Faculty of Medicine

University of Khartoum
Batch 89 - Qayasir

Surgery OSCE
Collected by 6th Study Group
(Ali seif, Hazim, Ahmed Mudathir, Migdad Haiyder, Abubakr Khalaf & Mohamed
Emad)

Contents
General...................................................................................................................................................... 3
Lump Examination .................................................................................................................................... 4
Thyroid Examination ................................................................................................................................. 6
Breast Examination ................................................................................................................................... 7
Abdominal Examination ............................................................................................................................ 8
Hernia Examination................................................................................................................................... 9
Scrotal Examination ................................................................................................................................ 10
Incisional Hernia Examination................................................................................................................. 11
Stoma Examination ................................................................................................................................. 12
Ulcer Examination ................................................................................................................................... 13
Varicose Veins Examination .................................................................................................................... 14
Oral Swelling Examination ...................................................................................................................... 15
Obstructive Jaundice History .................................................................................................................. 18
Dysphagia ................................................................................................................................................ 20
Gastric Outlet Obstruction ...................................................................................................................... 22
UPPER GI BLEEDING ................................................................................................................................ 23
Lower GI Bleeding ................................................................................................................................... 24
Diabetic Foot ........................................................................................................................................... 25
Breast History.......................................................................................................................................... 26
Thyroid History........................................................................................................................................ 26

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Surgery OSCE Collected by 6th Study Group
 Bronchogenic Carcinoma ........................................................................................................................ 26
Hematuria ............................................................................................................................................... 26
Urine Retention....................................................................................................................................... 26
Renal Colic / Mass ................................................................................................................................... 26
Mycetoma ............................................................................................................................................... 26
Hydrocephalus ........................................................................................................................................ 26

Sources:
- Clinical Rounds
- Manoj for OSCE
- OSCE for Medical Finals

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Surgery OSCE Collected by 6th Study Group
 General
1. Surgery Examination:
3. Surgery History (VIVA / Long
- Thyroid
Case)
- Breast
- Dysphagia
- Hernia
- Upper GI Bleeding
- Inguinoscrotal
- Lower GI Bleeding
- Lump (lipoma / Sebaceous
- Anorectal Conditions & IBD
Cyst / Ganglion / Dermoid
- Gastric Outlet Obstruction
Cyst / Neurofibroma /
- Jaundice
Parotid Swelling)
- Abdominal Distention
- Ulcer (Incisional Hernia /
- Hematuria
Venous Ulcers / Skin Ulcers
- Urine Retention
/ Mycetoma / Cleft Lip)
- Renal Colic
- Abdominal Examination for
- Limb Ischemia
Organomegaly
- Diabetic Foot
- Stoma (Colostomy)
- Chronic Discharging sinus
- Vascular (Varicose Veins)
Leg
- Vascular (Chronic Limb
- Breast
Ischemia)
- Thyroid
- Hydrocephalus

2. Surgery Maneuvers 4. Surgery Communication Skills

- NG Tube Insertion - Vascular Referral
- Cannula Insertion - Informed Consent
- Urinary Catheterization - Stoma
- Suturing - Breast Cancer
- Hydrocephalus
- Palliative Patient
- Diabetic Septic Foot

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Surgery OSCE Collected by 6th Study Group
 Lump Examination
- WIPE (Wash hands, Introduce
Yourself, Permission, Position,
Exposure)

- Others by Palpation:
- Inspection:
o Compressibility (e.g Vascular)
o Site
o Pulsatile/Expansible
o Size
o Fluctuation & Cross
o Shape
fluctuation
o Skin Over it
o Transillumination
 Discharge
o Reducibility (Hernia)
 Dilated Veins
 Pigmentation
- Complete Examination by:
o Scars
o Regional Proximal LNs
o Color
 (Head and Neck = Cervical
LNs; Trunk = Axillary LN;
- Palpation Lower Limbs = inguinal)
(Ask About Pain, Look at Face) o ± Percussion
o Tenderness o ± Auscultation
o Temperature o Distal Pulsations
o Thrills o Other AREAS TO EXAMINE
o Lump Size  E.g: Back for tenderness
o Surface (Smooth, Nodular,
Lobulated, Irregular)
o Consistency (Soft, Firm, Hard)  Thanks the patient, Cover Him
o Edges (Well defined/Ill  Findings & Discussion
defined)
o Mobility (2 axis)
o Fixation to Skin
o Fixation to underlying Muscle

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Surgery OSCE Collected by 6th Study Group
Lumps: - Complications of Ganglion:
Wound infection / recurrence
 Lipoma:
- Mx: Aspiration but can recur or
- Benign fat tumor originating from
best to do Bloodless field with
subcutaneous fat
tourniquet under general
- Multiple painful lipomas =
anaesthesia
dercum’s disease
- Turns to malignant if; thigh,
- O/E: Site: Hand & Wrist, smooth
shoulder, retroperitoneum
surface, soft & fluctuant,
- Mx: Reassure, if affecting the pt.
TRANSILLUMINTE ON DORSUM
surgical excision
OF HAND.
- O/E: Soft – Lobulated – Slippery
Edge – Not attached to skin
 Dermoid Cyst:
-
- Cyst deep to skin so it is not fixed
 Sebaceous Cyst:
to skin
- Multiple: Gardner’s syndrome
- Congenital: Sequestration; while
associated with FAP & osteomas
acquired: implantation
- Complications:
- Site: External angular dermoid or
Infection/Ulceration/
midline
Calcification/Sebaceous horn
- Most important is to do Skull X-
formation (see pic)
Ray or CT, because DDx is
- Mx: Eliptical incision then
Meningocele, so if cyst arise from
excision
above the skull it is Dermoid or
- O/E: Site: hairy areas
from Brain and Herniate to the
(Axilla/face), u can see punctum,
skin
cross fluctuate, ATTACHED TO
- Mx:
SKIN
- O/E: Site:
 Ganglion:
- Cystic swelling arising from
tendon sheath related to
synvioum. (Myxomatous
degeneration)
- Ddx: Bursae

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Surgery OSCE Collected by 6th Study Group
 Thyroid Examination - From Behind (Permission, position of
- WIPE (Wash hands, Introduce hand, place thumbs on back of neck &
Yourself, Permission, Position, tilt head forward) (Palpate using palm
Exposure) of fingers and start laterally, both sides
and isthmus)
* Position: Pt. Sitting on chair; - Lump Size - Surface
Exposure of neck region - Consistency - Edges
- Inspection: (anterior neck swelling) - Mobility - Fixation to Skin
o Site: Thyroid; central or diffuse - Fixation to Sternocleidomastoid
o Moves with Swallowing muscle
o Tongue Protrusion (if cyst suspected - Dipping Test (Lower border, ask to
ie. Central swelling) swallow water again) (for
o Size retrosternal extension)
o Shape - Others by Palpation:
o Skin Over it o Lymph Nodes (Paratracheal,
 Surgical Scars submental, submandibular, ant.
 Dilated Veins & post. Cervical, pre & post
 Visible Pulsations auricular, occipital,
 Pigmentation supraclavicular)
o Scars o Eyes:
o Suprasternal Notch Empty or not  Exophthalmos / Lid retraction
- Palpation (Ask About Pain, Look at Face)  Lid Lag (hold pt. head)
- From Front: (4 Ts)  Ophthalmoplegia (ask abt. Pain
o Tenderness & diplopia)
o Temperature o Hand (Pulse, Clubbing, Tremor,
o Thrills Palmar Erythema, Swelling)
o Trachea
- Percussion for Retrosternal extension - Complete Examination by:
- Auscultation for Bruit o Lower Limb for pretibial myxedema
o CNS examination for proximal
myopathy & Reflexes
o Full Cardiovascular examination
 Thanks the patient, Cover Him
 Findings & Discussion

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Surgery OSCE Collected by 6th Study Group
 Breast Examination - Palpation (Ask to start with normal
- WIPE (Wash hands, Introduce Breast; Ask About Pain, Look at Face)
Yourself, Permission, Position, o Palpate all quadrants with palm of
Exposure) fingers
o Tenderness / Temperature /Thrills
* Position: Pt. ideally in 45 degrees. o Lump:
– could be sitting in the couch  Size / Surface / Consistency
- Inspection: Ask pt. to elevate her hand  Edges / Mobility (2 Axises)
on her head  Fixation to Skin
o Symmetry of Both Breasts  Fixation to Pectoralis Major
o Lump: (‫)كوعي وأضغطي على وسطك‬
o Site: Quadrants  If inferior lump; fixation to
o Size serratus anterior (‫)أضغطي علي أنا‬
o Shape
o Skin Over it (3PUS) (ask pt abt pain & - Axillary Lymph Nodes (Anterior,
elevate breast with dorsum of hand Posterior, Medial, Lateral, Apical)
looking for skin changes) - Supraclavicular LNs from behind
 Peau’ de Orange o If +ve, comment on No. / firm or
 Pigmentation not / mobile or fixed
 Puckering (Skin Tethering)
 Ulceration
 Surgical Scars - Complete Examination by:
o Nipple-Areola Complex: (Retraction, o Contralateral Breast & Axillary
Deviation, Destruction, Discoloration, Lymph Nodes
Displacement, Discharge) (Ask about o Neurological Examination for Brain
discharges and ask pt. to press on Mets
nipple to confirm) o Chest for Pleural Effusion
o Axilla & Upper limbs (Lumps, skin o Abdominal ex for organomegaly &
changes) Ascites
o Back for Tenderness
 Thanks the patient, Cover Him
 Findings & Discussion

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Surgery OSCE Collected by 6th Study Group
 Abdominal Examination - Complete Examination by:
- WIPE (Wash hands, Introduce o Examine the external genitalia, per
Yourself, Permission, Position, rectal, Lymph nodes and general
Exposure (nipple to mid thigh) examination

- Inspection: at the end of bed

o Contour, distention, flanks, visible  Thanks the patient, Cover Him
bulges, movement with respiration  Findings & Discussion
o Kneel at the right side:
o Visible pulsations; peristalsis
o Scars
o Dilated Veins & Umbilicus
o Hernial Orifices & coughing

- Palpation (Ask About Pain, Look at

Face)
o Tenderness / Temperature
o Superficial masses 9 quadrants
o Guarding or rigidity

- Deep palpation for organs:

o Liver & liver span
o Spleen
 Mass (Hypochondrium; moves with
respiration; dull on percussion; not
bimanually palpable; can feel a
notch or not)
o Kidneys bimanually
o Shifting dullness for ascites

- Auscultation
o Renal Bruit / Bowel sounds /
Splenic Rub / Venous Hum /
Hepatic Bruit

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Surgery OSCE Collected by 6th Study Group
 Hernia Examination o Ask pt. to reduce it & locate
- Examine the groin area Anterior Superior Iliac Spine (ASIS)
- WIPE (Wash hands, Introduce
Yourself, Permission, Position, o Locate deep inguinal ring &
Exposure ) Occlude the ring by Thumb facing
- Pt. lying; expose umbilicus to knees big toe of pt. & ask patient to
- Look for scrotal swellings; if +ve ask cough (cough no. 3)
 Doesn’t protrude after closure: indirect
pt to stand (for extension to
inguinal hernia
scrotum)  Protrudes: direct inguinal hernia

- Inspection: - Complete Examination by:

o Site (swelling in groin area) o Examine the other groin & other
o Size / Shape hernial orifices
o Skin Over it (Pulsation; dilated veins; o Scrotum examination
pigmentation, Scars)  Thanks the patient, Cover Him
o Reducible: (Ask pt if can reduce the
 Findings & Discussion
swelling; if can reduce it) > so it is
reducible hernia Dx:
- Right or Left - Inguinal or Femoral
o Cough impulse (Ask pt. to Cough (1);
- Direct or indirect - Reducible or not
visible cough impulse; other hernial
orifices looks normal
Management
- Palpation (Ask About Pain, Look at Face) Complications & causes of hernia
o +ve Palpable cough impulse Risk of strangulation
(Cough no. 2)
o Tenderness / Temperature /Thrills N.B:
o Lump: Size / Surface / Consistency Pubic Tubercle:
/ Margins - From symphysis pubis below and lateral
o Defect type first bony prominence; or do flexion of
knee and resisted adduction
Deep inguinal ring:
- Others by palpation:
- Mid-point between ASIS & pubic tubercle;
o Palpate the Pubic Tubercle above it by 2.5 cm
 Hernia is above & medial; so it’s
inguinal hernia
 If below and lateral; it’s femoral
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Surgery OSCE Collected by 6th Study Group
 Scrotal Examination -
- Examine the groin area - Complete Examination by:
- WIPE (Wash hands, Introduce o Abdominal examination for masses
Yourself, Permission, Position, & hernial orifices
Exposure )
- Pt. lying; expose umbilicus to knees  Thanks the patient, Cover Him
- ask pt to stand  Findings & Discussion
Dx:
- Inspection: -
o Site (swelling in hemiscrotum area)
o Size / Shape Management
o Skin Over it (Pulsation; dilated veins;
pigmentation
o Scars (between two testis)

- Palpation (Ask About Pain, Look at Face)

o Tenderness / Temperature /Thrills

o Feel vas deferens; if can get

above the swelling; it’s a pure
scrotal swelling
o Palpate Testis (if you can feel
them separately; it’s not vaginal
hydrocele)
o Palpate the swelling: ( Size/
Surface / Consistency / Margins;
fixation)
o Cross Fluctuation test
o Transillumination test

- If dilated veins; comment & feel; and

ask pt to lie down: Scrotum feels like
a bag of worm that disappears when
lying flat

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Surgery OSCE Collected by 6th Study Group
 Incisional Hernia Examination - Ask pt to elevate his head; mass
- WIPE (Wash hands, Introduce didn’t appear after putting
Yourself, Permission, Position, abdominal muscles on action; so
Exposure ) it’s intrabdominal

- Inspection: at the end of bed

- Complete Examination by:
o Contour, distention, flanks, visible
o Rest of Abdominal Examination
bulges, movement with respiration
o Groin; genitalia & per-rectal
o Lymph-nodes; chest & general exam.
o Kneel at the right side:
o Visible pulsations; peristalsis
 Thanks the patient, Cover
o Dilated Veins & Umbilicus
Him/her
o Scar:
 Findings & Discussion
 Site; Size; Shape; Healing

o Bulging in margin of scar (size & shape) Dx:

o Hernial Orifices & coughing

o Cough impulse (Ask pt. to Cough (1);
visible cough impulse;
o Cough 2: (other hernial orifices looks
normal)

- Palpation (Ask About Pain, Look at Face)

o +ve Palpable cough impulse
(Cough no. 3)
o Reducible or not?
o Tenderness / Temperature /Thrills
o Lump: Size / Surface / Consistency
/ Margins
o Defect Size & Content

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Surgery OSCE Collected by 6th Study Group
 Stoma Examination - Stoma bag:
- WIPE (Wash hands, Introduce  Site; Secretions & content
Yourself, Permission, Position,  Ask to remove the bag to examine
Exposure ) the stoma (usually you will not be
allowed); so;
3 Objectives:  I can barely see the skin; but it
1. Type of stoma: looks normal; Excoriation or not
a. Temporal or permanent ( ‫خيطوا ليك‬  Mucosa (Healthy, color, signs of
‫)فتحة الشرج‬ necrosis)
b. End – loop – divided – double barrel  Edges (Spouted or flattened)
c. Ileostomy or colostomy  Type (end, loop, double barrel,
divided)
Ileostomy:
 Retraction / Prolapse
- Rt. Hypochondrium (not always); spouted;
excoriation around; fluid secretion  Ask pt. to cough for parastomal
Colostomy: herniation
- Left side; stitched at level of skin; solid  Palpate for stenosis or obstruction
secretions stool  Ask pt. about anal verge &
examine the perineum
2. Complicated or not  Ask about discharges of stoma &
- Prolapse / Retraction / Stenosis / it’s functioning
Necrosis / Herniation
- Complete Examination by:
3. Functioning or not? o Rest of Abdominal Examination
o Groin; genitalia & per-rectal
- Inspection: at the end of bed o Lymph-nodes & general exam.
o Contour, distention, flanks, visible
bulges, movement with respiration  Thanks the patient, Cover
Him/her
- Kneel at the right side:  Findings & Discussion
o Visible pulsations; peristalsis
o Dilated Veins & Umbilicus
- Surgical Scars (usually there is; so
comment on it)

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Surgery OSCE Collected by 6th Study Group
 Ulcer Examination  Venous Ulcers:
- WIPE (Wash hands, Introduce Inspection:
Yourself, Permission, Position,
Exposure ) - Just above the medial malleolus in
- Inspection: the gaiter area
o Site / Size / Shape / Skin Over it / Scar - Large in size; Shape (regular or not)
o Ulcer (BEDD) - Skin over it (LEGS)
 Base (on inspection floor; palpation o Lipodermatosclerosis / Eczema / LL
base) swelling)
 Edge - Dilated veins & scars
 Describe structure at the base o Ulcer (BEDD)
 Discharge  Floor is pink in color
 Edge is sloping
- Palpation: (ask about pain; look at  Granulation tissue at the base
face)  No Discharge
o Tenderness / temperature
o Ulcer (BEDD) - Palpation: (ask about pain; look at
- Base / Edge / Describe structure at face)
base / discharge o Tenderness / temperature
- Size/ Base / Edge / Describe
o Mobility of ulcer structure at base / discharge
o Distal Pulses & Proximal LNs o Mobility of ulcer
o Sensory examination o Distal Pulses & Proximal LNs
o Sensory examination by 10 gm
- Complete Examination by: monofilament test
o Other areas to examine (e.g - Complete Examination by:
Varicosities) o Ask pt to stand; to assess varicosities
and examine them
 Thanks the patient, Cover Dx:
Him/her Mx: - after doing ABPI; if less than 0.8 it’s
contraindicated to this approach
 Findings & Discussion
4 layers dressing
Could be Venous / ischemic / TB / Vaseline / Crepe bandage / cotton /
adhesive plaster
Marjolin / SCC / BCC / Mycetoma
Outcome

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Surgery OSCE Collected by 6th Study Group
 Varicose Veins Examination o Saphena Varix (2.5 cm below &
- WIPE (Wash hands, Introduce lateral to pubic tubercle)
Yourself, Permission, Position, (if +ve; There is swelling in the upper
Exposure) thigh it is compressible with positive
* Position: Patient Standing and is cough impulse; so it’s the saphena
moving ant, post and laterally while u varix)
r commenting (not you moving) o Distal Pulses & Proximal LNs
o Inspection: if pt. Is lying down; comment on o Check for LL Edema
symmetry of limbs and obvious scars then ask o Tourniquet tests: pt lying, Put his
him to stand leg on your shoulder or ask
examiner to assist, explain to pt,
o There is tortuous dilated elongated milk the varicosities up, close SFJ,
superficial veins along the distribution apply tourniquet in mid-thigh, and
of the long (or short) saphenous vein ask pt to stand and see what
extending from just above the medial happens. (Interpretation down)
malleolus reaching the upper thigh in o Percussion & Auscultation for
the right lower limb. (describe veins, machinery Murmurs
distribution and it’s sites) - Complete Examination by:
o Anterior, medial and posterior veins  Conducting peripheral vascular ex.
o LEGS:  Abdominal examination & digital
 Lipodermatosclerosis rectal ex for masses and genitalia
 Eczema  Doppler ultrasound to localize site
 Gaps = Ulcers (Venous ulcers) of incompetence and patency of
 Swellings (LL edema) perforators & check deep vascular
 Scars status.
 ABPI: for treatment options
- Palpation (Ask About Pain, Look at  Thanks the patient, Cover Him
Face)  Findings & Discussion
o Tenderness / Temperature /Thrills
Etiology of varicose veins? (Primary or
o Venous Thickening for secondary)
Lipodermatosclerosis / Suitable investigations work up: (duplex us)
Compressible Principles of management? (If mild;
o If Ulcer is present; examine it conservative lifestyle modification & stockings /
Ligation with avulsion / stripping below knee /
(BEDD) stockings)

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Surgery OSCE Collected by 6th Study Group
 Oral Swelling Examination  Discussion:
o Diagnosis
- WIPE (Wash hands, Introduce
o Benign & malignant tumors
Yourself, Permission, Position, of parotid
Exposure ) o Investigations
- Inspection: o Types of Parotidectomy
o Site / Size / Shape o Complications of surgery
o Skin Over it (dilated veins, discharge,
pigmentation)
o Scars
o Ear lobule elevation
o Facial Palsy & Facial nerve ex (Facial
asymmetry, mouth deviation…etc)
o Inspection of oral cavity for ductal
orifice.

- Palpation: (ask about pain; look at

face)
o Tenderness / temperature / Thrills
o Surface / Consistency / Edge/ mobility
& Fixation
o Facial nerve examination
o Cervical Lymph nodes
o Bimanual palpation of Parotid ducts

- Complete Examination by:

o Regional Cervical LNs & distal
pulsation

 Thanks the patient, Cover

Him/her
 Findings & Discussion

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Surgery OSCE Collected by 6th Study Group
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Surgery OSCE Collected by 6th Study Group
 History

In any history; ensure the following:

- Proper Introduction, establish purpose of interview,
consent
- Allow the patient to express history in his own words,
Check for further symptoms, actively listen and elicit
information in structured manner.
- Appropriate use of language, open and close ended
questions and avoidance of leading multiple questions
- Thank the patient
- Summarize findings
- Mention Differential Diagnosis
- Work up and management.

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Surgery OSCE Collected by 6th Study Group
 Obstructive Jaundice History
Either presents with Jaundice /or/ Abdominal Pain
DDx:
- Benign: CBD Stones
- Malignant: - Ca Head Pancreas / Periampullary Carcinoma /
Cholangiocarcinoma
- Iatrogenic Following ERCP
- Biliary Leak / Stricture
PD Name, Age, Occupation, Residence, Marital Status
HPI Onset?
(ODIPARA) How it was discovered? Noticed it or someone else?
Duration?
Progression since start? Continuous, Intermittent or Progressive?
Intensity:
Agg. & Relieving Factors: Fatty Meals with stones
Associations:
- To confirm Obs Jaundice:
- Dark Urine / Pale Stool / Pruritus / Steatorrhea
- Identify the cause:
- Stones: Pain? +/- Fever with rigor
- Ca Pancreas: Constitutional (Weight Loss, Anorexia, N&V) / Recurrent
Onset DM / Backpain
- Periampullary: Melena
Other GI Symptoms: Dyspepsia/ Change in Bowel habits / Anemia
SR: Morning Headache, Sleep-wake disturbance
Weight Loss
Cough & Hemoptysis
Bleeding from any site?
Urine Amount, frequency & color
Backache
PMH: - Jaundice - Hx of Stones - DM / HTN
- Past ERCP - Past Endoscopy - Hemolytic Anemia - Blood Transfusion
FH - Malignancy - Stones - Similar Condition
DH - Current & chronic medications - Contraceptives - Allergies
SH - Alcohol - Smoking - Insurance - Impact on daily activity & Mobility

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Surgery OSCE Collected by 6th Study Group
 1. Summarize Findings & Mention Differential Diagnosis?
- If stones: Acute, Painful, intermittent Jaundice, usually Female, Young, aggravatedby
fatty meals, ask abt use of contraceptives

- Jaundice if Malignant: Gradual onset, deep,

- Ca Head: painless continuous jaundice.
- Periampullary:
o If in ampulla of vater: Intermittent jaundice & melena
o If in duodenum around ampulla: Progressive abdominal colicky jaundice

2. Findings on examination?
- Jaundice (deep green or yellow) / Neck for Supraclavicular LN / Abdomen for
Palpable Gallbladder, organomegaly & ascites / DRE for rectal bleeding or mass /
Skin for scratch
3. Investigations?
4. Preoperative Preparations for biliary surgery?
5. Complications of Causes?
6. Management of Causes?

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Surgery OSCE Collected by 6th Study Group
 Dysphagia
- Difficulty in Swallowing
PD Name, Age, Occupation, Residence, Marital Status
HPI Onset? (Sudden or Gradual)
(ODIPARA) Started for Fluids or Solids?
Duration?
Progression? Static or Progressive? To solids / to fluids
Intensity: Complete or partial? Last meal? Hydration?
Level of Obstruction?
Agg. & Relieving Factors:
Associations:
- Painful or Painless?
- Heartburn or regurgitation?
- Coffee ground vomitus, Hematemesis & Melena
- Chocking / Crepitations & swelling / Ingestion of corrosives / trauma of
chest
Constitutional: Fever / Weight Loss / Fatigue / Anorexia
Other GI Symptoms: Dyspepsia/ Abd pain / Change in Bowel habits / Jaundice
/Anemia
SR: Morning Headache, Sleep-wake disturbance
Weight Loss
Cough & Hemoptysis
Back pain
Urine Amount, frequency & color
PMH: - Similar condition - PUD or GERD - History of Endoscopy or Surgery
- Neck Trauma - Goiter - Heart disease - Blood Transfusion
FH - Malignancy - Similar Condition
DH - Current & chronic medications - Anti Acids or PPI - NSAIDs - Allergies
SH - Alcohol - Smoking - Insurance - Impact on daily activity & Mobility

1. Summarize Findings & Mention Differential Diagnosis?

o Esophageal

2. Findings on examination?
- Pallor / Jaundice / Neck for Supraclavicular LN / Abdomen for masses & LNs / Back
for tenderness / other systems for mets

3. Investigations?
- To assess General condition of pt: CBC / Blood Glucose / Chest X-Ray / ESR /
- To know the cause: Barium Swallow / UG Endoscopy & Biopsy / Manometry
- For staging: CT Chest / EUS & Biopsy / Abdominal US

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Surgery OSCE Collected by 6th Study Group
 4. Management of Causes?
- Achalasia: (Heller’s myotomy + Nissen fundoplication)
- Cancer:
- Upper or middle third = McQueen operation.
- Lower third = Iver-lewis operation
- Palliative therapy = stenting, feeding jejunostomy, chemotherapy.

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Surgery OSCE Collected by 6th Study Group
 Gastric Outlet Obstruction
- Complain: Vomiting (or) Epigastric Pain
PD Name, Age, Occupation, Residence, Marital Status
HPI Onset? (Sudden or Gradual)
(ODIPARA) Duration?
Progression? Static or Progressive?
Intensity: Amount? Frequency? Projectile or Not? Color?
IF PAIN: Analyze using SOCRATES
Agg. & Relieving Factors:
Associations:
- Painful or Painless?
- Duration relation of pain or vomiting to meals
- Newly onset DM (polyuria)
- Alcohol
- PUD? NSAIDS use?
- Jaundice?
Constitutional: Fever / Weight Loss / Fatigue / Anorexia
Other GI Symptoms: Dyspepsia/ Abd pain / Change in Bowel habits / Jaundice
/Anemia
SR: Morning Headache, Sleep-wake disturbance
Weight Loss
Cough & Hemoptysis
Back pain
Urine Amount, frequency & color
PMH: - Similar condition - PUD - History of Endoscopy or Surgery
- Pancreatitis - Blood Transfusion - HTN or DM
FH - Malignancy - Similar Condition
DH - Anti-Acids or PPI - NSAIDs -Current & chronic medications - Allergies
SH - Alcohol - Smoking - Insurance - Impact on daily activity & Mobility

1. Summarize Findings & Mention Differential Diagnosis?

- Gastric Carcinoma - Ca Head of Pancreas - Chronic Pancreatitis
- Fibrosed Healed peptic Ulcer - Gastroparesis
2. Findings on examination?
- Pallor / Jaundice / Neck for Supraclavicular LN / Abdomen for masses & LNs / Succession
splash / Visible Peristalsis / Paraortic LN & Sister Mary Joseph Nodes / Palpable GB
3. Investigations?
- To assess General condition of pt: CBC / Blood Glucose / Chest X-Ray / ESR /
- To know the cause: UG Endoscopy & Biopsy / CT Abdomen / Abd US / Stool for elastase
- For staging: CT Chest / EUS & Biopsy / Abdominal US
4. Management of Causes?

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Surgery OSCE Collected by 6th Study Group
 UPPER GI BLEEDING
- Complain: Vomiting of Blood (or) Melena
PD Name, Age, Occupation, Residence, Marital Status
HPI Onset? (Sudden or Gradual)
(ODIPARA) Duration?
Progression? Static or Progressive?
Intensity: Amount? Frequency? Projectile or Not? Color? Clots? Palpitations?
Loss of consciousness? Dizziness? Fainting (Syncopal Attacks)?
Hospital Admission? If Admitted; what have been done? Transfusion of Blood?
Associations:
- Other GI Symptoms: PUD? (abd pain related to meals)
- Dyspepsia (early satiety, indigestion)
- Change in Bowel habits / Jaundice /Anemia
- Fatigue / Recurrent Infections
Constitutional: Fever / Weight Loss (Specify) / Fatigue / Anorexia /
Bleeding from other sides
SR: Morning Headache, Convulsions, Sleep-wake disturbance
Cough & Hemoptysis
Back pain, joint pain & swelling
Urine Amount, frequency & color

PMH: - Similar condition - PUD - Schistosomiasis (farmer, swimming in Tur3a)

- History of UG or lower GI Endoscopy or Surgery
- Hospital admission and Blood Transfusion - HTN or DM - ESRD
FH - Malignancy - Similar Condition
DH - Anti-Acids or PPI - NSAIDs – Anticoagulants -Current & chronic
medications - Allergies )‫(أدوية رطوبة – أدوية سيولة‬
SH - Alcohol - Smoking - Insurance - Impact on daily activity & Mobility

1. Summarize Findings & Mention Differential Diagnosis?

- Esophageal varices due to Portal HTN caused most likely by periportal fibrosis secondary
to Schistosomiasis
- Bleeding peptic Ulcer
2. Findings on examination?
3. Investigations?
4. Management of Causes?

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Surgery OSCE Collected by 6th Study Group
 Lower GI Bleeding
- Complain: Rectal Bleeding
PD Name, Age, Occupation, Residence, Marital Status
HPI Site: Lower GI Bleeding
(ODIPARA) Onset? (Sudden or Gradual)
Or Duration?
SOCRATES Progression? Static or intermittent or Progressive?
Character & Intensity: Amount? Color? Smell?
- Fresh Bloods? Clots?
- If Massive: Loss of consciousness? Dizziness? Fainting (Syncopal
Attacks)? Hospital Admission? If admitted; what have been done?
Timing:
- Relation to Stool (Mixed, streaks, around, before or after)
- Associated Pain with defecation?
- Type of stool & Stool Caliber (Hard or Soft with mucus)?
- Bleeding from other sides

Associations:
- Abdominal Pain
- STAM ALPOP (Spurious diarrhea, Tenesmus, Alternating bowel habits,
Melena, Anemia, Loss of weight, Prolapse(piles), Od, Pian
- Fever
- Jaundice
- Anemia / Recurrent Infections / Fatigue / Anorexia /
- If IBD, ask about Extraintestinal manifestations
SR: - Morning Headache, Convulsions, Sleep-wake disturbance
- Cough & Hemoptysis, SOB
- Back pain, joint pain & swelling
- Urine Amount, frequency & color
PMH: - Similar condition - PUD - IBD
- Schistosomiasis / Portal HTN / Jaundice
- History of UG or lower GI Endoscopy or Surgery
- Hospital admission and Blood Transfusion - HTN or DM
FH - Malignancy - Similar Condition
DH - Anti-Acids or PPI - NSAIDs – Anticoagulants - Current & chronic
medications - Allergies
SH - Alcohol - Smoking - Insurance - Impact on daily activity & Mobility

1. Summarize Findings & Mention Differential Diagnosis?

2. Findings on examination?
3. Investigations?
4. Management of Causes?

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Surgery OSCE Collected by 6th Study Group
 Diabetic Foot
- Complain:
PD Name, Age, Occupation, Residence, Marital Status
HPI Throbbing pain? Prevents sleep and keep pt awake?
(ODIPARA) N.B: (pain indicates normal sensation and presence of pus; and absence of pain
and sensation indicates severity of neuropathy)
Fever and rigors
Nausea & Vomiting
Swollen whole foot & leg
Enlargement of inguinal lymph nodes
History of intermittent claudication
HPI:
- Any inflecting cause?
- What did the patient do as an intervention?
- Any wound care done?
- Antibiotics taken?
- Blood sugar being tested?
SR: Morning Headache, Convulsions, Sleep-wake disturbance
Cough & Hemoptysis
GIT symptoms
Back pain, joint pain & swelling
Urine Amount, frequency & color
PMH: - Similar condition - Previous foot sepsis or surgery
- Admission for diabetes (hyperglycemia or hypoglycemia)
- Previous Operation - Foot Care - Allergy
- Hospital admission and Blood Transfusion - HTN or DM
FH - Diabetes - Similar Condition
DH - Control of diabetes & HTN -Current & chronic medications - Allergies
SH - Alcohol - Smoking - Insurance - Impact on daily activity & Mobility

1. Summarize Findings & Mention Differential Diagnosis?

-
5. Findings on examination?
6. Investigations?
7. Management of Causes?

25 | P a g e
Surgery OSCE Collected by 6th Study Group
 Breast History
Thyroid History
Bronchogenic Carcinoma
Hematuria
Urine Retention
Renal Colic / Mass
Mycetoma
Hydrocephalus

26 | P a g e
Surgery OSCE Collected by 6th Study Group