كل يوم case 🫀🩻🩺

اليوم هستري ال lump جدا بسيط ان شاءالله يجي بوحده من المحطات بعد التحيه والسلام وتقديم النفس واخذ المعلومات الشخصيه نسئله 7اسئلة فقط 1|شكد صالها عندك 2|شوكت طلعتلتك 3|وين مكانها 4|هل انت لاحظتها او شخص اخر 5|شنو الاعراض الي اجتك وي هاي lump صخونه الم Do you have any fever, weight loss, night sweats, or loss of appetite? ……………………………………………………… *Symptoms depend on type of lump مثلا اذا بالثايرود تسئلون على Difficulty swallowing or breathing, hoarseness اذا بال بريست تسئلون على skin changes وال damp او nipple discharge Hernia: symptoms of obstruction (vomiting, constipation, ascites, reducible or not, anything can increase abdominal pressure) 6| progressive خفت راحت ازدادت طلعت بمكان ثاني اكو وقت معين تزداد 7|وحده بس طلعتلتك لو اكثر من وحده يعني مو سنكل لا تكول multiple 8|تسئلي على تاريخ الماضي مالته 😂هاي موجوده بكل هستري شنو ماخذ علاجات شنو مسوي عمليات الأمراض المزمنه العندك شكرا عندك العافيه #osce4

Regarding contrast study for intestinal obstruction: Gastrografin is preferred to barium for studying distal small bowl 1/Gastrografin has no therapeutic potential 2/Gastrografin is less hazardous than barium if aspiration occurs #surg1 3/Gastrografin can cause serious fluid shift Barium can convert partial small bowl obstruction into complete obstruction

A 7-year-old boy fell from his bicycle and described landing on his outstretched right arm in abduction with the elbow in extension. He complained immediately of severe pain around the right elbow, but no other parts of his body were painful. He has presented to the emergency department. Examination Inspection of his right elbow reveals some swelling. On palpation of the elbow, he has most tenderness across the lateral aspect of his distal right humerus. This tenderness is associated with a significant reduced range of motion of the elbow flexion and extension. He has no neurovascular deficit of the arm. A radiograph is shown in Fig. 8.1. بالصوره ماشفت كسر واضح ؟وين موجود ؟ • What is the diagnosis? • How would you classify this ? • How would you manage this patient? lateral condyle of the humerus

A 34-year-old lady presented to the emergency department with painful swelling of left elbow after fall from downstair and X ray showed elbow dislocation; most probable associated fracture is? #surg2 lateral condyle of humerus medial condyle of humerus olecranon fracture capitellum fracture

A 4 years old boy presented to the outpatient clinic with painful swelling of right elbow joint after fall on ground and x ray revealed supracondylar fracture of humerus with posterior displacement of distal piece: the most fear complication? Brachial artery injury median nerve injury ulnar artery injury radial artery injury

#surg2

هذني مو يجيبون منهن وانما نفس النمط يحبون يجيبون مثلهن واحد يتدرب عليهن

• What is the diagnosis? • How would you examine this young patient? • How would you manage her injury? • What are possible complications of this injury? #surg2 • There are two types of supracondylar fracture: the extension type (most common) and the flexion type. • A fall onto an outstretched hand may lead to an extension-type fracture whereas a fall onto the elbow produces a flexion supracondylar fracture. • Examination of the degree of swelling and deformity as well as an assessment of neurological and vascular status of the forearm is essential. • The nerve most commonly injured is the anterior interosseous branch of the median nerve. • Treatment of undisplaced fractures comprises collar and cuff or an above-elbow plaster. Treatment of displaced fractures comprises manipulation under anaesthetic and stabilization with plaster and/or wires.

A 6-year-old girl was playing on a trampoline in a garden when she fell off. She landed on the grass but developed pain and swelling in her elbow immediately. Her mother took her to the emergency department. The elbow is markedly swollen and tender in the distal humerus both medially and laterally. The girl is reluctant to move the elbow owing to the pain. Assessment of the neurovascular status of the limb reveals a palpable radial pulse with no neurological compromise. A radiograph is shown in Fig. 13.1.

A skin traction B collar and cuff sling C broad arm sling D hip spica E gallows traction F internal fixation G complete bedrest and immobilization H manipulation under local anaesthesia and backslab I long thumb spica cast J analgesia ! encourage weight-bearing For each clinical scenario below suggest the most appropriate management. Each option may be used only once. 1 A 24-year-old man presents with a swollen painful hand after falling over playing squash. X-ray reveals a scaphoid fracture. 2 A 75-year-old woman presents to A&E with groin pain and inability to bear weight following a fall. X-ray reveals an undisplaced fracture of the superior pubic ramus. 3 A 65-year-old woman presents with a displaced extracapsular fractured neck of femur. 4 A 35-year-old woman presents after a fall on an outstretched arm. X-ray shows a minimally displaced surgical neck fracture of the right humerus. 5 A 75-year-old woman presents to A&E with a displaced Colles fracture. #surg2

A compartment syndrome B osteoporosis C pneumothorax D ulnar nerve injury E pulmonary embolus F median nerve injury G delayed union H Sudeck’s atrophy I malunion J myositis ossificans K haemarthrosis L radial nerve injury For each clinical scenario below give the most likely cause for the clinical find- ings. Each option may be used only once. 1 A 25-year-old man presents with a blue right arm with absent radial pulse and painful passive finger extension following a supracondylar fracture of humerus. 2 A 40-year-old woman presents 5 weeks after a radial fracture with a painful swollen hand. The hand is cold and cyanosed with heightened temperature sensi- tivity. 3 A 70-year-old woman complains of right-sided pleuritic chest pain 10 days after a fractured neck of femur. 4 A 60-year-old woman complains of pain, swelling and reduced mobility 4 months after suffering a fractured tibia. X-ray shows absence of callus at the fracture site. #surg2 5 A 65-year-old woman who falls on her outstretched arm has weakness in wrist extension.

A Colles fracture B scapular fracture C posterior dislocation of shoulder D olecranon fracture E anterior dislocation of shoulder F scaphoid fracture G Galeazzi fracture H fracture of clavicle I Monteggia fracture J supracondylar fracture K fractured humeral shaft L Smith’s fracture For each clinical scenario below suggest the most likely injury that has resulted. Each option may be used only once. 1 A 24-year-old woman presents with pain on wrist movements after falling on her hand. On examination there is tenderness and swelling in the anatomical snuff box. 2 A 68-year-old woman presents with a fracture of the distal radius with dorsal displacement of the distal fragment after a fall. 3 A 7-year-old boy presents with a swollen painful elbow following a fall. He is unable to move the arm due to pain. 4 A 19-year-old rugby player falls on a backward stretched hand and presents with loss of shoulder contour and absent sensation in the military badge area below the shoulder. 5 A 40-year-old woman presents after a fall on an outstretched hand, with pain in the upper arm and a wrist drop.

There are 2 important lines described which help in the diagnosis of dislocation and fracture .

A 75-year-old man develops hematochezia and presents with blood pressure of 90/60 mm Hg and heart rate of 120 beats/min. His vital signs improve slightly with crystalloid and packed red cells infusion. Which of the following is consi- dered the most appropriate next step(s) in management? A. EGD, proctosigmoidoscopy, and a barium enema B. NG tube, proctosigmoidoscopy, and a tagged RBC scan with or without mesentery angiography C. NG tube, mesentery angiography, and colonoscopy D. EGD and colonoscopy E. Preparation of the patient for emergency operative intervention Which of the following conditions is almost always associated with painless hematochezia? A. Bleeding from Crohn colitis B. Ischemic colitis involving the descending colon C. Bleeding duodenal ulcer D. Superior mesentery artery embolus E. Aortoenteric fistula developing 1 year after an abdominal aortic aneurysm repair Which of the following diagnostic modalities has the greatest specificity in identifying the source of lower GI tract bleeding? A. Tagged RBC scan B. Barium enema C. Colonoscopy D. Surgical exploration E. CT scan

A 67-year-old man presents to the emergency department with a 6-hour history of bleeding per rectum. The patient’s symptoms began after he developed an urge to defecate that was followed by several voluminous bowel movements contain- ing maroon-colored stool mixed with blood clots. The patient complains of feeling light-headed just prior to arriving at the hospital but denies any abdominal pain. His past medical history is significant for borderline hypertension managed with diet control. His surgical history is significant for a right inguinal hernia repair 2 years ago. His blood pressure is 100/80 mm Hg, pulse rate 110 beats/min, and respiratory rate 20 breaths/min. The results of an examination of his abdomen are unremarkable. The rectal examination revealed no masses and a large amount of maroon-colored stool in the rectal vault. What should be your next step? What is the most likely diagnosis? How would you confirm this diagnosis?

من باب الطمئنينة محطة ادوات تخدير محطة جراحة أطفال محطة breast imaging ذني ثلاث محطات مضمونة للي يريد بس ينجح يعني... عندك بعد 9 محطات (اغلبهن زينات) اذا كل وحدة تكول بس اسمك هم ينجحوك😂🤍