Department of SurgeryDepartment of SurgeryOSCE: 5 APRIL 2011OSCE: 5 APRIL 2011

Paediatric-, Plastic-& Vascular SurgeryPaediatric-, Plastic-& Vascular Surgery

Answer all questions in written on the Answer all questions in written on the answer sheets providedanswer sheets provided

Remember your Remember your name and student nrname and student nr on on each pageeach page

The OSCE consists of 16 stations, The OSCE consists of 16 stations,

5 marks each, 5 minutes per station5 marks each, 5 minutes per station No cell phone, books or study material No cell phone, books or study material

may be brought into the examination may be brought into the examination venuevenue..

DEPARTMENT OF DEPARTMENT OF PAEDIATRIC SURGERY –PAEDIATRIC SURGERY –

QUESTIONS 1 – 5 QUESTIONS 1 – 5

Slide 1 – Paediatric SurgerySlide 1 – Paediatric Surgery

Questions – slide 1Questions – slide 1

What is the diagnosis suggested by the X-Ray?What is the diagnosis suggested by the X-Ray?Wat is die diagnose wat hierdie X-Straal voorstel?Wat is die diagnose wat hierdie X-Straal voorstel?

How do these babies classically present?How do these babies classically present?Wat is die klassieke presentering van hierdie babas?Wat is die klassieke presentering van hierdie babas?

What are the referring doctor’s duties before What are the referring doctor’s duties before transferring this baby?transferring this baby?Wat is die verwysende dokter se pligte voordat Wat is die verwysende dokter se pligte voordat hierdie baba na ‘n tersiere inrigting oorgeplaas word?hierdie baba na ‘n tersiere inrigting oorgeplaas word?

Slide 2 – Paediatric SurgerySlide 2 – Paediatric Surgery

Questions for slide 2Questions for slide 2A. Give a differential diagnosis?A. Give a differential diagnosis?

Gee ‘n differensiële diagnose?Gee ‘n differensiële diagnose?

B. What do you think is the most B. What do you think is the most probable diagnosis here and how probable diagnosis here and how would you treat this girl?would you treat this girl?Wat dink jy is die mees waarskynlike Wat dink jy is die mees waarskynlike diagnose hier en hoe sou jy hierdie diagnose hier en hoe sou jy hierdie kind behandel?kind behandel?

Slide 3 – Paediatric SurgerySlide 3 – Paediatric Surgery

Questions for slide 3Questions for slide 3A. What is the name of this abnormality?A. What is the name of this abnormality?

Wat is die naam van hierdie abnormaliteit?Wat is die naam van hierdie abnormaliteit?

B. Why is this condition clinically important?B. Why is this condition clinically important?Hoekom is hierdie toestand klies belangrik?Hoekom is hierdie toestand klies belangrik?

C. What is the embryological explanation for C. What is the embryological explanation for this condition?this condition?Wat is die embriologiese verduideliking vir Wat is die embriologiese verduideliking vir hierdie toestand?hierdie toestand?

Slide 4 – Paediatric SurgerySlide 4 – Paediatric Surgery

Questions for slide 4Questions for slide 4This child presents with a reducible lump.This child presents with a reducible lump.

Hierdie kind presenteer met ‘n reduseerbare Hierdie kind presenteer met ‘n reduseerbare swelling.swelling.

A. What is the likely diagnosis?A. What is the likely diagnosis?Wat is die mees waarskynlike diagnose?Wat is die mees waarskynlike diagnose?

B. When must surgery be done and what B. When must surgery be done and what does it consist of?does it consist of?Wanneer moet chirurgie gedoen word en Wanneer moet chirurgie gedoen word en what behels dit?what behels dit?

Slide 5 – Paediatric SurgerySlide 5 – Paediatric Surgery

Questions for slide 5Questions for slide 5This is a 3 week old child who has vomited This is a 3 week old child who has vomited

some bile and shows mild abdominal some bile and shows mild abdominal distension.distension.

Hierdie is ‘n 3 week oue kind wat gal gebraak Hierdie is ‘n 3 week oue kind wat gal gebraak het en wys ‘n effense buikopsetting.het en wys ‘n effense buikopsetting.

A. What is the likely diagnosis?A. What is the likely diagnosis?Wat is die waarskynlike diagnose?Wat is die waarskynlike diagnose?

B. Why is this a surgical emergency?B. Why is this a surgical emergency?Hoekom is hierdie ‘n chirurgiese noodgeval?Hoekom is hierdie ‘n chirurgiese noodgeval?

Plastic SurgeryPlastic Surgery

STATIONS 6 - 10STATIONS 6 - 10

STATION 6 STASIESTATION 6 STASIEPlastic surgeryPlastic surgery

1. 1. Name the diagnosis Name the diagnosis Gee die diagnose? Gee die diagnose?

2. What other morphological 2. What other morphological types of this condition maytypes of this condition may be present.be present. Noem ander morfologiese Noem ander morfologiese tipes van hierdie tipes van hierdie

verskynsel verskynsel wat teenwoordig kan wat teenwoordig kan

weeswees

33. How would you treat it?. How would you treat it? Hoe sal u dit behandel?Hoe sal u dit behandel?

STATION 7 STASIESTATION 7 STASIEPlastic SurgeryPlastic Surgery

1.1. What type of wound is this and What type of wound is this and name one possible cause?name one possible cause?Watter tipe wond is dit en noem Watter tipe wond is dit en noem ‘n moontlike oorsaak (1)‘n moontlike oorsaak (1)

2.2. Name the Name the principles principles of of management/Noem die management/Noem die beginsels van behandeling beginsels van behandeling (4)(4)

STATION 8 STASIESTATION 8 STASIE 1.1. Name the diagnosis/Gee die Name the diagnosis/Gee die

diagnosediagnose

2.2. Discuss the Discuss the treatment/Bespreek die treatment/Bespreek die behandelingbehandeling

3.3. What additional workup will What additional workup will be required/Watter be required/Watter bykomende voorbereiding bykomende voorbereiding word vereisword vereis

STATION 9 STASIESTATION 9 STASIE

1.1. Grade the depth of Grade the depth of the burn injury/Watter the burn injury/Watter graad van graad van brandwonde is dit(1)brandwonde is dit(1)

2.2. What are the What are the principlesprinciples of of management/Bespreemanagement/Bespreek die k die beginselsbeginsels van van behandeling(4)behandeling(4)

STATION 10 STASIESTATION 10 STASIE

This child has been in a MVA This child has been in a MVA (motor vehicle accident) He is (motor vehicle accident) He is fully conscious and fully conscious and systemically and systemically and neurologically normal. neurologically normal.

Question:Question: What are the What are the principalsprincipals of of

management (5)management (5) Die kind was in ‘n Die kind was in ‘n

motorongeluk. Hy is by sy motorongeluk. Hy is by sy volle bewussyn en sistemies volle bewussyn en sistemies en neurologies is daar geen en neurologies is daar geen afwykings. afwykings.

Vraag:Vraag: Noem die Noem die beginsels beginsels van sy van sy

behandeling 5)behandeling 5)

VASCULAR SURGERYVASCULAR SURGERY

STATIONS 11 - 16STATIONS 11 - 16

Station 11

Leflleftt subclavian artery

a

b

A 23 years old male patient presented with a supraclavicular mass. He had a history of a left supraclavicular stab two months prior.

a. Looking at the angiogram above, name the artery as indicated in arrow (b)(1)

b. Looking at the angiogram above, what is the pathology indicated by arrow (a) (2)

c. Give four hard signs of vascular trauma (4)

Station 12

75 years old lady with known hypertension, diabetes, hyperlipidaemia and chronic smoker. With a long history of upper limb claudication. Clinically both upper limbs had no palpable pulsesa. In aortic arch disease what is a significant blood pressure difference between two limbs(2)b. Where is the likely source of the emboli (2)c. In a younger patient what other three causes of this pathology besides atherosclerosis must you think of (6)

STATION 13

Station 14

STATION 15a

b

A 60 year old male patient presented with left lower limb 20 metres claudication distance. He had no palpable left lower limb.

a. Please name the artery as indicated by arrow “a” (1)

b. Please name the artery as indicated by arrow “b” (1)

c. What is the diagnosis? (1)d. Give two surgical options available for this patient

(2)

Station 16

Above is a picture of a 35 years old female who presented with a 24 hour history of iliofemoral deep vein thrombosis treatment with anticoagulation only, now with an obviously gangrenous foot

a. What is the diagnosis? (2)b. How could the luminal patency been immediately achieved (3)c. Give three systemic complications of revascularizing this dead limb (3)

QUESTION 1

a. Give four common risk factors for atherosclerosis (2)b. How do you define critical limb ischaemia (6)c. why is ABI not always reliable in diabetic patient (2) QUESTION 2a. Give four soft signs of vascular trauma (4)b. Give three indications for vascular imaging in lower limb trauma (3)c. Give three possible causes for early vascular repair thrombosis (3)

QUESTION 3a. What are the two causes of acute arterial occlusion (2)b. Give three signs of a dead limb (6)c. What is the treatment of Rutherford three limb (acute arterial occlusion) (2)