FCPS-II TOACS (short surgical course-Nov-2008)

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A chest x-ray of an adult with air under right dome of diaphragm and an NG tube lying in stomach
1- Findings
2- Probable diagnosis
3- Management plan
A scenario stating that histopathologic report of an excised lump form right side of neck reveals metastatic
adenocarcinoma
1- Name the sites from where primary tumour can metastasize
2- What investigations would help in detecting the primary tumour
3- Management plan
A chest x-ray of an adult showing gut loops in left lung field
What are the findings in the x-ray
Provisional diagnosis
How will you manage this patient
A scendrio stating that a 40 years old man underwent Laproscopic cholecystectomy 6 days ago. Now patient has
developed high grade fever, pain right hypochondrium and jaundice, investigations reveal bilirubin -6, ALT 40
mg, alkaline phosphatase-600
1- What is your diagnosis
2- What investigations will you carry out and mention reasons for doing these
3- Treatment plan
An elderly male presented in emergency room with altered consciousness and abdominal pain. He has previous
history of fracture humerus managed by internal fixation , his previous ultrasound shows renal concretions
1- Diagnosis?
2- What investigations will help in diagnosis and mention reasons?
3- How will you manage this case?
A patient underwent appendicetomy. After operation he had gastric aspiration and could not maintain oxygen
saturation. So he was put on mechanical ventilation and nursed in ITC. His ABGs result shows (value of PH,
PaCO2 , PaO2, and bicarbonate was showing respiratory acidosis)
1- What is your diagnosis?
2- How will you manage this case?
3- What ventilator settings of mechanical ventilator would you adjust?
A photograph showing a circular ulcer about 1x1 cm on the ball of big toe. Clean granulation tissue in floor,
minimal serous discharge, probably punched out edges and surrounding skin excoriation
1- Findings?
2- Diagnosis?
3- How will you treat this case?
A photograph showing an ulcer on left nasal site
1- Diagnosis?
2- How will you confirm your diagnosis?
3- What is your management plan?
A middle aged man presented in emergency room with a single episode of massive haematemsis. He had
undergone surgery for ruptured abdominal aortic aneurysm about 3 months ago
1- Diagnosis?
2- Investigations with interpretations?
3- How will you treat this case?
Perform FNAC of a breast lump in a 23 years old lady
CT scan of chest showing a chest tube on left side with haemothorax (fluid) in left lung field. Examiner asked
about findings and how to manage this patient?
Histopathological report of an excised breast lump in a lady reveals infiltrationg ductal carcinoma of a 3.1x3.2
cm dimension. FNAC of this lump had shown this lump to be fibroadenoma. Examiner asks to satisfy this
patient.

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You have performed proctoscopy on a patient for bleeding per rectum which was very painful for the patient
Examiner asks you to counsel the patient to take consent for colonoscopy, whereby, the patient is already very
apprehensive because of the agonizing experience of proctoscopy
Double contrast barium enema films of ulcerative colitis with col-enteric fistula. Examiner asks you about the
findings and how will you manage it?
You have performed emergency surgery on a child for perforated appendix. On post-operative day, child has
become toxic and his condition deteriorated. He is shifted to ITC and USG shows fluid collection in pelvis.
Examiner asks you to counsel the mother of the child