marks) 5 7 a. What is the finding in this picture? (3 marks) 3 4 An 80 -year old man presented with painful inability to pass urine. 2 14 15 16 17 18

OSCE Question 16 24 Jan 2005 Question Number 1 A woman of 48 years presented with a 6 months history of right loin discomfort. On routine testing of her urine the GP found that she had a urinary tract infection. She was referred to the Urology Department for further investigations. a. What does this X-ray show? (3 marks) b. What is the cause of this lesion? (2 marks) c. What is the further management of this patient? (5 marks) 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

OSCE Question 17 24 Jan 2005 Question Number 1 8 9 11 12 13 c. What is the likely prognosis? (3 marks) 6 10 b. Describe the findings in the gastrocope image. (4 marks) 5 7 a. What other procedure may have been performed during gastroscopy? (3 marks) 3 4 A 50 year old patient presented with upper gastrointestinal haemorrhage and gastroscopy was performed. 2 14 15 16 17 18

OSCE Question 18 24 Jan 2005 Question Number 1 b. What should be done next? (3 marks) c. What lifestyle factors can reduce the risk of recurrence of this disease? (5 marks) 4 5 6 7 8 9 10 11 12 14 15 16 a. What are they? (2 marks) 3 13 A 52 -year old man presents with gross haematuria. IVU showed normal upper tracts but at cystoscopy, these lesions were seen. 2 17 18