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SURGERY OSCE

INSTRUCTIONS: There will be 24 Stations and each student is given 2 minutes to answer and/or do the necessary questions/procedure on each station.

STATION 1: HISTORY TAKING

The student will act as a doctor and the resident will act as your patient J (resident = difficult patient… haha!)

Ask for the General Data of the patient (name, age, sex, …)

Ask for the Chief Complaint (e.g. abdominal pain)

Ask for the HPI (onset, pain scale, duration, associated symptoms such as fever, nausea, etc., medications, etc.)

Try to do PE (try to palpate)

CLUE: the bread and butter of surgery is ACUTE APPENDICITIS; try to concentrate on extracting information that will support the diagnosis of Acute Appendicitis J According to Dr. Jing, acute appendicitis can also present as pain on the RUQ

STATION 2: SURPRISE STATION

I labeled this as a surprise station since we didn’t know that this will be based on the previous station (argh!)

The following were the questions asked during our OSCE

o

What is the age of the patient in the previous station? J (e.g. 30 years old)

o

What is the chief complaint? (e.g. abdominal pain)

o

What is your primary impression? (e.g. acute appendicitis)

o

What are your bases? (3)

§

e.g. abdominal pain (RUQ), pain scale of 10/10, (+) direct and rebound tenderness

o

What are your differentials? (3)

§

e.g. Meckel’s Diverticulum, Cholecystitis, Hepatitis

o

What is the definitive treatment?

§ e.g. Appendectomy

STATION 3: NGT INSERTION

The student will be asked to demonstrate the proper way of inserting a nasogastric tube

Try to explain on the resident what you are doing, step by step J

o

First, ask for the consent of the patient

o

Try to estimate the NGT that you will insert: from ear to nose, then from nose to xiphoid process

o

Put KY jelly on the NGT

o

Extend the patient’s neck and insert the NGT

o

Ask the patient to swallow until you reach the estimated part of NGT to be inserted

o

Use the suction to test if you have inserted it correctly on the stomach (use your stethoscope)

o

Secure the NGT with a micropore J

STATION 4: IFC INSERTION

The student will be asked to demonstrate the proper way of inserting an IFC

Try to explain on the resident what you are doing, step by step J

o

First, ask for the consent of the patient

o

Use povidone iodine (Betadine) to prepare the patient

o

Connect the IFC to the urine bag

o

Put KY jelly on the IFC

o

Ask the patient to breath deeply and insert the IFC until the Y-shaped end

o

Check if there is flow of urine

o Secure the IFC on the thigh with a micropore STATION 5: SUTURING

The student will be asked to demonstrate the proper way of suturing

Try to explain on the resident what you are doing, step by step J

The case given to us during our OSCE was a patient with a lacerated wound at the back

o

First, ask for the consent of the patient

o

The resident will ask you what kind of suture you’ll request; request for NYLON 3-0

o

Use povidone iodine (Betadine) to prepare the patient

o

The resident will ask you to make a simple interrupted stitch

§ Make sure to use your finger to push and lock the tie

STATION 6: SUTURES AND NEEDLES

The student will identify the sutures and needles prepared by the residents

Nylon

o Description: monofilament

o Use: skin on the face and scalp

o Needle: conventional cutting needle (triangular)

Vicryl

§ for suturing skin

o Description: purple

o Use:

o Needle: taper-point

§ soft tissues other than the skin

Prolene

o

Description: suture that is blue and shiny

o

Use: for vascular anastomosis, nerves

o

Needle: taper-point needle

§ soft tissues other than the skin

Absorbable Sutures

o

Vicryl

o

Chromic Catgut

o

Plain Catgut

o

PDS

o

Monocryl

Non-absorbable Sutures

o

Silk

o

Nylon

o

Prolene

o

Cotton

STATION 7: CHEST X-RAY

The student will be given a case of 54-year-old male, smoker, with a one week history of cough, dyspnea

A picture of an X-ray plate will be shown to the student

o The following were the questions asked (can’t remember the other questions) during our OSCE

§ What is the most significant finding in the X-ray? (e.g. pneumoperitoneum)

§ What is the most possible diagnosis? (e.g. PTB)

STATION 8: PULMO CASE

STATION 9: KNOT TYING

The student will be asked to demonstrate the one-hand and two-hand technique of knot tying

Make sure to use your finger to push and lock the tie

STATION 10: SURGICAL INSTRUMENTS

The student will identify the surgical instruments prepared by the residents

Try to familiarize with the following instruments

o

Army Navy

o

Iris

o

Mayo Curve

o

Mayo Straight

o

Kelly Curve

o

Kelly Straight

o

Metzenbaum

o

Needle Holder

o

Scalpel

o

Allis

STATION 11: PLAIN ABDOMINAL X-RAY

The student will be given a case and will be asked to identify the 2 X-ray plates prepared by the residents

CLUE: Try to differentiate between a Complete vs Partial Gut Obstruction

o

View the plate was taken, Type of X-ray requested (e.g. Plain Abdominal X-ray)

o

Pertinent findings on X-ray

o

Complete Diagnosis

STATION 12: GALLBLADDER

The student will be asked to identify the stones prepared by the residents

o

Cholesterol

– yellow

o

Pigment

– black, brown

o

Mixed

Components of Stone

o

Cholesterol

o

Bile Acid

o

Lecithin

STATION 13: INTRAOPERATIVE CHOLANGIOGRAM

The student will be asked to enumerate the normal findings in an IOC

o

Common bile duct not greater than 1 cm in diameter

o

No filling defect

o

No rat tailing

o

Arborization of hepatic duct

o

Dye should reach the duodenum

STATION 14: THYROID

The student will be given a case of a 34-year-old male with a chief complaint of anterior neck mass

Which has a greater tendency for malignancy

o Solid vs Cystic

o

Solitary vs Multiple

o

Fast enlargement overnight vs Slowly enlarging mass for months

o

Hard vs Soft

o

Tender vs Non-tender

o

Male vs Female

o

Child vs Adult

Definitive diagnosis of the case will be based on:

o Fine Needle Aspiration Biopsy (FNAB)

STATION 15: BREAST

The student will be given a case about a lactating patient with a breast mass

CLUE: Try to differentiate the signs and symptoms of fibroadenoma, fibrocystic disease, breast CA

o The following were the questions asked during our OSCE

§ What will be your primary impression?

§ What diagnostic test will you request to confirm your diagnosis?

Mammogram and core needle biopsy

§ What will you advise the patient if the histopath is positive for:

Fibroadenoma

Fibrocystic disease

Breast CA

– observation; surgical resection for large or growing lesions

– stop caffeine, NSAIDs, Vitamin E

– mastectomy

§ Best time to do breast examination: one week after menstruation

STATION 16: BURN

The student will be asked to compute for the estimated volume of Crystalloid necessary for initial resuscitation

Use the Parkland Formula

o V = Total Body Surface Area Burn (%) x Weight x 4mL

§ Example: 90% Burn in a 70kg patient

§ 90 x 70k x 4mL PLR = 25,200

§ 25,200 / 2 = 12,600 in the first 8 Hours

STATION 17: LIDOCAINE DOSE

The student will be asked to compute for the Maximum Dose of Lidocaine

o

Example: What is the Maximum Dose of Lidocaine in a 70kg patient?

o

(weight in kg) (lidocaine)

o

70kg x 8mg/kg = 560mg

o

560mg x 5mL/100mg = 28mL Maximum