4th Professional

Final Year MBBS

(9th-10th Semester)

Surgery OSCE
Collected & Solved By:
Dr. Faheem Abbas Bhatti
(KMC Batch-01)
DEPARTMENT OF SURGERY & APPLIED
OSCE EXAMINATION
STATION STATIC
READ THE SCENARIO AND ANSWER THE FOLLOWING QUESTIONS
• A 51-year-old woman presents to the emergency department with a
painful right groin. She also has some lower abdominal distension and
has vomited twice on the way to the hospital. She has passed some
flatus but has not opened her bowels since yesterday. She is otherwise
fit and well and is a non-smoker.
• On examination she looks unwell. Her blood pressure is 106/70 mmHg
and the pulse rate is 108/min. She is febrile with a temperature of
38.0°C. The abdomen is tender, particularly in the right iliac fossa, and
there is lower abdominal distension. There is a small swelling in the
right groin which is originating below and lateral to the pubic tubercle.
The lump is irreducible, and no cough impulse is present. Digital rectal
examination is unremarkable and bowel sounds are hyperactive.
• Investigations shows: Hemoglobin 14.1 g/dL , White cell count 18.0×10
9/L, Platelets 361×109/L, Sodium 133 mmol/L, Potassium 3.3 mmol/L,
Urea 6.1 mmol/L, Creatinine 63 mol/L, Amylase 75 IU/L.
• An X-ray of the abdomen is performed and is shown here.

Questions
1) What is the cause of the X-ray
appearances?
2) What is the swelling?
3) What are the anatomical
boundaries?
4) What is initial treatment in this
case?
5) What is the differential diagnosis for
a lump in the groin region?

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
 ANSWERS
1) The x-ray shows small-bowel dilation as a result of
obstruction due to trapped small bowel in the hernia sac.
2) This woman has a Right-sided Femoral Hernia.
3) Relations of the femoral canal
➢Anteriorly: Inguinal ligament
➢Posteriorly: Superior ramus of pubis & pectineus muscle
➢Medially: Body of pubis, pubic part of inguinal ligament
➢Laterally: Femoral vein
4) The patient should be kept nil by mouth, and intravenous
fluids and antibiotics begun. A nasogastric tube should be
passed and bloods taken in preparation for theatre.
Theatres should then be informed and the patient taken
for urgent surgery to reduce and repair the hernia, with
careful inspection of the hernial sac contents. If the bowel
is infarcted, it will need to be resected.
5) Differential diagnosis for a lump in the groin
a) Inguinal hernia
b) Femoral hernia
c) Hydrocoele of the cord/canal of nuck
d) Lipoma of the cord
e) Undescended testicle
f) Ectopic testicle
g) Saphena varix
h) Iliofemoral aneurysm
i) Lymph nodes
j) Psoas abscess

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
DEPARTMENT OF SURGERY & APPLIED
OSCE EXAMINATION
STATION STATIC
READ THE SCENARIO AND ANSWER THE FOLLOWING QUESTIONS
•A 38-year-old computer engineer is referred to
surgical outpatients complaining of pain in the
right groin. He has noticed this over the past few
months and his pain is worse on exertion. He has
also noticed an intermittent swelling. He is
otherwise ft and well. There is a family history of
bowel cancer. He is a smoker of 25 cigarettes per
day and drinks 10 units of alcohol per week.
•On examination, he is apyrexial with normal blood
pressure and pulse. The abdomen is grossly
normal but there is some tenderness in the right
groin. The patient is asked to stand. In the right
groin, there is a swelling, which is more
pronounced when the patient coughs. The other
groin and the scrotal examination are normal.

Questions
1) What is the likely diagnosis?
2) What are the anatomical boundaries?
3) What are the complications associated with this
condition?
4) How should the patient be treated?
w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
 ANSWERS
1) The patient is likely to have an Inguinal Hernia.
2) The boundaries of the inguinal canal are:
➢Anteriorly: the external oblique and internal
oblique muscle in the lateral third
➢Posteriorly: the transversalis fascia and the
conjoint tendon (merging of the pubic
attachments of the internal oblique and
transverse abdominal aponeurosis into a
common tendon)
➢Roof: arching fibres of the internal oblique and
transverse abdominus muscles
➢Floor: the inguinal ligament
3) Complications of an Inguinal Hernia:
a) Incarceration, i.e. Irreducible
b) Bowel obstruction
c) Strangulation
d) Reduction en-masse: reduction through the
abdominal wall without pushing bowel
contents out of the hernial sac
4) The patient should have a surgical repair of the
hernia. This can be done by either an open or
laparoscopic approach. Both involve reduction
of the hernia and placement of a mesh to
prevent recurrence.
w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
DEPARTMENT OF SURGERY & APPLIED
OSCE EXAMINATION
STATION STATIC
READ THE SCENARIO AND ANSWER THE FOLLOWING QUESTIONS
•A 14-year-old boy presented to the emergency
department with a 24- h history of increasing
abdominal pain. The pain localized to the right
iliac fossa and a diagnosis of acute appendicitis
was made. At operation, the appendix was found
to be normal and the anomaly shown in Figure
below was found in a loop of small bowel.

Questions
1) What is the diagnosis?
2) What are the characteristics of this anomaly?
3) How can this present?
4) How would you deal with this intraoperative
finding?
w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
 ANSWERS
1) The photograph demonstrates a Meckel’s
Diverticulum located on the anti-mesenteric border
of a segment of ileum.
2) Tis is a remnant of the omphalomesenteric duct. The
‘rule of twos’ is associated with this condition, i.e. it is
present in 2 per cent of the population, it is 2 inches
long and located 2 feet from the ileocaecal valve.
3) The mode of presentation may be:
➢Inflammation and perforation of the diverticulum
presenting with abdominal pain and peritonitis,
mimicking acute appendicitis
➢Rectal bleeding from peptic ulceration caused by
acid secretion from the ectopic gastric mucosa
➢Intestinal obstruction from intussusception or
entrapment of the bowel in a mesodiverticular band
or a fibrous band that may connect the apex of the
diverticulum to the umbilicus or anterior abdominal
wall.
4) The diverticulum should be removed by a segmental
small-bowel resection. A symptomless diverticulum
that is an incidental finding at laparotomy should not
be excised, but the patient should be informed of its
existence.

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
DEPARTMENT OF SURGERY & APPLIED
OSCE EXAMINATION
STATION STATIC
READ THE SCENARIO AND ANSWER THE FOLLOWING QUESTIONS
• A 50-year-old man presents to the emergency department with vomiting
and severe epigastric pain, which radiates through to the back. The pain
was of gradual onset, coming on over the past 2 days. He denies any
previous episodes. He is not on any regular medication but admits to
drinking in excess of eight cans of lager a day. He is a heavy smoker but
denies any recreational drug use. He is homeless and relates his heavy
drinking to depression.
• On examination, the patient is sweaty and agitated. He says he is unable to
lie flat for the examination and vomits persistently. His blood pressure is
150/80 mmHg and he has a pulse rate of 120/min. Palpation of his
abdomen reveals tenderness in the epigastrium. The abdomen is not
distended, and he has normal bowel sounds. Rectal examination is
unremarkable.
• Investigations shows: Hemoglobin 12g/dl (11.5–16.0g/dl), Mean cell
volume 102fl (76–96fl), White cell count 13.3 × 109/l (4.0–11.0 × 109/l),
Platelets 310 × 109/l (150–400 × 109/l), Sodium 132mmol/l (135–
145mmol/l), Potassium 4.2mmol/l (3.5–5.0mmol/l), Urea 5mmol/l (2.5–
6.7mmol/l), Creatinine 72μmol/l (44–80μmol/l), Amylase 4672iu/dl (0–
100iu/dl), AST 30iu/l (5–35iu/l), GGT 212iu/l (11–51iu/l), Albumin 25g/l
(35–50g/l), Bilirubin 12mmol/l (3–17mmol/l), Glucose 5mmol/l (3.5–
5.5mmol/l), Lactate dehydrogenase (LDH) 84iu/l (70–250iu/l), Total serum
calcium 2.35mmol/l (2.12–2.65mmol/l).

Questions
1. What is the most likely diagnosis?
2. Which important differential diagnosis should be excluded?
3. What are its causes?
4. What are the other causes of the elevated serum marker of this
condition?

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
 ANSWERS
1) The most obvious abnormal result is the raised amylase,
giving a diagnosis of Acute Pancreatitis.
2) Differential diagnosis that should be excluded:
a) Gallstones
b) Perforated peptic ulcer
3) Causes of Acute pancreatitis:
▪Common (80 percent): Gallstones, Alcohol
▪Rare (20 percent): Idiopathic, Infection (mumps,
coxsackie b virus), Iatrogenic (endoscopic retrograde
cholangiopancreatography [ERCP]), Trauma, Ampullary
or Pancreatic tumors, Drugs (salicylates, azathioprine,
cimetidine), Pancreatic structural anomalies (pancreatic
divisum), Metabolic (hypertriglyceridaemia, raised Ca2+),
Hypothermia.
4) Causes of Hyperamylasaemia:
a) Perforated peptic ulcer
b) Mesenteric infarction
c) Cholecystitis
d) Generalized peritonitis
e) Intestinal obstruction
f) Ruptured ectopic pregnancy
g) Diabetic ketoacidosis
h) Liver failure/Renal failure
i) Bowel perforation
j) Ruptured abdominal aortic aneurysm
w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
DEPARTMENT OF SURGERY & APPLIED
OSCE EXAMINATION
STATION STATIC
LOOK AT THE DIAGRAM AND ANSWER THE FOLLOWING QUESTIONS

QUESTIONS
1) Identify the object?
2) Write down its parts?
3) Write down its type?
4) Write down the uses/indications?
5) Write down the contraindications?
w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
 ANSWERS

1. Proctoscope
2. Parts: Proctoscope sheath (outer sheet)
and Obturator (inner part)
3. Types: Illuminating and Non-
illuminating
4. Indications:
a) Diagnostic: Hemorrhoids, Fissure in
ano, Polyps, Stricture, Fistula in ano,
For biopsy of tumour.
b) Therapeutic: Injection therapy,
Cryotherapy, Polypectomy
5. Complications: Bleeding, Severe pain,
Difficulty in urinating

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
DEPARTMENT OF SURGERY & APPLIED
OSCE EXAMINATION
STATION STATIC
LOOK AT THE DIAGRAM AND ANSWER THE FOLLOWING QUESTIONS

QUESTIONS

1) Identify the object?

2) Write down the types?
3) Write down the uses/indications?
4) Write down the complications?
w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
 ANSWERS
1. Self Retaining Foley’s Catheter
2. Types:
a) Intermittent Catheter: has 1-opening is used to drain
the bladder for short periods (5-10 minutes), inserted
by the patient
b) Indwelling/Retention catheter: has 2-openings, also
known as Foley- inflatable balloon (5cc-30cc), placed
into bladder and secured there for a period of time
c) Continuous catheter: has 3-openings or lumens (1 to
drain urine, 1 for filling balloon, and 1 for irrigation),
used for periodic or continuous bladder irrigation
d) Suprapubic catheter: inserted into bladder through
abdominal wall over suprapubic bone for continuous
drainage
e) Condom catheter: also known as a sheath or Texas
catheter, used for incontinence
3. Indications:
a) Relieve Urinary Retention
b) Empty the Bladder Before, During or After Surgery
c) Obtain a Sterile Urine Specimen from a Female Patient
d) Allows accurate measurement of urine output
e) Measure Residual Urine
4. Complications: Urethral trauma, Infection (UTI),
Obstructed catheter , Urethral tares, Ruptured bladder,
Bladder spasm, Possible allergic reaction to tape or latex

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
DEPARTMENT OF SURGERY & APPLIED
OSCE EXAMINATION
STATION STATIC
READ THE SCENARIO AND ANSWER THE FOLLOWING QUESTIONS
• A 19-year-old man presents with a 2-day history of
abdominal pain. The pain started in the central abdomen
and has now become constant and has shifted to the right
iliac fossa. The patient has vomited twice today and is off
his food. His motions were loose today, but there was no
associated rectal bleeding.
• On examination, the patient has a temperature of 37.8°C
and a pulse rate of 110/min. On examination of his
abdomen, he has localized tenderness and guarding in the
right iliac fossa.
• Investigations shows: Hemoglobin 14.2 g/dL (1.5–16.0
g/dL), Mean cell volume 86fL (76–96 fL), White cell count
19 109/L (4.0–11.0 109/L), Platelets 250 109/L (150–400
109/L), Sodium 136 mmol/L (135–145 mmol/L),
Potassium 3.5 mmol/L (3.5–5.0 mmol/L), Urea 5.0 mmol/L
(2.5–6.7 mmmol/L), Creatinine 62 μmol/L (44–80 μmol/L),
C-reactive protein 20 mg/L (5 mg/L) Urinalysis is clear.
Questions
1) What is the likely diagnosis?
2) What are the differential diagnoses for this
condition?
3) How would you manage this patient?
4) What are the complications of any surgical
intervention that may be required?
w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
 ANSWERS
1) The history and the findings on examination strongly suggest
Acute Appendicitis.
2) Differential diagnoses of acute appendicitis
a) Mesenteric adenitis
b) Psoas abscess
c) Meckel’s diverticulitis
d) Crohn’s ileitis
e) Non-specific abdominal pain
Additionally in females:
f) Ovarian cyst rupture
g) Ovarian torsion
h) Ectopic pregnancy (females must have pregnancy test)
3) The treatment is appendicectomy. The patient should be
rehydrated with preoperative intravenous fluids, and receive
analgesia. Antibiotics should be given if the diagnosis is clear
and the decision for surgery has been made. Surgery should
be carried out promptly in a patient who has signs of
peritonitis, in order to avoid systemic toxicity. The appendix
can be removed by open operation or laparoscopically.
4) Complications:
a) Wound infection: reduced by using broad-spectrum
antibiotics
b) Intra-abdominal collections and pelvic abscesses
c) Prolonged ileus
d) Fistulation between the appendix stump and the wound
e) Deep Vein Thrombosis, Pulmonary Embolism,
Pneumonia, Atelectasis
f) Late complications: Incisional Hernia, Adhesional
Obstruction
w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
DEPARTMENT OF SURGERY & APPLIED
OSCE EXAMINATION
STATION STATIC
READ THE SCENARIO AND ANSWER THE FOLLOWING QUESTIONS

•History: A 43-year-old man attends the surgical

outpatient clinic complaining of intermittent
bleeding per rectum for the past 2 months. The
blood is always bright red, separate from the stool
and drips into the pan. He also complains of
itching around the anus. There is no other past
medical history of note.
•Examination: Abdominal examination is
unremarkable. Rectal examination and
proctoscopy shows internal haemorrhoids at the 3
and 7 o’clock positions.

Questions
1) What are the differential diagnoses?

2) What other examinations are required?

3) How would you classify haemorrhoids?

4) What are the treatments for haemorrhoids?

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
 ANSWERS
1) The most likely cause for the per rectal bleeding is
haemorrhoids. Differential diagnoses of haemorrhoids are:
a) Anal fissure
b) Perianal haematoma
c) Carcinoma
d) Anal polyp
e) Inflammatory bowel disease
2) Sigmoidoscopy is mandatory to exclude rectal pathology
up to the rectosigmoid junction. If there is any doubt as to
the cause of bleeding, especially in the older patient, a
flexible sigmoidoscopy or full colonoscopy should be
carried out.
3) Haemorrhoids can be classified as:
a) 1st-degree haemorrhoids: remain in the rectum
b) 2nd-degree haemorrhoids: prolapse through the anus on
defecation but reduce spontaneously
c) 3rd-degree haemorrhoids: prolapse but require manual
reduction
d) 4th-degree haemorrhoids: prolapse & cannot be reduced
4) Patients should be advised to take plenty of fluid, fruit,
fibre and laxatives to keep the stool soft and to avoid
straining. Treatments include phenol injections into the
submucosa above the haemorrhoids and/or rubber-band
ligation. Large second-degree and third-degree piles
may require haemorrhoidectomy.

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
DEPARTMENT OF SURGERY & APPLIED
OSCE EXAMINATION
STATION STATIC
READ THE SCENARIO AND ANSWER THE FOLLOWING QUESTIONS

•History: A 33-year-old woman is referred to the

breast clinic after noticing a painless lump in her
right breast during self-examination. She reports
no associated nipple discharge or skin changes and
is currently mid-menstrual cycle. She has a 3-year-
old daughter and has no family history of breast
disease. She smokes 15 cigarettes per day.
•Examination: On examination of the right breast,
a 3-cm lump is found in the upper outer quadrant.
It is rubbery in consistency, mobile and non-
tender. There are no skin changes. There is no
evidence of lymphadenopathy in either axillae or
supraclavicular fossae. The left breast is normal
and abdominal examination is unremarkable.
Questions
1) What are the possible diagnoses?
2) What is the likely diagnosis in this patient?
3) How should this be confirmed?
4) How should the patient be managed?
w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
 ANSWERS
1) The possible (differential) diagnoses are:
a) Fibrocystic disease (fluctuation in size with
menstrual cycle and often associated with
mild tenderness)
b) A breast cyst (smooth, well-defined
consistency like fibroadenoma but a hard as
opposed to a rubbery consistency)
c) Breast carcinoma (irregular, indistinct
surface and shape with hard consistency)

2) The most likely diagnosis is a Benign

Fibroadenoma.

3) Confirmation of the diagnosis should be with

FNAC or Excision biopsy.

4) If FNAC is performed, treatment options include

wide local excision or observation, depending on
patient wishes. Malignant change occurs in 1 in
1000.

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
DEPARTMENT OF SURGERY & APPLIED
OSCE EXAMINATION
STATION STATIC
READ THE SCENARIO AND ANSWER THE FOLLOWING QUESTIONS
• History: A 54-year-old man presents to the emergency department with a
4-day history of abdominal distension, central colicky abdominal pain,
vomiting and constipation. On further questioning he says he has passed
a small amount of flatus yesterday but none today. He has had a previous
right-sided hemicolectomy 2 years ago for colonic carcinoma. He lives
with his wife and has no known allergies.
• Examination: On examination, his blood pressure and temperature are
normal. The pulse is irregularly irregular at 90/min. He has obvious
abdominal distension, but the abdomen is only mildly tender centrally.
The hernial orifices are clear. There is no loin tenderness and the rectum
is empty on digital examination. The bowel sounds are hyperactive and
high pitched. Chest examination finds reduced air entry bibasally.
• Investigations: Haemoglobin 12.2g/dl (11.5–16.0g/dl), White cell count
10.6×109/l (4.0–11.0×109/l), Platelets 435×109/l (150–400×109/l), Sodium
136mmol/l (135–145mmol/l), Potassium 3.7mmol/l (3.5–5.0mmol/l), Urea
6.2mmol/l (2.5–6.7mmol/l), Creatinine 77μmol/l (44–80μmol/l).
• An x-ray of the abdomen is performed and is shown below.

Questions
1) What is the diagnosis?
2) What features on the x-ray point
towards the diagnosis?
3) How should the patient be managed
initially?
4) What are the common causes of this
condition?

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
 ANSWERS
1) The most likely diagnosis is Small-bowel Obstruction.
2) Typical features on the x-ray include dilated gas-filled
loops of bowel and air-fluid levels.
3) Initial management:
a) Keep the patient nil by mouth
b) In small-bowel obstruction there is substantial fluid loss
and intravenous fluid resuscitation is necessary
c) Regular observation
d) Urinary catheter to monitor fluid balance
e) Consider central venous line to monitor fluid balance in
shocked patients
f) Pass a nasogastric tube & perform regular aspirates
g) Consider high-dependency unit (HDU) or intensive
care unit (ICU) transfer for optimization prior to
surgery if required
4) Aetiology of small-bowel obstruction:
a) Adhesions – common after previous abdominal or
gynecological surgery
b) Incarcerated herniae, e.g. Inguinal, femoral,
paraumbilical, spigelian, incisional
c) Gallstone ileus
d) Inflammatory bowel disease
e) Radiation enteritis
f) Intussusception

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
DEPARTMENT OF SURGERY & APPLIED
OSCE EXAMINATION
STATION STATIC
READ THE SCENARIO AND ANSWER THE FOLLOWING QUESTIONS
• History: A 32-year-old man presents to the colorectal
outpatient clinic with an 8-week history of pain on
defaecation. The pain is around the anus and typically
lasts an hour after passing stool. He normally suffers with
constipation but this has now worsened as he is reluctant
to pass motion because of the pain. He intermittently
notices a small amount of fresh blood on the tissue paper
after wiping himself. He has no family history of
inflammatory bowel disease or colorectal cancer. He is
otherwise well and takes no regular medications.
• On examination, the patient appears well with no evidence
of pallor, jaundice or lymphadenopathy. Abdominal
examination is unremarkable. Examination of the anus
reveals a small linear defect in the skin at the 6 o’clock
position. Rectal examination could not be performed as it
caused too much discomfort for the patient.

Questions
1) What is the most likely diagnosis?
2) What are the typical findings on examination?
3) What are the differential diagnoses?
4) What treatment would you recommend?

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
 ANSWERS
1) The most likely diagnosis is an Anal Fissure.
2) Examination typically reveals a linear tear in the midline
and posteriorly. Anterior fissures are more common in
female patients. Chronic fissures are associated with skin
tags, and the exposed fibres of the internal sphincter may
be visible at their base. Anal fissures are common in
patients with Crohn’s disease and ulcerative colitis.
3) Differential diagnoses:
a) Perianal haematoma
b) Anorectal abscess
c) Anorectal carcinoma
d) Anal warts
e) Anal herpes
4) Management: More than half of fissures will heal with:
a) Conservative treatment: include the use of laxatives,
high dietary fibre, fruit and plenty of fluids to ensure
the stool is soft. Topical local anesthetic (e.g.lidocaine)
can be used for pain relief.
b) Non-healing fissures may respond to the use of topical
0.2 percent glyceryl trinitrate ointment. This can cause
headaches & dizziness, so is not suitable for all patients.
c) Direct injection of botulinum toxin into the anal
sphincter helps relieve spasm and promotes healing.
d) Lateral sphincterotomy is used less frequently now as it
is associated with a small risk of incontinence.

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
DEPARTMENT OF SURGERY & APPLIED
OSCE EXAMINATION
STATION STATIC
READ THE SCENARIO AND ANSWER THE FOLLOWING QUESTIONS
• History: You are the surgical doctor in the pre-assessment
clinic and you are asked to review a 56-yearold man who is
due to have a transurethral resection of a bladder tumour
(TURBT). He has non-insulin-dependent diabetes and had
a myocardial infarction 7-years-ago. His current
medications include metformin 500mg BD, gliclazide
80mg OD, aspirin 75mg OD, lisinopril 20mg OD and
gaviscon PRN. He has no known allergies. He gave up
smoking after his myocardial infarction.
• Examination: Observations are normal. The patient
appears comfortable. Heart sounds are normal and the
chest is clear. The abdomen is soft, non-tender and the
genitalia are normal.

Questions
1) Which investigations would be appropriate prior to his
surgery?
2) What types of complications commonly affect patients with
diabetes?
3) Where should the patient be placed on the operating list?
4) What regimen would you recommend for keeping good
glycaemic control in the perioperative and postoperative
period?

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
 ANSWERS
1) Full blood count, Urea and Electrolytes, Blood glucose and
a Haemoglobin. Full cardiovascular, respiratory,
abdominal & neurological examination should be
performed. The lower limbs should be examined for
peripheral neuropathy and ulceration. The peripheral
pulses palpation for peripheral vascular disease.
Fundoscopy to assess the retina. BP measurement in both
the lying and standing positions to assess for autonomic
neuropathy. An ECG to screen for cardiac disease.
2) Patients with diabetes have an increased risk of
postoperative complications:
a) Atherosclerosis: ischaemic heart disease/peripheral
vascular disease/cerebrovascular disease
b) Nephropathy: renal insufficiency
c) Retinopathy: limited visual acuity
d) Autonomic neuropathy: gastroparesis, decreased bladder
tone
e) Peripheral neuropathy: lower-extremity ulceration,
infection, gangrene
f) Poor wound healing
g) Increased risk of infection
3) The patient with diabetes should be placed first on the
operating list to avoid prolonged fasting.
4) Tight glycaemic control (6–10 mmol/L) and the prevention
of hypoglycemia are critical in preventing perioperative
and postoperative complications.
w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
DEPARTMENT OF SURGERY & APPLIED
OSCE EXAMINATION
STATION INTERACTIVE
Command: He is 40-year old came through OPD
complaining of pain right hypochondrium. Ask the
relevant history from the patient.
STEPS

1) Introduction

2) Consent

3) Onset of pain

4) Duration of pain

5) Nature of pain

6) Intensity

7) Associated symptoms: Dyspepsia, Heart Burn,

Jaundice

8) Relation with fatty and spicy food or full meal

9) Aggravating/Alleviating factors

10) Radiation/Referral

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
DEPARTMENT OF SURGERY & APPLIED
OSCE EXAMINATION
STATION INTERACTIVE
You have taken the history. Now answer the questions
asked by the examiner.
Questions:
1. What is the differential diagnosis?
2. What investigations you would
advice?
3. What treatment will you advise?
Answers:
1. Gall stones, Cholecystitis,
Hepatitis, Peptic Ulcer
2. CBC, LFT, U/S scan, Hepatitis B
and C, Urine DR
3. Laparoscopic cholecystectomy,
Open cholecystectomy

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
DEPARTMENT OF SURGERY & APPLIED
OSCE EXAMINATION
STATION INTERACTIVE
Command: EXAMINE THE SWELLING
STEPS
1) Site
2) Color and Texture of overlying swelling
3) Shape & Size
4) Temperature
5) Tenderness
6) Surface
7) Edge
8) Consistency
9) Fluctuance
10) Fluid Thrill
11) Translucency
12) Resonance
13) Pulsality
14) Compressibility
15) Reducibility
16) Mobility

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
DEPARTMENT OF SURGERY & APPLIED
OSCE EXAMINATION
STATION INTERACTIVE
Command: He is a 40-year old patient presents with
abdominal pain since one day. You are asked to perform
palpation in abdominal examination.
STEPS

1) Introduction/Consent

2) Exposure

3) Guarding/Rigidity

4) Tenderness/Rebound tenderness

5) Murphy's sign

6) Palpation of liver

7) Palpation of spleen

8) Palpation of kidneys

9) Fluid Thrill

10) Shifting dullness

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
DEPARTMENT OF SURGERY & APPLIED
OSCE EXAMINATION
STATION STATIC
READ THE SCENARIO AND ANSWER THE FOLLOWING QUESTIONS
➢ A 22 years young boy is presented with pain in right
iliac fossa with nausea, vomiting and loss of
appetite. His abdominal examination reveals a
tender lump in the right iliac fossa.

QUESTIONS
1) What is the likely diagnosis?
2) What are the differential diagnoses for this
condition?
3) What investigation you would suggest in this
patient?
4) How would you manage this patient?
w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r
“You get a strange feeling when you’re about to
leave a place. Like you’ll not only miss the
person you love but you’ll miss the person
you’re now, at this time and this place, because
you’ll never be this way ever again.”
KMC Batch-01

w w w. f a c e b o o k . c o m / H u m a n s o f K M C K h p r