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General Surgical Scheme

1111.... SwellingsSwellingsSwellingsSwellings

� Differential Diagnosis of swelling case

• If the Pt. told you that it was after trauma � Haemangioma.

• If the swelling has an expansile pulse � Aneurysm.

• If the swelling has a transmitted pulse � Swelling

over an artery.

• The swelling is reducible & shows expansile impulse on cough

� Hernia or Saphena varix.

• The swelling moves up and down with deglutition � Thyroid

enlargement or thyroglossal cyst.

• The swelling moves with protrusion of the tongue �

Thyroglossal cyst.

• The swelling increase in size in very short period � A tumor.

• Not one of these so by exclusion � Lipoma or Sebaceous cyst.

⇒ How to diagnose a swelling?

a. Anatomically: organ involved. b. Etio-pathological diagnosis:

Traumatic, Inflammatory (F.H.M.A), Neoplastic.

c. Functional diagnosis "compensated or not".



2222.... HerniaHerniaHerniaHernia

� A Swelling shows

- Expansile impulse on cough.

- Reducible, and …..

⇒ Near linea alba, so the hernia may be �

� Umbilical "it is rounded; usually there is absence

of the shape of umbilicus".

� Para umbilical "it is cresenteric, usually

presence shape of the umbilicus"

� Other with no incision � Epigasteric.

⇒ Any where at a site of an incision, the hernia may be �

� Incisional "A scar of previous operation other than

hernia".

� Recurrent hernia "A scar of previous hernia operation".

⇒ At the inguinal region & above the inguinal ligament, hernia

may be �

� Direct "At Hassel Bach's triangle, Reduced backwards &

don't descend to scrotum".

� Indirect "Hernia reduced upwards, backwards and

laterally & may descend to scrotum".

� Saphena varix:

� Site: at femoral triangle.

� With Trendlenberg test � incompetent sapheno-

femoral junction.



3333.... ThyroidThyroidThyroidThyroid

Neck ا�� ا�ـ Neck lumps إ�� ا��ت ا�ـ •

⇒ Enlarged lymph node, thyroid enlargement, thyroglossal cyst,

and tumour.

��ت ا��ن �� ا�ـ • Thyroid ��ة �� ا !�� وا

⇒ Simple goitre, solitary nodule, 1ry thyrotoxicosis or 2ry

thyrotoxicosis autonomous toxic nodule.

� What are the suggestive of malignant goitre??

1. Recent rapid increase in size.

2. Hard consistency.

3. Fixation to the surroundings.

4. Local pain referred to the ear.

5. Fixed hard cervical lymph nodes.

6. Signs of distant metastasis.



4444.... UlcersUlcersUlcersUlcers

a. Vascular � venous ulcer, ischemic ulcer, lymphoma ulcer.

b. Traumatic � direct trauma or bed sore.

c. Infection � chronic osteomylitis, T.B & syphilis.

d. Neoplastic: ⇒ Primary skin ulcer "epithelioma, melanoma, basal

cell carcinoma".

⇒ Marjolin's ulcer "epithelioma on top of ulcer, burn".

⇒ Ulcerative deep malignancy "bone tumours". e. Others: neuropathy & rheumatoid ulcer.

�

• Venous � Ask about history of DVT.

• Ischemia � Ask about history of Claudication pain, Color

change & Atrophic tissue.

• Neuropathy � �� )ن '&�% $�# و�� " •

��01� آ�ن '&�% � . آ�% �&��.، ,�+�*؟؟ � 5&�01� إ�1$� �5"رض ��,2* و� "؟؟ �� %�إ�1$� ��5� $;&* أو �5ردة �� ر�8� زي إ�1$� �� إ�

زي إ�1$� �� و,�؟؟

• Malignant �

.إ�� آ #ت 15#'* �� و�< �=�# 8�ا 5course>#�� ا�ـ �

• Others � From the shape of the edge.

� The most common is venous ulcer.

� @A ن ه��ا�� C� �Dا�� ه� � ��!

⇒ Complication of thrombophlebitic limb or

complication of 2ry varicose veins.



OSCE Exam QuestionsOSCE Exam QuestionsOSCE Exam QuestionsOSCE Exam Questions

��

o Case 1 � "Examine the NeckExamine the NeckExamine the NeckExamine the Neck". � State True or False:

1. The Pulse is less than 80/min. 2. The patient has +ve stellwag sign. 3. The patient has no fine tremors on extremities.

� What is your diagnosis?

� Primary toxic goiter.

These are a group of questions from the previous end

round exams.

In the OSCE exam you are asked to examine a Case, and

then you answer on those questions & just to state if

these sentences are true or false.

This is just a sample for the exam to guide you & to say

take care of something there.



o Case 2 � "Examine the Neck""Examine the Neck""Examine the Neck""Examine the Neck". � State True or False:

1. The patient pulse is more than 100/min. 2. The swelling moves up and down with deglutition and with

protrusion of the tongue. 3. The swelling has nodular surface.


� Simple nodular goiter.

o Case 3 � "Examine the Neck"."Examine the Neck"."Examine the Neck"."Examine the Neck". � 1ry toxic goiter.

� State True or False:

1. There is pretibial myxedema. 2. +ve Vongrafe sign. 3. Moves up & down with deglutition and with protrusion of tongue.

o Case 4 � "Examine the Neck"."Examine the Neck"."Examine the Neck"."Examine the Neck". � Simple nodular goiter.


1. It is in posterior triangle. 2. Superficial to sternomastoid. 3. There is a retrosternal extension.

o Case 5 � "Examine the thyroid".Examine the thyroid".Examine the thyroid".Examine the thyroid". � There may be a Stethoscope near the patient, so take care.


1. There is thrill over upper pole. 2. The swelling is pulsating. 3. The skin shows a scar. 4. The right lobe is enlarged. 5. There is a retrosternal extension.



o Case 6 � "Examine the "Examine the "Examine the "Examine the Neck".Neck".Neck".Neck". � 2ry toxic goiter.


1. The trachea is central. 2. There are nodules in both lobes. 3. There are visible pulsations over the superior pole of thyroid. 4. There is audible bruit over the thyroid.

o Case 7 � "Examine the Neck"."Examine the Neck"."Examine the Neck"."Examine the Neck". � 1ry toxic goiter.


1. There is thrill on upper pole. 2. The Berry's sign is +ve. 3. The pemperton sign is -ve. 4. There is a dull sternum. 5. The swelling moves up & down with deglutition.

o Case 8 � "Examine the Thyroid"."Examine the Thyroid"."Examine the Thyroid"."Examine the Thyroid". � State True or False:

1. This is a case of secondary toxic goiter. 2. The gland is nodular asymmetrical. 3. There is retrosternal dullness. 4. The best line for treatment of this case is surgery. 5. The gland moves upwards with deglutition and protrusion of the

tongue.

o Case 9 � "Examine the Examine the Examine the Examine the Thyroid".Thyroid".Thyroid".Thyroid". � State True or False:

1. There is thyroid enlargement. 2. There is scar of previous operation. 3. The swelling is completely covered with sternomastoid. 4. RT supraclavicular LN is enlarged. 5. The swelling moves with protrusion of tongue.



o Case 10 � "Examine "Examine "Examine "Examine the Thyroid".the Thyroid".the Thyroid".the Thyroid". � Simple nodular goiter.


1. The swelling moves with deglutition. 2. The swelling is hard. 3. The swelling moves with protrusion of tongue. 4. The swelling is bilateral. 5. The swelling is attached to skin.

o Case 11 � "Examine the "Examine the "Examine the "Examine the NeckNeckNeckNeck".".".". � 2ry thyrotoxicosis.


1. It is a case of 1rythyrotoxicosis. 2. The patient has a fine tremor. 3. The pulse > 100. 4. The only line of ttt is surgical.

o Case 12 � "Examine both Groins"."Examine both Groins"."Examine both Groins"."Examine both Groins". � State True or False:

1. The swelling doesn't reach the scrotum. 2. This is a direct hernia. 3. Internal ring test is negative.


� Right indirect inguinal hernia in a male patient, non complicated, enterocele, fit for surgery.

o Case 13 � "Examine both Groins"."Examine both Groins"."Examine both Groins"."Examine both Groins". � Rt. Indirect inguinal hernia.


1. The patient has oblique inguinal hernia. 2. The patient has left femoral hernia. 3. The hernia is irreducible. 4. This is a case of recurrent hernia.



o Case 14 � "Examine both Groins"."Examine both Groins"."Examine both Groins"."Examine both Groins". � Rt. indirect inguinal hernia.


1. There is a scar in left groin. 2. It shows malgaigne bulging. 3. It is downward & lateral to pubic tubercle. 4. It is strangulated. 5. There is sliding bladder.

o Case 15 � "Examine Right Groins"."Examine Right Groins"."Examine Right Groins"."Examine Right Groins". � Rt. indirect inguinal hernia.


1. This is oblique uncomplicated hernia. 2. It is partially irreducible. 3. It shows transmitted impulse. 4. The patient is kept in the hospital for herniotomy. 5. Internal ring test is positive.

o Case 16 � "Examine the Abdomen"."Examine the Abdomen"."Examine the Abdomen"."Examine the Abdomen". � State True or False:

1. The abdomen is distended. 2. The swelling is not completely reducible. 3. The most urgent complication is strangulation.


� Supraumblical hernia, non complicated, in a female patient.

o Case 17 � "Examine the Abdomen"."Examine the Abdomen"."Examine the Abdomen"."Examine the Abdomen". � State True or False:

1. The hernia is reducible. 2. The hernia is obstructed. 3. There is Gurgling sensation on palpation.


� Epigastric hernia in a male patient, non complicated, omentocele.



o Case 18 � "Examine the "Examine the "Examine the "Examine the SpleenSpleenSpleenSpleen".".".". � State True or False:

1. There is left renal swelling. 2. The spleen is enlarged and reaching the right iliac fossa. 3. There is positive ballottement test. 4. A notch can be felt on the ant boarder of the swelling.

o Case 19 � "Examine the Abdomen"."Examine the Abdomen"."Examine the Abdomen"."Examine the Abdomen". � Incisional & Para umbilical hernia.


1. There is only Para umbilical hernia. 2. Mid line previous incision. 3. It is tender. 4. It shows an expansile impulse on cough. 5. Appears more on contraction of abdominal muscles.

o Case 20 � "Examine the Abdomen"."Examine the Abdomen"."Examine the Abdomen"."Examine the Abdomen". � Para umbilical, Incisional hernias & 2 scars "one above the umbilicus & the

other at inguinal region". � State True or False:

1. There is Para umbilical hernia. 2. There is incisional hernia. 3. More than one scar. 4. Both hernias are reducible. 5. Malgaigne bulge is seen.

o Case 21 � "Examine the Abdomen"."Examine the Abdomen"."Examine the Abdomen"."Examine the Abdomen". � Umbilical hernia.


1. It is a paraumblical hernia. 2. There are signs of inflammation. 3. There is an ulcer. 4. The swelling shows impulse on cough. 5. There is a scar of previous operation.



o Case 22 � "Examine the Abdomen"."Examine the Abdomen"."Examine the Abdomen"."Examine the Abdomen". � Umbilical hernia.


1. The mass has an expansile impulse in cough. 2. Occupation is important to be asked in this case. 3. It is not complicated. 4. Abdominal & pelvic sonar is important. 5. Strangulation could occur due to twisting of 2 loops of intestine.

o Case 23 � "Examine Both Lower "Examine Both Lower "Examine Both Lower "Examine Both Lower Limbs".Limbs".Limbs".Limbs". � State True or False:

1. The patient has +ve Fagan test. 2. The condition is unilateral. 3. There is Saphenofemoral incompetence.


� Bilateral 1ry varicose veins non complicated.

o Case 24 � "Examine Both Lower Limbs"."Examine Both Lower Limbs"."Examine Both Lower Limbs"."Examine Both Lower Limbs". � State True or False:

1. There is competent Saphenofemoral junction. 2. There is no thrill on Saphenous opening. 3. The condition is bilateral.


� 2ry varicose veins in left limb & complicated.

o Case 25 � "Examine Left Leg"."Examine Left Leg"."Examine Left Leg"."Examine Left Leg". � 1ry unilateral varicose veins.


1. There is Saphenofemoral incompetence. 2. There is affection of the short Saphenous vein. 3. There is venous ulcer. 4. There is no pigmentation.



o Case 26 � "Examine "Examine "Examine "Examine Both Lower LimbsBoth Lower LimbsBoth Lower LimbsBoth Lower Limbs".".".". � State True or False:

1. Dorsalis pedis pulse is present. 2. 2ry to incompetent right Saphenofemoral junction. 3. Right leg is longer than left. 4. There is atrophy blanche.

o Case 27 � "Examine Both Lower Limbs"."Examine Both Lower Limbs"."Examine Both Lower Limbs"."Examine Both Lower Limbs". � State True or False:

1. Short saphenous vein is palpable. 2. Venous refill takes longer than 10 min. 3. There is evidence of lipodermatosclerosis. 4. There is evidence of haemosiderosis.

o Case 28 � "Examine Both Lower Limbs"."Examine Both Lower Limbs"."Examine Both Lower Limbs"."Examine Both Lower Limbs". � Old obese female.


1. This is a case of secondary varicose. 2. Varicosities appear along the course of short saphenous. 3. Veins are pulsating. 4. There is incompetent Saphenofemoral junction. 5. Modified Perth's test is positive for this case.

o Case 29 � "Examine Both Lower Limbs"."Examine Both Lower Limbs"."Examine Both Lower Limbs"."Examine Both Lower Limbs". � Unilateral 2ry varicose veins.


1. The prominent system affected is short saphenous. 2. The long saphenous is pulsating. 3. There is apparent sahena varix. 4. There is pigmentation. 5. This is a case of 2ry varicose veins.



o Case 30 � "Examine Both Lower Limbs"."Examine Both Lower Limbs"."Examine Both Lower Limbs"."Examine Both Lower Limbs". � 2ry varicose veins.


1. A case of 1ry varicose veins. 2. There is an incompetent perforator. 3. The ulcer is healed. 4. It is not complicated. 5. The treatment is surgical. 6. Venograhy is the best investigation to be done.

o Case 31 � "Examine Both Lower Limbs"."Examine Both Lower Limbs"."Examine Both Lower Limbs"."Examine Both Lower Limbs". � 1ry varicose veins in right side.


1. The dilated veins are bilateral. 2. There is an ulcer in the right side. 3. There is a scar in the right side. 4. The shape of dilatations is saccular. 5. There are dilatations in sapheno femoral junction.

o Case 32 � "Examine the Back"."Examine the Back"."Examine the Back"."Examine the Back". � State True or False:

1. The swelling has slippery edges. 2. The swelling is sub muscular. 3. The most common complication is malignant transformation.


� Subcutaneous lipoma of the back.



o Case 33 � "Examine the Neck"."Examine the Neck"."Examine the Neck"."Examine the Neck". � Lymphadenopathy following sore throat.


1. This is anatomical site for lymph node. 2. It is related to throat condition. 3. Submental LN is palpable. 4. It is soft in consistency. 5. Pagets test is +ve.

o Case 34 � "Examine the Face"."Examine the Face"."Examine the Face"."Examine the Face". � State True or False:

1. The condition is related to sun exposure. 2. The safety margin of excision is more than 5 mm. 3. Distant metastasis is the most common complication.


� Basal cell carcinoma of the nose "Rodent Ulcer".

o Case 35 � "Examine the Face"."Examine the Face"."Examine the Face"."Examine the Face". � Squamous cell carcinoma at angle of mouth.


1. Safety margin is less than 5mm. 2. It is related to nicotine.



� � �� End RoundEnd RoundEnd RoundEnd Round

��

o Case 1 � "Examine the "Examine the "Examine the "Examine the Right ElbowRight ElbowRight ElbowRight Elbow".".".". � Cystic Swelling in the elbow.


1. The skin is abnormal. 2. The swelling is deep to the muscle. 3. The swelling is solid. 4. The skin over the swelling showed dimpling on movement. 5. Paget test is a fluctuation test for large swelling.

o Case 2 � "Examine "Examine "Examine "Examine Both Both Both Both GroinsGroinsGroinsGroins".".".". � Hernia (indirect) "patient above 40 years".


1. This is oblique uncomplicated hernia. 2. It is partially irreducible. 3. It shows transmitted impulse. 4. The patient is kept in the hospital for herniotomy. 5. Internal ring test is positive.

o Case 3 � "Examine "Examine "Examine "Examine the Neckthe Neckthe Neckthe Neck".".".". � 2ry toxic goiter "Female 33 years".


1. This is a case of secondary toxic goiter. 2. The gland is nodular asymmetrical. 3. There is retrosternal dullness. 4. The best line for treatment of this case is surgery. 5. The gland moves upwards with deglutition and protrusion of the

tongue.

��"� ��"� �



o Case 4 � "Examine "Examine "Examine "Examine Left LegLeft LegLeft LegLeft Leg".".".". � 1ry varicose veins "Old obese female".


1. This is a case of secondary varicose. 2. Varicosities appear along the course of short saphenous. 3. Veins are pulsating. 4. There is incompetent Saphenofemoral junction. 5. Modified Perth's test is positive for this case.

o Case 5 � "Examine "Examine "Examine "Examine the Abdomenthe Abdomenthe Abdomenthe Abdomen".".".". � Para umbilical, Incisional hernias & 2 scars "one above the umbilicus & the

other at inguinal region".


1. There is paraumbilical hernia. 2. There is incisional hernia. 3. More than one scar. 4. Both hernias are reducible. 5. Malgaigne bulge is seen.

o Case 6 � "Examine "Examine "Examine "Examine the Neckthe Neckthe Neckthe Neck".".".". � Simple nodular goiter.


1. There is thyroid enlargement. 2. There is scar of previous operation. 3. The swelling is completely covered with sternomastoid. 4. Rt. supraclavicular LN is enlarged. 5. The swelling moves with protrusion of tongue.



o Case 7 � "Examine "Examine "Examine "Examine Both LegsBoth LegsBoth LegsBoth Legs".".".". � Unilateral 2ry Varicose Veins.


1. The prominent system affected is short saphenous. 2. The long saphenous is pulsating. 3. There is apparent sahena varix. 4. There is pigmentation. 5. This is a case of 2ry varicose veins.

o Case 8 � "Examine "Examine "Examine "Examine the Scapulathe Scapulathe Scapulathe Scapula".".".". � Sebaceous cyst.


1. The swelling is tender. 2. The swelling is pulsating. 3. The swelling is attached to skin. 4. It has a well defined edge. 5. The draining LN is enlarged.

o Case 1 � "Examine "Examine "Examine "Examine the the the the Neck & FaceNeck & FaceNeck & FaceNeck & Face".".".". � Dermoid cyst.


1. The swelling is cystic. 2. The swelling has slippery edges. 3. The swelling is attached to skin. 4. There is a scar. 5. It is a sebaceous cyst.

��"��"� �



o Case 2 � "Examine "Examine "Examine "Examine Both LegsBoth LegsBoth LegsBoth Legs".".".". � Primary varicose vein in right side.


1. The dilated veins are bilateral. 2. There is an ulcer in the right side. 3. There is a scar in the right side. 4. The shape of dilatations is saccular. 5. There are dilatations in Saphenofemoral junction.

o Case 3 � "Examine "Examine "Examine "Examine the Abdomenthe Abdomenthe Abdomenthe Abdomen".".".". � Umbilical hernia.


1. It is a paraumbilical hernia. 2. There are signs of inflammation. 3. There is an ulcer. 4. The swelling shows impulse on cough. 5. There is a scar of previous operation.

o Case 4 � "Examine "Examine "Examine "Examine the Neckthe Neckthe Neckthe Neck".".".". � Simple nodular goiter.


1. The swelling moves with deglutition. 2. The swelling is hard. 3. The swelling moves with protrusion of tongue. 4. The swelling is bilateral. 5. The swelling is attached to skin.



o Case 1 � "Examine "Examine "Examine "Examine the Neckthe Neckthe Neckthe Neck".".".". � 2ry thyrotoxicosis.

� State Yes or No:

1. Is the swelling hard? 2. Is the swelling attached to the skin? 3. Is the ttt conservative? 4. FNAC is an essential of diagnosis? 5. Is the swelling present in the digastric triangle? 6. Is the swelling nodular? 7. Cancer in this case is more common in males than females? 8. Does the swelling move up &down with protrusion of the tongue? 9. Does the swelling arise embriologically from the tongue?

o Case 2 � "Examine "Examine "Examine "Examine the Backthe Backthe Backthe Back".".".". � Lipoma at the left side of the back.

� State Yes or No:

1. Is the swelling compressible? 2. Are the edges well defined? 3. The main line of ttt is excision? 4. This swelling usually turns malignant? 5. Does this swelling have impulse on cough?

��"�� א"� �



o Case 3 � "Examine "Examine "Examine "Examine Both GroinsBoth GroinsBoth GroinsBoth Groins".".".". � Right inguino-scrotal hernia.


1. This hernia may contain urinary bladder? 2. This hernia may contain intestine? 3. This hernia may be obstructed? 4. The main line of ttt is essentially surgical? 5. The hernia is more common in elderly? 6. The hernia is bilateral in 60% of cases? 7. Does the hernia have impulse on cough? 8. Is this hernia reducible?

o Case 4 � "Examine "Examine "Examine "Examine Both GroinsBoth GroinsBoth GroinsBoth Groins".".".". � Left inguinal hernia "indirect".


1. This hernia has +ve cross fluctuation? 2. This hernia may contain sigmoid colon? 3. This hernia protruded through the superficial inguinal ring? 4. This hernia is common in elderly? 5. This hernia is bilateral in 60% of cases? 6. This hernia has expansile pulsations? 7. This hernia occurred due to direct trauma? 8. The direction of this hernia is forwards?



o Case 1 � "Examine "Examine "Examine "Examine the Abdomenthe Abdomenthe Abdomenthe Abdomen".".".". � Incisional hernia.


1. The mass is seen on cough and standing and disappear on lying down.

2. Treatment is herniotomy only. 3. It is not complicated now. 4. Complications don't occur in this type of hernia.

o Case 2 � "Examine "Examine "Examine "Examine the Neckthe Neckthe Neckthe Neck".".".". � 2ry thyrotoxicosis.


1. It is a case of 1ry thyrotoxicosis. 2. The patient has a fine tremor. 3. The pulse > 100. 4. The only line of ttt is surgical.

o Case 3 � "Examine "Examine "Examine "Examine the Abdomenthe Abdomenthe Abdomenthe Abdomen".".".". � Umbilical hernia.


1. The mass has an expansile impulse in cough. 2. Occupation is important to be asked in this case. 3. It is not complicated. 4. Abdominal & pelvic sonar is important. 5. Strangulation could occur due to twisting of 2 loops of intestine.

��"�!� ��א��"� �



o Case 4 � "Examine "Examine "Examine "Examine Both LegsBoth LegsBoth LegsBoth Legs".".".". � 2ry Varicose veins.


1. A case of 1ry varicose veins. 2. There is an incompetent perforator. 3. The ulcer is healed. 4. It is not complicated. 5. ttt is surgical. 6. Venograhy is the best investigation to be done.

o Case 5 � "Examine "Examine "Examine "Examine Both GroinsBoth GroinsBoth GroinsBoth Groins".".".". � Inguinal hernia.


1. This case may be complicated. 2. There is a scar for an operation. 3. Hernia is partially reducible.

o Case 6 � "Examine "Examine "Examine "Examine the Neckthe Neckthe Neckthe Neck".".".". � Thyroid Case.


1. There is a thrill. 2. The gland superficial to sternomastoid muscle. 3. Carotid pulse can be felt. 4. Surface is irregular.



o Case 1 � "Examine "Examine "Examine "Examine the Swellingthe Swellingthe Swellingthe Swelling".".".". � Lipoma.


1. The swelling has slippery edges. 2. It is pseudo fluctuant. 3. It is translucent. 4. It is partially attached to the skin. 5. Its consistency is soft.

o Case 2 � "Examine "Examine "Examine "Examine the Neckthe Neckthe Neckthe Neck".".".". � A thyroid case.


1. Enlargement in the Rt. lobe only. 2. There is retrosternal extension. 3. Trachea is central. 4. Pretracheal lymph node palpable.

o Case 3 � "Examine "Examine "Examine "Examine the Neckthe Neckthe Neckthe Neck".".".". � A thyroid case.


1. Carotid pulse on both sides can be felt. 2. Left deep cervical LN can be palpable. 3. Swelling in the submandibular region. 4. There is sinus in the skin.

��"�"��# �"� �



o Case 4 � "Examine "Examine "Examine "Examine the Backthe Backthe Backthe Back".".".". � Sebaceous cyst.


1. The swelling has slippery edges. 2. It is soft in consistency. 3. It is Pseudo fluctuant. 4. It is translucent. 5. It is partially attached to the skin.

o Case 5 � "Examine "Examine "Examine "Examine Both GroinsBoth GroinsBoth GroinsBoth Groins".".".". � Hernia Case.


1. It is idiopathic hydrocele. 2. Inguinal LN are impalpable. 3. There is left oblique inguinal hernia.

o Case 6 � "Examine "Examine "Examine "Examine Both LegsBoth LegsBoth LegsBoth Legs".".".". � An ulcer in the leg.


1. The base is indurated. 2. Unhealthy granulation tissue present. 3. There is everted edge at one side. 4. There are varicose veins.

o Case 7 � "Examine "Examine "Examine "Examine Both GroinsBoth GroinsBoth GroinsBoth Groins".".".". � Hernia case.


1. There is Rt. direct inguinal hernia. 2. There is infantile hydrocele. 3. There is enlarged epididymis. 4. There is enlarged spermatic cord. 5. There is loss of Rt. testicular sensation.



o Case 8 � "Examine "Examine "Examine "Examine the Neckthe Neckthe Neckthe Neck".".".". � A case of lymphadenopathy.


1. Swelling seen in the left side of neck. 2. The swelling is in the carotid triangle. 3. There is intra oral ulcer. 4. Supraclavicular LN is palpable.

o Case 1 � "Examine "Examine "Examine "Examine the Abdomenthe Abdomenthe Abdomenthe Abdomen".".".". � Incisional & paraumbilical hernias.


1. Patient has 2 scars. 2. Incisional hernia over Cesarean section produced. 3. Both hernias are reducible. 4. Patient has paraumbilical hernia. 5. It shows malgaigne sign.

o Case 2 � "Examine "Examine "Examine "Examine the Neckthe Neckthe Neckthe Neck".".".". � Thyroid case "No thyrotoxicosis or malignant symptoms".


1. The thyroid gland is enlarged. 2. Rt. supraclavicular LN is enlarged. 3. There is previous scar in the neck. 4. The swelling is covered by sternomastoid muscle. 5. It moves up & down with protrusion of tongue.

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o Case 3 � "Examine "Examine "Examine "Examine Left LegLeft LegLeft LegLeft Leg".".".". � Varicose veins case.


1. The prominent system affected is short saphenous. 2. Saphena varix is present. 3. The varicosity is secondary. 4. There is pigmentation around medial malleoulus. 5. The affected veins pulsate.

o Case 4 � "Examine "Examine "Examine "Examine the Swellingthe Swellingthe Swellingthe Swelling".".".". � A swelling in the Rt. Lid.


1. The swelling is attaching to the skin. 2. There is enlarged LN. 3. It has a well defined edge.

Other notes produced by ALL TEAM

Your way for easy surgery

� These Notes Contain

- Full detailed lectures of Prof.Dr. Hussein Khairy.

- Hints from notes of Dr. Wael Metwaly.

- Hints from notes of Dr.Amr El Shayeb.

- Our curriculum from Oral book.

all team scheme & osce final

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