GCS 16



Fellowship course Week 11 – SurgeryWRITTEN EXAMINATIONSHORT ANSWER QUESTIONS EXAMINATION TIME: 60 MinutesQuestion 1 (17 marks) 6 minutesList five (5) ultrasound features of a normal appendix. (5 marks)___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________List six (6) ultrasound features of appendiceal inflammation. (6 marks)__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 1 (continued)State (3) pros of CT abdomen in the diagnostic process of suspected appendicitis. (3 marks)_____________________________________________________________________________________________________________________________________________________________________________________________________________________State (3) cons of CT abdomen in the diagnostic process of suspected appendicitis. (3 marks)_____________________________________________________________________________________________________________________________________________________________________________________________________________________Question 2 (12 marks) 6 minutesA 65 year old male presents with 4 days of scrotal pain. BP95/70, PR 110, Sats 98%. BSL 16.A photograph of the patient is taken.What is the diagnosis? (1 marks)_________________________________________________________________________What is the significance of this condition? State three (3) points of significance. (3 marks)_____________________________________________________________________________________________________________________________________________________________________________________________________________________List two (2) risk factors for the development of this condition? State two (2) points of significance. (2 marks)______________________________________________________________________________________________________________________________________________Question 2 (Continued)Analgesia is provided. Disposition is arranged.List two (2) key treatment steps that you would institute in the first 20 minutes of your care. Provide one (1) justification for each choice. (4 marks)Treatment step(2 marks)Justification(2 marks)12List two (2) treatment methods that are utilised for definitive treatment. (2 marks)______________________________________________________________________________________________________________________________________________Question 3 (12 marks) 6 minutesAn 82 year old woman presents with 10 hours of abdominal pain. Your clinical assessment leads to a clinical diagnosis of mesenteric ischaemia.List three (3) options for definitive imaging in this patient. State one (1) relevant pro and one (1) con for each of these options. (9 marks)Imaging option(3 marks)Pro(3 marks)Con(3 marks)1.2.3.Question 3 (continued)A diagnosis of mesenteric ischaemia is supported by your chosen imaging.State three (3) factors that may affect a decision regarding operative treatment for this patient. (3 marks)______________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 4 (13 marks) 6 minutes A 68 year old year old female presents to ED with an acutely painful right leg.List five (5) examination features that would support the diagnosis of an ischaemic leg. (5 marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 4 (continued)List five (5) key investigations that you would order in the Emergency Department if you suspected an ischaemic leg. (5 marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________A proximal left femoral artery thrombosis is confirmed.List three (3) specific treatments options that may be utilised to treat this condition. (3 marks)_____________________________________________________________________________________________________________________________________________________________________________________________________________________Question 5 (15 marks) 6 minutesA 60 year old male is brought to the Emergency Department with confusion, fever and a painful left leg.-52641574612500A photograph of his left leg is taken:Question 5 (continued)State the most likely diagnosis. (1 mark)___________________________________________________________________________List four (4) investigations that you would perform in this case. Provide one (1) justification for each choice. (8 marks)Investigation(4 marks)Justification(4 marks)1.2.3.4.Question 5 (continued)Analgesia and fluids are provided.State three (3) treatments that you would consider for this patient. Provide one (1) justification for each choice. (6 marks)Treatment(3 marks)Justification(3 marks)1.2.3.Question 6 (15 marks) 6 minutesA 26 year old man presents with a history of a painful penis. There is no history of trauma.-47879082740500A photo of the patient is taken:Question 6 (continued)State the diagnosis. (1 mark)___________________________________________________________________________List two analgesic medications that you would utilise for this patient. (2 marks)______________________________________________________________________________________________________________________________________________State four (4) steps utilised in the Dundee-Perth technique of reversal of this problem. (4 marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 6 (continued)State five (5) steps for an alternative technique (other than the Dundee-Perth technique) for the reversal of this problem (after appropriate analgesia is provided). (5 marks)___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________The patient represents 1 month later with balanitis.List three (3) steps in the treatment of this problem. (3 marks)_____________________________________________________________________________________________________________________________________________________________________________________________________________________Question 7 (12 marks) 6 minutesState the definition of priapism. (1 mark)______________________________________________________________________________________________________________________________________________A 35 year old male presents to ED with priapism.List five (5) likely causes of priapism in this man. (5 marks)_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 7 (continued)State six (6) key management steps for this patient in the emergency department. (6 marks)______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 8 (16 marks) 6 minutesA 38 year old female presents to the Emergency Department with left sided abdominal pain.A CT scan is taken:-45974022034500Question 8 (continued)State four (4) abnormal findings shown in this image. (4 marks)___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________List three (3) further key investigations that you would perform for this patient. Provide one (1) justification for each choice. (6 marks)Investigation(3 marks)Justification(3 marks)1.2.3.Question 8 (continued)List six (6) factors that would influence your disposition for this patient. (6 marks)______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 9 (12 marks) 6 minutes A 15 year-old boy presents to your ED with his parents, with a painful right testicle for the last 6 hours.List four (4) key clinical features that may help to distinguish torsion from epididymitis in this patient. (4 marks)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________List two (2) pros for the use of Ultrasound in this patient. (2 marks)______________________________________________________________________________________________________________________________________________Question 9 (continued)List two (2) cons for the use of Ultrasound in this patient. (2 marks)______________________________________________________________________________________________________________________________________________An ultrasound is performed within 1 hour and confirms a right testicle with no flow.List four (4) pieces of information that you would communicate to the patient and his parents. (4 marks)__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 10 (12 marks) 6 minutesAn 83 year old male presents to Emergency Department with abdominal pain.An X-ray is taken:Question 10 (continued)State two (2) abnormalities shown in this X-ray. (2 marks)______________________________________________________________________________________________________________________________________________List four (4) risk factors for the development of this condition. (4 marks)____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Question 10 (continued)List three (3) potential complications of this condition. (3 marks)_____________________________________________________________________________________________________________________________________________________________________________________________________________________ List the two (2) corrective treatments required for this condition. (2 marks)______________________________________________________________________________________________________________________________________________ ................
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