Station 13 (Static) TOACS April 2013

Picture of diabetic foot with amputated toes

1. Describe findings
2. Investigations
3. Treatment Options
it was picture of a foot wid 4th n 5th toe amputation done , with underlying pus in sole of foot wid
erythema
Station 6 (Interactive)

Scenario of young male with RTA, post liver packing and shifting to ICU. Picture showing monitor.

1. Findings on monitor and interpretation (PB, Pulse, Capnography, and Temp)
2. Further monitoring that will be required ( urinary output CVP and PA cathether Swan Ganz)
3. Abdominal compartment Syndrome definition and effects
4. Principles of damage control laparotomy
5. Transfusion Protocol
The scenario centred around hypovolemic shock and damage control surgery , tested basic knowledge like
Dcs, triad of death , types and classes of shock , abdomen compartment syndrome etc


Station 15 (Static) TOACS April 2013

Picture and History of adult male with 3 month history of vomiting and weight loss. Picture showing a man
with NG tube showing green fluid in bag, CVC in place, X Ray Abdomen showing dilated small bowel loops
with air fluid levels.

1. Acute surgical problem in the scenario
2. Anthropometric measurements to asses nutritional status
3. Method of providing nutrition to this patient
4. Complications of this method
Small bowl obstruction

Station 8 (Interactive) TOACS April 2013
Counselling

Take informed consent of patient for elective laparoscopic cholecystectomy.
His typical question was about probability of him to die

Station 10 (Interactive) TOACS April 2013
Polytrauma patient with GCS 8

1. Management of airway
2. How to confirm proper placement of airway
3. If patient become cyanosed during shifting to CT room, what to do?
4. What may be causes
5. How to check for those causes
6. What will happen if airway not secured
d stress was on word "secure" airway ....d scenario was taken frm atls book , those who hav done atls
wudve had no problem answering the questions , plz read atls manual regarding airway management
"cuffed endotracheal tube " was d answer to a "secure" airway

Station 12 (Interactive)

Patient with h/o thyrotoxicosis with acute onset pain in R lower limb, cold and pulseless limb

1. Diagnosis
2. Further investigations
3. Management Options
4. Size of Fogary Catheter to use
5. Vascular clamps ( bull dog and satinski)
there was also h/o of palpitations which possibly lead to atrial fib leading to limb ischemia due to
embolus
Thyrotoxicosis can be undrlyng cause of AF
Station 9 (Static) TOACS April 2013
Incorrect BLS algorithm given

Please rewrite correct algorithm

i think its in new wash manual..all algorithm are give

Station 2. (Interactive) Logbook
Procedures you did and saw

Discussed axillary clearance in MRM
Discussed surgery for duodenal perforation

Strangulated hernia and abscess
thyriod..how to identified parathyroid peroperatively..how to prevent RLN

Station 1 (Static) TOACS April 2013
Picture of 35 yrs male with recurrent parotid swelling. Scar mark visible.

1. Most likely diagnosis
2. Clinical features to suggest malignancy.
3. What investigations you need to confirm diagnosis
4. Options of treatment
5. What are complications of surgical intervention
Station 14 (Interactive) TOACS April 2013

45 year male with 3 week history of obstructive jaundice and weight loss

1. Further investigations
2. Possible causes
3. Preop Preparation ( vitamin K, hydration for hepatorenal syndrome, antibiotics)
Station 11 (Static) TOACS April 2013

Picture of 1 year old child with hydrocele ( transillumination test on scrotum shown)

1. Diagnosis
2. Differentials
3. Treatment
4. Complications if untreated
Station 7 (Static)

Xray showing sigmoid volvulous in a 50 year old male with 1 day history of abdominal distention, agitation
and constipation.

1. Describe findings
2. Diagnosis
3. Definitive Management Optio
Station 5 (Static)

Endoscopic picture of young male with arthritis and history of NSAID use (Peptic Ulcer)

1. Most likely diagnosis
2. Possible complications
3. How will you manage the complications
Station 4 (Interactive)
Surgical skills

Bowel anastomosis ( end to end)
Station 3 (Static)
Barium swallow of alcoholic and smoker with dysphagia and weight loss showing irregular growth and
narrowing of distal esophagus

1. What are the findings
2. How to confirm the Diagnosis
3. Further investigations and rationale
4. Treatment options
Semihemi Hemi ca oesophagus,gut anastomosis,abdominal compartment syndrome,couselng for lap
chole,trauma n management of airway,hydrocele,acute limb ischemia,obstructive jaundice,acute
intestinal obstruction due to tb abdome nutritional management,diabetic foot,gastric ulcer,log buk


CPSP should Remove one station which was AHA protocol according to 2010. No body could understand the
Question
There was written about taking brachial pulse but we usually take carotid pulse in trauma patient. This
shows that there was rearrange and correction both....anyhow very much confusion about this question

TOACS IMM SURGERY NOV 2012
Epidural haematoma ,
log book
disphragmatic rupture
kesseler s repair
epidural set
couselling for vasetomy of a husband
rectal prolaps
trauma scenerio
phimosis
varicose
gct bone tumour
ingrowing toe nail
pyloric stenosis
TOACS 2012 :
1) Counsell a patient for vasectomy
2) Spinal set
3)Gastric outlet obstruction
4) IGTN
5) gIANT CELL TUmor or osteosarcoma ...pathetic x ray !
6) Extra dural haematoma
7) trauma scenario
rectal prolapse ...waisay i think it was haemorroid
9)diaphragm rupture
10) TPN
11) VEricose veins
12) T TUBE CHOLANGIOGRAM
13) tendon repair
imm oct 9,2012
regarding blast injuries which is appropriate
1 bones are generally spared
2 air filled and gas containng cavities affected early
3 bullets travel in straight line
4 typanic membrane needs more pressure to rupture than lungs
5 exit wounds are larger than entry wounds
2 seems to be right answer as blast injuries are divided into primary blast injuries tht damages air filled
spaces and organs like lung ,ear and GIT ,secondary blast injuries are due to flying objects that strikes
and tertiary blast injuries in which ppl fly and hit other objects due to high explosions , as Ear Injuries
can occur from as little as 5-15 PSI of overpressure ,Lung Injuries occur when the victim experiences
overpressure of greater than 40 pounds per square inch (PSI). so tympanic membrane needs less
pressure and bone are damaged too

IMM Toacs 2010:
Case of Refractory ITP:
Indications of Splenectomy in ITP?
Important considerations in preparation of patient for splenectomy?
Complications and outcome?

Mocks ......infected pancreatic necrosis and infantile hypertrophic pyloric stenosis

A 35 years old man with chronic liver disease presents in the emergency department with history of massive
hematemesis. After resuscitatin , he undergoes upper GI endoscopy which reveals bleeding esophageal
varices.
(a) What initial steps you would take to control the bleeding ?
(b) How will you manage this patient if he stills bleeds after initial steps.
(secure airway . two large bore iv cannula . cross match . ringer lactate . blood transfusion) ,,,, control of
coagulopathy by FFPs. dec platelet count by platelet transfusion , aspiration of stomach by NG tube.
emergency endoscopy . injection or banding.
if still bleeding , 3 options. 1. transfer the patient to radiology suit for TIPSS. 2..pas grastro esophageal
tube like sangstaken blakemore tube . 3. perform emergency laparotomy and make portosystemic
shunts. options are end to end portocavel shunt . side to side porto caval shunt . splenorenal shunt with
splenectomy . mesocaval shunt.distal splenorenal shunt . mortality of surgery is 50%


30april surgery IMM TOACS where i have appeared also. i will sap pray for me too.
INTERACTIVE STATION NO.1.
Q. Your fellow is stung with bee, he developed despnea, fainting , and his pulse was 120 b/mint. now give
answers asked by examiner, then he asked me following questions.
a) what pt is suffering from ?
b) how will u manage this pt immediately when pt falled on ground and how when brought in emergency?
c) why pt developed respiratory problem ?
d) how will u manage respiratory problem?
This patient likely had hypersensitivity reaction. Immidiate management starts with ABC and aims at
adrenaline IV if hemodynamically unstable
naphylaxis due tobee sting.after general assessment of pt ,elevate foot end .pt immediately shifted to er
n intubation if required,o2 inhalation,adrenaline(i/m or i/v).i.v antihistamines,i.v steriods adminstred.n
monitoring of vitals
Type 1 hypersensitivity reaction
If outside hosp then raise legs. Mouth to mouth breathing
In the hosp ett with mechanical ventillation. iv epinephrine. Steroids. Antihistamine. Fluids
Resp problem due to laryngeal edema and bronchospasm