Faculty of Medicine

University of Khartoum
Batch 89 - Qayasir

Surgery OSCE
Collected by 6th Study Group
(Ali seif, Hazim, Ahmed Mudathir, Migdad Haiyder, Abubakr Khalaf & Mohamed
Emad)

Contents
General...................................................................................................................................................... 3
Lump Examination .................................................................................................................................... 4
Thyroid Examination ................................................................................................................................. 6
Breast Examination ................................................................................................................................... 7
Abdominal Examination ............................................................................................................................ 8
Hernia Examination................................................................................................................................... 9
Scrotal Examination ................................................................................................................................ 10
Incisional Hernia Examination................................................................................................................. 11
Stoma Examination ................................................................................................................................. 12
Ulcer Examination ................................................................................................................................... 13
Varicose Veins Examination .................................................................................................................... 14
Oral Swelling Examination ...................................................................................................................... 15
Obstructive Jaundice History .................................................................................................................. 18
Dysphagia ................................................................................................................................................ 20
Gastric Outlet Obstruction ...................................................................................................................... 22
UPPER GI BLEEDING ................................................................................................................................ 23
Lower GI Bleeding ................................................................................................................................... 24
Diabetic Foot ........................................................................................................................................... 25
Breast History.......................................................................................................................................... 26
Thyroid History........................................................................................................................................ 26

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Surgery OSCE Collected by 6th Study Group
 Bronchogenic Carcinoma ........................................................................................................................ 26
Hematuria ............................................................................................................................................... 26
Urine Retention....................................................................................................................................... 26
Renal Colic / Mass ................................................................................................................................... 26
Mycetoma ............................................................................................................................................... 26
Hydrocephalus ........................................................................................................................................ 26

Sources:
- Clinical Rounds
- Manoj for OSCE
- OSCE for Medical Finals

2|Page
Surgery OSCE Collected by 6th Study Group
 General
1. Surgery Examination:
3. Surgery History (VIVA / Long
- Thyroid
Case)
- Breast
- Dysphagia
- Hernia
- Upper GI Bleeding
- Inguinoscrotal
- Lower GI Bleeding
- Lump (lipoma / Sebaceous
- Anorectal Conditions & IBD
Cyst / Ganglion / Dermoid
- Gastric Outlet Obstruction
Cyst / Neurofibroma /
- Jaundice
Parotid Swelling)
- Abdominal Distention
- Ulcer (Incisional Hernia /
- Hematuria
Venous Ulcers / Skin Ulcers
- Urine Retention
/ Mycetoma / Cleft Lip)
- Renal Colic
- Abdominal Examination for
- Limb Ischemia
Organomegaly
- Diabetic Foot
- Stoma (Colostomy)
- Chronic Discharging sinus
- Vascular (Varicose Veins)
Leg
- Vascular (Chronic Limb
- Breast
Ischemia)
- Thyroid
- Hydrocephalus

2. Surgery Maneuvers 4. Surgery Communication Skills

- NG Tube Insertion - Vascular Referral
- Cannula Insertion - Informed Consent
- Urinary Catheterization - Stoma
- Suturing - Breast Cancer
- Hydrocephalus
- Palliative Patient
- Diabetic Septic Foot

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Surgery OSCE Collected by 6th Study Group
 Lump Examination
- WIPE (Wash hands, Introduce
Yourself, Permission, Position,
Exposure)

- Others by Palpation:
- Inspection:
o Compressibility (e.g Vascular)
o Site
o Pulsatile/Expansible
o Size
o Fluctuation & Cross
o Shape
fluctuation
o Skin Over it
o Transillumination
 Discharge
o Reducibility (Hernia)
 Dilated Veins
 Pigmentation
- Complete Examination by:
o Scars
o Regional Proximal LNs
o Color
 (Head and Neck = Cervical
LNs; Trunk = Axillary LN;
- Palpation Lower Limbs = inguinal)
(Ask About Pain, Look at Face) o ± Percussion
o Tenderness o ± Auscultation
o Temperature o Distal Pulsations
o Thrills o Other AREAS TO EXAMINE
o Lump Size  E.g: Back for tenderness
o Surface (Smooth, Nodular,
Lobulated, Irregular)
o Consistency (Soft, Firm, Hard)  Thanks the patient, Cover Him
o Edges (Well defined/Ill  Findings & Discussion
defined)
o Mobility (2 axis)
o Fixation to Skin
o Fixation to underlying Muscle

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Surgery OSCE Collected by 6th Study Group
Lumps: - Complications of Ganglion:
Wound infection / recurrence
 Lipoma:
- Mx: Aspiration but can recur or
- Benign fat tumor originating from
best to do Bloodless field with
subcutaneous fat
tourniquet under general
- Multiple painful lipomas =
anaesthesia
dercum’s disease
- Turns to malignant if; thigh,
- O/E: Site: Hand & Wrist, smooth
shoulder, retroperitoneum
surface, soft & fluctuant,
- Mx: Reassure, if affecting the pt.
TRANSILLUMINTE ON DORSUM
surgical excision
OF HAND.
- O/E: Soft – Lobulated – Slippery
Edge – Not attached to skin
 Dermoid Cyst:
-
- Cyst deep to skin so it is not fixed
 Sebaceous Cyst:
to skin
- Multiple: Gardner’s syndrome
- Congenital: Sequestration; while
associated with FAP & osteomas
acquired: implantation
- Complications:
- Site: External angular dermoid or
Infection/Ulceration/
midline
Calcification/Sebaceous horn
- Most important is to do Skull X-
formation (see pic)
Ray or CT, because DDx is
- Mx: Eliptical incision then
Meningocele, so if cyst arise from
excision
above the skull it is Dermoid or
- O/E: Site: hairy areas
from Brain and Herniate to the
(Axilla/face), u can see punctum,
skin
cross fluctuate, ATTACHED TO
- Mx:
SKIN
- O/E: Site:
 Ganglion:
- Cystic swelling arising from
tendon sheath related to
synvioum. (Myxomatous
degeneration)
- Ddx: Bursae

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Surgery OSCE Collected by 6th Study Group
 Thyroid Examination
- WIPE (Wash hands, Introduce
Yourself, Permission, Position,
Exposure)
* Position: Pt. Sitting on chair;
Exposure of neck region
- Inspection: (anterior neck swelling)
o Site: Thyroid; central or diffuse
o Moves with Swallowing
o Tongue Protrusion (if cyst suspected
ie. Central swelling)
o Size
o Shape
o Skin Over it
 Surgical Scars
 Dilated Veins
 Visible Pulsations
 Pigmentation
o Scars
o Suprasternal Notch Empty or not
- Palpation (Ask About Pain, Look at Face)
- From Front: (4 Ts)
o Tenderness
o Temperature
o Thrills
o Trachea
- Percussion for Retrosternal extension
- Auscultation for Bruit
Surgery OSCE Collected by 6th Study Group
- From Behind (Permission, position of
hand, place thumbs on back of neck &
tilt head forward) (Palpate using palm
of fingers and start laterally, both sides
and isthmus)
- Lump Size - Surface
- Consistency - Edges
- Mobility - Fixation to Skin
- Fixation to Sternocleidomastoid
muscle
- Dipping Test (Lower border, ask to
swallow water again) (for
retrosternal extension)
- Others by Palpation:
o Lymph Nodes (Paratracheal,
submental, submandibular, ant.
& post. Cervical, pre & post
auricular, occipital,
supraclavicular)
o Eyes:
 Exophthalmos / Lid retraction
 Lid Lag (hold pt. head)
 Ophthalmoplegia (ask abt. Pain
& diplopia)
o Hand (Pulse, Clubbing, Tremor,
Palmar Erythema, Swelling)
- Complete Examination by:
o Lower Limb for pretibial myxedema
o CNS examination for proximal
myopathy & Reflexes
o Full Cardiovascular examination
 Thanks the patient, Cover Him
 Findings & Discussion
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 Breast Examination
- WIPE (Wash hands, Introduce
Yourself, Permission, Position,
Exposure)
* Position: Pt. ideally in 45 degrees.
– could be sitting in the couch
- Inspection: Ask pt. to elevate her hand
on her head
o Symmetry of Both Breasts
o Lump:
o Site: Quadrants
o Size
o Shape
o Skin Over it (3PUS) (ask pt abt pain &
elevate breast with dorsum of hand
looking for skin changes)
 Peau’ de Orange
 Pigmentation
 Puckering (Skin Tethering)
 Ulceration
 Surgical Scars
o Nipple-Areola Complex: (Retraction,
Deviation, Destruction, Discoloration,
Displacement, Discharge) (Ask about
discharges and ask pt. to press on
nipple to confirm)
o Axilla & Upper limbs (Lumps, skin
changes)
Surgery OSCE Collected by 6th Study Group
- Palpation (Ask to start with normal
Breast; Ask About Pain, Look at Face)
o Palpate all quadrants with palm of
fingers
o Tenderness / Temperature /Thrills
o Lump:
 Size / Surface / Consistency
 Edges / Mobility (2 Axises)
 Fixation to Skin
 Fixation to Pectoralis Major
(‫)كوعي وأضغطي على وسطك‬
 If inferior lump; fixation to
serratus anterior (‫)أضغطي علي أنا‬
- Axillary Lymph Nodes (Anterior,
Posterior, Medial, Lateral, Apical)
- Supraclavicular LNs from behind
o If +ve, comment on No. / firm or
not / mobile or fixed
- Complete Examination by:
o Contralateral Breast & Axillary
Lymph Nodes
o Neurological Examination for Brain
Mets
o Chest for Pleural Effusion
o Abdominal ex for organomegaly &
Ascites
o Back for Tenderness
 Thanks the patient, Cover Him
 Findings & Discussion
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 Abdominal Examination - Complete Examination by:
- WIPE (Wash hands, Introduce o Examine the external genitalia, per
Yourself, Permission, Position, rectal, Lymph nodes and general
Exposure (nipple to mid thigh) examination

- Inspection: at the end of bed

o Contour, distention, flanks, visible  Thanks the patient, Cover Him
bulges, movement with respiration  Findings & Discussion
o Kneel at the right side:
o Visible pulsations; peristalsis
o Scars
o Dilated Veins & Umbilicus
o Hernial Orifices & coughing

- Palpation (Ask About Pain, Look at

Face)
o Tenderness / Temperature
o Superficial masses 9 quadrants
o Guarding or rigidity

- Deep palpation for organs:

o Liver & liver span
o Spleen
 Mass (Hypochondrium; moves with
respiration; dull on percussion; not
bimanually palpable; can feel a
notch or not)
o Kidneys bimanually
o Shifting dullness for ascites

- Auscultation
o Renal Bruit / Bowel sounds /
Splenic Rub / Venous Hum /
Hepatic Bruit

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Surgery OSCE Collected by 6th Study Group
 Hernia Examination
- Examine the groin area
- WIPE (Wash hands, Introduce
Yourself, Permission, Position,
Exposure )
- Pt. lying; expose umbilicus to knees
- Look for scrotal swellings; if +ve ask
pt to stand (for extension to
scrotum)
- Inspection:
o Site (swelling in groin area)
o Size / Shape
o Skin Over it (Pulsation; dilated veins;
pigmentation, Scars)
o Reducible: (Ask pt if can reduce the
swelling; if can reduce it) > so it is
reducible hernia
o Cough impulse (Ask pt. to Cough (1);
visible cough impulse; other hernial
orifices looks normal
- Palpation (Ask About Pain, Look at Face)
o +ve Palpable cough impulse
(Cough no. 2)
o Tenderness / Temperature /Thrills
o Lump: Size / Surface / Consistency
/ Margins
o Defect type
- Others by palpation:
o Palpate the Pubic Tubercle
 Hernia is above & medial; so it’s
inguinal hernia
 If below and lateral; it’s femoral
Surgery OSCE Collected by 6th Study Group
o Ask pt. to reduce it & locate
Anterior Superior Iliac Spine (ASIS)
o Locate deep inguinal ring &
Occlude the ring by Thumb facing
big toe of pt. & ask patient to
cough (cough no. 3)
 Doesn’t protrude after closure: indirect
inguinal hernia
 Protrudes: direct inguinal hernia
- Complete Examination by:
o Examine the other groin & other
hernial orifices
o Scrotum examination
 Thanks the patient, Cover Him
 Findings & Discussion
Dx:
- Right or Left - Inguinal or Femoral
- Direct or indirect - Reducible or not
Management
Complications & causes of hernia
Risk of strangulation
N.B:
Pubic Tubercle:
- From symphysis pubis below and lateral
first bony prominence; or do flexion of
knee and resisted adduction
Deep inguinal ring:
- Mid-point between ASIS & pubic tubercle;
above it by 2.5 cm
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 Scrotal Examination -
- Examine the groin area - Complete Examination by:
- WIPE (Wash hands, Introduce o Abdominal examination for masses
Yourself, Permission, Position, & hernial orifices
Exposure )
- Pt. lying; expose umbilicus to knees  Thanks the patient, Cover Him
- ask pt to stand  Findings & Discussion
Dx:
- Inspection: -
o Site (swelling in hemiscrotum area)
o Size / Shape Management
o Skin Over it (Pulsation; dilated veins;
pigmentation
o Scars (between two testis)

- Palpation (Ask About Pain, Look at Face)

o Tenderness / Temperature /Thrills

o Feel vas deferens; if can get

above the swelling; it’s a pure
scrotal swelling
o Palpate Testis (if you can feel
them separately; it’s not vaginal
hydrocele)
o Palpate the swelling: ( Size/
Surface / Consistency / Margins;
fixation)
o Cross Fluctuation test
o Transillumination test

- If dilated veins; comment & feel; and

ask pt to lie down: Scrotum feels like
a bag of worm that disappears when
lying flat

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Surgery OSCE Collected by 6th Study Group
 Incisional Hernia Examination - Ask pt to elevate his head; mass
- WIPE (Wash hands, Introduce didn’t appear after putting
Yourself, Permission, Position, abdominal muscles on action; so
Exposure ) it’s intrabdominal

- Inspection: at the end of bed

- Complete Examination by:
o Contour, distention, flanks, visible
o Rest of Abdominal Examination
bulges, movement with respiration
o Groin; genitalia & per-rectal
o Lymph-nodes; chest & general exam.
o Kneel at the right side:
o Visible pulsations; peristalsis
 Thanks the patient, Cover
o Dilated Veins & Umbilicus
Him/her
o Scar:
 Findings & Discussion
 Site; Size; Shape; Healing

o Bulging in margin of scar (size & shape) Dx:

o Hernial Orifices & coughing

o Cough impulse (Ask pt. to Cough (1);
visible cough impulse;
o Cough 2: (other hernial orifices looks
normal)

- Palpation (Ask About Pain, Look at Face)

o +ve Palpable cough impulse
(Cough no. 3)
o Reducible or not?
o Tenderness / Temperature /Thrills
o Lump: Size / Surface / Consistency
/ Margins
o Defect Size & Content

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Surgery OSCE Collected by 6th Study Group
 Stoma Examination
- WIPE (Wash hands, Introduce
Yourself, Permission, Position,
Exposure )
3 Objectives:
1. Type of stoma:
a. Temporal or permanent ( ‫خيطوا ليك‬
‫)فتحة الشرج‬
b. End – loop – divided – double barrel
c. Ileostomy or colostomy
Ileostomy:
- Rt. Hypochondrium (not always); spouted;
excoriation around; fluid secretion
Colostomy:
- Left side; stitched at level of skin; solid
secretions stool
2. Complicated or not
- Prolapse / Retraction / Stenosis /
Necrosis / Herniation
3. Functioning or not?
- Inspection: at the end of bed
o Contour, distention, flanks, visible
bulges, movement with respiration
- Kneel at the right side:
o Visible pulsations; peristalsis
o Dilated Veins & Umbilicus
- Surgical Scars (usually there is; so
comment on it)
Surgery OSCE Collected by 6th Study Group
- Stoma bag:
 Site; Secretions & content
 Ask to remove the bag to examine
the stoma (usually you will not be
allowed); so;
 I can barely see the skin; but it
looks normal; Excoriation or not
 Mucosa (Healthy, color, signs of
necrosis)
 Edges (Spouted or flattened)
 Type (end, loop, double barrel,
divided)
 Retraction / Prolapse
 Ask pt. to cough for parastomal
herniation
 Palpate for stenosis or obstruction
 Ask pt. about anal verge &
examine the perineum
 Ask about discharges of stoma &
it’s functioning
- Complete Examination by:
o Rest of Abdominal Examination
o Groin; genitalia & per-rectal
o Lymph-nodes & general exam.
 Thanks the patient, Cover
Him/her
 Findings & Discussion
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 Ulcer Examination
- WIPE (Wash hands, Introduce
Yourself, Permission, Position,
Exposure )
- Inspection:
o Site / Size / Shape / Skin Over it / Scar
o Ulcer (BEDD)
 Base (on inspection floor; palpation
base)
 Edge
 Describe structure at the base
 Discharge
- Palpation: (ask about pain; look at
face)
o Tenderness / temperature
o Ulcer (BEDD)
- Base / Edge / Describe structure at
base / discharge
o Mobility of ulcer
o Distal Pulses & Proximal LNs
o Sensory examination
- Complete Examination by:
o Other areas to examine (e.g
Varicosities)
 Thanks the patient, Cover
Him/her
 Findings & Discussion
Could be Venous / ischemic / TB /
Marjolin / SCC / BCC / Mycetoma
 Venous Ulcers:
Inspection:
- Just above the medial malleolus in
the gaiter area
- Large in size; Shape (regular or not)
- Skin over it (LEGS)
o Lipodermatosclerosis / Eczema / LL
swelling)
- Dilated veins & scars
o Ulcer (BEDD)
 Floor is pink in color
 Edge is sloping
 Granulation tissue at the base
 No Discharge
- Palpation: (ask about pain; look at
face)
o Tenderness / temperature
- Size/ Base / Edge / Describe
structure at base / discharge
o Mobility of ulcer
o Distal Pulses & Proximal LNs
o Sensory examination by 10 gm
monofilament test
- Complete Examination by:
o Ask pt to stand; to assess varicosities
and examine them
Dx:
Mx: - after doing ABPI; if less than 0.8 it’s
contraindicated to this approach
4 layers dressing
Vaseline / Crepe bandage / cotton /
adhesive plaster
Outcome

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Surgery OSCE Collected by 6th Study Group
 Varicose Veins Examination
- WIPE (Wash hands, Introduce
Yourself, Permission, Position,
Exposure)
* Position: Patient Standing and is
moving ant, post and laterally while u
r commenting (not you moving)
o Inspection: if pt. Is lying down; comment on
symmetry of limbs and obvious scars then ask
him to stand
o There is tortuous dilated elongated
superficial veins along the distribution
of the long (or short) saphenous vein
extending from just above the medial
malleolus reaching the upper thigh in
the right lower limb. (describe veins,
distribution and it’s sites)
o Anterior, medial and posterior veins
o LEGS:
 Lipodermatosclerosis
 Eczema
 Gaps = Ulcers (Venous ulcers)
 Swellings (LL edema)
 Scars
- Palpation (Ask About Pain, Look at
Face)
o Tenderness / Temperature /Thrills
o Venous Thickening for
Lipodermatosclerosis /
Compressible
o If Ulcer is present; examine it
(BEDD)
Surgery OSCE Collected by 6th Study Group
o Saphena Varix (2.5 cm below &
lateral to pubic tubercle)
(if +ve; There is swelling in the upper
thigh it is compressible with positive
cough impulse; so it’s the saphena
varix)
o Distal Pulses & Proximal LNs
o Check for LL Edema
o Tourniquet tests: pt lying, Put his
leg on your shoulder or ask
examiner to assist, explain to pt,
milk the varicosities up, close SFJ,
apply tourniquet in mid-thigh, and
ask pt to stand and see what
happens. (Interpretation down)
o Percussion & Auscultation for
machinery Murmurs
- Complete Examination by:
 Conducting peripheral vascular ex.
 Abdominal examination & digital
rectal ex for masses and genitalia
 Doppler ultrasound to localize site
of incompetence and patency of
perforators & check deep vascular
status.
 ABPI: for treatment options
 Thanks the patient, Cover Him
 Findings & Discussion
Etiology of varicose veins? (Primary or
secondary)
Suitable investigations work up: (duplex us)
Principles of management? (If mild;
conservative lifestyle modification & stockings /
Ligation with avulsion / stripping below knee /
stockings)
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 Oral Swelling Examination  Discussion:
o Diagnosis
- WIPE (Wash hands, Introduce
o Benign & malignant tumors
Yourself, Permission, Position, of parotid
Exposure ) o Investigations
- Inspection: o Types of Parotidectomy
o Site / Size / Shape o Complications of surgery
o Skin Over it (dilated veins, discharge,
pigmentation)
o Scars
o Ear lobule elevation
o Facial Palsy & Facial nerve ex (Facial
asymmetry, mouth deviation…etc)
o Inspection of oral cavity for ductal
orifice.

- Palpation: (ask about pain; look at

face)
o Tenderness / temperature / Thrills
o Surface / Consistency / Edge/ mobility
& Fixation
o Facial nerve examination
o Cervical Lymph nodes
o Bimanual palpation of Parotid ducts

- Complete Examination by:

o Regional Cervical LNs & distal
pulsation

 Thanks the patient, Cover

Him/her
 Findings & Discussion

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Surgery OSCE Collected by 6th Study Group
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Surgery OSCE Collected by 6th Study Group
 History

In any history; ensure the following:

- Proper Introduction, establish purpose of interview,
consent
- Allow the patient to express history in his own words,
Check for further symptoms, actively listen and elicit
information in structured manner.
- Appropriate use of language, open and close ended
questions and avoidance of leading multiple questions
- Thank the patient
- Summarize findings
- Mention Differential Diagnosis
- Work up and management.

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Surgery OSCE Collected by 6th Study Group
 Obstructive Jaundice History
Either presents with Jaundice /or/ Abdominal Pain
DDx:
- Benign: CBD Stones
- Malignant: - Ca Head Pancreas / Periampullary Carcinoma /
Cholangiocarcinoma
- Iatrogenic Following ERCP
- Biliary Leak / Stricture
PD Name, Age, Occupation, Residence, Marital Status
HPI Onset?
(ODIPARA) How it was discovered? Noticed it or someone else?
Duration?
Progression since start? Continuous, Intermittent or Progressive?
Intensity:
Agg. & Relieving Factors: Fatty Meals with stones
Associations:
- To confirm Obs Jaundice:
- Dark Urine / Pale Stool / Pruritus / Steatorrhea
- Identify the cause:
- Stones: Pain? +/- Fever with rigor
- Ca Pancreas: Constitutional (Weight Loss, Anorexia, N&V) / Recurrent
Onset DM / Backpain
- Periampullary: Melena
Other GI Symptoms: Dyspepsia/ Change in Bowel habits / Anemia
SR: Morning Headache, Sleep-wake disturbance
Weight Loss
Cough & Hemoptysis
Bleeding from any site?
Urine Amount, frequency & color
Backache
PMH: - Jaundice - Hx of Stones - DM / HTN
- Past ERCP - Past Endoscopy - Hemolytic Anemia - Blood Transfusion
FH - Malignancy - Stones - Similar Condition
DH - Current & chronic medications - Contraceptives - Allergies
SH - Alcohol - Smoking - Insurance - Impact on daily activity & Mobility

18 | P a g e
Surgery OSCE Collected by 6th Study Group
 1. Summarize Findings & Mention Differential Diagnosis?
- If stones: Acute, Painful, intermittent Jaundice, usually Female, Young, aggravatedby
fatty meals, ask abt use of contraceptives

- Jaundice if Malignant: Gradual onset, deep,

- Ca Head: painless continuous jaundice.
- Periampullary:
o If in ampulla of vater: Intermittent jaundice & melena
o If in duodenum around ampulla: Progressive abdominal colicky jaundice

2. Findings on examination?
- Jaundice (deep green or yellow) / Neck for Supraclavicular LN / Abdomen for
Palpable Gallbladder, organomegaly & ascites / DRE for rectal bleeding or mass /
Skin for scratch
3. Investigations?
4. Preoperative Preparations for biliary surgery?
5. Complications of Causes?
6. Management of Causes?

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Surgery OSCE Collected by 6th Study Group
 Dysphagia
- Difficulty in Swallowing
PD Name, Age, Occupation, Residence, Marital Status
HPI Onset? (Sudden or Gradual)
(ODIPARA) Started for Fluids or Solids?
Duration?
Progression? Static or Progressive? To solids / to fluids
Intensity: Complete or partial? Last meal? Hydration?
Level of Obstruction?
Agg. & Relieving Factors:
Associations:
- Painful or Painless?
- Heartburn or regurgitation?
- Coffee ground vomitus, Hematemesis & Melena
- Chocking / Crepitations & swelling / Ingestion of corrosives / trauma of
chest
Constitutional: Fever / Weight Loss / Fatigue / Anorexia
Other GI Symptoms: Dyspepsia/ Abd pain / Change in Bowel habits / Jaundice
/Anemia
SR: Morning Headache, Sleep-wake disturbance
Weight Loss
Cough & Hemoptysis
Back pain
Urine Amount, frequency & color
PMH: - Similar condition - PUD or GERD - History of Endoscopy or Surgery
- Neck Trauma - Goiter - Heart disease - Blood Transfusion
FH - Malignancy - Similar Condition
DH - Current & chronic medications - Anti Acids or PPI - NSAIDs - Allergies
SH - Alcohol - Smoking - Insurance - Impact on daily activity & Mobility

1. Summarize Findings & Mention Differential Diagnosis?

o Esophageal

2. Findings on examination?
- Pallor / Jaundice / Neck for Supraclavicular LN / Abdomen for masses & LNs / Back
for tenderness / other systems for mets

3. Investigations?
- To assess General condition of pt: CBC / Blood Glucose / Chest X-Ray / ESR /
- To know the cause: Barium Swallow / UG Endoscopy & Biopsy / Manometry
- For staging: CT Chest / EUS & Biopsy / Abdominal US

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Surgery OSCE Collected by 6th Study Group
 4. Management of Causes?
- Achalasia: (Heller’s myotomy + Nissen fundoplication)
- Cancer:
- Upper or middle third = McQueen operation.
- Lower third = Iver-lewis operation
- Palliative therapy = stenting, feeding jejunostomy, chemotherapy.

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Surgery OSCE Collected by 6th Study Group
 Gastric Outlet Obstruction
- Complain: Vomiting (or) Epigastric Pain
PD Name, Age, Occupation, Residence, Marital Status
HPI Onset? (Sudden or Gradual)
(ODIPARA) Duration?
Progression? Static or Progressive?
Intensity: Amount? Frequency? Projectile or Not? Color?
IF PAIN: Analyze using SOCRATES
Agg. & Relieving Factors:
Associations:
- Painful or Painless?
- Duration relation of pain or vomiting to meals
- Newly onset DM (polyuria)
- Alcohol
- PUD? NSAIDS use?
- Jaundice?
Constitutional: Fever / Weight Loss / Fatigue / Anorexia
Other GI Symptoms: Dyspepsia/ Abd pain / Change in Bowel habits / Jaundice
/Anemia
SR: Morning Headache, Sleep-wake disturbance
Weight Loss
Cough & Hemoptysis
Back pain
Urine Amount, frequency & color
PMH: - Similar condition - PUD - History of Endoscopy or Surgery
- Pancreatitis - Blood Transfusion - HTN or DM
FH - Malignancy - Similar Condition
DH - Anti-Acids or PPI - NSAIDs -Current & chronic medications - Allergies
SH - Alcohol - Smoking - Insurance - Impact on daily activity & Mobility

1. Summarize Findings & Mention Differential Diagnosis?

- Gastric Carcinoma - Ca Head of Pancreas - Chronic Pancreatitis
- Fibrosed Healed peptic Ulcer - Gastroparesis
2. Findings on examination?
- Pallor / Jaundice / Neck for Supraclavicular LN / Abdomen for masses & LNs / Succession
splash / Visible Peristalsis / Paraortic LN & Sister Mary Joseph Nodes / Palpable GB
3. Investigations?
- To assess General condition of pt: CBC / Blood Glucose / Chest X-Ray / ESR /
- To know the cause: UG Endoscopy & Biopsy / CT Abdomen / Abd US / Stool for elastase
- For staging: CT Chest / EUS & Biopsy / Abdominal US
4. Management of Causes?

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Surgery OSCE Collected by 6th Study Group
 UPPER GI BLEEDING
- Complain: Vomiting of Blood (or) Melena
PD Name, Age, Occupation, Residence, Marital Status
HPI Onset? (Sudden or Gradual)
(ODIPARA) Duration?
Progression? Static or Progressive?
Intensity: Amount? Frequency? Projectile or Not? Color? Clots? Palpitations?
Loss of consciousness? Dizziness? Fainting (Syncopal Attacks)?
Hospital Admission? If Admitted; what have been done? Transfusion of Blood?
Associations:
- Other GI Symptoms: PUD? (abd pain related to meals)
- Dyspepsia (early satiety, indigestion)
- Change in Bowel habits / Jaundice /Anemia
- Fatigue / Recurrent Infections
Constitutional: Fever / Weight Loss (Specify) / Fatigue / Anorexia /
Bleeding from other sides
SR: Morning Headache, Convulsions, Sleep-wake disturbance
Cough & Hemoptysis
Back pain, joint pain & swelling
Urine Amount, frequency & color

PMH: - Similar condition - PUD - Schistosomiasis (farmer, swimming in Tur3a)

- History of UG or lower GI Endoscopy or Surgery
- Hospital admission and Blood Transfusion - HTN or DM - ESRD
FH - Malignancy - Similar Condition
DH - Anti-Acids or PPI - NSAIDs – Anticoagulants -Current & chronic
medications - Allergies )‫(أدوية رطوبة – أدوية سيولة‬
SH - Alcohol - Smoking - Insurance - Impact on daily activity & Mobility

1. Summarize Findings & Mention Differential Diagnosis?

- Esophageal varices due to Portal HTN caused most likely by periportal fibrosis secondary
to Schistosomiasis
- Bleeding peptic Ulcer
2. Findings on examination?
3. Investigations?
4. Management of Causes?

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Surgery OSCE Collected by 6th Study Group
 Lower GI Bleeding
- Complain: Rectal Bleeding
PD Name, Age, Occupation, Residence, Marital Status
HPI Site: Lower GI Bleeding
(ODIPARA) Onset? (Sudden or Gradual)
Or Duration?
SOCRATES Progression? Static or intermittent or Progressive?
Character & Intensity: Amount? Color? Smell?
- Fresh Bloods? Clots?
- If Massive: Loss of consciousness? Dizziness? Fainting (Syncopal
Attacks)? Hospital Admission? If admitted; what have been done?
Timing:
- Relation to Stool (Mixed, streaks, around, before or after)
- Associated Pain with defecation?
- Type of stool & Stool Caliber (Hard or Soft with mucus)?
- Bleeding from other sides

Associations:
- Abdominal Pain
- STAM ALPOP (Spurious diarrhea, Tenesmus, Alternating bowel habits,
Melena, Anemia, Loss of weight, Prolapse(piles), Od, Pian
- Fever
- Jaundice
- Anemia / Recurrent Infections / Fatigue / Anorexia /
- If IBD, ask about Extraintestinal manifestations
SR: - Morning Headache, Convulsions, Sleep-wake disturbance
- Cough & Hemoptysis, SOB
- Back pain, joint pain & swelling
- Urine Amount, frequency & color
PMH: - Similar condition - PUD - IBD
- Schistosomiasis / Portal HTN / Jaundice
- History of UG or lower GI Endoscopy or Surgery
- Hospital admission and Blood Transfusion - HTN or DM
FH - Malignancy - Similar Condition
DH - Anti-Acids or PPI - NSAIDs – Anticoagulants - Current & chronic
medications - Allergies
SH - Alcohol - Smoking - Insurance - Impact on daily activity & Mobility

1. Summarize Findings & Mention Differential Diagnosis?

2. Findings on examination?
3. Investigations?
4. Management of Causes?

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Surgery OSCE Collected by 6th Study Group
 Diabetic Foot
- Complain:
PD Name, Age, Occupation, Residence, Marital Status
HPI Throbbing pain? Prevents sleep and keep pt awake?
(ODIPARA) N.B: (pain indicates normal sensation and presence of pus; and absence of pain
and sensation indicates severity of neuropathy)
Fever and rigors
Nausea & Vomiting
Swollen whole foot & leg
Enlargement of inguinal lymph nodes
History of intermittent claudication
HPI:
- Any inflecting cause?
- What did the patient do as an intervention?
- Any wound care done?
- Antibiotics taken?
- Blood sugar being tested?
SR: Morning Headache, Convulsions, Sleep-wake disturbance
Cough & Hemoptysis
GIT symptoms
Back pain, joint pain & swelling
Urine Amount, frequency & color
PMH: - Similar condition - Previous foot sepsis or surgery
- Admission for diabetes (hyperglycemia or hypoglycemia)
- Previous Operation - Foot Care - Allergy
- Hospital admission and Blood Transfusion - HTN or DM
FH - Diabetes - Similar Condition
DH - Control of diabetes & HTN -Current & chronic medications - Allergies
SH - Alcohol - Smoking - Insurance - Impact on daily activity & Mobility

1. Summarize Findings & Mention Differential Diagnosis?

-
5. Findings on examination?
6. Investigations?
7. Management of Causes?

25 | P a g e
Surgery OSCE Collected by 6th Study Group
 Breast History
Thyroid History
Bronchogenic Carcinoma
Hematuria
Urine Retention
Renal Colic / Mass
Mycetoma
Hydrocephalus

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Surgery OSCE Collected by 6th Study Group