SURGERY OSCE

STATION 1: HISTORY TAKING STATION 5: SUTURING

• The student will act as a doctor and the resident will act as • The student will be asked to demonstrate the proper way
your patient J (resident = difficult patient… haha!) of suturing
• Ask for the General Data of the patient (name, age, sex, • Try to explain on the resident what you are doing, step by
…) step J
• Ask for the Chief Complaint (e.g. abdominal pain) • The case given to us during our OSCE was a patient with
• Ask for the HPI (onset, pain scale, duration, associated a lacerated wound at the back
symptoms such as fever, nausea, etc., medications, etc.) o First, ask for the consent of the patient
• Try to do PE (try to palpate) o The resident will ask you what kind of suture you’ll
• CLUE: the bread and butter of surgery is ACUTE request; request for NYLON 3-0
APPENDICITIS; try to concentrate on extracting o Use povidone iodine (Betadine) to prepare the patient
information that will support the diagnosis of Acute o The resident will ask you to make a simple interrupted
Appendicitis J According to Dr. Jing, acute appendicitis stitch
can also present as pain on the RUQ § Make sure to use your finger to push and lock the
tie
STATION 2: SURPRISE STATION
• I labeled this as a surprise station since we didn’t know STATION 6: SUTURES AND NEEDLES
that this will be based on the previous station (argh!) • The student will identify the sutures and needles
• The following were the questions asked during our OSCE prepared by the residents
o What is the age of the patient in the previous station? • Nylon
J (e.g. 30 years old) o Description: monofilament
o What is the chief complaint? (e.g. abdominal pain) o Use: skin on the face and scalp
o What is your primary impression? (e.g. acute o Needle: conventional cutting needle
appendicitis) (triangular)
o What are your bases? (3) § for suturing skin
§ e.g. abdominal pain (RUQ), pain scale of 10/10,
(+) direct and rebound tenderness • Vicryl
o What are your differentials? (3) o Description: purple
§ e.g. Meckel’s Diverticulum, Cholecystitis, o Use:
Hepatitis o Needle: taper-point
o What is the definitive treatment? § soft tissues other than the skin
§ e.g. Appendectomy
• Prolene
STATION 3: NGT INSERTION o Description: suture that is blue and shiny
• The student will be asked to demonstrate the proper o Use: for vascular anastomosis, nerves
way of inserting a nasogastric tube o Needle: taper-point needle
• Try to explain on the resident what you are doing, § soft tissues other than the skin
step by step J
o First, ask for the consent of the patient • Absorbable Sutures
o Try to estimate the NGT that you will insert: o Vicryl
from ear to nose, then from nose to xiphoid o Chromic Catgut
process o Plain Catgut
o Put KY jelly on the NGT o PDS
o Extend the patient’s neck and insert the NGT o Monocryl
o Ask the patient to swallow until you reach the
estimated part of NGT to be inserted • Non-absorbable Sutures
o Use the suction to test if you have inserted it o Silk
correctly on the stomach (use your o Nylon
stethoscope) o Prolene
o Secure the NGT with a micropore J o Cotton

STATION 7: CHEST X-RAY

STATION 4: IFC INSERTION
• The student will be asked to demonstrate the proper
way of inserting an IFC
• Try to explain on the resident what you are doing,
step by step J
o First, ask for the consent of the patient
o Use povidone iodine (Betadine) to prepare
the patient
o Connect the IFC to the urine bag
o Put KY jelly on the IFC
o Ask the patient to breath deeply and insert
the IFC until the Y-shaped end
o Check if there is flow of urine
o Secure the IFC on the thigh with a micropore
• The student will be given a case of 54-year-old male,
smoker, with a one week history of cough, dyspnea
• A picture of an X-ray plate will be shown to the
student
o The following were the questions asked
(can’t remember the other questions) during
our OSCE
§ What is the most significant finding
in the X-ray? (e.g.
pneumoperitoneum)
§ What is the most possible
diagnosis? (e.g. PTB)
STATION 8: PULMO CASE • Definitive diagnosis of the case will be based on:
Pneumothorax o Fine Needle Aspiration Biopsy (FNAB)

STATION 9: KNOT TYING STATION 15: BREAST

• The student will be asked to demonstrate the one- • The student will be given a case about a lactating
hand and two-hand technique of knot tying patient with a breast mass
• Make sure to use your finger to push and lock the tie • CLUE: Try to differentiate the signs and symptoms of
fibroadenoma, fibrocystic disease, breast CA
STATION 10: SURGICAL INSTRUMENTS o The following were the questions asked
• The student will identify the surgical instruments during our OSCE
prepared by the residents § What will be your primary
• Try to familiarize with the following instruments impression?
o Army Navy § What diagnostic test will you
o Iris request to confirm your diagnosis?
o Mayo Curve • Mammogram and core
o Mayo Straight needle biopsy
o Kelly Curve
o Kelly Straight § What will you advise the patient if
o Metzenbaum the histopath is positive for:
o Needle Holder • Fibroadenoma
o Scalpel – observation;
o Allis surgical resection for large
or growing lesions
STATION 11: PLAIN ABDOMINAL X-RAY • Fibrocystic disease
• The student will be given a case and will be asked to – stop caffeine,
identify the 2 X-ray plates prepared by the residents NSAIDs, Vitamin E
• CLUE: Try to differentiate between a Complete vs • Breast CA
Partial Gut Obstruction – mastectomy
o View the plate was taken, Type of X-ray
requested (e.g. Plain Abdominal X-ray) § Best time to do breast examination:
o Pertinent findings on X-ray one week after menstruation
o Complete Diagnosis
STATION 16: BURN
STATION 12: GALLBLADDER • The student will be asked to compute for the
• The student will be asked to identify the stones estimated volume of Crystalloid necessary for initial
prepared by the residents resuscitation
o Cholesterol – yellow • Use the Parkland Formula
o Pigment – black, brown o V = Total Body Surface Area Burn (%) x
o Mixed Weight x 4mL
§ Example: 90% Burn in a 70kg
• Components of Stone patient
o Cholesterol § 90 x 70k x 4mL PLR = 25,200
o Bile Acid § 25,200 / 2 = 12,600 in the first 8
o Lecithin Hours

STATION 13: INTRAOPERATIVE CHOLANGIOGRAM STATION 17: LIDOCAINE DOSE

• The student will be asked to enumerate the normal • The student will be asked to compute for the
findings in an IOC Maximum Dose of Lidocaine
o Common bile duct not greater than 1 cm in o Example: What is the Maximum Dose of
diameter Lidocaine in a 70kg patient?
o No filling defect o (weight in kg) (lidocaine)
o No rat tailing o 70kg x 8mg/kg = 560mg
o Arborization of hepatic duct o 560mg x 5mL/100mg = 28mL Maximum
o Dye should reach the duodenum

STATION 14: THYROID

• The student will be given a case of a 34-year-old male
with a chief complaint of anterior neck mass
• Which has a greater tendency for malignancy
o Solid vs Cystic
o Solitary vs Multiple
o Fast enlargement overnight vs Slowly
enlarging mass for months
o Hard vs Soft
o Tender vs Non-tender
o Male vs Female
o Child vs Adult