Problem (1)

Fawzia Hassan Al Taher is 55 yrs old female admitted to the female

surgical word in Ibrahim Malik Teaching Hospital. She is complaining of
pain in right iliac fossa for 4 days, associated with vomiting in the first day,
no change in bowel habits, no urinary symptoms.
O/E:
Look ill .temp. 37. 5C
Pulse 90/min B.P 120/80mmhg.
Abd. Examination: tenderness and rigidity with palpable mass in the right iliac
fossa.
The treating doctor told her family that there is no need for operation now.
Questions:
1. Mention 3 possible important diagnoses?
1-Appendicular mass
2-Appendicular abscess
3-CA cecum
2. Mention 5 important questions supposed to be asked to Fawzia?
1-Is the pain followed by the vomiting or preceded.
2-Where the pain started.
3-Is there’s any pervious attach .
4- Is the pain worse by movement or cough.
5-Is there’s anaroxia
3. Mention 5 important investigations, which help you in your diagnosis?
1-CBC for leuckocytosis
2-Urine analysis (hematourea)
3-US
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 4-CT
5-Laproscopy

4. Outline the initial management for such case?

Bed rest for the fires days
Analgisa, antibiotic and IV fluid
marke out the size of the mass then if the mass resolve carry out
interval appendectomy after 3 months

Mention 4 indications to stop this form of treatment and shift to surgery?

Increase the size of the mass
Temperature fail to settle
Abscess formation
If pt toxic and tachycardia

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 Problem (2)
A 39years old lady, presented to her doctor with recurrent attacks of pain at
upper quadrant (R.U.Q) colicky, associated with vomiting, yellowish
discoloration of sclera and itching, dark urine and pale stool.
O/E : she was jaundiced. And had tenderness on R.U.Q.
1. Mention three possible causes of her problem.
Gallstones
Cholengiocarcenoma
Traumatic strcture
2. Mention three basic specific investigations
Abdominal US
MRCP
CT scan
3. Her doctor decided to subject her for surgery, mention 5 steps for
preparation.
Check PT
IV vitamine K
IV fluid
IV antibiotic
Fasting
4. Mention 2 surgical options for this problem.
If the gallstone in CBD explore the duct at time of cholecyctoctomy or
remove at ERCP and sphincterotomy
If the cause CA of head of pancrase whipple’s operation
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 Write short notes on the following:
(1) Complications of burns
Hypovolmic shock
Infection
Inhalation injury
Stress ulcer (curling’s ulcer)
Marjolin’s ulcer
Contraction

(2) Causes of intestinal obstruction

Dynamic
in the lumen fecal impact, gallstone ileus
In the wall stricture
Outside strangulated hernia
Adynamic paralytic ileius and mesenteric vascular occlusion

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 Problem (1):

A 30 year old man was knocked down by a speeding car. When brought to the
emergency room he was in pain with a pulse of 120 per minute, blood pressure
100/60 and respiratory rate of 40 per minute. He had bruises and lacerations on his
left lower chest with severe tenderness on touching the lower left ribs.

1- What are the organs expected to be injured?

Spleen , diphrame, plurea , left kideny

2- What is your initial management?

Airway

Breathing

Circulation

When seen hours later, the pulse was 130 per minute and blood pressure of
90/40. On examining the abdomen, there was a tender left upper abdomen.

3- how can you explain this deterioration?

Hypovolmic shock due to bleeding due to ruptured spleed

4- How are you going to manage this patient at this level?

Give blood if still un stable midline incision for total spleenoctomy is

preformed

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Problem (2):

A 50 years old nulliparous lady presented with painless lump on her left breast.
Physical examination revealed hard 3 cms lump.
1. Mention the provisional diagnosis?
CA breast
2. Mention two differential diagnoses?
fibroadenoma
CA breast
3. Mention three investigations you have to do them?
Mamography
Chest US
True cut Biopsy
4. Outline the management for your provisional diagnosis?
simple mastectomy combined with axillary clearance
wide local excision with postopratve adjuvant therapy

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Problem (3):

A 35 year old gentleman, known case of mitral stenosis, presented to emergency

room with severe sudden right calf pain.
1. What is the most likely cause of his calf pain?

2. What are the other important symptoms and signs expected in this patient?

3. What is the urgent treatment?

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Problem (4):
22 years old medical student while driving his car to college sustained RTA. She
presented to Emergency dep. She complains of sever head ache, during examination
she collapsed and went into deep coma.

1) What is the most probable diagnosis?

Extradural hematoma
2) What are the clinical criteria supporting diagnosis?
The age of the patient
The complain due to trouma
Lucid period the pt was conscious the she got comatos
3) What is the most important investigations to be done?
CT brain will appear lens shape and thiking of the bone in affected area
4) What is the proper management?
Burr hole carnotomt
5) What is the prognosis?
Good

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Problem (5):
3 days old neonate has normal anal opening presented with delayed passage of
meconium and developed abdominal distension and vomiting.
1) What is the most likely diagnosis? 7

2) How can you clinically confirm your diagnosis?

3) What are the initial steps in the management of this neonate?

4) What is the best radiological study will help you in the diagnosis?

5) What the next step to do to reach a final diagnosis?

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Problem (6):
35 years old man presented to (A & E) c/o sever colicky right loin pain which
radiates to groin with Red Urine. He was Not taking any medicine:
1) What is the most likely cause of his problem?

2) Mention 3 possible causes?

3) What immediate Treatment you do?

4) What are the relevant investigations which can help you to reach diagnosis?

5) What are the steps you do to treat this condition?

6) Mention 3 complications which can happen if this condition is not treated

properly?

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Problem (7):
50 years old male patient, from Gazera area, has very low Haemeglobin. He is
admitted for blood Transfusion, what are the steps to do so as to arrange for blood
Transfusion.
1- Blood group and and cross matching
2- Pt in ABO and Rh group
3- If blood required urgently O negative may be given
4- write the name and date of birth and unit number
5- CBC for hemoglobin.
6- Prepare calcium for hypocalcemia

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Problems
1
A 27-year-old male presented to the emergency room with a 6-hour history
of sudden onset severe epigastric pain. He had past history of hunger pain.
On examination, the patient looked ill; pulse rate was 104/ min, BP 110/70.
There is generalized tenderness and board like rigidity all over the
[Link] sounds were absent. White blood cell (WBC) count was
8,000 and temperature is 37.4°C.

(1) Mention three possible differential diagnoses?

Perforated DU
Acute pancratits
Acute cholecystitis
Preforted appendistits
MI

(2) Mention two important blood tests?

LFTs for serum amaylase
CBC

(3) Mention one important radiological investigation?

Abdominal x-ray erect .

(4) Outline the initial treatment?

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 (5) What is the definitive treatment?

Suture of the ulcer with omentum patch

(6) Mention three drugs that should prescribed to the patient after definitive
treatment?

2
A 15-year-old boy sustained penetrating trauma to the left upper part of
his abdomen. On examination he was pale, blood pressure was90/60, pulse
rate was 120/min and respiratory rate was 16/min. On abdominal
examination, there was generalized tenderness and distention.

(1) Discuss the initial treatment for this patient

(2) Mention 3 important blood tests?

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(3) Mention 2 important radiological investigations?

The patient was planned for urgent laparotomy. Spleen was found to be
injured and splenectomy was done.
(4) Mention 3 important complications of this operation?

The doctor recommends postoperative vaccination.

(5) Mention three types of vaccines?

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3

A 55-year-old man had progressive difficulty swallowing for three months.

He can now only manage a liquidized diet and has lost approximately 12kgs
in weight. He is a heavy smoker with a moderate alcohol intake, but has no
other past medical history of note. On examination he had obvious signs of
weight loss.
(1) Mention another 3 important symptoms you should ask?

(2) Mention another 2 important signs in clinical examination?

(3) What is your diagnosis?

(4) Mention one important investigation to confirm the diagnosis?

(5) Mention two important radiological investigations?

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4
A 42-year-old man presented with severe right iliac fossa pain for 6 hours.
The pain was colicky and radiated to the testes. There was no anorexia or
vomiting. On examination the patient looked ill, not pale with normal
examination of the abdomen.
(1) Mention two differential diagnoses and which is the most likely?

(2) What is the initial treatment for this patient?

(3) Mention 4 important investigations and expected findings?

5 A 25 year old man is brought to the emergency room after sustaining burn
during a fire in his apartment. He has blistering and erythema of his face,
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neck, left upper limb and anterior trunk. He is agitated, hypotensive and
tachycardic. (His weight is 60 kg).
(1)Outline the steps of emergency management?

(2) What is your estimation (percentage of surface area) of his burn?

(4) How would you replace fluids and what type of fluid?

One day later, he vomited small amount of blood.

(5) What was the cause?

6 A 5 -day- old neonate presented with abdominal distension and failed to pass
meconium. On examination, there is marked abdominal distention and empty
rectum.
1) What is the most likely diagnosis?

2) What is the aetiology of this condition?

3) Mention one investigation to confirm the diagnosis?

4) Mention one radiological investigation that help to determine the extent of this
condition

5) Outline the initial treatment?

6) What is the definitive management?

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