SURGERY TOACS

APRIL 2012
Hassaan Bari
Aga Khan University
Dept of Surgery - AKUH
• Total stations – 15
• 8 .. Static Stations – Blue
• 7 .. Interactive Stations - Green

• Each station had a score of 10 in total …

• subdivided as per questions asked in the scenario or examiner …

• Nearly 5 minutes on each station .. There was no break in

between the stations (no rest stations) …

• For each static station .. a separate answer sheet was given and
we had to put roll number and station number on each and
every one of them !!!!!

Rules of the game …

Dept of Surgery - AKUH
• An elderly male with history of
hematuria …

• What it is ? (Vesical calculus)

• What are the types of stone ?
• How will you manage ?
• transurethral cystolitholapaxy,
• percutaneous suprapubic
cystolitholapaxy
• open suprapubic cystotomy
• What is the new development in its
management ?
• Laparoscopic extraperitoneal approach

Urinary bladder stone

Dept of Surgery - AKUH
• Scenario – one of your friends got a Bee stung …
suddenly he is having difficulty in breathing ..

• What will u do ….. ?

• What is the most important step of management… ?
(Brnochodialators, epinephrine)
• Which cells are involved & name the mediator …. ?
(mast cells)
• What type of reaction it is …. ? (type I)

Anaphylactic shock
Dept of Surgery - AKUH
• Scenario – A patient underwent laparoscopic inguinal
hernia repair … Now he is complaining of numbness
in RT upper thigh …

• Which nerve is involved .. Lateral cutaneous nerve of

thigh …
• What is TEP/TAPP ?
• What are the boundaries of Triangle of pain ?
• What are the boundaries of Triangle of doom ?

Laparoscopic inguinal hernia

Dept of Surgery - AKUH
Laparoscopic inguinal hernia
Dept of Surgery - AKUH
• Scenario – A middle age lactating
female came with history of fever
& painful swelling of left breast ?

• What is it ?
• How will u manage ?
• What are the causative organisms ?

Breast abscess
Dept of Surgery - AKUH
• Scenario – A young male with
history of RTA 2 hours back
… presented in ER with
severe pain in Rt leg …. The
x-ray shows …

• What is this patient having ?

• How will u manage ?
• What are the complications if
not treated ?

Compartment syndrome
Dept of Surgery - AKUH
• Scenario – a 4 months child
develops abdominal pain,
distension & vomiting’s with
passage of jelly currant stool …

• What it is ?
• What is the name of investigation
shown ?
• How will u manage ?
• When will you decide for surgery ?
• Procedure name ?

Intussusception
Dept of Surgery - AKUH
• Perform trucut biopsy on breast (apple)
• What are the complications ?

Trucut biopsy
Dept of Surgery - AKUH
• Scenario – A 35 years old female recently diagnosed to
have left breast Ca … (Stage III) Counsel her regarding
breast conservation therapy …

• Queries regarding
• 5 steps approach
• built repo
• pt understanding of disease
• your counseling or breaking bad news
• empathize
• conclude
• adjuvant chemotherapy …
• AXLND … ?
• Usage of left arm post surgery ? …

Counseling-BCT
Dept of Surgery - AKUH
• Inguinal Hernia repair ….

• Steps
• Complications
• Different types of repair … which is the best one ?

Log book
Dept of Surgery - AKUH
• Scenario – A young male with RTA … blunt chest
injury .. Landed in ER with severe dyspnea …

• What differentials will come in your mind … ?

• How will you diagnose/exclude them … ?
• How will u manage each of them … ?

Chest Trauma
Dept of Surgery - AKUH
• Scenario – A 35 years old male with history of
epigastric pain and vomiting …. He was admitted
with similar complain few days back …

• What it is .. ?
• How will u manage .. ?
• What are the complications if not treated ?

Pancreatic Pseudocyst
Dept of Surgery - AKUH
• Scenario – A middle age male
with 2 weeks history of
regurgitation and severe
epigastric burning pain ..
Underwent UGI Endoscopy …

• What it is … ?
• How will u manage … ?
• What are the complications … ?

GERD
Dept of Surgery - AKUH
• Scenario - A 65 years old female
with history of weight loss,
multiple vomiting's & abdominal
distension …

• What it is .. ?
• How will you manage .. ?
• What are the fluid requirements
according to weight ?
• What is paradoxical aciduria .. and
how will u manage it ?

Gastric outlet obstruction

Dept of Surgery - AKUH
• Scenario – A middle age male with
history of swelling as shown in figure ..

• What are the differentials ?

• How will you approach for diagnosis .. ?
• How will you manage ?
• What is freys syndrome ? ..(Sweating
while eating)
• Which nerve involved .. ? (AT nerve)

Facial/Neck Swelling
Dept of Surgery - AKUH
• A 36 years old farmer came to
clinic with history of cough &
hemoptysis … CXR was done …

• What are the differentials ?

• What it is ?
• What investigations will you do ?
• What are the management options
? ….

Hydatid cyst of Chest

Dept of Surgery - AKUH