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by All Team © "One Vision … One Mission " General Surgical Scheme 11.11

General Surgical Scheme

11.11 SwellingsSwellingsSwellingsSwellings

Differential Diagnosis of swelling case

• If the Pt. told you that it was after trauma Haemangioma. • If the
If the Pt. told you that it was after trauma Haemangioma.
If the swelling has an expansile pulse Aneurysm.
If the swelling has a transmitted pulse Swelling
over an artery.
The swelling is reducible & shows expansile impulse on cough
Hernia or Saphena varix.
The swelling moves up and down with deglutition Thyroid
enlargement or thyroglossal cyst.
The swelling moves with protrusion of the tongue
Thyroglossal cyst.
The swelling increase in size in very short period A tumor.
Not one of these so by exclusion Lipoma or Sebaceous cyst.
⇒ How to diagnose a swelling?
a. Anatomically: organ involved.
b. Etio-pathological diagnosis:
Traumatic, Inflammatory (F.H.M.A), Neoplastic.

c. Functional diagnosis "compensated or not".

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by All Team © "One Vision … One Mission " 22.22 HerniaHerniaHerniaHernia A Swelling shows -

22.22 HerniaHerniaHerniaHernia

A Swelling shows

- Expansile impulse on cough.

- Reducible, and …

⇒ Near linea alba, so the hernia may be
⇒ Near linea alba, so the hernia may be

Umbilical "it is rounded; usually there is absence of the shape of umbilicus". Para umbilical "it is cresenteric, usually presence shape of the umbilicus" Other with no incision Epigasteric.

Any where at a site of an incision, the hernia may be

Incisional "A scar of previous operation other than hernia". Recurrent hernia "A scar of previous hernia operation".

At the inguinal region & above the inguinal ligament, hernia may be

Direct "At Hassel Bach's triangle, Reduced backwards & don't descend to scrotum". Indirect "Hernia reduced upwards, backwards and laterally & may descend to scrotum".

Saphena varix:

Site: at femoral triangle. With Trendlenberg test incompetent sapheno- femoral junction.

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by All Team © "One Vision … One Mission " 33.33 ThyroidThyroidThyroidThyroid Neck ـ ا ا

33.33 ThyroidThyroidThyroidThyroid

Neck ـ ا ا Neck lumps ـ ا ت ا إ

Enlarged lymph node, thyroid enlargement, thyroglossal cyst, and tumour.

ا ة او Thyroid ـ ا ن ا ت

What are the suggestive of malignant goitre?? 1. Recent rapid increase in size. 2. Hard
What are the suggestive of malignant goitre??
1. Recent rapid increase in size.
2. Hard consistency.
3. Fixation to the surroundings.
4. Local pain referred to the ear.
5. Fixed hard cervical lymph nodes.
6. Signs of distant metastasis.

Simple goitre, solitary nodule, 1ry thyrotoxicosis or 2ry thyrotoxicosis autonomous toxic nodule.

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by All Team © "One Vision … One Mission " 44.44 UlcersUlcersUlcersUlcers a. Vascular venous ulcer,

44.44 UlcersUlcersUlcersUlcers

a. Vascular venous ulcer, ischemic ulcer, lymphoma ulcer.

b. Traumatic direct trauma or bed sore.

c. Infection chronic osteomylitis, T.B & syphilis.

d. Neoplastic:

chronic osteomylitis, T.B & syphilis. d. Neoplastic : ⇒ Primary skin ulcer "epithelioma, melanoma, basal

Primary skin ulcer "epithelioma, melanoma, basal cell carcinoma".

Marjolin's ulcer "epithelioma on top of ulcer, burn". Ulcerative deep malignancy "bone tumours".

⇒ ⇒ e. Others: neuropathy & rheumatoid ulcer. • Venous Ask about history of DVT.
e. Others: neuropathy & rheumatoid ulcer.
Venous Ask about history of DVT.
Neuropathy
؟؟ ، آ ن آ
؟؟ و ضر إ
إ إ يز ر ةدر وأ إ
؟؟ و إ يز
Others From the shape of the edge.

و ن

Ischemia Ask about history of Claudication pain, Color change & Atrophic tissue.

Malignant و ت آ إ course ـ ا

The most common is venous ulcer.

ه ن ا ه ا

Complication of thrombophlebitic limb or complication of 2ry varicose veins.

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by All Team © "One Vision … One Mission " OSCE OSCE OSCE OSCE Exam Exam

OSCEOSCEOSCEOSCE ExamExamExamExam QuestionsQuestionsQuestionsQuestions

These are a group of questions from the previous end round exams. In the OSCE
These are a group of questions from the previous end
round exams.
In the OSCE exam you are asked to examine a Case, and
then you answer on those questions & just to state if
these sentences are true or false.
This is just a sample for the exam to guide you & to say
take care of something there.
o Case 1 "ExamineExamineExamineExamine thethethethe NeckNeckNeckNeck".
State True or False:
1. The Pulse is less than 80/min.
2. The patient has +ve stellwag sign.
3. The patient has no fine tremors on extremities.

What is your diagnosis? Primary toxic goiter.

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by All Team © "One Vision … One Mission " o Case 2

o Case 2 "Examine"Examine"Examine"Examine thethethethe Neck"Neck"Neck"Neck".

State True or False:

1. The patient pulse is more than 100/min.
2. The swelling moves up and down with deglutition and with protrusion of the tongue. The swelling has nodular surface.

3.

What is your diagnosis? Simple nodular goiter. o Case 3 "Examine"Examine"Examine"Examine thethethethe
What is your diagnosis?
Simple nodular goiter.
o
Case 3 "Examine"Examine"Examine"Examine thethethethe Neck".Neck".Neck".Neck".
1ry toxic goiter.
State True or False:
1.
2.
3.
There is pretibial myxedema.
+ve Vongrafe sign.
Moves up & down with deglutition and with protrusion of tongue.
o
Case 4 "Examine"Examine"Examine"Examine thethethethe Neck".Neck".Neck".Neck".
Simple nodular goiter.
State True or False:
1. It is in posterior triangle.
2. Superficial to sternomastoid.
3. There is a retrosternal extension.
o
Case 5 "ExamineExamineExamineExamine thethethethe thyroid".thyroid".thyroid".thyroid".
There may be a Stethoscope near the patient, so take care.
State True or False:

1.

2. The swelling is pulsating.

3. The skin shows a scar.

4. The right lobe is enlarged.

5. There is a retrosternal extension.

There is thrill over upper pole.

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by All Team © "One Vision … One Mission " o Case 6

o Case 6 "Examine"Examine"Examine"Examine thethethethe Neck".Neck".Neck".Neck".

2ry toxic goiter. State True or False:

1. The trachea is central.
2. There are nodules in both lobes. There are visible pulsations over the superior pole of thyroid. There is audible bruit over the thyroid.

3.

4. o Case 7 "Examine"Examine"Examine"Examine thethethethe Neck".Neck".Neck".Neck".
4.
o
Case 7 "Examine"Examine"Examine"Examine thethethethe Neck".Neck".Neck".Neck".
1ry toxic goiter.
State True or False:
1. There is thrill on upper pole.
2. The Berry's sign is +ve.
3. The pemperton sign is -ve.
4. There is a dull sternum.
5. The swelling moves up & down with deglutition.
o
Case 8 "Examine"Examine"Examine"Examine thethethethe Thyroid".Thyroid".Thyroid".Thyroid".
State True or False:
1.
2.
3.
4.
5.
This is a case of secondary toxic goiter.
The gland is nodular asymmetrical.
There is retrosternal dullness.
The best line for treatment of this case is surgery.
The gland moves upwards with deglutition and protrusion of the
tongue.
o
Case 9 "ExamineExamineExamineExamine thethethethe Thyroid".Thyroid".Thyroid".Thyroid".
State True or False:

1. There is thyroid enlargement.

2. There is scar of previous operation.

3. The swelling is completely covered with sternomastoid.

4. RT supraclavicular LN is enlarged.

5. The swelling moves with protrusion of tongue.

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by All Team © "One Vision … One Mission " o Case 10

o Case 10 "Examine"Examine"Examine"Examine thethethethe Thyroid".Thyroid".Thyroid".Thyroid".

Simple nodular goiter.

State True or False:

4. 5. 1. The swelling moves with deglutition. 2. The swelling is hard. The swelling
4.
5.
1. The swelling moves with deglutition.
2. The swelling is hard.
The swelling moves with protrusion of tongue.
The swelling is bilateral.
The swelling is attached to skin.
3.
o
Case 11 "Examine"Examine"Examine"Examine thethethethe NeckNeck".NeckNeck".".".
2ry thyrotoxicosis.
State True or False:
1. It is a case of 1rythyrotoxicosis.
2. The patient has a fine tremor.
3. The pulse > 100.
4. The only line of ttt is surgical.
o
Case 12 "Examine"Examine"Examine"Examine bothbothbothboth Groins".Groins".Groins".Groins".
State True or False:
1. The swelling doesn't reach the scrotum.
2. This is a direct hernia.
3. Internal ring test is negative.
What is your diagnosis?
Right indirect inguinal hernia in a male patient, non complicated, enterocele, fit for surgery.
o
Case 13 "Examine"Examine"Examine"Examine bothbothbothboth Groins".Groins".Groins".Groins".
Rt. Indirect inguinal hernia.

State True or False:

1. The patient has oblique inguinal hernia.

2. The patient has left femoral hernia.

3. The hernia is irreducible.

4. This is a case of recurrent hernia.

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by All Team © "One Vision … One Mission " o Case 14

o Case 14 "Examine"Examine"Examine"Examine bothbothbothboth Groins".Groins".Groins".Groins".

Rt. indirect inguinal hernia.

State True or False:

1. There is a scar in left groin. 2. It shows malgaigne bulging. It is
1. There is a scar in left groin.
2. It shows malgaigne bulging.
It is downward & lateral to pubic tubercle.
It is strangulated.
There is sliding bladder.
3.
4.
5.
o
Case 15 "Examine"Examine"Examine"Examine RightRightRightRight Groins".Groins".Groins".Groins".
Rt. indirect inguinal hernia.
State True or False:
1. This is oblique uncomplicated hernia.
2. It is partially irreducible.
3. It shows transmitted impulse.
4. The patient is kept in the hospital for herniotomy.
5. Internal ring test is positive.
o
Case 16 "Examine"Examine"Examine"Examine thethethethe Abdomen".Abdomen".Abdomen".Abdomen".
State True or False:
1. The abdomen is distended.
2. The swelling is not completely reducible.
3. The most urgent complication is strangulation.
What is your diagnosis?
Supraumblical hernia, non complicated, in a female patient.
o
Case 17 "Examine"Examine"Examine"Examine thethethethe Abdomen".Abdomen".Abdomen".Abdomen".
State True or False:

1. The hernia is reducible.

2. The hernia is obstructed.

3. There is Gurgling sensation on palpation.

What is your diagnosis?

Epigastric hernia in a male patient, non complicated, omentocele.

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by All Team © "One Vision … One Mission " o Case 18

o Case 18 "Examine"Examine"Examine"Examine thethethethe SpleenSpleen".SpleenSpleen".".".

State True or False:

1. There is left renal swelling.
2. The spleen is enlarged and reaching the right iliac fossa.
3. There is positive ballottement test. A notch can be felt on the ant boarder of the swelling.

4.

o Case 19 "Examine"Examine"Examine"Examine thethethethe
o
Case 19 "Examine"Examine"Examine"Examine thethethethe Abdomen".Abdomen".Abdomen".Abdomen".
Incisional & Para umbilical hernia.
State True or False:
1. There is only Para umbilical hernia.
2. Mid line previous incision.
3. It is tender.
4. It shows an expansile impulse on cough.
5. Appears more on contraction of abdominal muscles.
o
Case 20 "Examine"Examine"Examine"Examine thethethethe Abdomen".Abdomen".Abdomen".Abdomen".
Para umbilical, Incisional hernias & 2 scars "one above the umbilicus & the
other at inguinal region".
State True or False:
1. There is Para umbilical hernia.
2. There is incisional hernia.
3. More than one scar.
4. Both hernias are reducible.
5. Malgaigne bulge is seen.
o
Case 21 "Examine"Examine"Examine"Examine thethethethe Abdomen".Abdomen".Abdomen".Abdomen".
Umbilical hernia.
State True or False:

1. It is a paraumblical hernia.

2. There are signs of inflammation.

3. There is an ulcer.

4. The swelling shows impulse on cough.

5. There is a scar of previous operation.

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by All Team © "One Vision … One Mission " o Case 22

o Case 22 "Examine"Examine"Examine"Examine thethethethe Abdomen".Abdomen".Abdomen".Abdomen".

Umbilical hernia.

State True or False:

4. 5. 1. The mass has an expansile impulse in cough. 2. Occupation is important
4.
5.
1. The mass has an expansile impulse in cough.
2. Occupation is important to be asked in this case.
3. It is not complicated.
Abdominal & pelvic sonar is important.
Strangulation could occur due to twisting of 2 loops of intestine.
o
Case 23 "Examine"Examine"Examine"Examine BothBothBothBoth LowerLowerLowerLower Limbs".Limbs".Limbs".Limbs".
State True or False:
1. The patient has +ve Fagan test.
2. The condition is unilateral.
3. There is Saphenofemoral incompetence.
What is your diagnosis?
Bilateral 1ry varicose veins non complicated.
o
Case 24 "Examine"Examine"Examine"Examine BothBothBothBoth LowerLowerLowerLower Limbs".Limbs".Limbs".Limbs".
State True or False:
1. There is competent Saphenofemoral junction.
2. There is no thrill on Saphenous opening.
3. The condition is bilateral.
What is your diagnosis?
2ry varicose veins in left limb & complicated.
o
Case 25 "Examine"Examine"Examine"Examine LeftLeftLeftLeft Leg".Leg".Leg".Leg".
1ry unilateral varicose veins.
State True or False:

1. There is Saphenofemoral incompetence.

2. There is affection of the short Saphenous vein.

3. There is venous ulcer.

4. There is no pigmentation.

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by All Team © "One Vision … One Mission " o Case 26

o Case 26 "Examine"Examine"Examine"Examine BothBothBothBoth LowerLowerLowerLower LimbsLimbs".LimbsLimbs".".".

State True or False:

1. Dorsalis pedis pulse is present.
2. 2ry to incompetent right Saphenofemoral junction.
3. Right leg is longer than left. There is atrophy blanche.

4.

o Case 27 "Examine"Examine"Examine"Examine BothBothBothBoth LowerLowerLowerLower
o
Case 27 "Examine"Examine"Examine"Examine BothBothBothBoth LowerLowerLowerLower Limbs".Limbs".Limbs".Limbs".
State True or False:
1. Short saphenous vein is palpable.
2. Venous refill takes longer than 10 min.
3. There is evidence of lipodermatosclerosis.
4. There is evidence of haemosiderosis.
o
Case 28 "Examine"Examine"Examine"Examine BothBothBothBoth LowerLowerLowerLower Limbs".Limbs".Limbs".Limbs".
Old obese female.
State True or False:
1. This is a case of secondary varicose.
2. Varicosities appear along the course of short saphenous.
3. Veins are pulsating.
4. There is incompetent Saphenofemoral junction.
5.
Modified Perth's test is positive for this case.
o
Case 29 "Examine"Examine"Examine"Examine BothBothBothBoth LowerLowerLowerLower Limbs".Limbs".Limbs".Limbs".
Unilateral 2ry varicose veins.
State True or False:
1.
2.

The prominent system affected is short saphenous. The long saphenous is pulsating. There is apparent sahena varix.

3.

4. There is pigmentation.

5. This is a case of 2ry varicose veins.

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by All Team © "One Vision … One Mission " o Case 30

o Case 30 "Examine"Examine"Examine"Examine BothBothBothBoth LowerLowerLowerLower Limbs".Limbs".Limbs".Limbs".

2ry varicose veins.

State True or False:

1. A case of 1ry varicose veins. 2. There is an incompetent perforator. The ulcer
1. A case of 1ry varicose veins.
2. There is an incompetent perforator.
The ulcer is healed.
It is not complicated.
The treatment is surgical.
Venograhy is the best investigation to be done.
3.
4.
5.
6.
o
Case 31 "Examine"Examine"Examine"Examine BothBothBothBoth LowerLowerLowerLower Limbs".Limbs".Limbs".Limbs".
1ry varicose veins in right side.
State True or False:
1. The dilated veins are bilateral.
2. There is an ulcer in the right side.
3. There is a scar in the right side.
4. The shape of dilatations is saccular.
5. There are dilatations in sapheno femoral junction.
o
Case 32 "Examine"Examine"Examine"Examine thethethethe Back".Back".Back".Back".
State True or False:
1.
2.
3.
What is your diagnosis?
Subcutaneous lipoma of the back.

The swelling has slippery edges. The swelling is sub muscular. The most common complication is malignant transformation.

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by All Team © "One Vision … One Mission " o Case 33

o Case 33 "Examine"Examine"Examine"Examine thethethethe Neck".Neck".Neck".Neck".

Lymphadenopathy following sore throat.

State True or False:

1.

This is anatomical site for lymph node. It is related to throat condition. Submental LN is palpable. It is soft in consistency. Pagets test is +ve.

2. 3. 4. 5. o Case 34 "Examine"Examine"Examine"Examine thethethethe
2.
3.
4.
5.
o
Case 34 "Examine"Examine"Examine"Examine thethethethe Face".Face".Face".Face".
State True or False:
1. The condition is related to sun exposure.
2. The safety margin of excision is more than 5 mm.
3. Distant metastasis is the most common complication.
What is your diagnosis?
Basal cell carcinoma of the nose "Rodent Ulcer".
o
Case 35 "Examine"Examine"Examine"Examine thethethethe Face".Face".Face".Face".
Squamous cell carcinoma at angle of mouth.
State True or False:
1. Safety margin is less than 5mm.
2. It is related to nicotine.

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by All Team © "One Vision … One Mission " End End End End Round Round

EndEndEndEnd RoundRoundRoundRound

" " o Case 1 "Examine"Examine"Examine"Examine thethethethe RightRightRightRight
" "
o
Case 1 "Examine"Examine"Examine"Examine thethethethe RightRightRightRight ElbowElbow".ElbowElbow".".".
Cystic Swelling in the elbow.
State True or False:
1.
2.
3.
4.
5.
The skin is abnormal.
The swelling is deep to the muscle.
The swelling is solid.
The skin over the swelling showed dimpling on movement.
Paget test is a fluctuation test for large swelling.
o
Case 2 "Examine"Examine"Examine"Examine BothBothBothBoth GroinsGroins".GroinsGroins".".".
Hernia (indirect) "patient above 40 years".
State True or False:
1. This is oblique uncomplicated hernia.
2. It is partially irreducible.
3. It shows transmitted impulse.
4. The patient is kept in the hospital for herniotomy.
5. Internal ring test is positive.
o
Case 3 "Examine"Examine"Examine"Examine thethethethe NeckNeck".NeckNeck".".".
2ry toxic goiter "Female 33 years".
State True or False:

1. This is a case of secondary toxic goiter.

2. The gland is nodular asymmetrical.

3. There is retrosternal dullness.

4. The best line for treatment of this case is surgery.

5. The gland moves upwards with deglutition and protrusion of the tongue.

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by All Team © "One Vision … One Mission " o Case 4

o Case 4 "Examine"Examine"Examine"Examine LeftLeftLeftLeft LegLeg".LegLeg".".".

1ry varicose veins "Old obese female".

State True or False:

1.

2.

This is a case of secondary varicose. Varicosities appear along the course of short saphenous. Veins are pulsating. There is incompetent Saphenofemoral junction. Modified Perth's test is positive for this case.

3. 4. 5. o Case 5 "Examine"Examine"Examine"Examine thethethethe
3.
4.
5.
o
Case 5 "Examine"Examine"Examine"Examine thethethethe AbdomenAbdomen".AbdomenAbdomen".".".
Para umbilical, Incisional hernias & 2 scars "one above the umbilicus & the
other at inguinal region".
State True or False:
1. There is paraumbilical hernia.
2. There is incisional hernia.
3. More than one scar.
4. Both hernias are reducible.
5. Malgaigne bulge is seen.
o
Case 6 "Examine"Examine"Examine"Examine thethethethe NeckNeck".NeckNeck".".".
Simple nodular goiter.
State True or False:
1.
2.
3.
4.

5.

There is thyroid enlargement. There is scar of previous operation. The swelling is completely covered with sternomastoid. Rt. supraclavicular LN is enlarged. The swelling moves with protrusion of tongue.

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by All Team © "One Vision … One Mission " o Case 7

o Case 7 "Examine"Examine"Examine"Examine BothBothBothBoth LegsLegs".LegsLegs".".".

Unilateral 2ry Varicose Veins.

State True or False:

1. The prominent system affected is short saphenous. 2. The long saphenous is pulsating. There
1. The prominent system affected is short saphenous.
2. The long saphenous is pulsating.
There is apparent sahena varix.
There is pigmentation.
This is a case of 2ry varicose veins.
3.
4.
5.
o
Case 8 "Examine"Examine"Examine"Examine thethethethe ScapulaScapula".ScapulaScapula".".".
Sebaceous cyst.
State True or False:
1. The swelling is tender.
2. The swelling is pulsating.
3. The swelling is attached to skin.
4. It has a well defined edge.
5. The draining LN is enlarged.
" "
o
Case 1 "Examine"Examine"Examine"Examine thethethethe NeckNeckNeckNeck &&&& FaceFace".FaceFace".".".
Dermoid cyst.
State True or False:
1. The swelling is cystic.
2. The swelling has slippery edges.

3.

4. There is a scar.

5. It is a sebaceous cyst.

The swelling is attached to skin.

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by All Team © "One Vision … One Mission " o Case 2

o Case 2 "Examine"Examine"Examine"Examine BothBothBothBoth LegsLegs".LegsLegs".".".

Primary varicose vein in right side.

State True or False:

1. The dilated veins are bilateral. 2. There is an ulcer in the right side.
1. The dilated veins are bilateral.
2. There is an ulcer in the right side.
There is a scar in the right side.
The shape of dilatations is saccular.
There are dilatations in Saphenofemoral junction.
3.
4.
5.
o
Case 3 "Examine"Examine"Examine"Examine thethethethe AbdomenAbdomen".AbdomenAbdomen".".".
Umbilical hernia.
State True or False:
1. It is a paraumbilical hernia.
2. There are signs of inflammation.
3. There is an ulcer.
4. The swelling shows impulse on cough.
5. There is a scar of previous operation.
o
Case 4 "Examine"Examine"Examine"Examine thethethethe NeckNeck".NeckNeck".".".
Simple nodular goiter.
State True or False:
1. The swelling moves with deglutition.
2. The swelling is hard.
3. The swelling moves with protrusion of tongue.
4. The swelling is bilateral.
5. The swelling is attached to skin.

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by All Team © "One Vision … One Mission " " א " o Case 1

" א "

o Case 1 "Examine"Examine"Examine"Examine thethethethe NeckNeck".NeckNeck".".".

2ry thyrotoxicosis. State Yes or No: 1. 2. 3. 4. 5. 6. 7. 8. 9.
2ry thyrotoxicosis.
State Yes or No:
1.
2.
3.
4.
5.
6.
7.
8.
9.
o Case 2 "Examine"Examine"Examine"Examine thethethethe BackBack".BackBack".".".
Lipoma at the left side of the back.
State Yes or No:
1. Is the swelling compressible?
2. Are the edges well defined?
3. The main line of ttt is excision?
4. This swelling usually turns malignant?
5. Does this swelling have impulse on cough?

Is the swelling hard? Is the swelling attached to the skin? Is the ttt conservative? FNAC is an essential of diagnosis? Is the swelling present in the digastric triangle? Is the swelling nodular? Cancer in this case is more common in males than females? Does the swelling move up &down with protrusion of the tongue? Does the swelling arise embriologically from the tongue?

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by All Team © "One Vision … One Mission " o Case 3

o Case 3 "Examine"Examine"Examine"Examine BothBothBothBoth GroinsGroins".GroinsGroins".".".

Right inguino-scrotal hernia.

State True or False:

3. 4. 5. 6. 7. 1. This hernia may contain urinary bladder? 2. This hernia
3.
4.
5.
6.
7.
1. This hernia may contain urinary bladder?
2. This hernia may contain intestine?
This hernia may be obstructed?
The main line of ttt is essentially surgical?
The hernia is more common in elderly?
The hernia is bilateral in 60% of cases?
Does the hernia have impulse on cough?
Is this hernia reducible?
8.
o
Case 4 "Examine"Examine"Examine"Examine BothBothBothBoth GroinsGroins".GroinsGroins".".".
Left inguinal hernia "indirect".
State True or False:
1.
2.
3.
4.
5.
6.
7.
8.

This hernia has +ve cross fluctuation? This hernia may contain sigmoid colon? This hernia protruded through the superficial inguinal ring? This hernia is common in elderly? This hernia is bilateral in 60% of cases? This hernia has expansile pulsations? This hernia occurred due to direct trauma? The direction of this hernia is forwards?

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by All Team © "One Vision … One Mission " " א " o Case 1

" א "

o Case 1 "Examine"Examine"Examine"Examine thethethethe AbdomenAbdomen".AbdomenAbdomen".".".

Incisional hernia. State True or False: 1. 2. 3. 4. o Case 2 "Examine"Examine"Examine"Examine
Incisional hernia.
State True or False:
1.
2.
3.
4.
o
Case 2 "Examine"Examine"Examine"Examine thethethethe NeckNeck".NeckNeck".".".
2ry thyrotoxicosis.
State True or False:
1. It is a case of 1ry thyrotoxicosis.
2. The patient has a fine tremor.
3. The pulse > 100.
4. The only line of ttt is surgical.
o
Case 3 "Examine"Examine"Examine"Examine thethethethe AbdomenAbdomen".AbdomenAbdomen".".".
Umbilical hernia.
State True or False:
1.
2.
3.

The mass has an expansile impulse in cough. Occupation is important to be asked in this case. It is not complicated.

The mass is seen on cough and standing and disappear on lying down. Treatment is herniotomy only. It is not complicated now. Complications don't occur in this type of hernia.

4. Abdominal & pelvic sonar is important.

5. Strangulation could occur due to twisting of 2 loops of intestine.

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by All Team © "One Vision … One Mission " o Case 4

o Case 4 "Examine"Examine"Examine"Examine BothBothBothBoth LegsLegs".LegsLegs".".".

2ry Varicose veins.

State True or False: 1. A case of 1ry varicose veins. 2. There is an
State True or False:
1. A case of 1ry varicose veins.
2. There is an incompetent perforator.
3. The ulcer is healed.
4. It is not complicated.
5. ttt is surgical.
6. Venograhy is the best investigation to be done.
o
Case 5 "Examine"Examine"Examine"Examine BothBothBothBoth GroinsGroins".GroinsGroins".".".
Inguinal hernia.
State True or False:
1. This case may be complicated.
2. There is a scar for an operation.
3. Hernia is partially reducible.
o
Case 6 "Examine"Examine"Examine"Examine thethethethe NeckNeck".NeckNeck".".".
Thyroid Case.
State True or False:
1. There is a thrill.
2. The gland superficial to sternomastoid muscle.
3. Carotid pulse can be felt.
4. Surface is irregular.

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" "

o Case 1 "Examine"Examine"Examine"Examine thethethethe
o
Case 1 "Examine"Examine"Examine"Examine thethethethe SwellingSwelling".SwellingSwelling".".".
Lipoma.
State True or False:
1. The swelling has slippery edges.
2. It is pseudo fluctuant.
3. It is translucent.
4. It is partially attached to the skin.
5. Its consistency is soft.
o
Case 2 "Examine"Examine"Examine"Examine thethethethe NeckNeck".NeckNeck".".".
A thyroid case.
State True or False:
1. Enlargement in the Rt. lobe only.
2. There is retrosternal extension.
3. Trachea is central.
4. Pretracheal lymph node palpable.
o
Case 3 "Examine"Examine"Examine"Examine thethethethe NeckNeck".NeckNeck".".".
A thyroid case.
State True or False:
1. Carotid pulse on both sides can be felt.

2. Left deep cervical LN can be palpable.

3. Swelling in the submandibular region.

4. There is sinus in the skin.

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by All Team © "One Vision … One Mission " o Case 4

o Case 4 "Examine"Examine"Examine"Examine thethethethe BackBack".BackBack".".".

Sebaceous cyst.

State True or False:

3. 4. 5. 1. The swelling has slippery edges. 2. It is soft in consistency.
3.
4.
5.
1. The swelling has slippery edges.
2. It is soft in consistency.
It is Pseudo fluctuant.
It is translucent.
It is partially attached to the skin.
o
Case 5 "Examine"Examine"Examine"Examine BothBothBothBoth GroinsGroins".GroinsGroins".".".
Hernia Case.
State True or False:
1. It is idiopathic hydrocele.
2. Inguinal LN are impalpable.
3. There is left oblique inguinal hernia.
o
Case 6 "Examine"Examine"Examine"Examine BothBothBothBoth LegsLegs".LegsLegs".".".
An ulcer in the leg.
State True or False:
1. The base is indurated.
2. Unhealthy granulation tissue present.
3. There is everted edge at one side.
4. There are varicose veins.
o
Case 7 "Examine"Examine"Examine"Examine BothBothBothBoth GroinsGroins".GroinsGroins".".".
Hernia case.
State True or False:

1. There is Rt. direct inguinal hernia.

2. There is infantile hydrocele.

3. There is enlarged epididymis.

4. There is enlarged spermatic cord.

5. There is loss of Rt. testicular sensation.

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by All Team © "One Vision … One Mission " o Case 8

o Case 8 "Examine"Examine"Examine"Examine thethethethe NeckNeck".NeckNeck".".".

A case of lymphadenopathy.

State True or False:

3. 4. 1. Swelling seen in the left side of neck. 2. The swelling is
3.
4.
1. Swelling seen in the left side of neck.
2. The swelling is in the carotid triangle.
There is intra oral ulcer.
Supraclavicular LN is palpable.
" א א "
o
Case 1 "Examine"Examine"Examine"Examine thethethethe AbdomenAbdomen".AbdomenAbdomen".".".
Incisional & paraumbilical hernias.
State True or False:
1. Patient has 2 scars.
2. Incisional hernia over Cesarean section produced.
3. Both hernias are reducible.
4. Patient has paraumbilical hernia.
5. It shows malgaigne sign.
o
Case 2 "Examine"Examine"Examine"Examine thethethethe NeckNeck".NeckNeck".".".
Thyroid case "No thyrotoxicosis or malignant symptoms".
State True or False:
1.
The thyroid gland is enlarged.

2. Rt. supraclavicular LN is enlarged.

3. There is previous scar in the neck.

4. The swelling is covered by sternomastoid muscle.

5. It moves up & down with protrusion of tongue.

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by All Team © "One Vision … One Mission " o Case 3

o Case 3 "Examine"Examine"Examine"Examine LeftLeftLeftLeft LegLeg".LegLeg".".".

Varicose veins case.

State True or False:

1.

The prominent system affected is short saphenous. Saphena varix is present. The varicosity is secondary. There is pigmentation around medial malleoulus. The affected veins pulsate.

2. 3. 4. 5. o Case 4 "Examine"Examine"Examine"Examine thethethethe
2.
3.
4.
5.
o
Case 4 "Examine"Examine"Examine"Examine thethethethe SwellingSwelling".SwellingSwelling".".".
A swelling in the Rt. Lid.
State True or False:
1. The swelling is attaching to the skin.
2. There is enlarged LN.
3. It has a well defined edge.
Other notes produced by ALL TEAM
Your way for easy surgery
These Notes Contain
-
Full detailed lectures of Prof.Dr. Hussein Khairy.
-
Hints from notes of Dr. Wael Metwaly.
-
Hints from notes of Dr.Amr El Shayeb.
-
Our curriculum from Oral book.

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