Final Surgery Exam - Female

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This exam is divided into two parts

Part 1:

The Written Exam:

Date: Saturday, 14/1/2012

Time: 9-11:30  (1:30 min/ MCQ)

Venue: Main auditorium

Number of MCQs: 80 (0.375 grades/ MCQ)

What is included in the exam?

All lectures, sessions and tutorials that we took are included in the exam except these topics:

Medico Legal Issues, the Common Congenital Anomalies lecture, the Brain Tumors tutorial.

Sources for the Exam:

Official sources: Current, Bailey and Love, Toronto Notes, Scott and Browse

But if you don’t have time to study them, all interns assured me that you can study Recall or Mont Reid with Toronto Notes for the Urology and Orthopedics plus some sheets from previous years and it will be enough inshAllah.

Important points:

  • Common MCQS are important, especially for the subspecialties
  • Half of the exam will be from GS (40 MCQs) and the rest is from the subspecialties (6-7 MCQs/ subspecialty)
  • There are extra files and recordings of some extra sessions and revisions done by doctors during the last 2 weeks. You will find them in the Surgery Lectures topic.
  • Don’t forget the interns course sheets, especially the Colorectal Cancer and Drains and Tubes, which are available in the 6th Year Preparatory Course topic in the Forums.

A Suggested Way of Studying from a Consultant:

When you study, start with the most important topics that you should cover for both the written and the oral, and then go to the least important.

Study each system alone and cover all the topics in that system together so you can compare them together.

For example, study all the GI system diseases together so you can know the difference.

  When you memorize the investigations and management, be SYSTEMIC, that is the key and you have to know WHY they are done.

What you should do is DON’T wait for the doctor to ask you why you said this or that, you mention each investigation or a management option with mentioning WHY you mentioned them.

The most important topics are:

GS:

GI SystemAcute Abdomen, Hernias, Intestinal Obstruction, Upper and Lower GI Bleeding (VVV important!!!), Appendicitis, Colorectal Cancer, Perianal Diseases, IBD,

Biliary Tract, Pancreas and PUD.

OthersBreast Cancer, Thyroid Gland, Trauma, pre and post op preparation and complications.

Regarding the perianal diseases, these are the important points that dr.kensara has mentioned

1- Deferential diagnosis of anal diseases : benign : hemorrhoids, fissures,.. malignant: anal carcinoma,… (he said u don’t have to know the malignancy in details, just know the names) __ 2- Don’t perform PR examination if the patient have anal fissure. ___ 3- In order to differentiate between an abscess and anal fistula, take a swab for culture, if there is anaerobic organism so it’s a fistula. If it’s a staph it will be an abscess. __ the rest of the information that he mentioned are similar to what is written in Recall.

Subspecialties:

Urology: ALL of it from Toronto Notes.

Orthopedics: The Fractures and Orthopedics Emergencies are VERY important.

Neurosurgery: Head and Spinal Cord injury, Dermatomes and Myotoms, Peripheral Nerve examination and injuries. The answers for the MCQs that will come in the exam from Dr.Addass’s lecture are: Radial nerve, Carpal tunnel syndrome.

Plastic Surgery: Wound healing, Burns, grafts and flaps.

Vascular Surgery: Acute and Chronic Limb Ischemia, DVT, Diabetic Foot.

Pediatric Surgery: I.O., Bleeding, Pyloric stenosis, Esophageal anomalies, intussusception, Meckel’s Diverticulum.

The rest is important for the written, but leave it to last:

Endocrine Surgery, Skin Lesions and Tumors, Thoracic Surgery, Cardiovascular Surgery, Stomach Cancer, Carcinoid Tumors and Fistulas.

There are some topics that are not part of a lecture or a session but are very important for the exam. They are:

Shock, Surgical nutrition, surgical infections, fluids and electrolytes, drains and tubes, stomas, Carpal Tunnel Syndrome, Lymph Adenopathy (from Current or Bailey and Love), radiology (Mammogram, chest and abdominal X- rays), antibiotics, and the tumor markers.

The best source for these topics is Mont Reid

The Anatomy is very important for both written and oral exams (it is better to refer to an anatomy book)

Part 2:

The Short Clinical Cases Exam:

Date: Sunday, Monday, Tuesday and Wednesday, 15 -16 -17-18 /1/2012

Time: From 8 AM to 4 PM. The students will be divided to 2 groups, one in the morning and the other one in the afternoon

Oral Exam NAMES

Venue: The female and male surgical wards, 5th floor

The number of cases: Each student will have 2 cases, 20 min/ case

Each student must be examined in 1 GS case and one subspecialty case. The subspecialties included in the oral are (Orthopedics- Neurology -Vascular- Urology)

The sources for the Oral:

They are the same as the written, except if you don’t have time to study Browse, study the small book for the examination by Dr.Hamad Al Qahtani, which is available in Jareer Book Store for 60 SR. It is really nice and you can finish it quickly.

How is the Exam Going to be?

You will withdraw a piece of paper, which has the 2 cases that you are going to be examined on. In each case, you will go in this order:

The history, as usual, but don’t forget the risk factors and the precipitating factors as they are very important.

The examination, you will be asked for a specific thing like examine for organomegaly or the foot. Investigations, management, differential diagnosis and the discussion will be last.

  1. You should be systemic (labs first then radiology then specific investigations), the same applies to management (start with the preventive measures then go to the conservative then to the surgical options).
  2. In the discussion about the case, you will be asked extra questions about the case and other topics.
  3. If you forget to mention any important information that was a part of the checklist, you will lose marks.
  4. You will be asked about the pre/post operative preparation and complications in any case. They are VERY important.
  5. In peripheral nerve examination the most important nerves are written in dr.Addas’s book (p. 7-8)

Very important notes from Dr.Saleh’s meeting on Tuesday:

  • Orthopedics and Urology cases will be from their tutorial topics.
  • GS cases will be from the ward. You can visit it until next Wednesday.
  • There will be a checklist for each case. Here is an example for the Thyroid check list
  • The radiology included is (Mammogram, chest and abdominal X-Rays). Examples for the cases are: Pneumothorax as a trauma case, Acute Abdomen and Breast Cancer.
  • The neurosurgery oral topics are: Head and Spinal Cord injuries and Peripheral Nerves examination and injuries.
  • The Diabetic Foot case will be considered as a GS or a Vascular or a Plastic case but most of the times it will be considered as a Vascular case.
  • IV fluids are VERY important and you will be asked about them in any case. They are important for the written as well.
  • Acute and chronic limb ischemia and DVT are common as vascular short cases.
  • Burns and skin tumors will NOT come as a short case, but they are very important for the written. Basic principles of grafts and flaps and the skin tumors classifications are important for the MCQs.
  • The nutrition is NOT included in the written or the oral according to Dr.Saleh. However, previous years told me you have to be asked about it in any short case. It is better to study it.
  • We will not be asked about cases like Liver Cancer or Lung Cancer even if they are in the ward, but they might come in the short case as another case.
  • The drains and tubes part will be a part of the station, not a whole station. Dr.Saleh said that if he asks about them, it is for to give the student extra marks to get to the 90.

The Sheets:

 

All sheets are available in Alandalus library.

The lectures will be in a file arranged according to their number in the schedule: 2- Pre-Operative Assessment and Management (including surgical site infection, fluid and electrolytes). 2-Trauma (ABC, Abdominal and chest). 3 -Esophageal Disease. 4- Gastrointestinal Bleeding. 9- Intestinal Obstruction + Cancer Stomach, PUD. 14- Genito-Urinary Tumors, TB in Genitourinary, and the new study guide.

The library has a lot of sheets from previous years that can help you.

The important sheets that we know about are:

For the midterm:

Trauma sheet, Al Omda sheet, Breast Cancer sheet (it is the same as Prof.Merdad’s lecture), Toronto Notes the updated version 2011 (it is important for all subspecialties (Urology and Orthopedics), the common MCQs for all subspecialties (the GS MCQs will not be useful as Prof.Merdad said he will not repeat them this year), and Surgical Notes.

For the final exam:

Orthopedics Examination sheet, Diabetic Foot sheet, Vascular Diseases, Shock, the big Urology sheet, the big Orthopedics sheet and the Plastic Surgery sheet by Dr.Saleh.

The sheets are NOT available in Al Afaq.

Good Luck :)
اللهم لا سهل الا ما جعلته سهلا و انت تجعل الحزن ان شئت سهلا

Sources Committee : Ruba Felimban
Website Committee
6th year Female Leader: Wesal Abualkhair

40 Responses to “Surgery Final Exam”

  1. السلام عليكم …الله يعطيكم ألف عافية و يوفقكم يارب
    بس كنت أبا أسئل ياوصال محا يكون في
    inactive زي الميد تيرم ؟
    و لمن يقسمونا لي قروبين الي بعد الظهر يجو من 8 و لا متى ؟
    و تسلمي ياعسل

    • Wesal Abualkhair says:

      Wa Alakom Al salam,
      There is no inactive OSCE. It will be only written wich accounts for 30 marks and the short cases which account for 30 marks.
      The first group in the morning has to be in the 5th floor at 8:30 AM SHARP!!!! The second group is NOT allowed to come before 12:30 PM and should be there 12:30 SHARP as well.
      In the morning group, every hour 10 students will be examined from 9 to 12. In the afternoon group, every hour 8 students will be examined from 1 to 4.
      You have to get your stuff with you, like the stethoscope, the hammer and the flash light.
      Rabana yofikom :)

  2. ايش دا 80 سؤال على ساعه ونص ؟؟؟

  3. Wesal Abualkhair says:

    My dears,
    1) ER LECTURES ARE INCLUDED!!!!!!!!! Dr.Saleh just informed me with that. It is a separate module and it is a MUST to have questions from them. Focus on what Dr.Ebtisam and Dr.Hisham said in their lectures.
    2) Some files have been uploaded to the Surgery Lectures topic at the end in the Extras section. They are:
    Breast Cancer soft copy of the sheet that is in the library.
    Thyroid Examination sheet by Dr.Saleh Al Daghal.
    Saturday’s Ortho points.
    X-Rays in Ortho Trauma Patients.
    Updated file of Dr.Simbawa’s how to prepare for oral.

    3) I got the Thyroid and the Abdominal Masses files for the preparatory course. Check the Forum.

    4) Here is a check list of all the topics that you should cover in Surgery. Use it when you study:

    http://www.4shared.com/file/-GqrTjPl/Main_subjects_to_study.html

    Allah Yefth alakom. Say sobhan Allah wal hamed le Allah wala ellah ella Allah wala hawal wala koata ell be Allah when you study, it helped me :)

  4. ممكن نفهم يعني أيش
    It is a separate module !!

  5. Wesal Abualkhair says:

    Dear girls,
    These are the Antibiotic tables that Dr.Widinly told me about from Shwartz’s book and I told you about them last Saturday:

    http://www.4shared.com/file/vDccKYsz/Table_6.html

    The staging of Breast Cancer from the sheet that we uploaded yesterday in the extra section, which is the same one in the library, is old. Check the updated one from Current or eMedicine.

    The ER important points from Dr.Simbawa, Dr.Ebtisam and Dr.Hisham will be available tomorrow inshAllah in the evening. The ER is a module that accounts for 2 hours from the 24 hours of the Surgery course. Prof.Mashat said that they have to put at least from 4 to 5 MCQs from the lectures. I know it is last minute, but if you study the important points, they will be enough inshAllah and everything from Allah is good.

    The Urology revision is tomorrow in the ESWL class from 9 to 11 inshAllah. I will record it and upload it for you. I am sorry the revision wasn’t sooner, but the doctor was busy these past three days.

    Raban yofekom we yesehal alena kolana yarab.

  6. Hi girls, my name is in the morning patch .
    anyone knows if we are going to be held after the exam ?
    or we are allowed to go?
    please answer me … it;s very important

  7. تم إضافة ملفين لليورولوجي في موضوع المحاضرات :)
    متوفرة طبعًا في مجلد المشاركة

    بالتوفيق للجميع :)

  8. The mcqs which the dr. mentioned in cardiac disease lecture:
    @Indication for intrvention in VSD.
    @Risk factors for CAD
    @Types of cardiomyopathy.
    @HOCM is a cause of death in young males.
    @type A & B of aortic dissection.

  9. hi 
    this is the cases that i collect
    -pancreatitis.
    -colecystitis
    -lap chole
    -dm foot (alot)
    -breast mass alot لاتنسو تفحصو اللمف نود لانو بعضهم عندهم 
    -thyroid swelling
    incisional hernia
    para umbilical hernia
    ingunial hernia
    lower limb weakness
    brain tumer
    bldr stone
    renal stone
    bph
    bed sore
    wond infection مررررررررة زاكروة كويس لانو في كزا مريض
    pulmonary embolism
    ——

    هادا الأيميل من ألانترين أظن اسمها غدير اللى أون كول اليوم

  10. تم إضافة ملفات الطوارئ ومراجعة اليورولوجي في موضوع المحاضرات :)

    بالتوفيق للجميع :)

  11. السلام عليكم
    ممكن تعملوا سكان لحلول الام سي كيوز حق الاروثو

    ادري الوقت ضيق …
    بس ربنا يوفقها اللي تنزلو

    شكرا لكم

  12. ®Toxocology lecture .impo. MCQs
    @ cholinergic DUMPLE>>>>diarrhea
    ®Contraindcation to charcol AHLI MCQs
    ®Acetamenophen antidote>>Nactylecystine. Combination
    ®mcq toxin seen by X ray.
    ®slide toxicity
    ® alkli and acid effect on both stomach and esophegos.
    ®mammelian bites
    Dogs powerfull jow bacteria cabnocytophaga
    Cats bite sharp with its bacteria.
    The sechule.
    Cotralida , elipeda. Which is cytotoxic which neurotoxic.

  13. Wesal Abualkhair says:

    Girls
    Here is a brief feedback from most of the girls who had their exam today:

    DON’T PANIC!!! just relax and sleep very well. The test will take 10 minutes not 20 minutes. Your attitude is the KEY in the exam. They want to see if you have manners with the patients and if you have a systemic way of thinking in the management and investigations you order for the patient. They will ask you, what will you do for this patient when he comes to the ER? You can be tested on ANY case whether it is GS or subspecialty. Some students had 2 GS cases and some of them had 2 subspecialty cases.
    It depends on the examiner. The girls who were with Prof.Ashy were asked in details about the hand anatomy and Carpel Tunnel Syndrome. The students who were with Prof.Merdad were shown Mammograms and were asked about them in details.
    What you should cover is:
    All common topics, Colon, Biliary, Diabetic foot, Thyroid, Breast, Hernia, Upper and Lower GI bleeding, Ortho fractures, Bladder cancer, BPH, Stones, instruments, all X-Rays and mammograms.
    However, you might have some weird cases like carotid body tumor, pleural effusion and some rare cases.
    One student told me if you read Surgical Notes sheet and read Recall from A to Z, you will answer inshAllah a lot of their questions and you will do well inshAllah. No one was failed today wa al hemed le Allah.

    Rabana yofikom :) .

  14. hey girls
    i got two cases both of them were general
    1st case examiners were dr.thubaity and dr. towairgi (uro) the case was colon cancer, they told me to take history then we discussed
    1.intistinal obs. causes and DD, then colon cancers sign and symptoms,inv. , staging and management,, etc
    2. colostomy indications, prep, complications
    3. 5th day post op complications (general and local)
    4. bowel prep before RT hemicolectomy which was the done to the patient
    2nd case was breast lump + accessory breast tissue with dr. kensara and dr. sayad (uro)
    1. 3 questions in hx (they dont really pay attention to what ur saying )
    2. examination
    3. disscussion ( approach, investigations, biopsy types, findings in mammo, staging, management)
    its direct dont worry ,they didnt ask me about stuff i didnt know already..good luck allah yesahelakom

  15. my case was myasthenia gravis>>>thymoma>>>>thymectomy with dr. algethmy and dr. suha.
    Hx ask 2 quistions
    كم عمرك
    27
    ايش تشتكي منو
    من بعد رمضان ضعف في الذراع اليسار
    طيب وايش كمان
    عندي وهن عضلي
    طيب!!

    وبعدين ايش سويتي من بعد رمضان
    جيت المشتشفى وموعد وشالو لي الغدة الزعترية

    summarize HX!!!
    protocol of thymectomy.
    side of gland+blood supply
    sing of myasthenia gravis+ why there is weakness in her arm ?? is it paraplagia??
    pathophysiology
    why we do CTscan
    why we do x-ray
    pre op preparation
    then CXR + read it??????!!!!!!!!!!!!!

    الحمد لله على كل حال
    بس الصراحة الحق انها ميديسن اكثر من سيرجري

    other case with dr.merdad and dr.alhebshi
    breast cancer>>> just mamograme
    it was straight forward
    every thing from the sheet.
    والحمد لله
    ربي يكتب الخير للجميع

  16. Roaa cases :
    1- breast mass : fibroadenoma .
    Hx as breast cancer ( risk factor , symptoms of mets )
    Very easy case.
    2- neck mass : parotid enlagment.
    How to manage ?!
    As neck mass ( ultrasound , FNA )
    What is most likely diagnosis ?!
    Parotid .
    What is causes ?!
    Benign or malignant
    What stracture pass through it?!
    Facial nerve
    What is its branch ?!

  17. Drdina Hemdi says:

    myasthenia gravis>>>thymoma>>>>thymectomy!!!!!!!!!!!!!!!!!
    انصدمت

    neck mass : parotid enlagment !!!!!!
    parotid gland in face ( on front of ears ) not neck

    وبعدين يعني خلاص الحالات الكومون عشان يسالو في هده الحالتين

  18. Sunday PM batch
    I.O case..
    Read x-ray..is it small or larg bowel obstruction..how can you diff..causes of I.o
    Wt is the cause of fecalith vomit..bacterial fermentation..wt Bactria?bacteriod
    Normal amount of urin/day
    If you did afull investigation to pt with small bowel obstruction and u couldn’t find a cause ..wt to do?OR
    Answers from the DR him self
    ———-
    2-DF
    Take hx(Intrermitied cludication)
    Ex vascular
    Investigation/management
    Asked alot about antibiotic/F&E/septic shock (I wasn’t prepare well for these)
    What do you see in x ray of diabetic pt?forign body/air in sof tissue/osteomylitis/vascular calcification(answered by dr)
    If patient is nephropatic do you give gentamycine?wt you give?
    -•———-
    الحمد لله الذي لايحمد على مكروه سواه
    Plz pray for me

    Don’t be stressed out Cuse it will ruin every thing and you will forget alot
    Relax and sleep well

  19. afnan samman says:

    Hey Girls;

    This is yasmine speaking. I logged in from afnan’s account coz i do not have one of my own.
    Sorry for the extremely late reply but i slept like donkeys the moment I came back home. Anyways, nedkhol fel mohem. FACTS about today’s exam are as follows:

    1) Each station was only 10 minutes and not 20. Do not expect that you will be left to take an appropriate history and examination like what we have been exposed to in the previous years.
    2) You do not get to choose your cases. Each one of us today was assigned a lajna and cases beforehand. Ma kan fe (قرعه) wala bateekh.
    3) The station was directed i.e. you are asked questions and are expected to answer them. You will not be left to t7oosy and try to find out the diagnosis, so for those who still have time, don’t study like you will be given a complain and you have to work your way through it till the end and know what the diagnosis is.
    4) Mafy shay esmo case general w case subspecialty. You get what you are destined to get. Some of us were examined in 2 general cases, others were examined in 2 subspecialties.
    5) Some students got very typical straightforward cases, others had beautiful surprises! This time, we were not examined in only the common cases. Unexpected things came up. One of my cases was esophageal cancer presenting with mets to the bone!? (NO COMMENT). I was asked about how to investigate and manage mainly.
    6) We were not examined according to the organization we expected. I was one of the first 4 to have examined today though i was supposed to be 6th in order.

    MY OPINIONS AND RECOMMENDATIONS (NOT FACTS) are as follows:

    1) Don’t F****** panic. Though all of these surprises arose today NONE OF US FAILED! Don’t listen to anyone or anything negative. Focus on the task at hand and here are some tips on how to make the best of the time you have left.

    - Study the instruments and imaging very well. At least all of us were either asked about a device or asked about an x-ray, CT-Scan, or mammogram.
    - Cover the common topics QUICKLY as if studying them for the written exam. Don’t try to know how to differentiate between colon cancer and diverticulosis when presenting as an abdominal mass by history, just freaking read colon cancer and know everything about it.
    - Read ALL of the subspecialties section in recall. It will help you answer in case you got weird stuff alot. Cover everything coz as you see i was asked in thoracic surgery today.
    - On the exam day, do not dare panic or get a mental block. Those of us who did well today were not those who knew most, but those who were calmest and dealt with the cases strategically, as in gave options for investigation and treatment proving themselves safe doctors not surgical geniuses.
    - Be there as early as before the exam starts by half an hour.
    - Pray for calmness and composure, ask god for althabat and everything else of course and you will be having my prayers as well.

    Do not hesitate to ask if you have any questions…

    Best of luck Med07
    You go kick a**!

  20. heartbeat says:

    mar7ba
    i got 2 cases (GS and Uro )
    case 1 with dr.3adel (10 min)
    the patient had a hematuria
    u have to ask about the risk factors all (occupation ,chemical exposure ,radiation , smoking , …., dont forget to ask about the mediaction like anticoagulants )
    the dx was bld cancer
    histology ?
    most common presentation ?
    investigation ?(cbc ,urinanalysis,cytology ,u&e to asses al kidneys,c&s “if the patient has a LUTS” , us and cystescopy)
    staging and how to manage ? “broadly if T1 & T2 TURBT and intravesical chemo or immuno (BCG ), if T3 DO radical cystectomy +pelvic lymphadenectomy and in case of female u have to do hysterectomy and bilateral salpingo oopherectomy , T4 pallative u have to mention chemotherapy )

    case 2 was with dr.kensara (6-7 min)
    thyroid he ask me to skip the hx part and start in al examination
    inspection , palpation “dont forget the trachea” , percussion ,auscultation for bruit over the gland indicate disturbance of flow and hyervascularity )
    investigation 3 most common (TFT , thyroid antibodies and US ) the initial workup

    that’s all
    rabana ma3akoooom

  21. shemoo0oo says:

    Alsalm 3likom

    I had 2cases GS one:

    Pt with RUQ abd. Pain take history(dr.messari, one of uro dr.)
    DDx
    Invesgation (dr.messari gave LFT and ask me to read it) , when to say its obstructive jaundice from LFT ( ALP,GGT)
    Causes of jaundice

    2 case dr.mo5tar, dr.ban8sh

    Gall bladder stone

    Take history,examination ( how to measure liver span)
    DDx
    Labs
    How to prepar pt to OR
    Who to treat ? lap cole
    Pt 1 day develope fever ? Cause
    Type of wound in lap cole

    Insha2 allah every thing will be good

    Allah ma3ok

  22. Hi everybody
    My cases were :
    1- GS with dr.mokhtar & dr.bangash
    Lymphoma .
    Pt. Has fever 3 months ago with past history of lymph node enlargment.
    Take history
    Examination : inspection & palpation only ( i couldn’t feel any palpable gland)
    Then disscusion
    What is DD ?!
    Benign : infection 
    Acute infection :( URTI , tonslitis )
    Chronic infection : TB
    Malignant :
    Lymphoma ( hodjekn , non hodgkin )
    Definative investigation to deffrentiate between them ?!
    Biopsy .
    What you see if it is TB ?!
    Granoluma , ceasiating type.
    What is the treatment ?!
    Medical : isoniazde , rifampcin , ethambtol 
    For how long ?!
    6-9 months
    I said surgical exision but I think its wronge.
    D. Bangash asked
    Can TB cause neurogical deficet ?!
    Yes , it can be in the brain 
    What is called ?!
    Tebrculoma.
    The   END

    2- uro case with d. Tewarki and d. Messari
    BPH as in torento note.
    Very easy case ..

    Don’t pank , they want to test you’re general information and orgnization .
    Whatever the case is , start by general then go to specific , it is like OSCE but it is holding in 5th floor .

    Good luck 

  23. Hey girls
    neck mass exam & differential v imp cauez there are plenty of them.
    I had parotid tumor with dr.makawi
    U start by inspection; there is a mass in left side, below the ear measuring 7 by 5 cm, oval in shape, no scars, the skin is stretched & shiny over it, no dilated viens, no visible impulse, & the mass is lefting the ear lobule.
    By palpating ; the mass is hard in consistency, smooth surface, regular margin
    U say 2 complete my examination I want 2 performe biminual examn. & ENT
    سألني كمان كيف تبغي تعملي investigation
    US & FNA
    سألني ال most common tumor of parotid ; pleomorphic adenoma
    و سألني this tumor is benign and behave like malignant why
    cause of capsule invasion & recurrence
    What structure pass through this ; facial nerve
    Revise it from recal it’s only 2 pages

  24. الله يوفق كل وحدة كلفت نفسها واتنازلت في اول لحظات اجازتها عشان تكتب هنا وتفيد غيرها 
    تسلم الايادي وحدة وحدة وان شاء الله تلقو الاجر دنيا واخرة

  25. My second case was with dr. Saleh
    differential of upper abdominal pain ; acute cholecystitis, acute pancreatitis, perforated DU
    He replaied; how would differentiate bet them by physical exam
    PDU; sings of peritonitis , what are they?
    Acute cholecystitis Murphy’s sign & upper quadrant tenderness
    Pancreatitis epigastric tenderness
    How would manage pt with pancreatic in er
    I said IVF
    Dr. jabad asked which type
    NS OR RL
    How would know it is enough ; urin output
    What’s the minimal output ; .5/kg/h
    Maintence calculation
    ranson’s criteria

  26. F-amm الله يسعدك يارب و يوفقكم و يفتح عليكم

  27. afnan khoja says:

    allah yft7 3leekom ,,so sorry for the late comment
    the 1st case was diabetic foot with dr,saleh
    take Hx:
    C/C + duration then ask abt nuropathy(اوقات تحسي الصندل يطلع من رجولك)
    - infection (pain-swelling-discharge-hotness-fever)
    -ischemia (IC-rest pain)
    go for examination:
    expose BOTH
    symmetry
    atrophic changes
    ULCER (pressure area- hidden area-between fingers-describe)
    how to differentiate bet bone & tendon if it was exposed ??
    tendon ~~by moving the finger the tendon will contract lkn al bone will not
    palpate the pulse (dorsalis pedis & they ask abt it’s place)
    then investigation
    CBC – RFT …
    foot XRY ~~ to see if there’s gas in soft tissue gas forming bacteria:(clistrodium perforngi)do necrotising fascitis (go to OR & do debridment)
    for cl.perforngin give Penecillin
    advice for this patient :: daily inspection for the feet
    put cream on the dry skin —–
    that’s it :)
    the 2nd case was renal cell carcinoma with dr.alsayyad + dr.makkawy (i didn’t study uro :( so ma jawbt mazboo6

    take Hx
    Examination: palpable mass in the rt lumbar region(describe the mass)
    investigation:
    abdomen/pelvic CT (he asked me with or without contrast?)
    CI to give IV contrast (high creatinie_allergy to contrast)
    manegement:
    radical nephrectomy
    most common type of renal cell carcinoma(adenoma)
    incedintaly found
    DD abt mass(hydronephrosis-polycycstic kidney-renal tumor)
    if it’s involve the pelvis we shld do radical nephrourotrectomy
    ALL THE LUCK :)

  28. kefkom banat my cases
    1- with dr alda8l &jabad
    it was cholingitis
    they asked me to take breif HX
    then whats ur DD
    then do examination
    whats ur investigations ?
    he gave me the result of LFT comment on the result
    asked me about ERCP prepration

    2- with maccawi and alsayad ( uro)
    HX of hematourea the patient was female 55 years old
    he aske me about DD
    the he said she has bladder cancer whats the risk factors
    investigations
    mangments
    as in toronto notes

    allah yofe8kom yarab ma
    5allo omokom ted3i o kol shai yetsahl

  29. kefkom banat my cases
    1- with dr alda8l &jabad
    it was cholingitis
    they asked me to take breif HX
    then whats ur DD
    then do examination
    whats ur investigations ?
    he gave me the result of LFT comment on the result
    asked me about ERCP prepration

    2- with maccawi and alsayad ( uro)
    HX of hematourea the patient was female 55 years old
    he aske me about DD
    the he said she has bladder cancer whats the risk factors
    investigations
    mangments
    as in toronto notes

    allah yofe8kom yarab ma
    5allo omokom ted3i o kol shai yetsahl

  30. كتبت لكم رد طوووويل وكل شي بالتفصيل بس للاسف علق الايباد وكل شي راااااح :(
    My 2 cases were both general
    First parotid swelling with dr maki, mazen , and dr reda came later
    He asked me about LNgroup of the neck and its draing
    Examine facial nerve
    Why u exclude mumps in this pt .. I dont know

    2nd case was was acute cholangitis with dr zohor & hani
    As usual qs
    للاسف لازم اخرج دحين ان شاء الله لما ارجع اكتب لكم كل شي بالتفصيل

    اهم شي بنات رااااجعوا الفليود والالكتروليت
    لان اللي يدخل على د مكي حيساله فيها بالتفصيل
    هي والتي بي ان
    والله يوفقكم يارب ويسهل لكم ويرزقكم باطيب الدكاترة

  31. Hey Girls, These are my 2 cases:

    1- X-ray of Pneumoperitoneum (air under diaphragm)
    with: Dr.Abaddi & Dr.Taha(Uro)

    - read this x-ray
    - he’s 30 YO Chadian male came to ER with acute abd from 8 hrs, what do u wanna ask him in Hx?
    Ex?
    ER manegemnt? ABC + resestation
    (then he gave me a picture of shock)
    what u gonna do now? LAPROTOMY
    how to assess the fluid u gave in the resestation? by Urine output
    how? by inserting a Foly catheter!

    - Suppose this pt is a trauma pt with pelvic fracture
    will u insert the foly catheter for him? No, I’ve to make sure there is no urethral injury first.
    -How? (bl. at meatus-butterfly perineal hematoma- scrotal hematoma)
    - there is a bl. at meatus, what u gonna do? do retrograde urethrogram
    -what u gonna see if there is injury? extravasation
    -then u insert the foly catheter? No, i’ll insert a supra-pubic catheter!
    ________________________

    2- Cellulitis of Dorsum of the right foot
    with Dr.Banqash & Dr.Kensarah

    (There were 3 ulcers in both feet other than this celliolitis!)
    -Ex?
    -what is Dx? Cellulitis
    -what is cellulitis? it’s inflammation of subcutaneous tissues
    -what is most common organism can cause this? Streptococcus pyogenes
    -what antibiotic u’ll give? (PENICILLIN)< < decrease intracellular Glucose-> decrease ATP-> Disturbed WBC function!
    -other than Immunity disturbance? Neuropathy & Angiopathy!

    ___________________________________________The End

    Gd Luck! :D o rabana yfta7aha 3lekum yarab.

  32. paroted mass:
    causes: caliculas__ obstruction of duct____ infiction
    construction of duct due to radio expouser, tumor, congenital__pain when eating because it stimulate secretion
    acute parotiditis___ swelling ,fever
    absess
    in children mumps(conservative treatment)
    if there is ni infiction conservative:massage , hydration ,rest if tere is pain analgesia if there infection AB
    malignancy:
    benign: most common pleomorphic adenoma 80%
    painless mobile slow progress mass
    poorly capsulated___ recurrance
    malignant:common mucoepidermoid carcenoma29%
    rapid growth mass pain faisial nerve palsy cervical adenopathy
    risk factor:expose to sun alchol hair dey 7 chemical expose to radiation breast cancer herps HIV
    diagnosis by US CT MRI FNA
    PET(positron emission tomography) for staging and floow up
    treatment
    if in superfasial lobe: superfacial parotidectomy
    ddep: total parotidectomy with preserve of fasial nerve
    LN resection if involved
    facial N if involve resect involved part and reanostomose or graft
    adjuvent radio
    facial n had 5 branches frontal zygomatic buccal mandibular and cervical
    Ex facial N: symetry of face ask pt to smile
    nasolibial fold
    ask pt to look up and see the wrinkels
    ask pt to clos eye strongly
    اتمني تفيدكم وسوري لانه مو مرتب بس كتبته بسرعة عشان بذاكر جود لك جميعا

  33. Dr.Mi-chan R says:

    sooooory for the delay :( i was busy and I was after noon gp
    Hi there for the last gp wish u good luck
    Well this the cases that come to me
    1-parotid gland nodule with dr.kensara+dr.bangash
    Advice : BE CLAM AND COOOL
    INTRDUCE UR SELF TO DOCTOR + PATIENT
    Ok here what I have in this case
    Examine the module..inspection,palpatition (don’t forget the cervical lymph exam)
    NOTE: some doctors say inspect BUT u don’t only inspect cont to palpation until he said stop..
    DDX
    I said acoording to site it mostly parotid nodule but it could be lymph node and then give DDX acoording for lymph I said acute infiction +chronich infiction(TB) ,lymphoma
    Then he(dr.kensara) asked what we call the lymph node enlaged due to TB >cold nodule
    How dose TB transment (???? ?????? ) the doctor like this one
    >By human+ bovin
    Human>air …bovin>un pastrid milk
    Which type of transmition infect the cervical >bovin >drinking milk
    Ok what ur DDX for parotid nodule
    >I said infection,obstraction of duct..he asked by what?> by stons, beignin tuomer( polymorphic adenoma),malignant (mucoepiderms carcinoma -check the right spilling from Recall in face surgery dection) also due to mets thyriod >ta5eef bs he didn’t say any thing loool
    Then he said if we plan for surgery to remove it what sturcture we must care about > facial N
    What’s it’s branch >5 branches (tembral, Zaygomatic,bucal,marginal mandibular,cervical)
    The dr.bangash ask , what invs u will do> us to see syst or solid, FNA for cytology
    CBC>WBC+ERS (inflamtory markers)
    Then he said what antbiotic to give to treat TB
    >See maidah comment ubove cause I forget it looool

    Ok next case was rectoviscal fistoal :S with dr.hatim +dr.Taha uro
    1- take hx brife (complain + urine ,GI analysis brife too+ don’t forget hx of surgey or what have been done to him now )
    2- give me sumry or the hx
    (Ficalith matiral in urine with dysuria+hematouria, for 4 months ago, no GI sym, no prives Hx of surgery, no IBD, and now he have colonstomy) u can while give the sumry give u DD acoording to what u understand from the patiant and why he have colonstomy.
    Then he asked me to diff btw the colonstomy+illiostomy >by site and shape + content
    What it could be >end or loop
    How to tell>by puting ur finger in it to the opening
    What u going to find>loop u will find to opening and end one open >by the dr.hatim
    What r colonstomy complication>
    Local + systimic >see surgical notes :)
    The dr.Taha asks :S
    1- what do we call fecals in urine >I don’t know :/..he said it’s fecalourea
    U know some may complain have air in urine do u know what’s called?>I don’t know :/
    It’s pnemouria:/
    Have ever heard or read of these conditions I replay I had not :|
    Then he asked what’s the causes of fistola>ulcerlative colitis,absses clection,injery ..
    Can cancer cause it? >Yes by invasion
    Which one>blader cancer:/
    And what about colon >also colon cance
    Which part>sigmoid :/
    What else >>?? ( I forget totaly about rectal problem looool)
    Which commone colon or blder ( both taha and hatim ask :( )
    I replay I don’t know :)
    Done :/

    That’s all
    Bty my answer to dr.taha parts I don’t know if it’s right or not soory :(
    But good luck for all
    ربنا يسهل لكم وتجيكم كيسات تحلوها ودكاترة طيبين :)
    اهم شي كوني واثقة من نفسك وخليكي هادىه قدر الامكان لاتتوتروا وناموا ولو ساعتين الدكاترة يبغوا يشوفوا اعصابك وقداىة ترابطك ومو لازم تجاوبي كل شيء تراهم عارفين اننا تحت ضغط ومقدرين
    اذا ما تعرفي قولي ما اعرف او قولي الجزء الي تعرفية والباقي قولي ما اعرفه لانه في دكاترة يزعلوا لما تتفلسفي
    اعتبري نفسك في مناقشة راوند لا في اختبار
    كوني حنونه على المريض ولا تنسي تعرفي بنفسك له
    وخليك مرتبة او منظهمه في الانفستيغاشون والتريتمنت
    غطوا الكومون ولو جاتكم حالات مش كومون كونوا هادين واتكلموا بشكل نظامي يعني عامليها على انها كمون على حسب موقعها اي شيء في الوجه والرقبة كانك بتتعاملي مع ثايرويد مثلا :)
    والله الموفق
    اللهم لا سهل الا ما جعلته سهل وانت تجعل الحزن سهلا

  34. Hi there i’v got 2 GS cases one in divertculosis and the other one was Hodjkin lymphoma ..
    Gd luck all

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