Module Discipline Topic LO

Clerkship Surgery Malignant breast Staging of Breast Ca

conditions`

Clerkship Surgery Diagnosis of Breast Ca

Clerkship Surgery Treatment of Breast

Cancer

Clerkship Surgery

Clerkship Surgery

Clerkship Surgery Nipple Discharge Diagnosis of nipple

discharge

Clerkship Surgery Diagnosis of nipple

discharge
Clerkship Surgery Treatment of nipple
discharge

Clerkship Surgery Mastalgia

Clerkship Surgery Treatment of mastalgia

Clerkship Surgery Axillary Swelling

Clerkship Surgery

Clerkship Surgery
Clerkship Surgery Dysphagia

Clerkship Surgery

Clerkship Surgery

Clerkship Surgery Paraumblical

hernia

Clerkship Surgery Ectopic testis

Clerkship Surgery Crohn's disease

Clerkship Surgery Rectus sheath

hematoma
Clerkship Surgery Psoas abscess

Clerkship Surgery Benign Bleeding

Per Rectum

Clerkship Surgery

Clerkship Surgery Malignant

bleeding per
rectum

Clerkship Surgery Perianal abscess

Clerkship Surgery Rectal polyp

Clerkship Surgery Pilonida sinus

Clerkship Surgery Thyroid

Clerkship Surgery Thyroid

Clerkship Surgery Thyroid

Clerkship Surgery Thyroid

Clerkship Surgery Parathyroid

Clerkship Surgery Parathyroid

Clerkship Surgery Parathyroid

Clerkship Surgery Submandibular

gland
Clerkship Surgery Submandibular
gland

Clerkship Surgery Neck Swelling--

Congenital and
Acquired cysts

Clerkship Surgery Neck Swelling--

Congenital and
Acquired cysts

Clerkship Surgery Neck Swelling--

Congenital and
Acquired cysts

Clerkship Surgery Neck Swelling--

Congenital and
Acquired cysts

Clerkship Surgery Cervical

Lymphadenopat
hy

Clerkship Surgery Cervical

Lymphadenopat
hy
Clerkship Surgery Parotid

Clerkship Surgery Carcinoma Lip

Clerkship Surgery Salivary Stones

Clerkship Surgery Carcinoma

tongue

Clerkship Surgery Rannula

Clerkship Surgery Premalignant

Intraoral ulcer

Clerkship Surgery Malignant

Intraoral ulcers

Clerkship Surgery Benign Breast

Conditions

Clerkship Surgery Benign Breast

Conditions
Clerkship Surgery Benign Breast
Conditions
Clerkship Surgery Benign Breast
Conditions

Clerkship Surgery Benign Breast

Conditions

Clerkship Surgery Painful Leg Aretrial Disease

Swelling

Clerkship Surgery Painful Leg Venous Disease

Swelling

Clerkship Surgery Painful Leg

Swelling

Clerkship Surgery Skin Ulcer BCC

Clerkship Surgery Skin Ulcer SCC

Clerkship Surgery Skin Ulcer Marjolin's Ulcer

Clerkship Surgery Skin/Subcutaneo Lipoma

us swelling

Clerkship Surgery Skin/Subcutaneo Ganglion

us swelling

Clerkship Surgery Skin/Subcutaneo Carbuncle

us swelling

Clerkship Surgery HeadInjury

Clerkship Surgery HeadInjury

Clerkship Surgery HeadInjury

Clerkship Surgery Brain Tumors

Clerkship Surgery

Clerkship Surgery Brain Abscess

Clerkship Surgery Approach to

Polytrauma
patient
Clerkship Surgery Approach to
Polytrauma
patient

Clerkship Surgery Approach to

Polytrauma
patient

Clerkship Surgery Approach to

Polytrauma
patient

Clerkship Surgery Approach to

Polytrauma
patient

Clerkship Surgery Approach to

Polytrauma
patient
Clerkship Surgery Approach to
patients with
burn

Clerkship Surgery Approach to

patients with
burn

Clerkship Surgery Approach to

patients with
burn

Clerkship Surgery Approach to

patients with
burn
Clerkship
 Scenario Lead In

A middle aged lady presents with a 7cm mass in left breast. There What is TNM clinical staging?
are palpable left axillary lymph nodes which are fixed. There is no
clinical evidence of distant metastasis. Core biopsy shows Invasive
ductal carcinoma.

A 55 years old female presented with history of lump left breast for What is the most likely
last 2 months which is progressively increasing in size. On diagnosis?
examination it is 3 x 3 cm in size, firm to hard in consistency with
skin dimpling. Her left axillary lymph nodes are also enlarged.

A 35 years old female presented with history of a painful hard lump What should be the next step
in her right breast for last one month. On examination her breast is in management:
swollen, tender and there is skin edema.

A 55 years old female presented with left breast lump 6x10 cm in The optimum treatment for
upper outer quadrant with no palpable axillary lymph nodes. this patient is
Histopathology shows invasive ductal carcinoma. Staging shows no
distant metastasis.

A 40 year-old woman presents with oestrogen receptor positive The best treatment option is:
stage IV invasive ductal carcinoma.

A bilateral green coloured

nipple discharge in a 40 years
old female is most likely due
to:

A 45 year old female preswnts with nipple discharge which is clear What is the most likely
in nature. It is from a single duct. There is no mass on examination diagnosis?
and imaging.
A 40 years old lady presents with black colored discharge from right The best treatment option
nipple, multiple ducts. On examination there is no underlying lump. then is:
You perform nipple discharge cytology which turns out to be
negative for malignant cells. The ultrasound is also normal. Despite
reassurance the discharge is proving intolerable. a. Repeated
antibiotic cover

A 45 years old pre-menopausal lady presents with pain in her right What is the next management
breast for last two months. The pain is non-cyclical. On examination step:
of breasts both the breasts are lumpy but there is no dominant
lump on both sides. Her axillary lymph nodes are not enlarged.

A 34 year old female presents with cyclic breast pain which is worse You would advise her to:
before menstrual cycle.

A 40 years old obese female presents with tender non fluctuant What is the appropriate
swelling in right axilla for 2 months. She also complains of fever. She treatment for her condition?
is a chronic smoker and is recently diagnosed diabetic. There is no
past significant history.

A 25 yearold female presents in OPD with complains of swellings in What should be the next step
both axillae for 6 months. The swellings are painless. There is no in management:
mass lesion in either breast.

A 24 yrs old female has presented with firm nodules in the axilla. She will be assessed further
Her breast examination is normal. by:
A 35 year old woman has dysphagia for last 2 years. She regurgitates The most likely diagnosis is:
food after ingestion and is getting recurrent bouts of pneumonitis.
There is no previous history of heartburn or caustic ingestion. There
is no history of weight loss.

A 67-year-old woman presents with progressive dysphagia. She has What is the next step in
experienced a 10-kg weight loss over last 6 moths. management?

Localized tumours of the

esophagus are best treated by:

A 55 yrs old female presented with a small paraumbilical hernia (1 What is the best treatment
cm defect size) for last 2 years. option:

A 6 year boy was brought with complaint of absent right testis. What is the most suitable
Testis was found in inguinal area and could be brought down to the treatment required?
bottom of scrotum.

A 45 year old woman compalins of alternating constipation and What is likely diagnosis?
diarrhoea for 6 months. Diarrhoea is often associated with pain in
right iliac fossa.She also noted a couple of painful bluish nodules on
skin.

A 40 year old woman developed pain right lower quadrant while What is most likely diagnosis?
playing tennis. She presents to Emergency Department . On
examnation there is an apparent mass in abdominal wall.
A 20 year old female presents in OPD with complains of low grade What is the likely diagnosis?
fever, loss of weight and backache for 2 months.On abdominal
examinaton there is a swelling in inguinal region which is mildly
tender.

A 6 years old boy presented with history of bleeding per rectum off What further investigation
and on for last 3 months. Physical examination was unremarkable may clarify the diagnosis?
except melanin spots on his lips.

A 60 year old male presents with histoyr of bleeding per rectum for What is the best treatment
3 months on and off. Proctoscopy shows 2nd degree haemorrhoids. option?
He had an MI 2 months back.

23. A 60 years old man presents with anemia, bleeding per rectum The best diagnostic
and constipation for 4 months. DRE and proctoscopy is normal. investigation for this patient is

A 55 year old male, known diabetic presents with pain around anal What is the treatment of
region for 3 days associated with fever. On examiantion there is a choice for this patient?
fluctuant swelling on right side which is tender to touch.

A 3 year old child has history of something coming out of anus and The most likely diagnosis is:
bleeding per rectum for last one year.

The following can be the site

of pilonidal sinus:
A bruit over the thyroid gland
indicates:
A 55 year old female has a midline neck swelling for 10 years. Her What is the likely cause of
voice has recently become hoarse hoarseness?
A 17 years old girl from Hazara district, presented in surgical OPD The most likely cause of this
with a swelling of her neck for the past 5 years. On examination, she condition is:
had a butterfly shaped swelling in her neck which moved on
deglutition, was firm in consistency.

A 38-year-old patient presents with a 2.5-cm right-sided thyroid What is likely diagnosis?
mass. On examination there is mild enlargement of the cervical
lymph nodes. A thyroidectomy is performed and histology reveals a
non-encapsulated infiltrative mass. Psammoma bodies and
epithelial cells with large clear areas within the nuclei are noted.

A 35 years old female had an operation on her thyroid gland, On This injection is:
first post operative day, she complained of tingling around her lips
and later stiffness of her fingers and wrist. The resident doctor
ordered an intravenous injection for the patient.

Parathyroid hyperplasia
usually presents clinically with:

A 55 year old male presents with a prominent neck swelling on What is likely diagnosis?
rigthof midline. His right cervical lymph nodes are also enlarged.
Serum Parathyroid hormone levels are increased.

A 66 years old lady presented with recurrent pain in right lower jaw The diagnostic investigation
which was brought on by eating or even tasting something. Onset of for this condition is:
pain was accompanied by a vague swelling in the area of her right
lower jaw.
A 52 year old lady presents with complains of dryness of mouth for What is the most likely
past few months. She also complains of grittiness in her eyes. On diagnosis?
examination, she has a diffuse swelling of right parotid gland.

A subcutaneous cystic swelling

presenting in the midline of
neck above hyoid bone that
moves with tongue protrusion
is most likely:

A 2 year old child has been brought to OPD by parents who are What is the definitive
concerned by a large swelling on right side of his neck. On treatment of the swelling?
examination its is soft, partially compressible and brilliantly
translucent.

A 40 years old female from a high altitude area presents with a which of the following is
swelling on left side of neck in anterior triangle. It is painless and investigation of choice?
mobile from side to side but not up and down

A branchial cyst develops from

the vistigial remnants of:

A 56 years old male presented in OPD with a nodule overlying his His clinical examination must
lower jaw 4 cm posterior to the chin on right side. It was fixed with include examination of:
the underlying bone and slightly tender on examination.

A 25 years old female presented with history of fever and night What is the best investigation
sweats for last 2 months. On examination her cervical and axillary to reach a diagnosis?
lymph nodes are enlarged, rubbery and non-tender. Her spleen is
also enlarged.
 The appropriate surgical
procedure for pleomorphic
adenoma of the parotid gland
is:

Which of the following is most

common type of carcinoma
lip?

The gland hich is the most

common site of stone
formation is:

A 67 year old male smoker has been daignosed with tongue cancer What is the best management
which crosses the midline. option?

A 14 year old school girl presents with a swelling in the floor of What is appropriate
mouth for 3 months. It is soft, fluctuant and painless in submental management option?
region.

Regarding intra oral ulcers,

which of the following is
associated with potential risk
for malignant transformation?

A 56 years old male presented with a painless ulcer at the buccal History obtained from this
aspect of his mouth. It had raised edges and necrotic floor. patient must include an
inquiry about:

Regarding acute inflammation

of breat

Gynaecomastia occurs in:

A 25 year old girl presented with a lump in her left breast for 4 On FNAC it turns out to be a
months. The size of the lump is 5x5 cm and it is freely mobile and fibroadenoma. What is the
has no skin tethring. best treatment option?
 Asymmetrical breast
enlargement in a teenage girl
is most likely due to

A 6 days old baby boy has been brought in OPD with history of What is the probable diagnosis
discharge from breast which is milky in nature.

A 35-year-old patient complained of shortness of breath and The most likely diagnosis is:
palpitations on 3rd day after left hemicolectomy for CA colon.
Examination showed blood pressure 90/40 mmHg with
accompanying tachycardia.

A 62-year-old man presented with a flat sloping edged ulcer over The most likely diagnosis is:
the left medial malleolus.

A 67-year-old woman notices a swollen right leg following a 6-hour Which of the following would
plane flight. be a reasonable next step for
the treating physician?

A 66-year-old man presents with a deep ulcerated lesion on the The most likely diagnosis is:
nose, with a rolled edge.
A 60-year-old man complains of a bleeding ulcer on the upper The most likely diagnosis is:
region of the left cheek. It has an everted edge and there are some
palpable cervical lymph nodes.

Longstanding burn scars are

likely to developa chronic non
healing ulcer called:

A 33-year-old man presents with a swelling on the upper arm which What is the most appropriate
has been growing slowly for a number of years. Examination reveals next step in management?
a soft, compressible, non-tender lobulated mass.

A 28-year-old man presents with a painless swelling on the dorsum The most likely cause for the
of the right hand. Examination reveals a smooth, spherical, tense, clinical findings is:
1.5-cm swelling. The overlying skin can be drawn over it.

A 60 year old male with poorly controlled diabetes presents with a What is the appropriate
painful swelling over nape of neck for 10 days. Clinical examination treatment?
reveals a carbuncle.

The following value of

sustained intracranial pressure
is associated with poor
outcome in traumatic brain
injury:
 The most common initial
manifestation of increasing
intracranial pressure in the
victim of head trauma is

An 86-year-old man is brought to A&E with a suspected The Glasgow Coma Score
subarachnoid haemorrhage. On examination he is moaning (GCS) of the patient is:
incomprehensibly with his eyes closed. Nail-bed pressure causes
limb flexion and eye-opening.

The first management option

for a pituitary prolactinoma
will be:

Which of the following

statements about
craniopharyngiomas is true?

A 55 years old female presents with 7 day history of high grade Based on history and
fever, headache and weakness of right arm. She had a renal examination most probable
transplant 3 months back and was on immunosuppressive agents diagnosis is:
before her present condition developed. On examination her GCS is
15/15 but the power in right arm is 3/6. Rest of the examination is
unremarkable.

Shock can be most

comprehensively defined as:
A man fell off a bridge while driving a motor cycle at high speed. He What is the diagnosis?
is in severe pain and tender in left lower chest (9th to 11th ribs) and
in abdomen. On examination the pulse is 120/min, BP 90/70.
Abdomen is rigid and still. DRE reveals local tendness and boggy feel
anteriorly.

A 28 year male was runover by a tractor trolley causing compression What is the diagnosis?
injury to his chest. He complained of retrosternal pain. He is
tachypnoeic, pulse 130/min and BP 90/60. He is resuscitated
according to ATLS protocol. Condition remains stable. Resident
doctor reports that he can listen bowel sounds high up in left hemi
thorax.

Sucking chest wounds after

penetrating trauma to chest
are best managed initially by:

An 18 year old college student was brought into A & E with history What is the most appropriate
of alleged assault. His airway and breathing are spontaneously management step?
maintained. His pulse is 130/min, blood pressure is 85/55. Chest
examination is unremarkable. Abdomen is distended tender and
rigid.

A 31 year old lady is struck by a car. On arrival in the emergency What is the most appropriate
department she has a systolic blood pressure of 105mmHg and a course of action?
pulse rate of 126 beats per minute. On Abdominal examination
diffuse tenderness and some left sided flank bruising. A FAST scan is
normal.
 Inhalational injury in a burned
patient should be suspected if:

A patient having a partial

thickness burn should be
admitted to hospital if he has:

The lucid interval is typically

present in:

A 24 year old man is admitted to A&E with 35% full thickness burns Which fluid is normally
after being involved in a house fire. avoided during resuscitation in
the first 8-12h?
 A B C D E

T1N1M0 T1N0M1 T2N1M0 T3N2M0 T2N0M0

Fibrocystic Fibroadenoma Phylloides tumor Breast Carcinoma

disease tuberculosis breast*

Biopsy* Antibiotics Incision and x-ray MRI

drainage

Neoadjuvantc Modified Modified radical Simple Chemoradiother

hemoradiothe radical mastectomy mastectomy apy only
rapy followed mastectomy
by surgery with axillary
clearance*

Tamoxifen* Cytotoxic Mastectomy and No further Immunotherapy

chemotherapy immediate intervention
reconstruction

Duct ectasia* Breast abscess Tuberculous mastitis Ductal carcinoma

in situ

Fat necrosis Breast cancer Pget's disease Breast abscess Intraductal

papilloma
Microdochect Cone excision Radiation to the Mastectomy
omy of the major major ducts
ducts*

Reassure the Repeated self Bilateral ultrasound Bilateral FNAC

patient breast of breast Mammogram *
examination

Surgery Take more Biopsy Evening primrose

caffiene oil

Loose weight Stop smoking Topical and oral Radical excision

antibiotics

Reassure the FNAC of the Trucut biopsy Ct scan of Axilla Ultrasound

patient swelling

Blood C/P , Chest Xray Examination of other Examination of FNAC of the

ESR and Chest alone axilla other axilla and swelling
Xray groins
Stricture due Carcinoma Hiatus hernia Cardiac achalasia Cockscrew
to reflux esophagus oesphagus
oesophagitis

Upper GI CT scan neck Barium follow Ultrasound neck

endoscopy through
and biopsy

Endoscopic Radiotherapy Chemotherapy Oesophagectomy Intra luminal

fulguration intubation

Laparoscopic Mayo’s repair* Onlay mesh repair Darning repair Conservative

hernia repair treatment

Follow up * hCG injections Orchiectomy Orchiopexy Testosterone

injections

Carcinoid Crohn's disease Ileocaecal Ulcerative colitis

tumor tuberculosis

Acute Cecal Torsion of ovarian Rectus sheath Cholecystitis

appendicitis carcinoma cyst hematoma
Ileocecal Psoas abscess Inguinal lymph node Obstructed
tuberculosis femoral hernia

Small bowel Barium meal Colonoscopy Stool examination Barium Enema

follow
through

Haenorrhoide Laxatives Increase fibre diet Band Ligation

ctomy

Ultrasound Barium enema Plain x-ray abdomen C T scan Colonoscopy

Sits baths IV antibiotics Fistulectomy Incision and

drainage

Carcinoma Solitary rectal Anal fissure Haemorrhoids Rectal polyp*

rectum ulcer

Abdominal Umbilicus* Popliteal fossa Thigh

wall
Multinodular Carcinoma Hypothyroidism Hyperthyroidism* Euthyroid gland
goiter thyroid
Myxoedema MNG Hypothyroidism Hyperthyroidism Carcinoma of
thyroid
Iodine Viral infection Bacterial infection Autoimmunity Benign
deficiency neoplasm

follicular papillary anaplastic carcinoma lymphoma medullary

carcinoma carcinoma* carcinoma

Calcium Diazepam Midazolam Nalbuphine Tramadol

gluconate

Latent tetni Diarrhea Hyperglycemia Renal stones, Thyrotoxicosis

alternating abdominal pain
with and psychic
constipation disorders

Parathyroid Parathyroid MEN 1 Parathyroid

hyperplasia carcinoma adenoma

Blood CP Sialography Thyroid Ultrasonic Xray skull

autoantibodies examination of
thyroid
Pleomorphic Sjogrens wharthins tumor Sarcoid Adenoid cystic
adenoma syndrome carcinoma

Cervical Lipoma Dermoid cyst Aberrant thyroid Throglossal cyst

lymph node

Excision Observe for Inj Phenol Sclerosant Aspiration

spontaneous injection
resolution

Ultrasound CT angiography FNAC Biopsy

First branchial 2nd branchial 3rd branchial cleft 2nd branchial arch 3rd branchual
sleft cleft arch

Hypopharynx Teeth Larynx Lateral surface of Tonsils

tongue

CT scan neck Ultrasound Lymph node excision FNAC

neck biopsy
Enucleation of Superficial Incisional biopsy Superficial partial Total
the tumour parotidectomy parotidectomy parotidectomy
with possibly
scarifying facial
nerve

Basal cell Squamous cell Melanoma Marjolin’s ulcer Keratocanthom

carcinoma carcinoma*** a

Sub lingual Submandibular Parotid Minor salivary

glands

Excision with Excision with Hemiglossectomy Total glossectomy

2cm margin $cm margin

Excision of Excision of cyst, Aspiration and Conservative

cyst and submandibular Cytology treatment
submandibula and sublingual
r gland gland

Decreases Decreases with Higher in non increases with

with increasing age smokers alcohol
increasing age of lesion consumption
of patient

Diabetes Family history Narcotic addiction Sexual promiscuity Tobacco

mellitus chewing

Bacterial It is always Incision and Antibioma usually Wall biopsy of

mastitis is the associated with drainage is the resolves in a few all breast
commonest lactation treatment of choice days abscesses is
variety* in cellulitic stage necessary

Carcinoma Peptic ulcer Carcinoma breast Bronchial Chronic liver

prostate disease carcinoma disease*
Reassurance Antiestrogens Excision Quadrantectomy Subcutaneous
mastectomy
Benign lump As part of Breast Abscess Fibrocystic disease Malignant lump
normal of breast
development
process

Intraductal Fibrocystic Mastitis of infants Breast abscess Duct ectasia

papilloma disease

Anaphylaxis Cardiac Hypovolemia Pulmonary Sepsis

tamponade embolism*

Venous ulcer* Squamous cell Bowen’s disease Basal cell Apthous ulcer
carcinoma carcinoma

Prescribe Start 6 months Order a pelvic CT Prescribe one Order a venous

compression of warfarin scan to look for baby aspirin per duplex
stockings and anticoagulation lymphadenopathy day evaluation*
leg elevation

Aphthous Basal cell Squamous cell Venous ulcer

ulcer carcinoma* carcinoma
Squamous cell Basal cell Keratocanthoma Sebhoric keratosis Melanoma
carcinoma carcinoma*

Curling's Ulcer Marjolin’s Cushing's Ulcer Trophic Ulcer

ulcer*

FNAC Core cut Biopsy Incisional biopsy Excision

Ganglion* Lipoma Furuncle Carbuncle Abscess

Oral IV antibiotics Debridement Deroofing

antibiotics and aseptic followed by followed by
and aseptic dressing antibiotics antibiotics
dressing

>10 mm Hg >15 mm Hg >20 mm Hg* >25 mm Hg >30 mmHg

Change in Ipsilateral Contralateral Hemiparesis Hypertension
level of pupillary pupillary dilatation
consciousness dilatation
s*

0 3 4 7 9

Somatostatin Dopamine Dopamine Trans-sphenoidal Wait and see

analogues agonists* antagonists surgery approach

The primary The tumors are The tumors are Signs and May cause
mode of uniformly solid usually malignant symptoms of compression of
treatment is acromegaly may the optic tracts
radiation be present and visual
therapy symptoms

Acute Cerebral Subdural empyema Acute subdural Metastasis to

meningitis abscess* hematoma brain

A sudden A diminished A hypotensive state An unexpected Inadequate

large volume effective with peripheral psychological cardiac output
blood loss circulating fluid vasoconstriction insult
volume*
Pneumothora Rupture of Liver trauma Colonic rupture Rupture of
x spleen* diaphragm

Pneumothora Flail chest Splenic rupture Haemothorax Diaphragmatic

x rupture*

Dressing Immediate Immediate needle Debridement and

taped on chest insertion in 2nd closure
three-sides* intubation intercostal space

CT scan head Endotracheal Laparotomy Large bore IV FAST scan

intubation access and fluid
resuscitation

Arrange a Arrange an Perform a Perform diagnostic Arrange an

departmental urgent laparotomy peritoneal lavage urgent
abdominal abdominal MRI abdominal CT
USS scan scan scan
Electrical burn Singed nasal Patient is a known > 60% burn Tachycardia is
has occurred vibrissae on case of present
in a closed examination* bronchiectasis
space

Burns of Burn > 10% No associated bony Case of scalds only Insists on
hands and area injury admission
face*

acute chronic intracerebral extradural subacute

subdural subdural hematomas hematomas* subdural
hematomas hematomas hematomas

Plasmalyte Hartmann's Albumin solution Dextrose saline Dextran 40

 Correct option Difficulty level Importance
(A/B/C/D/E)
D Difficult Important

E Easy Important

A Moderate Important

B Difficult Essential

A Moderate Essential

A Moderate Important

E Difficult May know

B Moderate Important

D Moderate Important

D Easy Important

C Moderate Important

B Easy May know

D Easy Important
D Easy Essential

A Easy Essential

D Easy Essential

B Easy Essential

A Moderate Essential

B Difficult Important

D Moderate May know

B Moderate May know

A Difficult Important

D Easy Essential

E Moderate Essential

D Easy Essential

E Easy Important

B Easy Important

D Easy Essential

E Easy Essential
A Easy Essential

B Moderate Important

A Easy Essential

D Easy Essential

B Moderate Important

B Moderate Important
B Difficult May know

E Easy Essential

A Moderate Important

B Easy Important

B Easy May know

B Moderate Important

D Moderate Essential
B Easy Essential

B Easy Essential

B Easy Essential

D Moderate Important

B Difficult May know

D Difficult May know

E Moderate Important

A Easy Essential

E Easy Essential

C Moderate Important
D Moderate Essential

C Moderate Important

D Easy Essential

A Moderate Important

E Easy Essential

B Moderate Important
A Moderate Important

B Moderate Important

D Moderate Important

A Easy Essential

D Moderate Essential

C Moderate Important
A Difficult Important

D Easy Essential

B Moderate Important

E Difficult May know

B Difficult May know

B Moderate Essential
B Easy Essential

E Easy Essential

A Easy Essential

D Easy Essential

E Easy Essential
B Moderate Important

A Moderate Essential

D Easy Essential

C Easy Essential