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)
§ for suturing skin

• Vicryl
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 – observation; surgical resection for large or growing lesions
• Fibrocystic disease – stop caffeine, NSAIDs, Vitamin E
• Breast CA – 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