Clinical Surgery Notes for MRCS OSCE part B exam for DOWNLOAD

Very Important

It is not the intention of these note to be a complete comprehensive notes for the clinical examination in General Surgery or for the OSCE part B MRCS examination.

The main intention of these notes is to create a skeleton upon which you can build up your plans in clinical examination. In addition to that, it can be used for a quick revision before the exam.

You can NOT go for the exam without keeping these notes by heart.

But also, you can NOT got for the exam with these notes alone.

Please refer to clinical examination textbooks like

  • “Browse’s Introduction to the Symptoms & Signs of Surgical Disease, Fifth Edition by Kevin G. Burnand (Editor), John Black (Editor), Steven A. Corbett (Editor),”
  • “Clinical Cases and OSCEs in Surgery (MRCS Study Guides)” by Manoj Ramachandran (Author), Marc A Gladman (Author)

Note that, you have to practice each examination as much as you can on real patients, volunteers or even your colleagues.

These notes cover 6 out of 18 stations of the MRCS OSCE part B exam.

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Your feedback are highly recommended and appreciated.

Skin lesions of Surgical importance

Terms (of surgical importance) used to describe skin pathology
Macule Localized change in color of the skin

Not elevated (or palpable) or freckled

Papule Small solid elevation

Flat toped, conical, rounded, polyhedral, follicular (hairs), smooth or scaly

Vesicle Small collection of fluid

Between the dermis and epidermis (a blister)

Bulla Collection of fluid larger than a vesicle

Under epidermis

Wheal Transient elevation of the skin caused by edema
Cyst Tumor that contains fluid
Naevus Lesion present from birth

Composed of mature structures normally found in the skin but present in excess or an abnormal disposition

Also used to describe lesions composed of naevus cells as melanocytic or pigmented naevi

Papilloma Benign overgrowth of epithelial tissue
Tumor Literally, a swelling

Commonly but inaccurately used to mean an malignant swelling

Hamartoma Overgrowth of one or more cell types that are normal constituents of the organ in which they arise

The commonest examples

Haemangiomata

Lymphngiomata

Neurofibromata

Ulcer Area of solution of an epithelial surface

Continue reading “Skin lesions of Surgical importance”

History Taking

General sheet / Information Gathering

Hello Mr. …. Sit down please. I am …(position)…

Personal history Name – Age – Occupation

Complaint PainSwelling / Ulcer – Dysfunction – Others

History of present complaint Analysis

Other symptoms Relation to the main complaint

What is the problem? ….

Tell me more about that.

Tell me more about ….  What about ….?  Do you have ….?

History of present investigations and treatment

 

Systematic direct questions

I’m now going to ask you a series of questions about common medical problems.

This to make sure we do not mess anything that may be important.

  • CVS

Do you have any trouble with your heart, chest pain or palpitation?

  • Respiratory

Do you have any trouble with your lungs, shortness of breath, coughing or sputum?

  • GIT

Do you have problem in digestion, lose weight, difficulty in swallowing, heart burn, nausea/vomiting, abdominal pain, swelling, change of bowel habits, rectal bleeding?

  • Genitourinary

Do you have any problems passing urine, change of color, pain, smell?

  • Diabetes Mellitus
  • Female

Do you have problems in menstruation?

Past history

Have you been admitted to any hospital before?

Did you have any operation before?

Do you have children? How many? How old is the youngest? (Female)

Do you take any medication or contraceptive pills (Female)?

Do you have any allergy?

Family history

Do you have any similar problem in your family (children, parents, brothers, sisters)?

Does anyone of your family have a heart disease, DM, blood pressure, tumor or any chronic disease?

Social history

Do you smoke? That do you smoke? How much? For how long?

Do you drink? How much/week?

Patient concern 

Are you concerned about anything?

Summery 

To summarise …. (+ve. findings)

Ulcer – History

Ulcer Analysis

  • Site (where is it?)
  • Onset (sudden or gradual?)
  • Course (does it increase or decrease in size with the time?)
  • Duration (when did it appears?)
  • Other swellings (do you have other swellings?)
  • Relation to other symptoms like pain or swellings
  • Possible Cause(why do you think you’ve got it?)
  • Constitutional symptoms (did you become feverish?)

Swelling – History

Swelling analysis

  • Site (where is it?)
  • Onset (sudden or gradual?)
  • Course (does it increase or decrease in size with the time?)
  • Duration (when did it appears?)
  • Other swellings (do you have other swellings?)
  • Relation to other symptoms like pain (is it painful?)
  • Possible Cause (why do you think you’ve got it?)

Pain – History

Pain analysis

  • Site & referral (where is it? Where it goes?)
  • Onset (sudden or gradual?)
  • Course (how often does it happen?)
  • Duration (when did it start?)
  • Severity (how bad is it?)
  • Character (Burning, throbbing, stabbing, constricting, tightness, colicky or just a pain) (what does it feel like?)
  • Relieving factors (what eases it?)
  • Exacerbating factors (what brings it?)
  • Cause like trauma (why do you think you’ve got it?)

Lymphatic Disorders

 

Lymphadenopathy

Inspection

Number Multiple
Site
Shape
Size
Surface
Skin and color Inflammatory signs Acute lymphadenitis
Infiltrative signs Advanced malignancy
Sinus TB
Special signs Transmitted pulsations Para-aortic LN
Move with deglutition Para-tracheal LN

Palpation

Relations to the surroundings

Mobility

Relation to skin
Relation to muscles
Relation to nerves
Relation to arteries
Relation to veins
Other swellings Generalized lymphadenopathy
Temperature
Tenderness
Edge Well defined Scattered

Discrete

Ill defined Matted

Amalgamated

Reducibility
Solid, fluid or gas

Consistence

Fluctuation

Hard Advanced lymphoma
Firm TB

Chronic lymphadenitis

Cystic Cold abscess
Percussion Sternum for  :  Mediastinal masses

Tenderness in leukaemia

Auscultation Despine sign in case of mediastinal lymph nodes
After examination we will be able to answer these questions
      • Anatomical diagnosis
      • Localized or generalized
      • Aetipathologicaly (Infective, Neoplastic, Others )
      • Functional ( Pressure manifestations, Metastasis )

Lymphoedema

Inspection

  1. Grossly swollen legs
  2. Preserved skin creases
  3. Buffalo hump (dorsum of the foot)
  4. Square toes

Palpation

  1. Non pitting edema
  2. Inguinal lymph nodes

 

TAKING HISTORY FROM A PATIENT WITH a lymphadenopathy

Follow the general scheme (on this page)  and use the following set of symptoms in the part of “Other symptoms Relation to the main complaint

Lymphadenopathy - History
Lymphadenopathy – History

TAKING HISTORY FROM A PATIENT WITH A LYMPHEDEMA

Follow the general scheme (on this page)  and use the following set of symptoms in the part of “Other symptoms Relation to the main complaint

Lymphedema - History
Lymphedema – History