OSCE-Surgery

• Burns on legs• 4 complications

local

-wound contractures

-scarring (full thickness)

general

-infection

-shock

-renal failure from initial hypovolemia d2 plasma loss

-psychological disturbance

• Breast Ca with ulcer• Describe• T staging of TNM

-T1:<2

-T2:2-5

-T3:>5

-T4:skin invasion/chest wall/ both• Clinical type of breast Ca (4 marks)

-Phylloides tumour

-Invasive ductal Ca

-ductal Ca in situ

-medullary Ca

Thyroid lump-multinodular goiter• Ix before operation-TFT-ultrasound-thyroid isotope scan-FNAC• 2 presenting featuresLocal mass efffects:-stridor-dyspnoea-dysphagic-SVC obstruciton

Polycystic kidney• 2 symptoms:

-haematuria

-loin discomfort

-hypertension

• 2 associated symptoms:

-berry aneurysm

-liver cyst

Marjolin ulcer• Long standing venous ulcer- squamous cell carcinoma

• Neck Swelling• Describe (6 marks)• 2 differentials (2 marks)

-goitre

-throglossal cyst

-lipoma• What would you ask patient to do (2 marks)

-swallow saliva-goitre

-protrude tounge-thyroglossal cyst

– Carcinoma of the breast(a) and (b) Characteristic skin dimpling over breast carcinomas. This may be a subtle sign and only be visible in tangential light. (c) Nipple retraction and widespread 'peau d'orange' resulting from a large central breast carcinoma. Peau d'orange is caused by a combination of cutaneous infiltration by tumour and skin oedema (and occasionally by infection). Locally advanced breast cancer may cause distortion of the breast. The colour change and ulceration are uncommonly seen and only occur in neglected cases. Note also the puncture wound of a core biopsy (arrowed). There was no obvious axillary node enlargement.

• Pic of pt with left breast Ca• Describe (5 marks)

• Diagnosis (2 marks)

-breast ca• 3 investigations for this patient (3 marks)

-clinical

-radiological-u/s (<35 yrs old) ,mammography(>35 yrs old)

-cytopathology- Fine Needle Aspiration Cytology

4th degree haemorrhoids

• 40 yrs old, male with anal pain• Diagnosis: hemorrhoid 3◦

• 4 causes:

-constipation with prolonged straining

-congestion from a pelvic tumour

-pregnancy

-portal hypertension

-CCF