1. National University of Singapore Department of Surgery OSCE 24 January 2005 Warning! Begin only when told to do so Begin

2. 1 1 4 4 7 7 10 13 16 2 2 5 5 8 8 11 14 17 3 3 6 6 9 9 12 15 18 Question Number 24 Jan 2005 OSCE Question a.Give 3 differentials based on just inspection alone. (3 marks) b. On examination, the left testicle is hard, non-tender and enlarged. Give 3 relevant serum tests you would do. (3 marks ) c.What is the surgical management and the appropriate incision to remove this testicle? (4 marks) 01 A 37-yr old man noticed that his left scrotum was getting bigger over the past 2 months. This picture is taken with the patient lying down.

3. 1 1 4 4 7 7 10 13 16 2 2 5 5 8 8 11 14 17 3 3 6 6 9 9 12 15 18 Question Number 24 Jan 2005 OSCE Question a.Describe the abnormalities seen on this X-ray. (4 marks) b.Give your likely diagnosis & 2 differential diagnoses? (3 marks) c.What is the most appropriate immediate treatment for this patient? (3 marks) 02

4. 1 1 4 4 7 7 10 13 16 2 2 5 5 8 8 11 14 17 3 3 6 6 9 9 12 15 18 Question Number 24 Jan 2005 OSCE Question a.What is your diagnosis? (2 marks) b.What is the most useful staging investigation at the time this picture was taken? (2 marks) c.What are the common complications of this lesion? (3 marks) d.List the modes/routes of spread of this disease. (3 marks) A 70 year old lady presented to hospital with vomiting and epigastric discomfort for 1 month. Examination revealed that she was mildly dehydrated. A vague swelling was palpable at epigastrium. Blood investigation showed that she had microcytic anemia. A gastroscopy was performed and revealed an ulcerating lesion at atrium. 03

5. 1 1 4 4 7 7 10 13 16 2 2 5 5 8 8 11 14 17 3 3 6 6 9 9 12 15 18 Question Number 24 Jan 2005 OSCE Question a.Describe the lesion seen & give your diagnosis. (3 marks) b.What would this patient complain of before presenting to the Emergency Department? (3 marks) c.What predisposing conditions may result in this lesion? (2 marks) d.If conservative treatment fails, name an operation to treat this. (2 marks) 04

6. 1 1 4 4 7 7 10 13 16 2 2 5 5 8 8 11 14 17 3 3 6 6 9 9 12 15 18 Question Number 24 Jan 2005 OSCE Question This patient presented with right sided abdominal pain and fever. This investigation was done. a.What is this investigation called? (3 marks) b. What does it show? (3 marks) c.In the context of the diagnosis you are considering, name 4 other findings that the investigator should look for. (4 marks) 05

7. 1 1 4 4 7 7 10 13 16 2 2 5 5 8 8 11 14 17 3 3 6 6 9 9 12 15 18 Question Number 24 Jan 2005 OSCE Question a.What is this sign called? (2 marks) b.Explain the phenomenon seen in the right eye? (2 marks) c.What is the probable cause of this lesion? (2 marks) d.What is the best immediate management? (2 marks) e.What long-term complications may result from this if left untreated? (2 marks) A 38 year old lady presented to the outpatient clinic with a swelling over the right preauricular region. Excision of the lesion was performed. The picture shows the appearance a week after the surgery. 06

8. 1 1 4 4 7 7 10 13 16 2 2 5 5 8 8 11 14 17 3 3 6 6 9 9 12 15 18 Question Number 24 Jan 2005 OSCE Question a.What would you like to ask during history-taking? (3 marks) b.What diagnoses would you consider? (3 marks) c.How would you establish the diagnosis? (2 marks) d.What are the principles of surgical management of this condition? (2marks) This 84 yr old Chinese lady complained of a nodule growing on the skin of her right forehead. 07

9. 1 1 4 4 7 7 10 13 16 2 2 5 5 8 8 11 14 17 3 3 6 6 9 9 12 15 18 Question Number 24 Jan 2005 OSCE Question a.Give 2 differential diagnoses of this lesions. (4 marks) b.Name a simple test to confirm the diagnosis. (3 marks) c.What treatment would you recommend. (3 marks) 08

10. 1 1 4 4 7 7 10 13 16 2 2 5 5 8 8 11 14 17 3 3 6 6 9 9 12 15 18 Question Number 24 Jan 2005 OSCE Question 09 A 23 year old female complaints of sudden onset pleuritic chest pain on the right-hand side and shortness of breath. The Chest X-Ray in A&E is shown. a.What is the abnormality seen? (3 marks) b.How would you treat this condition? (3 marks) c.What surgical treatments are available for this condition? (4 marks)

11. 1 1 4 4 7 7 10 13 16 2 2 5 5 8 8 11 14 17 3 3 6 6 9 9 12 15 18 Question Number 24 Jan 2005 OSCE Question This patient presented with a mass in the left neck. 10 a.Name 3 possible conditions. (3 marks) b.List 4 areas you would examine. (4 marks) c.List 2 investigations you would order. (2 marks) d.What operation would you perform? (1 mark)

12. 1 1 4 4 7 7 10 13 16 2 2 5 5 8 8 11 14 17 3 3 6 6 9 9 12 15 18 Question Number 24 Jan 2005 OSCE Question This child was diagnosed to have biliary atresia at birth. 11 a.What is the likely condition of the liver now? (4 marks) b.What is the cause of the abdominal distension? (3 marks) c.Name the definitive treatment for her current condition. (3 marks)

13. 1 1 4 4 7 7 10 13 16 2 2 5 5 8 8 11 14 17 3 3 6 6 9 9 12 15 18 Question Number 24 Jan 2005 OSCE Question a.What are the abnormalities seen on this ERCP? (4 marks) b.How would these patients present normally? (2 marks) c.Name 2 long term complications of this condition? (4 marks) 12

14. 1 1 4 4 7 7 10 13 16 2 2 5 5 8 8 11 14 17 3 3 6 6 9 9 12 15 18 Question Number 24 Jan 2005 OSCE Question A 50 year old lady presented with breathlessness and was found to have a hard mass in the right breast. a.Describe the Chest X-Ray findings? (3 marks) b.What is the treatment for this chest condition? (4 marks) c.Name three methods to obtain histological diagnosis of the right breast mass. (3 marks) 13

15. 1 1 4 4 7 7 10 13 16 2 2 5 5 8 8 11 14 17 3 3 6 6 9 9 12 15 18 Question Number 24 Jan 2005 OSCE Question A 50 year old man was found unconscious on the floor. An urgent CT scan was done. a.What are the likely neurological signs of this patient? (4 marks) b.What is the treatment for this condition? (3 marks) c.What is the long term prognosis and likely neurological deficit? (3 marks) 14

16. 1 1 4 4 7 7 10 13 16 2 2 5 5 8 8 11 14 17 3 3 6 6 9 9 12 15 18 Question Number 24 Jan 2005 OSCE Question An 80-year old man presented with painful inability to pass urine. a.What is the finding in this picture? (3 marks) b.After catheterisation, give 3 investigations you would do in the ward. (3 marks) c.Creatinine is raised at 288 mmol/l. A renal ultrasound confirmed bilateral hydronephrosis. What do you do next? (4 marks) 15

17. 1 1 4 4 7 7 10 13 16 2 2 5 5 8 8 11 14 17 3 3 6 6 9 9 12 15 18 Question Number 24 Jan 2005 OSCE Question A woman of 48 years presented with a 6 months history of right loin discomfort. On routine testing of her urine the GP found that she had a urinary tract infection. She was referred to the Urology Department for further investigations. a.What does this X-ray show? (3 marks) b.What is the cause of this lesion? (2 marks) c.What is the further management of this patient? (5 marks) 16

18. 1 1 4 4 7 7 10 13 16 2 2 5 5 8 8 11 14 17 3 3 6 6 9 9 12 15 18 Question Number 24 Jan 2005 OSCE Question A 50 year old patient presented with upper gastrointestinal haemorrhage and gastroscopy was performed. a.What other procedure may have been performed during gastroscopy? (3 marks) b.Describe the findings in the gastrocope image. (4 marks) c.What is the likely prognosis? (3 marks) 17

19. 1 1 4 4 7 7 10 13 16 2 2 5 5 8 8 11 14 17 3 3 6 6 9 9 12 15 18 Question Number 24 Jan 2005 OSCE Question 18 a.What are they? (2 marks) b.What should be done next? (3 marks) c.What lifestyle factors can reduce the risk of recurrence of this disease? (5 marks) A 52 -year old man presents with gross haematuria. IVU showed normal upper tracts but at cystoscopy, these lesions were seen.