SURGERY finale 'runaway' 2012

Long Case (Prof.Saufi)

Mdm.N.S/59yo/M/Lady/Housewife/Jerantut/kco treated Rt renal stones 4yrs ago/presented with abdominal pain for 3d and postprandial vomitting for 2d prior to admission

i) Abdominal pain -S=flank
                             O=sudden
                             C=dull ache
                             R=sometimes radiated to back
                             A=associated with mild fever
                             T=continuous
                             E=not aggravated by movement and relieved by vomiting
                             S=5/10

ii) Vomitting - postprandial = 2-3 min after eating or drinking
                   - contained mucus + food particles
                   - no sore throat, hemoptysis or coughing

Both symptoms preceded by urinary incontinence associated with, frequency, urgency, dysuria, dribbling and so on. The patient noticed to have mass at Lt side of flank.
 
O/E - Ballotable Lt kidney

Questions

1) Analyze symptoms and what do you think the system involved?
2) what is your working diagnosis? why?
3) In this patient where is the level of obstruction?
4) Causes of unilateral and bilateral urine retention??
5) If caused by colon, where?? what are the parts of colon?
6) Investigations?Why and components to look at??
7) Compare between abdominal x-ray and KUB?? and how do you prepare for both (NBM, clean bowel etc)
8) what do you look in ultrasound??
9) If the patient has renal stone, what is your choice of treatment?? (nephrostomy, ESWL, antibiotics, etc)

Short Case (Mr.Zailani)

Examine the abdomen (pt of invasive breast ca with mets to pubic bone and femur)

1) Your positive findings??(mass at pelvic region) describe it?
2) what do you think the mass is that? why?
3) other causes??
4) Relevant imaging?? what to look for?? (u/sound, AXR. CXR, etc.)

Lesson for today:
- learn more about investigations (blood, urine, imaging) in detailed.
- don't merely send it if we don't know what to look for

Ya Allah..berikanlah aku PASS..ameenn
tiba masa tuk fokus kat ramadhan and mak ayah pulak
(apa pun rezeki yg tertulis untuk aku, aku terima seadanya).. Good luck kawan2 yg nk exam esok !!!

ALLAH knows best !!!!