OSPE

a. Plain x-ray -1
b. Contrast x-ray -1
c. Orthopaedic X-ray -1
d. Specimen -1
e. Instrument/s -1
f. Appliances (Catheter, tubes, stoma or reservoir
bags etc) -1
g. Data interpretation -1
h. Procedure stations -2
i. Splint/bandage -1
Plain X Ray
 Question
Describe the X ray?
What is your Dx?
What are the cause of this situation?
What are the cardinal feature of this situation?
How will you resuscitate the pt?
What are the stage of generalized peritonitis?
What is the treatment?
 Question
Describe the X ray?
What is your Dx?
What are the cause of this situation?
What are the cardinal feature of this situation?
How will you resuscitate the pt?
What is the treatment?
How many fluid level regarded as normal?
What is strangulation?
What are the feature suggest strangulation?
 Question
Describe the X ray?
What is your Dx?
What is the radiological findings
What are the predisposing factor of this situation?
What are the cardinal feature of this situation?
What is volvulus?
What is compound volvulus?
What are the cause of large gut obstruction?
How will you resuscitate the pt?
What is the treatment?3 option
Mention life threatening complication if treatment delayed?
 Question
Describe the X ray?
What is your Dx?
How will you confirm?
How the pt can present?
What other investigation you suggest?
What is the importance of IVU?
 Question
Describe the X ray?
What is your Dx?
How pt present?
What are the other investigation you suggest?
What are the treatment option?
Barium Swallow X-ray of Esophagus—
Achalasia Cardia
 Question
What is the name of X ray?
Name of the dye?
What are the finding present in this X ray
What is your DX?
What type of disorder it is?
What are the clinical feature?
How will you confirm the Dx?
 Question
What is the name of the X ray?
What are the finding in this X ray?
What is your Dx?
Why stomach is dilated?
Why not antral malignancy?
How will you confirm?
How patient present to you?
How will you prepare the patient for surgery?
Why need stomach preparation?
Barium meal follow through
 Question
What is the name of the X ray?
What are the findings present in this X-ray?
What is your probable Dx?
What are the other investigation you can
suggest?
Write down the principle of Mx?
Barium enema
 Question
What is the name of the X Ray?
What are the findings?
What is your probable Dx?
How will you confirm your Dx?
Write down 3 clinical feature of ca colon?
Describe the X ray
 Question
What is your Dx?
What are the cause of this condition?
What is hydronephrosis?
How will you prepare the pt for this
investigation?
Name contrast used in this X ray?
What is this?
Data intepretation
• A 30 years female presented with following
laboratory data

S. Bilirubin 15 mg/dl
SGPT : 50 U/L
Alkaline phosphatase : 600U/L
INR: raised
 Question
1)What is the clinical type of jaundice?
Write 2 investigation findings in favour of yout dX?
2) What is the first imaging investigation you
suggest?
3)Name one biochemical test that is required
before any intervention?
4)What are the feature of cholangitis
5)How will you prepare the patient for surgery?
 Preoperative preparation
Adequate hydration and correction of
electrolyte imbalance
Imrovement of nutrition
Correction of coagulopathy
Prevention of infection by prophylactic antibiotic
Prevention of hepatorenal shutdown
A 30 kg male presented with 20% deep burn

1. Name 2 method of calculating the percentage of

burn?
2. How will you calculate the fluid requirement in
first 24 hours in this patient
3. What type of fluid used in resuscitation?
4. Write type of shock in burn patient?
5. Name 3 complication
 A 30 years male presented in emergency with a chest
ray showing cresentric gas shadow under the both
dome of diaphragm
What is your Dx?
What are the cause of pneumoperitoneum?
Write down the cardinal feature of
pneumoperitoneum?
What are the stage of generalized peritonitis?
How will you resuscitate the patient?
What is your treatment plan?
Identify the object
 Question
Identify the object with their size?
Mention the parts of it?
Name 3 IV fluid?
What complication may arise from it?
 Question
Identify the object?
What are the parts of these object?
Write 3 indication of its uses?
Name 2 contraindication of its uses per urethra
How its sterilized?
 Indications

• Gastric decompression
• Gavage (feeding)
• Gastric lavage (irrigation or dilution of gastric
contents)
• Sampling of the gastric contents for analysis
 Contraindications

• Basilar skull fractures (Risk of NG reaching brain)

• Facial fractures (risk of cribiform plate disruption
and NG reaching brain)
• Obstructed nasal passages (if needed orogastric
intubation is considered)
• Caustic ingestion or esophageal strictures (risk of
perforation)
• Coagulopathy (Risk of uncontrollable epistaxis)
 Markings in the body of the tube:

• 1st marking (single line): 40 cm from tip of

tube (Tip lies at Gastroesophageal junction)
• 2nd marking (two lines): 50 cm from tip of
tube (Tip lies at Body of Stomach)
• 3rd marking (three lines): 60 cm from the tip
of tube (Tip lies at the Pylorus of stomach)
• 4th marking (four lines): 70 cm from the tip of
tube (Tip lies at the Duodenum)
 Complication
During insertion
• malposition (the m
• epistaxsis
• vomiting and aspiration
• placement into the anterior cranial fossa (i.e. base of skull fracture or cranial floor surgery)
• oesophageal variceal hemorrhage (if varices present)
• oesophageal or posterior pharyngeal perforation
b. During use
• sinusitis
• reflux and aspiration
• unplanned dislodgement or migration
• blockage, kinking and knotting
c. During removal
• mucosal adherence and trauma
• failure (e.g. kinking and knotting)
• dislodgement of endotracheal tube
 How will you confirm the correct
position
• Aspirate with syringe – aspiration of gastric
contents or bile
• Auscultate on epigastrium – as air is injected
into tube with 50 ml syringe (audible gurgling
sound
 Use of drain tube
1) remove any intraperitoneal or wound
collection of ascites, serum, bile, chyle,
pancreatic or intestinal secretion;
2) act as a signal for any postoperative
haemorrhage or anastomotic leakage;
3) provide a track for later drainage.
 Complication
Source of infection
Pain and discomfort
Increase hospital stay
 Uses
Following choledocholithotomy
Following repair of bile duct
 Uses
Name 3 common fluid uses in ward
Indication of IV fluid
Oropharyngeal airway tube
Identify the object.
Uses:
1.To make airway clear to prevent fall back of
tongue
2.Post operative pt
3.Unconscious pt
4.Help in collection of secretion
 Suture materials
Absorbable sutures: These sutures get absorbed in
the tissues either by enzymatic digestion or by
phagocytosis. Depending on the source, these
sutures may be:
1. Natural absorbable sutures:
− Plain and chromic catgut.
2. Synthetic absorbable sutures:
− Polyglycolic acid (dexon)
− Polyglactin 910 (vicryl)
− Polydioxanone suture (PDS)
Nonabsorbable sutures: These sutures remain in
the tissues for indefinite period.
Depending on the source, these sutures may be:
1. Natural nonabsorbable sutures:
− Silk.
2. Synthetic nonabsorbable sutures:
− Polypropylene (prolene)
1–Thickness of the sutures;
2–Code number;
3–Type of suture;
4–Length of the suture;
5–Name of manufacturer;
6–Lot number/batch
number; 7–Description of
the needle;
8–Manufacturing licence
number, manufacturing date
and expiry date;
9–Price of the foil pack.
 Characteristics of Catgut

„ erived from the submucosa of sheep's

D
intestine or serosa of cattle's intestine. It is
99% collagen.
„This is absorbed by a process of enzymatic
digestion by proteolytic enzymes contained
in the polymorphs and macrophages
„Catgut is easy to handle and knots well
Uses
a. Plain catgut:
Used during circumcision to suture the cut margins of
the prepuce
Used in repair of wounds of lip or oral cavity.
b. Chromic catgut:
Used to suture muscles, bowel anastomosis, closure of
peritoneum.
Used during appendicectomy
Used during cholecystectomy
 What do you mean by an atraumatic
suture?
SYNTHETIC ABSORBABLE SUTURES
Common Features
„Synthesized in laboratory
„These may be monofilament (polydioxanone and finer sizes vicryl) or
polyfilament(vicryl and vicryl rapide)
„They can be of natural color or can be colored green (dexon) or violet
(vicryl)
„They are twice as strong as compared to natural absorbable suture
„They are absorbed by a simple process of hydrolysis and evoke
minimal tissue reaction
„They have excellent handling properties. Once tied the knots are
secure
„These are sterilized by ethylene oxide
Characteristics
„This is a natural nonabsorbable suture
„The silk is derived from the cocoon of silk worm
larvae
„Handling property is best and it knots securely
„This is sterilized by gamma irradiation
 Uses

used for herniorrhaphy

„Used for closure of midline abdominal incision
„Used for repair of incisional hernia
„2-0 or 3-0 sutures are used for repair of tendon
injuries
„Finer sutures 4-0, 5-0 are used for vascular
anastomosis and for repair of nerve injury
Specimen
WHAT IS THE SPECIMEN?
What are your identifying point?
Write down the typical presentation?
What complication will arise if untreated?
Write down 2 clinical sign to Dx the condition?
Write down the surgical option?
What are the incision can be given to the pt?
Identify the specimen
What are the indication of operation?
Whar are the complication may arise if not
operated?
How pt present?
Which one is the gold standard surgical
procedure?
How many port required in standard
laparoscopy surgery?
What is the type of stone?
What are the other type?
Write 4 factor responsible for their formation?
Identify the specimen
What is your DX?
What operation done?
What is the most commonest site of metastasis?
How will you confirm the DX?
Name some investigation to detect the distant
metastasis
A 60 years male presented with a feature of dyspepsia. This is
the resected secimen. Identify the specimen
How will you confirm the Dx?
What are the modality of treatment of this
condition?
What are the surgical option?
What are the macroscopic type of ca stomach
Name 2 clinical sign of distant metastasis
What are the route of spread of malignant
lesion
Identify the specimen
What is your Dx?
What are the clinical feature
What are the indication of this operation
What are structure removed in this operation
How will you prepare the pt
 Instrument
BP blade and handle,
surgical scissors,
Needle holder,
Sponge holding forceps ,
towel clip
Alli’s tissue forces,
artery forceps,
Sinus forceps,
Dissecting forceps,
Kocher’s artery forceps,
kidney tray,
Gully pot,
intestinal clamps,
Deavers’ abdominal retractor,
Morris abdominal retractor
 Procedure station 2
Gloving
Gowning
Painting
Knotting
Drapping
Stitch off