1

SURGICAL CASE PRESENTATION SCHEME

Description Scoring First part of GENERAL PRESENTATION It corresponds to grade 4 if it fully exposed 5 eliminatory 1

1.

Personal data of the patient I have had to examine the patient XYyears oldfrom (urban or rural environment), with the profession of who has been admitted in our clinic indate..in (emergency or elective) condition, for the following complaints:........................ (3-5 most important complaints will be presented)

2.

The patient reports that the disease began ........ (time ago). Type of onset of symptoms (insidious, sudden, etc) HISTORY - 3 stages: - Debut - Symptoms history (what kind of symptoms, evolution, etc) - Actual state, plus any treatment till present for the actual disease Other illnesses and operations (past or concomitant) and their treatment From historical data, I have focused on a condition of . (digestive system, abdominal wall, etc the main location of the disease) GENERAL PSYSICAL EXAMINATION I didnt find any pathological changes, or I found the following pathological changes.. Examination findings from every system should be presented 1) Constitution (asthenic, hyperstenic, cashectic, etc) 2) Position 3) Walking 4) Skin and annexes 5) Muscular and fatty tissue 6) Bones and joint 7) Lymphatic system Respiratory system 1) Thorax type (emphysematous, etc) 2) Participation to the respiratory movements 3) Palpation - pectoral thrill 4) Percussion 5) Diaphragm mobility 6) Auscultation Cardio-vascular system 1) Apexian shock 2) Cardiac dullness 3) Cardiac sounds 4) Heart murmurs 5) AT, Puls 6) Palpable puls at peripheral arteries

3. 4.

1 15 eliminatory

5.

Digestive system 1) Oral cavity and dentition 2) Inspection of the abdomen in supine and standing. 3) Abdomen ...(position relative to xiphopubic plan) participates or not to respiratory movements, umbilical scar, pubic hair growth and other pathological elements 4) Superficial palpation 5) Deep palpation, liver lower edge, upper limit, prehepatic diameter, the lower pole of the spleen, hernia zones 6) Percussion, spleen dullness, mobilizable dullness 7) Auscultation 8) Rectal examination - patient position, anal sphincter tone, anal canal, rectal ampulla, prostate, etc Uro-genital system 1) Renal lodges tender or not (Giordano) 2) Palpable or not kidney 3) Ureteral points 4) Genital organs Neuro-endocrine system 1) Temporo-spatial orientation 2) Osteotendinous reflexes, fotopupilary reflexes 3) Thyroid gland 4) Breast I have focused the LOCAL CLINICAL EXAMINATION on.....what system or region...........and I found the followings: Complete local examiantion is performed - Inspection - Palpation - Percussion - Auscultation Based on anamnesis informations, general examination and local physical examination, the PROBABLE DIAGNOSIS is......... For diagnosis confirmation the next PARACLINICAL AND LABORATORY INVESTIGATIONS are needed: - Investigations for POSITIVE DIAGNOSIS (always the first !) - Investigations for DIFFERENTIAL DIAGNOSIS - Investigations for GENERAL ECONOMY OF THE BODY AND ESTABLISHING THE OPTIMUM OPERATIVE MOMENT Required: HTC, L, Platelets, Ts, Tc, prothrombin index, blood glucose, urea, creatinine, electrolyte, urinalysis, Proteinemia, ECG, chest X-ray, TA, Pulse For each must be told why is required and what value

15 eliminatory

6. 7.

1 15 eliminatory

8. 9.

Based on the above... I have established the POSITIVE DIAGNOSIS OF:...................... Although the diagnosis appears to be well supported, other conditions for DIFFERENTIAL DIAGNOSIS should be considered: Not just list the conditions for differential diagnosis, but actually saying to each one condition, why is not the real diagnosis based on historical data, the objective clinical examination and laboratory data you have. !

5 eliminatory 40

10. Finally I have establish the FINAL DIAGNOSIS of

This includes diagnosis-related diseases and is exposed as complete diagnosis clinic, staging, etc.. END OF THE GENERAL PART 40%

100 POINTS

11. What kind OF TREATMENT INDICATION has the disease (absolute,

relative, emergency, delayed emergency)

The second part SURGICAL

2 10

12. UNTREATED EVOLUTION - COMPLICATIONS

Which are:......................

13. WHAT KIND OF TREATMENT IS INDICATED - surgical, medical,

oncological, multimodal, etc

5 10

14. PREOPERATIVE PREPARATION

GENERAL rebalancing the patient and it comorbidities, etc LOCAL - for example large bowel preparation in colon cancer

15. OPERATORY MOMENT is or not OPTIMUM 16. OPERATORY RISK ON ADRIANI MOORE SCALE
for scheduled operations: 1- young patient, small operation, 2- young patient, big operation, 3- elderly, small operation, 4 elderly, big operation,

2 2

17. ANESTHESIA - I prefer this kind of anesthesia because ....

Possible complications of anesthesia

10

18. PROPOSED OPERATION 19. SURGICAL TECHNIQUE:

-

30 eliminatory

Patient and operating team position Instruments special instruments Type of approach why do you choose it ? DESCRIPTION OF OPERATION STEP BY STEP INTRAOPERATIVE COMPLICATIONS how can they be solved TECHNIQUE VARIANTS

40 eliminatory

20. POSTOPERATIVE CARE

-

15

What king of drugs, dose and duration Wound dressing, drainage tubes removal, removing stitches, patient mobilization diet discharge - recommendations 10

EARLY POSTOPERATIVE COMPLICATIONS General how are they solved Local how are they solved

21. LATE POSTOPERATIVE COMPLICATIONS

General how are they solved Local how are they solved

10

22. PROGNOSIS
-

quo ad vitam - referes to the vital risk and life expectation quo ad sanationem if the patients health will be affected or not quo ad laborem in the work ability will be affected 1 150 POINTS

23. PARTICULARITIES OF THE CASE If there is any

END OF SPECIAL PART 60%

scoring 0-25 26-50

grade 1 2

51-75 76-100 101-125

3 4 5

126-150 151-175 176-200

6 7 8

201-225 226-250

9 10

Failure to comply in 20 minutes of exposure lowers the note by 1.