SURGERY

By Shaarmeen Chughtai and Quratulain Jamil in SMC batch 2013 (Files) Edit Doc
Please dont memorize the surgical procedures,just the names are enough,you should know
the important landmarks where the incision is to be made,EXCEPT THE STEPS you should
know everything else,the indications,complications,etc
Chap from Bailey
PART 1:chaps 1,2,3,4,5(echinococcus,amoebiasis,typhoid)
leave PART 2
PART 3:chaps 13,14,16,17,18(boxes and the sutures),20
PART 4:do whole except 24,25 ,30 and do only flaps from chap 29
leave PART 5 and 6
PART 7:only cleft lip and palate from chap 42 and chap 47
PART 8:chaps 48 and 50
PART 9:chap 52
PART 10:chaps 53 and 54complete
PART 11
PART 12:chaps 73,74(trauma) and chap 75
leave PART 13
surgery instruments
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OSCEE
in surgery u ll ve 15 stations out of which 7 are observerd. observed stations consist of 1.
history taking 2.viva related 2 history 3.examination 4.emaination 5.examintion 6.2 perform
sum task dat u ve learned at skills lab for eg catheterizatin, NG intubation etc 7. counselling.
rest unobserved stations consist of xrays, scenarios n pictures etc.

in every OSCE there IS a long case,the long case consist of 3 stations,one history taking,one
examination of the same patient and one viva related to that case,if you fail this long case
than you fail the whole osce cause this long case has the highest marks,i am sure about this
happening in Surgery but not for the other three subjects.

Surgery 1
Clonorchis senscens cholangiocarcinoma

Hydatid cyst- laproscopic enucleation, PAIR

MRI and ultrasound for lady for breast axillary biopsy
Train accident, what do u first do as medical investigator triage
Old patient with pneumothorax with facial injury treated with needle thoracotomy what
triage label yellow?
Crush injury from earthquake, tibia and fibula fracture debridement and external fixation
Old lady fell in bathroom intertrochantric fracture
Compartment Syndrome = pain on movement of digits
Traumatic fat necrosis of breast after trauma
10. Compartment syndrome fasciotomy/ slit the pop in middle
11. Male breast cancer modified radical mastectomy
12. Female breast cancer E/R, P/R and Her 2 neu positive hormone therapy, neoadjuvant
13. Female breast factor risk factor atypical hyperplasia/early menarche late menopause/
genetic/ old lady and family history/ bilateral carcinoma in first relative
14. Management of patient depends upon protocol ?
15. Ebb phase all of the above
16. Damage control sugery - minimize bleeding / all of the above
17. Response to injury increase glucocorticoids, increased gluconeogenesis
18. Epidural anesthesia post-op hypotension vasodilation after epidural
19. Epidural anesthesia better than spinal mutiple repeated dosing, less chances of
hemodynamic instability
20. Hydrocephalus in child slit of 3rd ventricle
21. 14 year old boy osteosarcoma
22. Most common complication after fracture shock lung, post traumatic stress
23. Intracapsular fracture hemiarthroplasty
24. Drug used to treat vasospasm verapamil, amlodipine, atenolol, adrenaline
25. Metabolic Acidosis = Rapid deep breathing/ decrease H2O and base deficit
26. Isotope scanning detects functioning tissue
27. Medulary carcinoma calcitonin
28. Branchila cyst sternocleidomastiod ant lower third
29. Parotid gland radio lucent 80% and not seen on xray
30. Salivary gland gland 2 parotid, 2 sub mandibular, 2 sublingual and 450 minor
31. Parotid is divided by facial nerve
32. Submandibular gland most common stone
33. Submandibular duct obstrction with stone
34. Z plast lengthening of scar (twice)
35. Local flap raised to adjacent area
36. Diathermy the plate should attached to good muscle part, connection should be safe
37. A pt was fully hydrated pre op now developed respiratory difficulty post op - atelactasis
38. Post appendix Pneumonitis, wound infection
39. Most common surgery for penis hypospadiasis , buried /hidden penis
40. CVP- pneumothorax
41. Random flap?
42. Cleft lip = Lower lateral cartilage on same side
43. Most common associatio pierre robin
44. TPN indication = resection and anastamosis
45. Hypertophied scar collagen making and breakdown
46. Hyperthermia sepsis
47. 7 mg/dl Hb pack red cell
48. Cause of distention on 2-3 day - Hypokalemia
49. Hypertrophic pyloric stenosis projectile vomiting
50. Ano-rectal deformity - ? high and low
51. carotid artery stenosis = duplex scan
52. Melanoma UV is the cause

53. Hydradenitis suppurativa surgery / flap

54. Osteomyelitis = starts at metaphysis
55. Intussuseption in children idiopathis, gastroenteritis?
56. Trimethoprim(except) - tendon
57. Glasgow coma score = 5 is well oriented
58. Speed of vehicle in trauma
59. Jaundic patient = clotting and prothrombin time
60. Most common common site of fracture proximal femur
61. Insertion of chest tube when bleeding is = 200 ml / hr
62. blunt chest trauma non invasive management
63. Duct ectasia
64. Emboli first sympom pain
65. Dry gangrene arterial occlusion
66. Pre-op anesthesia -anesthetist is supposed to do it
67. Recovery room trained nurses
68. Cellulitis- skin and subcutaneous tissue infection,
69. Extra dural hematoma
70. Bed sores in paraplegia change position, air mattress?
71. Very high risk of for thrombosis major pelvic and limb surgery
72. Antibioma
73. Firearm- knife injury, difference b/w permanent and temp
74. Parathyroid absorption of calcium from renal and gut
75. Varisose vein STD
76. Diaphragm injury 5th intercostal
77. Urea and creatinine disbalance nsaid/ hypovolemia
78. Tissue edema- Dec O2 in alveoli/peripheral edema, delayed gastric emptying
79. Arrythmia patient- ecg
80. What is the minimum monitoring except JVP
81. Risk factor for wound infection malnutrition (what were the other options ?)
82. Parotid pleomorphic adenoma
83. Normal saline Na 154/ K-0
84. Normal req. Na: 5o-90 and k: 50
85. Most simple measure of nutrition weight
86. Sjogren syndrome lymphoma, rheumatoid arthritis?
87. Best measure to decrease post of complications nutritional status of patient (dont
remember the other options)
88. Koch postulate same result in different host?
89. Nerve sheath tumor acoustic neuroma
90. Tourniquet test hour, 1 hour
91. SIRS (wrong one out) - PCO2
92. Endemic cretinism iodine deficiency

Surgery 2
1. anal cancer asociation: hiv/ hpv
2. Inflammation of penis- balanopthsis
3. Sacrococcygeal teratoma - arises from cocyx
4.nesbit operation : peyronies disease
5.dm causing drug: tacrolimus
6. banding for 2nd degree piles
7.inj sclerptheray for first degree piles.

8. rectal drainage
9.per-rectal drainge
10.cortocosteroids:severe UC
11. commonest site for GI tumour GE junction
12.Hydatid cyst: albendazole
13.adhesion
14.non op cause: inflamotory
15.pseudocyst definiton
16.carcinoid: neuroendocrine cells
17.hemorrhoidectomy complication - retention of urine
18.heamorage,complication of prostatectomy
19.biliary pancreatitis/ pancreatic pseudocyst
20.ulcerative colitis scenario
21.hernia diaphragmatic: (incorrect) immediately after operation
22.pancreatitis-trypsinogen
23.antireflux surgery n PPI
24. H.pylori eradication therapy - ppi+metro+amox/ clarithro+ppi+amox
25.ritcher hernia (portion of intestine)
26.appendix perforation (symptoms)
27. finger tip - (hernia exam).
28 picture - sliding hernia/richter hernia/ interstitial
29.observation (mucosa of gall bladder)
30.hernia 6 month child(longest option)
31.convince mother(it will reduce chance of malignancy)
32. 12yr child come after orchidopexy decrease risk of malignancy
33.testis will not descend fully after 3 month
34.CBD stone- ERCP +laprascopic cholecystectomy
35.melanoma/ basaloid (radio-resistant)
36.ileal atresia
37.atresia (4 types)
38.Descent of testis maternal gonadotrophins
39. Cyst with renal failure - renal transplantation
40.femoral hernia - operate urgent in the groin
41.Torsion testic - inversion of testis
42.comonly associated with inguinal hernia
43.meckel cause of hemorrhage
44.direct hernia - mesh repair
45.type B gasritis/ type A gastritis
46. TB (calification)
47. nsaid ulcers perforated ulcer first treatment if resuscitate and analgesic for the first 48
hours perforated ulcer
48. cholangiocarcinome(stenting)
49.vietnamiese woman - Worm infection
50. splenic artery aneurysm -more in female
51.splenic ruptur -splenectomy
52. apendicitis(extremes of ages)
53. Appendix most commonly retrocecal
54.diverticulum of blader: cystoscopy
55.jj stent: decrease intra renal pressure or nephrostomy is preferred in infection / stent is
used to maintain patentcy of the renal parenchyma something
56.acute non specific proctitis/ ulcerative colitis ?
57.int obstruction- vomiting, constipation, pain, distension
58. UC (serosa clear,colon involved)
59.diffuse peritonits: diagnostic peritoneal lavage/ US-CT

60.ectopic vesicae associated with epispadiasis

61. Chordee - bending fwd
62.citrobacter (not a cause of epididymo-orchitis)
63.prostate ca (psa high)
64.dna testing(cystic fibrosis)
65. Hypospadiasis glandular type
66.early dumping(vasomotor symptoms)
67.upper GI endoscopy(endoscopy)
68.graft rejection: hla antigen
69.dentate line white, morpho plus surgical importance
70. Anterior duodenal ulcer perforates
71. Prostate invasion - T4N0M0
72. esophageal tef with distal tef
73. Pyelonephritis Urine DR and Culture / urea
74. Lung tumour - pancoast
75. colostomy with large bowel obstruction
76. Biopsy contraindicated in hemanigiomas
77.post cholecystectomy: pre-op symptoms
78. Sigmoid volvulus (band adhesion, pelvic mesocolon
79.anal fissure- child birth trauma
80.budd chiari- hepatic venous thromobosis?
81.stomach n duodenum(gist)
82. prostate plexus between capsule etc
83. endocrine neoplasm of pancreas seen on CT
84. UC associated with sclerosing cholangitis
85. ascites CHF
86. sickle cel elongated and disrupted cell
87. receptor Dr adhesin, type 1 mannose sensitive/ resistant ?
88. enterochromaffin cells in stomach histamine has major role
89. post thoracotomy pan injected between the plueral space
90. Mesentric infarction presents as ?
91. definition of apoptosis
92.patient with left chect trauma
93. suture used to close cystic duct Prolene ?
94 use of Ercp justified when therapeutic intent
95. radiographic feture of small bowel obstruction valvulae convintes

surgery osce :) combination of instruments , specimen and suture

By: Fatima Shaukat
Photos: 110

4:05am

Saba Bukhari
SURGERY OSCE
By Shaarmeen Chughtai in SMC batch 2013 (Files) Edit Doc
Examinations:
Abdomen
Hernias
Inguinoscrotal
Thyroid
Breast
Lump
Ulcer
Varicose Veins
DRE
Proctoscopy,
Parotid
Cervical lymphadenopathy
Long/short cases:
Hernia
Thyroid
CA esophagus
Abdominal examination
breast mass
varicose veins
body swelling(lipoma, sab.cyst, fibroma, breast)
parotid
hydrocele
cholysystitis
Pre n post management of pancreatic cancer
Thoracic injury
Urethral injury
Jaundice
biliary obstruction by stone
Basal cell cancer
squamous cancer
abdominoperitoneal resection of ca rectum
swelling in submandibular region since 4yrs
Colostomy/ileostomy"
cleft lip
splenic rupture
Anal fistula
Stomach cancer
Lung cancer
Renal cancer

Thoracotomy indications
Pancreatic pseudocyst
appendicitis,
electrolyte
Wound infectn,
T.B
thyrotoxicosis.
Fat embolism,
Rectal cancer
Rectal prolapse
Hemorrhoids
Biliary atresia
Pelvic abscess
SKILLS:
urinary catheterization
iv canulation
ng tube
cpr
INSTRUMENTS:
lehys
t tube
choledocholithotomy forceps
prolene suture + needle
curved artery forceps
drain bottle

Spots pics:
hemorroid,
diverticulum,
esophegeal atresia
acute pancreatitis
jaundice managment
urethral injury
Imperforate anus
Cystic swelling on oral mucosa
Diverticulosis
intestinal lumen having multiple polyps
(CT, xray, contrast xray, barium swallow):
distal shaft fracture of tibia fibula
Pnemo/haemothorax
Pyloric stenosis barium xray
Ca Colon,
ints.obst,
liver mets,
hydatid cysts,
achalasia,
esophag stricture,
fracture of hip,

forearm or leg,
dislocate shoulder/hip,
mammogram,
cholangiogram.
Xray KUB
ct scan of EDH/SDH
colle's fracture
Histories:
Ca esophagus,
incisional hernia,
ileostomy/colostomy,
inguinal hernia,
cholecystitis,
paraumblical,
breast mass,
thyroid,
varicose,
hemmorhoid,
lipoma/sebcyst,
fibroma,
parotid,
hydrocele,
testicular ca,
appendix,
perianal fistula,
pancreatitis,
obst jaundice,
ca stomach,
ca pancreas,
Ulcer,
melanoma,
squamous cell,
basal

4:06am

Saba Bukhari
MEDICINE OSCE FOR FINAL YEAR STUDENTS:
By Shaarmeen Chughtai and Rabia Zubair in SMC batch 2013 (Files) Edit Doc
SCENARIOS: 10 spots-15 marks each ( 4 to 5 stations)
1-heriditary spherocytosis
2-chronic myloid leukemia
3-coagulopathy(hemophillia)
4-microcytic anemia

5-sickle cell anemia

6-lymphoma
7-aplastic anemia
8-hypersensitivity rash
9-xanthelma
10-shingles
11-poisoning
12-snake bite
13-pneumonia
14-sarcoidosis
15-small call lung carcinoma
16-asthma
17-copd
18-pulmonary embolism
19-acute pulmonary edema
20-pnemothorax
21-dka
22-honk
23-lactic acidosis
24-primary biliary cirhosis
25-bacterial peritonitis( complication of ascites)
26-palmar erythema
27-acute pancreatitis
28-cholestatic jaundice and complication
29-liver abcess
30--nephrotic syndrome
31-nephritic syndrome
32-Meningitis(acute bacterial)
33-stroke
34-subarachnoid hemorhage (thunderclap headache)
35-tb meningitis
36-facial palsy
37-hydrocephalus
38-acromegaly
39-thyrotoxicosis
40-hyper and hypothyroidsm
41-graves
42-addisons
43-siadh
44-encephalitis
45-rheumatoid arthritis
46-gout
47-SLE
48-CCF

49-Right Heart Failure

50-MI
51-MI followed by atrial fibrillation
52-Atrial fibrillation
53-diarhea
54-celiac disease
55-trosseu's sign and tetanus
56-herpes zoster
57-henosch scholen purpura(picture..very confusing looks like sickle cell)
58-raynaud's phenomena
59-thallesemic baby( african child with depressed nose)
PRESCRIPTIONS:(medicine comprehensive) 1spot-15 mks
UTI
malaria
typhoid
tb meningitis
liver abcess-amebic
infective endocarditis
hypothyroidsm
CHF
rheumatic fever
asthma
fever
Instruments: 1 or 2 spots
Foleys
trucuts
ETT
insulin syringe
ngt
i/v cannula
ambu bag
lp needle
liver biopsy needle
chest drain
nebulizer
Xrays: 2 spots
miliary tb
consolidation(pneumonia)
massive pleural effusion
collapse
bronchiectasis
ccf
hydropneumothorax
cardiomegaly
copd
hemopneumothorax
pleural effusion
pnemothorax
pericardial effusion
cavitating lesion

unilateral lymphadenopathy
heart failure
calcified tb
ECG 1 spot
anterolateral MI
prolonged PR interval
inversion plus tall R- wolf parkinson
ST depression and T wave inversion
bradycardia
tachycardia
T wave inversion
MI
SVT
hypokalemia
RATE, RHYTHM, TREATMENT
LAB REPORTS 1 spot
CSF reprt-TB meningitis
Indirect bilurubinemia
hypochromic microcytic anemia
HISTORIES: 1 station 30 mrks
Joint pain-rheumatoid arthritis
melena(inves,treatment,varices, CLD)
reactive arthritis
tb
stroke
pedal edema+polyuria=nephrotic syndrome
cough and hemoptytis
copd
fits
sudden loss of consiousness(pg 207 concise)loose motioncyanosisstable anginachange of
bowel habits- colorectal carcinoma
VIVAS(please do big davidson for these topics) one viva! 30 marks
CVS :Atrial fibrillation with mitral stenosismitral stenosis,aortic regur, vsd, MI , MR,stable
angina
RES:copd, tb, pneumonia ,bronchial carcinoma , asthma
CNS :stroke , transverse mylitis, Epilepsy
GIT: crohn's , ulcerative
LIVER :cld , hep b , pbc , hepatic encephalopathy , varices
MSK :rheumatoid arthritis, osteoarthritis
D/M: dka
Examination 3 stations! 30 marks each-total 90 marks!!
precordium
splenomegaly
abdomen(CLD-Pg 209 concise)
GPE( can be goitre) dont forget lymph nodes
ascites
lower limb MOTOR
facial palsy

respiratory system(lung fibrosis/ collapse)

thyroid examination(do from dr zahid surgery book)
posterior chest ex
check power and reflex of lower limb
cvs : auscultate and tell the murmur
RHF signs!
check all the pulses
jaundice signs! comprehensive
rh arthritis

4:06am

Saba Bukhari
GYNAE N OBS.
By Neelum Agha in SMC batch 2013 (Files) Edit Doc
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OBS. 2011
Hemolytic disease of newborn = mother is D ve and neonate D+ve (tt)
Large SPH = mistaken dates (ct)
Small SPH = mistaken dates (ct)
Aim of safe motherhood = care by skilled health personal for child birth (tt)
Risk factor of thromboembolism in preg = throbophilia ??? (written in top in tt so)
Complication revelant to twin prg = preterm (tt)
Death in placenta abruptia = antepartum hemorrhage, dic ?????
Massive PPH = uterine atony (tt)
Anemia in preg = iron deficiency (tt)
Change in preg = raised esr (tt)
Stop bleed after uterine atony = massage (tt)
Regard NTD = anecephalocele, encephalocele, spina bifida (tt)
Purpose of booking visit = risk assement (tt)
Early preg scan = confirm dates (tt)
Screening = rubella (tt)
Oogenesis =diploid cell produce haploid by meiosis (tt)
Polyhyraminons = occur in uncontrolled diabetes (tt)
Adroid pelvis = deep transverse arrest (tt)
Gravid = all preg including current (tt)
Important point in obs hx = recurrent miscarriage (tt)
Reassuring sign in labour = head engaged ??? , longitudinal lie, clear amniotic fluid,
adequate pelvis, rupture membrane..
Most common cause of still birth world wide= antepartum hemmorrahge ???
Best regarding implantation = secretion of HCG start after implanation (ct)
Alet line on partogarm = ideal labour, progress 1 cm / hour, action line drawn. (all in tt, )

Fetal blood = reticulocyte more (ct)

Chorionic villous sampling = done after 10 week (ct, tt)
Uterine involution = return of uterus to its normal size of 100 gm (tt)
Embryonic period = 4-10 weeks (tt)
Bishop score less than 5 = vaginal pessaries (ct)
2 breeh vaginal hx, now again breech = bicornvate uterus (ct)
Fetal acidosis = FBS (tt)
Shifting patient = uterus is empty, no products ????
Women with rubella IgG ve = susceptible women should be advised against exposure (ct)
Secondary PPH = retained product of conception (tt)
Case of uterine inversion = push it back with compression (tt)
Reproduction = spermatogenesis is formation of mature sperms (tt)
High MMR = pulmonary htn (tt)
No of prim oocyte at birth = 2 million (gTT)
Development arrest of ovum = metaphase II (tt)
Genetic sex = conception ???
Mesonephric cord = ????
Gestatinal sac visible = HCG> 1500 (tt)
Development of ovary = two week later to testis and grow slowly (gtt)
Bp during preg = decrease (tt)
Baby, tachypnoic, grunting, cyanotic = RDS (tt)
Best assessment of age at 12 week = CRL (tt)
Best assesemnt at 12-20 week = BPD, HC, FL (tt)
Identification of choronicity = monochorionic has inc mortality (tt)
Nucal transluancy seen on u/s = 11-13 week (tt)
Cordocentesis = all true (tt)
Prenatal screen of CHD = one sibling and father affected has risk of 2% (tt)
Twin mortality 6 time more than single = pretem (tt)
Female, bp 155/105, protinuria, epigastric pain = cessarain ???
Antihypertensive in preg = methyldopa ???
Feature showing abruption = tense tender abdomen (tt)
Contraception in brest feeding =POP (tt)
Mitral stenosis patient, intervation = avoid ergotamine ???
Pre preg counseling of mitral stenosis patient = cardiac fuction ????
Screening of DM = OGTT ???
Hypethyroid female = still birth (tt)
MCV < 60, investigation = serum ferritin (tt)
Purities and sleep disturbance in preg = cholestasis of pregnancy ???
Dection of hep B = Hbs ag ??
Regard hep B = brest feed immediately after active and passive immunization ???
Anatomy of female pelvis = has three planes ????
Fetal scalp = bones approximated, not fused ???
Attitude of fetus = flexion or extension of head relative to upper cervical spine (tt)
Normal duration of labour = < 8 hour in multipara (tt)
Syntocinon not given in multi = uterine rupture, uterine hyperstimulation, uterine inertia,
fetal compromise ?????
Partogaram = show events of labour ????
Best about labour = spontaneous, single, between 37-42 weeks (tt)
Contra of ventous = face presentation (tt)
Contra of forcep = head high up (tt)
Principal of ventous = head, not just scalp should descend with each pull (tt)
Brech delivery = call senior help obs ki bandi????
Secure bleeding = secure angles of incison of cs (tt)
Position in cs = tilted left lateral with head down (tt)

Previous cs, lower segment placenta now = placenta accrete

Indication of c. hysterectomy = p. previa (tt)
Female in labour since 16 hour, cervix 16 cm = cervical dystocia ???
Female 32 week, 40 week SPH, fulid thrill = polyhydramnos ???
Child died, cord felt on vaginal exam = cord prolapsed
Female in labour, raised bp and fits = termination of preg ???
Female in current preg, previous 3 birth, 2 live, one still and one miscarriage = G5 P 3+1 ???
At 34 week, hb 7 gm = infusion of iron sucrose ????
Neonatal admin in UK = 10 % (tt)
Neonate in intensive care = jaundice, mother has chd, premature ???
Apgar = grimice is response to suction cath (tt)
Lactational amenorrha = due to dec LH pulse (tt)
Most import feature of contraception = effectiveness ????
Not cause of fits = diazepam over dose
GYNAE RECALLLED 2011
Epithelium of vagina = stratified squamous (tt)
Size of uterus = 7.5*5*3 (tt)
Lies posterior to inguinal ligament =
Dorsal position of examination = commnest, embarsising, best for bimunual
examination ????
Ph of vagina = 3.5-4.5 (tt)
7 year old girl with menstruation = gnrh analogue (tt)
Hormonal control of menstruation =
Proliferative phase = mistosis seen in stroma and glands (tt)
Hormonal control of puberty =
20 yr old, married 10 month, present with prim ammenorhea = height ??? (top on list in tt)
Primary amenorrhea, most comprehensive hx = development hx (tt)
Best to confirm anvolunatory cycle= ultrasound (tt)
Sequence of test for sec. amenorrhea = pregnancy, prolactine, tsh, lh (tt)
Amenorrhea due to excersice = (tt says hypothalamic failure, dont remember options)
Early preg loss in endometriosis = luteal phase def (tt)
Coitus interuptus = timming
Contra of IUCD = malformation of uterus (tt)
Contra of IUCD = active pid
Minilap = reversible sterilization (tt)
Abortion with misoprotol =
Women had evacation of hm, need contraceptive advice = COC ???
Important point about coitus = coitus frequency ????
Intrauterine insemination = tubal patency
Constant feture of ectopic = ammenorhea, pain and syncope, ????
Women missed cycle 7 days ago = serum beta HCG (tt)
Abortion due to trauna, consul = missed abortion not due to trauma ????
8 week preg, os close, fetus dead, slight bleed, chance of spontaneous abortion = ????
Partial mole incidcnce = 1:700(tt)
Partion mole = triploid
H.m , for diagnosis = beta HCG
Charactersitc of leiomyomata = urinay frequency, varicose veins, menorrhagia, pain,
subfertiligy ????
Treatment of endometriosis = ocp given without break (tt)
Epithelial ovarian tumour = peak incidence 50-69
Ovarian cyst = torsion
Colposcopy = cervix (tt)
Urine tract endometriosis = cyclical hematuria and dysuria (tt)
Treatment of vin III = excision biopsy (tt)

Vulval cancer in form of nodule = radiacal vulvectomy

Myometrial invasion of endomentrial cancer = ???
Effects of estrogens = ????
2nd trimerster missgacarege, = bacterial vaginosis (tt)
Color less vaginal discharge, inc pre menstrual = physiological discharge ???
Dignossi of genital tb = raised esr, tuberculin test, chest x ray, montoux test, pcr????
Women had abortion followed by infection = Chlamydia (tt)
something coming out of vagina + urinary symtomps = cystourethrocele (tt)
spontaneous + provoked contraction of bladder = detrusuer instability (tt)
symptom of cystocyle = urine frequency (tt)
cause of uv prolapsed = child birth (tt)
vasomotor symptoms of menopause = hot flush and night sweets (tt)
contra to HRT =active liver disease (tt)
breat exam to exclude = tumours ???
intermenstrual bleeding nt responseive to progesterone = cervical polyp, cervical
ectropion ???
endometrium showing nuclear atypi and disordered growth = atypical hyperplasia ???
secondary amenorha since 6 month, heavy vaginal bleed, now biopsy show = proliferative
phase ???
endometriap polyp diagnosis = hysteroscopy (tt)
what if dead embryo left inside = infection ???
regarding methotrexate = give if embroyo less than 3.5 cm ???
slow growing mass in lower abdomen since 6 months = ovarian cyst, fibroid ????
first stage of puberty = growth spurt (tt)
commen presnt of benign ovarian tumour = asymptom (tt)
gold stanadard of ectopic = laproscopy (tt)
women underwent d and e, presents with bleed = RPOC (ct)
women underwent evacuatin of mole, important of histo report = take aporopiate action (ct)
female files litigation = histo report (ct)
women para 6, something communing out vagina = uv prolapsed
6 month old infertile copule, most imp q to wife = age of female partner (ct)
Mandatory for assisted reproduction = controlled ovarian stimulation (tt)
Posterior vagianl fornix = culdocentesis (tt)
18 year old female, anemic, menorrhageia = mefanimic acid (ct)
Endometrium = supplied by spiral arteries (tt)
Anatomy of uterus = all was true as per tt L
42 year, Obese, hypertensive women, menorrhageia = endometrial carcinoma (ct)
Ovulation sign = basal body temp (tt)
Risk of DVT = 1 % (ct)
Degree of menorrhagia = no of tampons (tt)
Post pill amenorrhea = suppression of hypothalamus (ct)
External feature of turner = webbed neck (tt)
Menorhagia, normal uterus, normal ovargy = DUB (tt)
You chose laproscopy for infertile women = endometrisis is visible (tt)
4*4 cm fibrid near cervix = hysterectomy (ct)
Dead fetus 14 weeks, mode of abortion = ????
Ovarian tumour = BSOP and hysterectomy for over 45 year (tt)
38 year old menorrhagia need contraception = levonorgesterol IUD (tt)
case of molar pregnancy investigation - longest answer with xray and suction
2nd degree UV prolapse treatment - vaginal hysterectomy with anterior colporrhaphy (tt
pg205 states that it should be vaginal hysterectomy with adequate support of vault)
gold standard for endometriosis -laproscopy
indication for hysteroscopy - bleeding
uroflowmetry is a part of routine uroflodynamics

case of PID with adnexal mass

Women present wit excessive bleeding?......hysteroscopy
regarding ovarian tumors? most common benn is serous cystadenoma
IU LNG ? Its also used in menoragia

Gynae OSCE :)
By: Fatima Shaukat
Photos: 42

4:07am

Saba Bukhari
IMPORTANT MESSAGES:
Skin:
itch,blistrs,leg ulcrs,eczma,psoriasis,acne,sq.cel ca,basal cel ca.
Davidsn say yeh topic parh k baqi skin short sE
CNS:
Headache n facial pain
Dizines,blackouts n funy trun
Coma n brain deth Stroke
Subarachnoid hemarhage
Multiple sclerosis
Acute transvese myelitis
Alzimer Parkinsons n akinetic rigid syndrm
Huntington Motor neuron disease Infection of cns(all
topicz)NeoplasmsHydrocephalusCervical n lumbar spondylosisCopresion of cordTrigerminal
neurpathyBels palsyMyasthenia gravis
Musculoskeletal:
osteoarth, RA, Seronegativ spondylo, crystal asosciated disease ( till CPPD depositn), bone &
joint inf (excluding viral), systemic C.T diseases, systemic vasculitis, osteomalac & rickets,
pagets, osteogen imperf, osteopet

Emergency topics: asthma, MI, stroke, PE, pneumothorax. Rx writing: TB, asthma, typhoid,
malaria, meningitis, IE, UTI, pep ulcer, hypo/hyper thyroidsm, DKA.Autosomal dominant
disorders:DOMINAN
DystrophyOsteog imperfctaMarfan'sIntermittent porphyriaNeurofibromatosisAdult polycys
Achondroplasia kdnyNoohan's syndTuberous sclerosis
Heredit spherocytosisHypercholestrmiaHuntingtonsManagemnt of a splenectomizd pt.!
1-vacinate wd these,2 wks b4 splenectmy:-pneumococcal-h.influenzae type Bmeningococcal grp C-influenza2-life-long prophylactc penicilin/ erythromycin.fwd: Remember
to identify lesion in stroke pt.1.specific sensation loss---> lesion in cortex2. Sensation loss at
contralateral face and trunk---> lesion at internal capsule (uncrossed
hemiplegia)3.Sensation loss at ipsilat face and contralat body---> lesion at brainstem
(crossed hemiplegia)Infectious diseases in med:PUO, acute diarhea (til antidiar agents),
chronic diar (pocket). Measles, rubella, only slapd cheek syndrome 4m parovirus,
chickenpox, shingl, mumps, influenza, IM, CMV, dengue, herpes simp. Staph, strept typhoid,
GIT infections (u may do them 4m pock & undrline extra points in big bk), diphtheria,
leprosy. Malaria. Amoeba, giardia, ascaris, schistosom. Candidiasis (superfic, system),
histoplasmFwdd.Neuro topics: LP, headache nd facial pain, coma, tests 4 cnfrming brain
stem death, dizines & funy turns, brain stem lesions, tab 26.24, 26.26, papiledema,
headache synd, vestib disordrs,epilepsy, disordrs of sleep, stroke, SAH, Multipl scl, transvrs
myelitis, alzheimers, parkinsons, wilsons,huntingtns motor neuron, meningits, alzheimer,
cereb absces, neurosyph, tetanus, botulism, raisd ICP

4:09am

Saba Bukhari
1st day 2nd shift surgry osce:
INTERACTIVE:
thyroid exam
hernia exam
abdominal exam(paraumblical hernia)
Hx on epigastric pain radiating to back(acute pancreatitis)
viva on Hx topic
skill> Male cathetrization
counselling on gall bladder cancer metastasis
NON INTERACTIVE:
cleft lip/palate pic
colonoscopy pic
scenario thyroid CA
scenario hemorrhoids
Xray radius fracture
xray pnemo?hemothorax
suture silk+self retaining retractr

4:10am

Saba Bukhari
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4:10am

Saba Bukhari
SURGERY OSCE: Do all examinations: abdomen, hernias, inguinoscrotal, thyroid, breast,
lump, ulcer, varicose veins, DRE, proctoscopy, parotid, cervical lymphadenopath. Do
coresponding histories of these topics.
Topics on which v gt long/short cases:
hernia, thyroid, ca esophagus n abdominal examination.
SKILLS: we got urinary catheterization, bt iv canulation, ng tube, cpr ana chahye
INSTRUMENTS
we got lehys n t tube.

4:10am

Saba Bukhari
http://www.slideshare.net/amir9935/surgical-instruments

Surgical instruments

www.slideshare.net
A detailed description of instruments used in surgery, including photographs taken in CG Hospital,
Davangere, India.

4:11am

Saba Bukhari
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surgery osce :) combination of instruments , specimen and suture

By: Fatima Shaukat
Photos: 110

4:11am

Saba Bukhari
Concept OSCE for Paeds is a must. See pictures from Kundi
4 Vivas Confirm: 1 on counseling of mother on IMCI and breast-feeding (Practice that in
URDU) 1 history and viva from mother

Optional: 1 on abdominal OR GPE (learn the values and the method on how to do FOC, AB
Girth, MAC, Ht, length) 1 on Kwashiorkar and Marasmus OR 1 on CNS (meningitis) OR Growth
and Development Milestones
Prescriptions and ECG dont come in Paeds OSCE.
1 instrument (do them from Concept
2diagramatic scenario
Topics: Mumps, Chicken Pox, Measles, Henoch Schonlein purpura (Learn their investigations,
management, complications and pictures)
VERY Imp topics for scenarios: Celiac Disease IBS and IBD (differences between them)
Thalassemia AML, ACL, ALL Polio Vaccination JRA Meningitis Malaria Pneumonia Glycogen
Storage Disease (Blue diaper disease) Neonatal Jaundice Kernicterus
IMP from Protocol: (treatment, DD etc) Diarrhea ARI Fever

4:11am

Saba Bukhari
TODAY'S GYNAE OSCE
2 nd SHIFT :
UNOBSERVED STATIONS
PCOS
ABTENATAL CARD
OVARIN CARCINOMA
RUBELLA
ECLAMPSIA
IRON DEFICIENCY ANEMIA
SUCTION CUREETE & HAGERS DILATOR
VENTOSE CUP
COPPER T IUCD
HYDATIDIFORM MOLE
MOLAR PREGNANCY
TWIN PREGNANCY

4:12am

Saba Bukhari

learn any 5 of these points after translating them in URDU: (5 from each baby and mother)
ADVANTAGES OF BREASTFEEDING
FOR BABY
1. Due to the anti-infective properties of breast milk, breastfed babies tend to have less
incidence of or less pronounced symptoms of ear infections, respiratory illness, allergies,
diarrhea, and vomiting.
2. Due to the digestibility of breastmilk, breastfed babies are rarely constipated.
3. The stools of breastfed babies are mild-smelling.
4. SIDS (Sudden Infant Death Syndrome) is less common in breastfed babies.
5. Breastmilk is constantly changing in its composition to meet the changing needs of the
baby. It has the exact combination of protein, fats, vitamins, minerals, enzymes, and sugars
needed for the human infant at various stages of his growth.
6. Breastfed babies are constantly exposed to a variety of tastes through their mother's milk.
7. Breastfed children are at less risk for chrohn's disease and juvenile diabetes.
8. Children who were breastfed are less likely to need orthodontic work such as braces due
to the unique sucking action required with breastfeeding. They also seem to have better
overall dental health than formula-fed children. Children who were breastfed need speech
therapy less often than those who were bottle-fed.
9. IQ levels are an average of 8 points higher in children who were breastfed.
10. Adult daughters who were breastfed are at less risk for breast cancer.
11. Adults who were breastfed have a lower risk for high cholesterol and asthma.
12. The bond between mother and child seems to be enhanced with breastfeeding.
FOR MOTHER
1. Nursing immediately following delivery causes the uterus to contract lessening the risk of
postpartum hemorrhage.
2. The uterus of a breastfeeding mother shrinks to its pre-pregnancy size more quickly.
3. Calories are burned while breastfeeding. It takes approximately 20 calories to produce an
ounce of milk.
4. Women who nurse their babies for at least 6 months lessen their chances of premenopausal breast cancer.
5. Osteoporosis and cervical cancer are less common in women who breastfed.
6. The return of fertility is delayed with breastfeeding.
7. Breastfeeding is more economical than formula feeding. The cost of formula for 12
months is approximately $1000 - $1200.
8. Breastmilk is always available, clean, and the right temperature.
9. Many mothers feel a special satisfaction in knowing that they alone are meeting the
nutritional needs of their babies.

4:12am

Saba Bukhari
https://www.youtube.com/watch?v=GSshV8k3JWM&feature=youtube_gdata_player

OSCE Clinical Skills -Pregnant abdomen

www.youtube.com
Sample from 'Ace the OSCE' a Prize Winning OSCE Video Library. 100% Pass rate by subscribers last year and
100%Money Back Guarantee you pass your OSCEs! Real...

4:12am

Saba Bukhari
http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/mechani
sm_of_normal_labor.htm

Mechanism of Normal Labor

www.brooksidepress.org
Usually, labor progresses in this fashion, if the fetus is of average size, with a normally positioned head, in a
normal labor pattern in a woman whose pelvis is of average size and gynecoid in shape.

4:13am

Saba Bukhari
Gynae/Obs : second shift, Anatomy hall A :
Station 1: ventouse cup station 2: miscarriage station 3: iron deficiency anemia blood report.
Station 4: p/a abdomen station 5: antenatal viva station 6: cervical dilator and uterine
suction curette. Station 7: antenatal card station 8: hydatidiform mole picture station 9:
eclampsia and management station 10: pelvic bone viva station 11: pcos station 12: rubella
station 13: ovarian tumor station 14: twin pregnancy station 15: multi load station 16:
vaginal discharge history station 17: vaginal discharge viva

4:13am

Saba Bukhari
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set=a.10151281003931120.457048.678931119&type=1

Paediatrics OSCE pics

with thanks to our professor!
By: Hassaan Khan YousafZai
Photos: 67

4:13am

Saba Bukhari
GYNAE OSCE 22nd SEPT 2012 HALL A
hx menorhagia
next sattion per usi ka viva n ur d/d of the pt( uterine fibroid tha mere patient ko)
PA
antenatal per viva taken by civil gynae HOD :@
labor stages on dummy pelvis, breech delievery ki postion dikhani thi dummy per
unobserve:
ventouse cup
sims speculum
volsellum
preterm labor
recovery ka ik station tha bht ajeb tha woo
abortion

hyatdform mole
rubella
hep E
ocp
Iron deficiency anemia
cancer ovary
placenta previa

4:14am

Saba Bukhari
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Gynae OSCE :)
By: Fatima Shaukat
Photos: 42

4:14am

Saba Bukhari
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4:14am

Saba Bukhari
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med xrays
By: Rehan Hyder
Photos: 42

4:15am

Saba Bukhari
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medical instruments
By: Rehan Hyder
Photos: 8

4:15am

Saba Bukhari
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peads xrays
By: Rehan Hyder
Photos: 14

4:15am

Saba Bukhari
http://www.damle.org/instruments/DrDamleInstruments.pdf

http://www.damle.org/instruments/DrDamleInstruments.pdf
www.damle.org

4:16am

Saba Bukhari
For gynae osce u need to do Cncept only n irfan fr a fw viva topics!
It ix 80%repeatd
2 instruments
One abdmnl examintn
One pelvimetry(boundries ov pelvis)or dlvry or brech dy mite ask u indictnx n causes of
breech ax wel
One randm viva mine ws on prenatal visits
One hstry
One diagnosis Ov hstry investigatnx causes treatment etc.
N v had 12 statics i gues including instruments
Aik pre op.cre pe note
One scenario on hydtifm mole
One iron dficncy anemia report
2 specimes oe ws ov hydatifm mle grape lik cluster
One spot ws on cntraceptivs
another spot. Ws on hep. E

4:17am

Saba Bukhari
Medicine Prescriptn writing.For malaria,typhoid n tb do cncpt. tb meningts same as tb bt add
tab prednisolone 5mg 2+2+2+2 then taper gradualy,
infctve endocrditis
inj benzyl penicilin 1.2g 4hourly 4wks
inj gentamicin 1mg/kg 8hrly 2wks
hypothyroidism.
Tab thyroxine 50ug o.d 3wks
thn 100ug o.d fr 3wks
adjust maintenance dose aftr 6wks.
Amebic abces
tab metronidazole 400mg
1+1+1 for 10days
tab chloroquine
1+0+1 fr 14days.
Chf
inj furosemid 40mg i.v b.d
tab captopril 6.25mg
1/4th tab b.d

tab isosorbide dinitrate

10mg tds

4:17am

Saba Bukhari
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