osce surgery latest

8/17/2019 OSCE Surgery latest

1/97

End of 4th Year OSCE

Surgery

Oct. – 2008

AL 2003

laminiroyahoo.com


2/97

• OSCE

• OS!E• "O!


3/97

• "n#trument# $

!rocedure#• "maging $ other "%

•

Communication #&ill#• Clinical #cenario#


4/97

"n#trument#

$

!rocedure#


5/97

'eedle#


6/97

'eedle#

(4)* +hite * A,#ce## drainage(8)* !in&(-)* Yello

2()* )reen – /lood culture

22)* /lac&23)* /lue * " in1ection#'AC

24)* ed * SC in1ection#25)* Orange – 66 #clerothera7y2)* /ron – "n#ulin SC antou% /C) 9":

in1ec.;2


7/97

Suture needle#

StraightCur=ed

ound ,odyCutting Standard

>a7erede=er#e

>raumatic EyedAtraumatic Eyele##


8/97

Suture needle#


9/97

Suture needle#


10/97

Suture material

'aturalSynthetic

A,#or,a,le

'on*a,#or,a,leono*?lamentulti*?lament /raided


11/97

Suture material

A,#or,a,le 'on* a,#or,a,le

Synthetic 'atural

Synthetic 'atural

ono

?lame

nt

!olygleca7rone9onocryl;

Catgut !oly7ro7ylene

9!rolene;!olydia%anone!olyamide

'ylon!olyglyconate

9ono#yn a%on;

ulti

?lament

!olyglycolic

acid9Centicryl :e%on;

!olye#ter /lac&

#il&

!olyglactin

96icryl;


12/97

Suture material


13/97

Continuou#• Sim7le• Su,cuticular

"nterru7ted• Sim7le• attra## * 6ertical

@oriontal

Suturing method#


14/97

Suturing method#


15/97

Cannula


16/97

Cannula

(4)*Orange +ide ,ore()*)rey

(


17/97

"6 Buid#

•

0.- #aline• 0.45 #aline

• 0.(8 #aline

• @artmannD##olution

• 5 (0

de%tro#e

• @ES

• Al,umin

• Cry#talloi

d#

• Colloid#


18/97

L! S7inal needle

•

F#e#• Contraindication#

• Com7lication#


19/97

E7idural needle

• F#e#


20/97

)a,rielD# #yringe

• F#e#

Sclero#ent 5 7henol in

almondoli=e oil


21/97

') yleD# tu,e

• Length * !hiltrum G >ragu# GHi7hi#ternum


22/97

') yleD# tu,e

• F#e#eeding

:iagno#tic Oe#o. atre#ia $* >Oil& #can)a#tric a#7irate

Small ,oel /a meal

>hera7eutic )a#tric la=arge)a#tric decom7re##ion

A# a drain tu,e catheter


23/97

') yleD# tu,e

• Correct 7o#itioning

(.Cough

2."n1ect air

3.A#7irate

4.Fnder ater ,u,,ling

5.CH

.Correct length


24/97

"C tu,e Che#t drain


25/97

"C tu,e Che#t drain

"C 7uncture

I

"C a#7irationI

"C tu,e in#ertion >horaco#tomy


26/97

"C tu,e Che#t drain

• Site – Safe triangle

• "ndication#(.!neumothora%

>en#ion

!er#i#tent ecurrent

Large in elderly 7t.6entilated 7t.

2.>raumatic haemo7neumothora%

3.alig. 7leural eJu#ion

4.Em7yema

5.!o#t o7. * >horacotomy

> h e r a

7 e u

t i c

! r o 7 h y

l a c

t i c


27/97

"C tu,e Che#t drain

• :aily a##e##ment

(.!tD# condition

2.>u,e functioning/u,,ling

luid le=elSinging of Buid column

3.A77aratu#Fnder ater #eal

Clam7ing

Le=el of the ,ottle


28/97

Airay# – Oro*7haryngeal )uedel


29/97

Airay# – Oro*7haryngeal )uedel

• Length

• "n#ertion

i


30/97

Airay# – LA

• Sie# 3cm * K4cm *

i


31/97

Airay# – E>>

CuJed – #oft hardFncuJed

einforced

'on*reinforced'orth 7oleSouth 7ole

Ai E>>


32/97

Airay# – E>>

Ai E>>


33/97

Airay# – E>>

Ai E>>


34/97

Airay# – E>>

or children

Ai E>>


35/97

Airay# – E>>

or #urgerie#)A in 7rone 7o#ition

Ai E>>


36/97

Airay# – E>>

or neuro eye #urgerie#

Ai E>>


37/97

Airay# – E>>

• Sie – ": in mm

2.0 !reterm2.5 !reterm3.0 >erm4.0 ( year

Children G Age4 $ 4


38/97

Airay# – E>>

• :uration

E>>< day# I >racheal #teno#i#

>racheo#tomy

• F#e#aintain airay6entilation – "!!6Admini#ter drug#!re=ent a#7irationemo=e #ecretion#

Ai > h t t ,


39/97

Airay# – >racheo#tomy tu,e#

Ai > h t t ,


40/97


Airay# >racheo#tomy tu,e#


41/97


• "ndication#

F77er airay o,#truction

!rolonged mechanical =entilation >o remo=e retained #ecretion# in L>

>o reduce dead #7ace

Airay# >racheo#tomy tu,e#


42/97


• Com7lication#

!neumothora%

@aemorrage

Surgical em7hy#ema

>u,e di#7lacement

Steno#i#

Frinary catheter#


43/97

Frinary catheter#

(. Sim7le ru,,er catheter

2. oley catheter

3. !aulD# tu,e 9Condomcatheter;

4. Self intermittent catheter5. etal catheter

• F#e#

Frinary catheter


44/97

Frinary catheter

N. ) oleyD# #elf retaining 2 ayurinary catheter

•3ay catheter•u,,er 6# Silicone catheter#•ale# * ( ) emale# – (4 )

Frinary catheter


45/97

Frinary catheter

Self intermittent catheter

Am,u


46/97

Am,u

>ray#


47/97

>ray#

• F#e#

o#Muito artery force7


48/97

o#Muito artery force7

• F#e#

Laryngo#co7e#


49/97

Laryngo#co7e#

Laryngo#co7e#


50/97

Laryngo#co7e#

• "ndirect – Laryngeal mirror

• !o#terior rhino#co7y mirror

E%ternal ?%ator#


51/97

E%ternal ?%ator#

E%ternal ?%ator#


52/97

E%ternal ?%ator#

• "ndication#

!el=ic fracture# – Fn#ta,le /leeding

'on–union

Com7ound fracture#

Lim, lengthening

C!


53/97

C!

• ecent change# – A>LS 2005guideline#

@and# o=er the centre of the che#t

302 che#t com7re##ion#

All 3 :C Shoc – each 30P


54/97

"maging

$

Other "%

H – CH erect


55/97

H – CH erect

H – CH erect


56/97

H – CH erect

•

A,normality – Air under thedia7hragm

• Cau#e#

!erforated 7e7tic ulcer

!erforated ,oel

u7tured a77endi%

• !re#entation

Acute a,domen

H – A,domen #u7ine


57/97


Small inte#tinalo,#truction

Large inte#tinalo,#truction



58/97

H A,domen #u7ine

•A,normality

:ilated ,oel loo7#

• Cau#e#

• !re#entation

Acute a,domen



59/97

H A,domen #u7ine

H – A,domen erect


60/97

H A,domen erect

H – QF/ "6F


61/97

H QF/ "6F

H * QF/ "6F

H – QF/ "6F


62/97

H QF/ "6F

Stag horn calculu# "6F

H – @i7


63/97

H @i7

H – @i7


64/97

H @i7

Other fracture# – H $ !O! ca#t#


65/97

Other fracture# H $ !O! ca#t#

• Colle#D – di#tal radial



66/97


• Colle#D – di#tal radial



67/97


• Sca7hoid

!aediatric radiology


68/97

!aediatric radiology

:ou,le ,u,,le

a77earance

:ia7hragmatic hernia

C> * /rain


69/97

C> /rain

C> * /rain


70/97

C a

• Le#ion

A hy7er den#e ,icon=e% #ha7ed area in theright tem7oro*7arietal region

• Condition

S acute E:@

• Cau#e#

>rauma – :amage to middle meningeal artery

• %

e#u#citation @"O Craniotomy R e=acuation

C> * /rain


71/97

C> * /rain


72/97

• Le#ion

A cre#cent #ha7e hy7er den#e area in lefttem7oro* 7arietal region

$ idline #hift

• Condition

LS acute S:@

• Age grou7

Elderly – +ide S: #7ace due to ,rain atro7hy

C> * /rain


73/97

C> * /rain


74/97

• Le#ion

A cre#cent #ha7e large hy7o den#earea in left tem7oral region

$ idline #hift

•

ConditionLS chronic S:@

• Cau#e#

AlcoholicElderly folloing recurrent fall#

Child a,u#e

C> * /rain


75/97

Cere,ral a,#ce## in LOcci7ital area

C> * /rain


76/97

SA@

C> * /rain


77/97

"C@


78/97

Criteria for admi##ion after headin1ury

• Altered le=el of con#ciou#ne##

• S&ull fracture

• 'eurological #ym7tom# or #ign#

• :icult a##e##ment * drug# alcohol

• 'o re#7on#i,le care gi=er

C> * /rain


79/97

"ndication# for C> #can

• )CS T (3 at any 7oint #ince the in1ury

• Su#7ected o7en or de7re##ed #&ull

fracture• Any #ign of ,a#al #&ull fracture

• !o#t*traumatic #eiure

•

ocal neurological de?cit

• "f )CS U 8 G "ntu,ation R =entilation

Audiogram


80/97

g

Conducti=ehearing lo##

• +a% im7action

• Otiti# media

• Oto#clero#i#

Audiogram


81/97

Sen#orineuralhearing lo##

•Acou#tic

neuroma•eningiti#

•Ototo%ic drug#

•

'oi#e induced


82/97

Communication #&ill#

Con#ent for "% S%


83/97

/ A " : E :

/ * ,ene?t#

* ri#A * alternati=e#

" * inMuiry

: * deci#ion

E * education

: * documentation

Short ca#e


84/97

C2 !2 E2 >

C * con#ent – )reet "ntroductionE%7lain

C * cha7erone! * 7o#itioning

! * 7ri=acy

E * e%7o#ureE * e%amination

> * than&ing


85/97

Clinical #cenario#


86/97


87/97


88/97


89/97

Flcer#


90/97

Flcer#


91/97

O#tomy


92/97

O#tomy


93/97

O#tomy


94/97


95/97


96/97


97/97

>he endN

)ood

luc&V

osce surgery latest

Documents