Department of Surgery OSCE: 5 APRIL 2011 Paediatric-, Plastic-& Vascular Surgery Answer all questions in written on the answer sheets provided Remember your name and student nr on each page The OSCE consists of 16 stations, 5 marks each, 5 minutes per station No cell phone, books or study material may be brought into the examination venue.

DEPARTMENT OF PAEDIATRIC SURGERY – QUESTIONS 1 – 5

Slide 1 – Paediatric Surgery

Questions – slide 1 What is the diagnosis suggested by the X-Ray? Wat is die diagnose wat hierdie X-Straal voorstel? How do these babies classically present? Wat is die klassieke presentering van hierdie babas? What are the referring doctor’s duties before transferring this baby? Wat is die verwysende dokter se pligte voordat hierdie baba na ‘n tersiere inrigting oorgeplaas word?

Slide 2 – Paediatric Surgery

Questions for slide 2 A. Give a differential diagnosis? Gee ‘n differensiële diagnose? B. What do you think is the most probable diagnosis here and how would you treat this girl? Wat dink jy is die mees waarskynlike diagnose hier en hoe sou jy hierdie kind behandel?

Slide 3 – Paediatric Surgery

Questions for slide 3 A. What is the name of this abnormality? Wat is die naam van hierdie abnormaliteit? B. Why is this condition clinically important? Hoekom is hierdie toestand klies belangrik? C. What is the embryological explanation for this condition? Wat is die embriologiese verduideliking vir hierdie toestand?

Slide 4 – Paediatric Surgery

Questions for slide 4 This child presents with a reducible lump. Hierdie kind presenteer met ‘n reduseerbare swelling. A. What is the likely diagnosis? Wat is die mees waarskynlike diagnose? B. When must surgery be done and what does it consist of? Wanneer moet chirurgie gedoen word en what behels dit?

Slide 5 – Paediatric Surgery

Questions for slide 5 This is a 3 week old child who has vomited some bile and shows mild abdominal distension. Hierdie is ‘n 3 week oue kind wat gal gebraak het en wys ‘n effense buikopsetting. A. What is the likely diagnosis? Wat is die waarskynlike diagnose? B. Why is this a surgical emergency? Hoekom is hierdie ‘n chirurgiese noodgeval?

Plastic Surgery STATIONS 6 - 10

STATION 6 STASIE Plastic surgery 1. Name the diagnosis Gee die diagnose? 2. What other morphological types of this condition may be present. Noem ander morfologiese tipes van hierdie verskynsel wat teenwoordig kan wees 3. How would you treat it? Hoe sal u dit behandel?

STATION 7 STASIE Plastic Surgery What type of wound is this and name one possible cause?Watter tipe wond is dit en noem ‘n moontlike oorsaak (1) Name the principles of management/Noem die beginsels van behandeling (4)

STATION 8 STASIE Name the diagnosis/Gee die diagnose Discuss the treatment/Bespreek die behandeling What additional workup will be required/Watter bykomende voorbereiding word vereis

STATION 9 STASIE Grade the depth of the burn injury/Watter graad van brandwonde is dit(1) What are the principles of management/Bespreek die beginsels van behandeling(4)

STATION 10 STASIE This child has been in a MVA (motor vehicle accident) He is fully conscious and systemically and neurologically normal. Question: What are the principals of management (5) Die kind was in ‘n motorongeluk. Hy is by sy volle bewussyn en sistemies en neurologies is daar geen afwykings. Vraag: Noem die beginsels van sy behandeling 5)

VASCULAR SURGERY STATIONS 11 - 16

c. Give four hard signs of vascular trauma (4) Station 11 a Leflleftt subclavian artery 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 pulses a. 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

a. Please name the artery as indicated by arrow “a” (1) STATION 15 a 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)

a. What are the two causes of acute arterial occlusion (2) 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 2 a. 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 3 a. 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)