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MULTIPLE CHOICE QUESTIONS
1. Regarding intussusceptions in children:
A. Presents with abdominal pain and constipation
B. Is most common in the 6 – 12 years age group
C. Meckel’s diverculum can induce intussusception
D. Characterized by invagination of the stomach into the duodenum
E. Abdominal radiography reveals air under the right hemi-diaphragm.
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2. Regarding a common peroneal nerve palsy:
A. Can occur following fracture of the neck of fibula
B. Produces anaesthesia of the sole of the foot
C. Causes loss of inversion of the foot
D. Causes a characteristic wrist drop
E. Causes loss of flexion of the knee
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3. In a patient presenting with signs and symptoms of intestinal obstruction:
A. In small bowel obstruction, vomiting occurs late while constipation occurs early
B. Dehydration is more in large bowel obstruction rather than small bowel obstruction
C. In large bowel obstruction, both vomiting and constipation occur early
D. Abdominal pain is usually localized at the hypogastric area
E. Distention is greater the more distal the lesion.
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BANK QUESTION OF SURGERY PDF
4. Typical features of prostatic carcinoma are:
A. Preservation of normal anatomy on digital rectal examination
B. Osteolytic rather than osteosclerotic bone metastases
C. Presentation with decreased frequency of urination
D. Slowly progressive obstructive uropathy
E. Responsive to radiotherapy
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5. A 40 years old man complaining of inability to pass urine for the last 16 hours. He has the history of pus discharge per urethra 2 years ago. The confirmatory investigation is;
A. IVU
B. Urinalysis
C. Cystogram
D. Pelvic X-ray
E. Pelvic Ultrasound
6. Regarding local anaesthesia:
A. Their main toxic effects are seen on the respiratory and gastrointestinal system
B. Preparation containing adrenalin are safe to use on digits and appendages
C. Adrenalin reduces absorption and prolongs the local effects
D. Their use is safe do not require rescuscitsatory equipment
E. Local anaesthetics act on large before small nerve fibers
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7. A 65 year old female sustained injury following a motor vehicle accident. On examination has obvious right temporal head injury and is unresponsive except to deep pain. The vitals are PR 80b/min, BP 190/110mmHg, RR 10b/min, O2 saturation 94%, GCS 5/15, dilated left pupil with no chest injury noted. What is your first priority in this patient?
A. CT Scan of the patient’s head
B. Treat the patients hypertension
C. Intubate and ventilate the patient
D. Cross match 2 units of blood and transfuse
E. Burr hole of the skull and evacuate the haematoma
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8. A 10 years old boy present with a swollen left forearm after falling down from the mango tree. The X-ray showed mid-shaft fracture of both radius and ulna bones of the left arm. What is the appropriate management?
A. Reduction under general anaesthesia followed by above elbow POP
B. Reduction under general anaesthesia followed up below elbow POP
C. Reduction under haematoma block followed by above elbow POP
D. Reduction under general anaesthesia followed by arm sling.
E. Reduction under haematoma block followed by arm sling.
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9. Regarding compartment syndrome:
A. Compartment pressure leads to arterial obstruction followed by venous obstruction
B. Requires fasciotomy to be performed on the next available elective operative list.
C. Are usually characterized by pain that is worse on passive movement
D. Can be diagnosed by the loss of distal peripheral pulses
E. They can occur only in the lower limb
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10. A 34 yrs old patient presents with fresh painless rectal bleeding. He also suffers from constipation. His weight is steady and his appetite normal. There is no family history of bowel cancer. The most likely diagnosis is:
A. Thrombosed piles
B. Colorectal cancer
C. Haemorrhoids
D. Diverticulitis
E. Anal fissure
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11. Regarding pre-operative preparation of patient:
A. Long preoperative hospital stay lowers the risk of acquiring staphylococcus infection.
B. Perioperative avoidance of hypothermia reduce rate of surgical site infection
C. Start prophylactic antibiotics 24 hours before the operation
D. In elderly patients, there is no need of obtaining consent
E. The operative site should be shaved
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12. The 20 years old man who was involved in Road traffic collision is found to be in respiratory distress. On examination there is reduce air entry on the left side of the chest and the trachea is deviated to the right side. Which of the following is the appropriate management option for this patient?
A. Decompression using a large bone cannula on the right side
B. Decompression using a large bone cannula on the left side
C. A CT Scan of the thorax
D. Inserting a chest drain
E. A chest X-ray
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13. The danger area of the face where from infection can spread directly to the cavernous sinus include:
A. Area around the lips and lower part of nose
B. From below the eyes up to the chin
C. Whole area of the face
D. Area around the lips
E. Maxillary sinus
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14. A young man is brought to the hospital after sustaining injury to the right hip in motor traffic accident. The patient is conscious with normal vital sign. Local examination revealed that the right hip is flexed, externally rotated abducted and the limb is elongated. The most likely diagnosis of this patient is:-
A. Central hip dislocation
B. Anterior hip dislocation
C. Posterior hip dislocation
D. Closed fracture of femur
E. Fracture dislocation of the femur
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15. A 32 year old man sustained injury on his shoulder after being involved in a motor traffic accident. X-ray showed a fracture of the mid-third of the right clavicle. The management include;
A. Triangular arm sling
B. Open reduction
C. Arm traction
D. Back slab
E. Splinting
16. A 20 years old boy brought to the hospital with painful swollen scrotum relieved by elevating testes. On examination, febrile at 390C, no history of trauma. The most likely diagnosis is;
A. Varicocele
B. Hydrocoral
C. Haematocoele
D. Epididymo cyst
E. Epididymo-orchitis
17. A 24 years old woman fell down from a height and sustained injury on her right wrist. On local examination of the left hand; shortened, swollen, tender on attempting motion. X-ray of left radius and ulna revealed fracture of the distal-third of left radius with dislocation of the left distal radial-ulnar joint. The following is the type of her fracture
A. Styloid facture
B. Burton fracture
C. Galeazzi fracture
D. Smith facture
E. Colle’s facture
18. A patient presents with a history of right scrotal swelling for 5 years now, no history of trauma. On examination has a swelling on the right scrotum that you cannot go above it and it can be reduced but recurs when the patient cough. What is the most likely diagnosis?
A. Right Hydrocele
B. Right epididymo – orchitis
C. Right scrotal tumour (teratoma)
D. Right direct reducible inguinal hernia
E. Right indirect reducible inguinal hernia
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19. In clinical examination for a patient with cholecystitis Murphy’s sign is positive when:
A. The patient screams in agony on deep palpation of right upper quadrant (RUQ)
B. The patient catches their breath during expiration on deep palpation of the RUQ
C. The patient feels nauseated on deep palpation of the RUQ
D. The patient coughs on deep palpation of the RUQ.
E. The patient catches their breath during inspiration on deep palpation of the RUQ
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20. A man was cut on his forearm by a rusting wreck while working in the garage. 1 hour later he arrived to the hospital. On examination; the wound was about 5cm long, highly contaminated and the bone was exposed. One of the following will be the mode of wound closure method:
A. Primary wound closure
B. Secondary wound closure
C. Tertiary wound closure
D. Delayed primary wound closure
E. Delayed secondary wound closure
1. A patient presented to you with a history of swelling on the right hip bone. On local examination; it is tender, and fluctuant. Diagnosed to have psoas abscess, the most likely predisposing factor is;
A. Animal bite
B. Septic wound.
C. Traumatic wounds
D. Immunocompromise
E. Congenital malformation
2. A 40 years old boy brought to the hospital with history of motor cycle accident and sustained injured on the chest. On examination; he was dyspnoeic, cyanotic; pale; BP=90/50, PR=110beats/minute. On respiratory examination; bilateral bulging of the chest, reduced vocal flemitus and breath sound. The most likely diagnosis is;
A. Pneumohaemothorax
B. Painful fractured ribs
C. Thoracic Empyema
D. Pneumothorax
E. Haemothorax
3. Presenting features of snake bite depends on the type of various toxin as follows:
A. Haematotoxins cause tissue damage
B. Neurotoxins affect the nervous system
C. Myotoxins act directly on heart muscle
D. Cardiotoxins act on the skeletal muscle
E. Cytotoxins cause local internal bleeding
4. Mr. Kidole was involved in motor traffic accident and sustained head injury. He presented with lucid interval of loss of consciousness that indicates has:
A. Severe head injury
B. Epidural haematoma
C. Subdural haematoma
D. Intracerebral haematoma
E. Sub-arachnoids haematoma
5. A patient is having a history of severe difficulty in breathing; foul smelling breath, cough and fever on examination there is dull percussion on right side of the chest. Has history of long standing pneumonia. The most likely diagnosis is:
A. Pleural effusion
B. Severe peritonitis
C. Empyema thoracic
D. Sub-phrenic abscess
E. Pulmonary Tuberculosis
6. An 8 years old girl came to your dispensary with history of generalized lymph node enlargement which is associated with intermittent fever and loss of body weight. The following is a differential diagnosis of above condition;
A. Liver cirrhosis
B. Sickle cell disease
C. Appendicular mass
D. Peptic ulcer disease
E. Rhabdomyosarcoma
7. An ulcer with underlying edges is typical of the following condition:
A. Malignant ulcers
B. Syphilitic ulcers
C. Any hatching ulcer
D. Mycobacterium ulcer
E. Basal cell carcinoma ulcer
8. A female of 45 years old come to you complaining of pain of the right index finger. On local examination; swollen index finger, tender, red and hot with pus formation under the nail bed. What is the most likely diagnosis:
A. Pyronychia
B. Pyomyositis
C. Osteomyelitis
D. Finger Abscess
E. Fungal infection
9. A young was brought at the hospital following bite by bees while working in his farm. On arrival to the dispensary his whole body was swollen. On examination; BP=90/40mmHg and PR=110 beats per minute. The most likely diagnosis;
A. Anaphylactic shock
B. Septic shock
C. Hypovolemic shock
D. Cardiogenic shock
E. Neurogenic shock
10. Burn injury may complicate to the following condition;
A. Buruli ulcer
B. Tropical ulcer
C. Marjolin ulcer
D. Rodent ulcer
E. Trophic ulcer
- SECTION B: MULTIPLE TRUE/FALSE QUESTIONS 10 MARKS
Instructions
· This section consists of four (4) questions with five (5) options each
· Write the word TRUE for correct statement and word FALSE for a wrong statement in the space provided. DO NOT WRITE LETTER “T” OR “F”
· Half mark will be awarded for each correct response
1. Regarding testicular torsion:
A. TRUE The highest incidence is in the neonatal and peripubertal periods
B. TRUE May present with abdominal pain and vomiting and few testicular symptoms
C. FALSE Radiological investigation with 2D ultra sound is invariably indicated
D. TRUE Testicular liability is reduced when surgery is delayed more than 6 hrs
E. TRUE Contralateral fixation (oorchidopexy) of the tests should be performed
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2. In a child presentation with osteomyelitis:
A. TRUE It is most commonly due to staphylococcus aureus infection
B. TRUE Can be due to salmonella infection in patient with sickle cell disease
C. TRUE Infection usually involve the metaphysic of long bones
D. FALSE Dead within the medullary canal is known as involucrum
E. FALSE New borne performing beneath the periosteum is known as the sequestrum.
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3. A 70 years old man comes to the health facility with history of increased frequency of micturition especially during night accompanied with urgency and poor stream on straining for 3 weeks. On abdominal examination; has distended abdomen on hypogastric region. With regard to the above condition;
A. FALSE It is associated with gonorrhoea
B. FALSE It is commonly caused by phimosis
C. TRUE Enlarged prostate can be a differential
D. FALSE Circumcision is one of the control measures
E. TRUE Raised prostate specific antigen can be found.
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4. Recognized causes of dysphagia include:
A. TRUE Iron deficiency anaemia
B. TRUE Pharyngeal pouch
C. FALSE Barrett’s oesophagus
D. TRUE Myasthenia gravis
E. TRUE Achalasia
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5. A 25 years old male present to the dispensary with history of painless rectal bleeding during defecation for 1 week. On rectal examination moderate enlarged, soft masses located on 3, 7 and 11 o’clock were found above the dentate line. According to grading (degrees) of the above illness;
A. TRUE In the first degree there is no prolapse
B. FALSE Forth degree not at risk of strangulation.
C. TRUE Third degree prolapse on defecation but manually reduced
D. FALSE Second degree prolapse on defecation but manually reduced.
E. TRUE Forth degree prolapse on defecation but not manually reduced
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6. Typical features of gastric carcinoma include:
A. FALSE Progression to involve the duodenum
B. TRUE Overall 5-year survival rate of 10%
C. FALSE Origin with a chronic peptic ulcer
D. FALSE Folate deficiency anaemia on presentation
E. TRUE Supra-clavicular lymphadenopathy
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7. Disorders predisposing to renal stone formation include:
A. TRUE Urinary tract infection
B. FALSE Prolonged mobilization
C. FALSE Hypoparathyroidism
D. TRUE Renal tubular acidosis
E. TRUE Sarcoidosis
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8. The general effect of burn are:
A. TRUE Increased basal metabolic rate
B. TRUE Impaired immune function
C. FALSE Hypernatraemia
D. FALSE Hyperalbuminaemia
E. TRUE Impairment of gut barrier function
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1. A 6 years old girl comes to health facility with a history of periodic fever, loss of body weight and night sweat. On examination; febrile, cachexic, generalize, tender and hot lymphadenopathy. Laboratory studies for above condition include;
A. TRUE Culture of the biopsied tissue
B. FALSE Radiography is never helpful
C. TRUE Gram strain of aspirated tissue
D. FALSE Full blood picture is extremely low
E. TRUE Serology to diagnose infectious mononucleosis
2. The following are the differential diagnoses for a patient presenting with a history of painless left breast lump which measures 3x5cm, mobile, firm and non tender. No other findings.
A. TRUE Papilloma
B. TRUE Fibro adenoma
C. FALSE Paget’s disease
D. FALSE Phyllodes tumour
E. TRUE Galactocele
3. The following are the pathological classifications of ulcers;
A. TRUE Traumatic are non specific
B. FALSE Tropical ulcers are specific
C. TRUE Trophic ulcers are non specific
D. FALSE Buruli ulcer is non-specific
E. FALSE Syphilitic ulcer is non-specific
4. The Mechanical causes of intestinal obstruction includes:-
A. FALSE Medication, especially narcotics.
B. TRUE Post-operative adhesions.
C. TRUE Worm infestation like ascariasis.
D. TRUE Obstructed hernia.
E. FALSE Intraperitoneal infection e.g. peritonitis
MATCHING ITEM QUESTIONS:
1. Match Condition from Column B with corresponding intervention procedure in Column A
- COLUMN A | - COLUMN B |
- PROCEDURE | - CONDITION |
1. H Intra-osseous puncture | A. Benign prostate Hyperplasia |
2. D Skeletal traction | B. Pyogenic Meningitis |
3. B Lumbar puncture | C. Dislocation of the Hip joint |
4. F Suprapubic catheterization | D. Fracture of femur |
5. G Under water seal drainage | E. Fracture of Humerus |
- | F. Urethral injury |
- | G. Pneumothorax |
- | H. Hemorrhagic shock |
2. Match Clinical features from Column B with diseases/Condition in Column A
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- | - COLUMN B |
- CONDITION | - CLINICAL FEATURES |
1. F Appendicitis | A. Air under diaphragm |
2. A Perforated peptic ulcer | B. Positive transilumination test |
3. B Hydrocele | C. Negative transilumination test |
4. G Posterior cruciate ligament tear | D. Decrease or absent bowel sound |
5. D Peritonitis | E. Exaggerated bowel sound |
- | F. Leukocytosis |
- | G. Positive posterior drawer test |
- | H. Positive anterior drawer test |
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1. Match the disease condition from column B with corresponding clinical signs in Column A
Column A: Clinical sign | Column B Diagnosis | |
1. | B Fail chest | A. Organophosphate poisoning |
2. | A Excessive salivation | B. Multiple rib fracture |
3 | F Obturator sign | C. Hernia |
4. | C Cough impulse | D. TB peritonitis |
5 | D Fluid Thrill | E. Inhaled foreign body |
|
| F. Appendicitis |
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| G. Hydrocele |
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| H. Tension Pneumothorax |
2. Match the breast diseases from column B with the characteristic features in column A
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SECTION D: SHORT ANSWER QUESTIONS 40 MARKS
Instructions:
· This section consists of eight (8) questions.
· Write your answer on the spaces provided
· Write a readable handwrite; DIRTY WORK IS NOT ALLOWED.
(1) What are the six (6) indications for admission of a burn patient? (3 Marks)
- Answers:
a) All burns >15% total body surface area in adult and >10% TBSA in children
b) Burns to the hands, face, perineum, joint surfaces
c) Respiratory burns/inhalation burns
d) Electrical burns
e) Circumferential burns
f) Chemical burn
g) Full thickness burn of >10% in adult
h) Suspicious of non-accidental burns
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(2) In a male patient presenting with a scrotal swelling:
a) What are the six (6) differential diagnoses (3 Marks) Answers:
· Hydrocele
· Varicocele
· Haematocele
· Scrotal – inguinal hernia
· Epididymal cysts
· Epididymo-oorchitis
· Testicular tumours
b) What compilations can arise incase surgery is performed? (2 Marks)
Answers:
· Bleeding
· Scrotal hematoma
· Wound infection
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(3) A 19 years old female, present with a laceration on the right palm during gardening. The wound is covered with a cloth that was applied at home. How will you manage this patient? (5 Marks)
- Answers:
· Surgical toilet with copious amount of NS at minor theatre
· Examination under local anaesthesia to rile out tendon damage
· Suturing of the laceration
· Anti-Tetanus cover depending plus metronidazole
· Analgesics, Inj Diclofenac 75mg, then oral 50mg 8hrly X 3/7
· Refer for specialized care incase of tendon damage
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(4) Classify diabetic foot according to Wegner’s classification (5 Marks)
- Answer:
GRADE CLINICAL FINDINGS
0 - Intact skin (impending ulcer)
1 - Superficial ulcer
2 - Deep ulcer to tendon or ligaments
3 - Osteomyleitis
4 - Gangrene of toes or forefoot
5 - Gangrene of the entire foot
(5) Outline the four (4) differential diagnosis for right iliac fossa pain (2 Marks)
Perforation through a solitary caecal diverticulum
Appendicitis
Crohn's disease
Diverticulitis
Meckel's diverticulitis
Perforated peptic ulcer
Right inguinal/femoral hernia
Carcinoma of caecum
Ectopic pregnancy
Pelvic inflammatory disease (PID)/salpingitis/pelvic abscess
Ovarian torsion
Ureteric colic
Testicular torsion or epididymo-orchitis
Acute pyelonephritis
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1. A hunter was bitten by a snake while hunting. He came to you with a swollen left leg, hot, red with mark of snake fangs. How will you treat this patient? (5 Marks)
Answers
- I.V fluid slowly
- Wash the wound with plenty of water
- Give tetanus toxoid
- Give polyvalent ant venom if available
- Monitor the vital signs
- Do not cut and sack blood
- Do not use tourniquet
2. A 5 years old boy was brought with a history of painful swelling on the axillary for 1 week. On examination; tender swelling on axilla, hot, redish and fluctuation test was positive. Describe the steps that should be followed when performing incision and drainage on the above patient. (5 Marks)
Answer
- Make an incision over the most prominent part of the abscess
- Introduce the tip of a pair of artery forceps into the abscess cavity
- Explore the cavity with a finger to break down all septa
- Give antibiotics for cutaneous cellulitis, fever
- Irrigate the abscess cavity with saline and drain or pack open
- Alternatively, pack the cavity open, place several layers of damp saline or petroleum gauze
- Control bleeding by tight packing.
3. A 45 years present to hospital with a history of protrusion of mass through the anus. Initially it was occurring during defecation and now protrudes even when walking or coughing. No history of bleeding. (5 Marks)
i. From the history what is most likely diagnosis? (1 Mark)
ii. Mention possible causes of above condition. (4 Marks)
Answer
i. Diagnosis – Rectal prolapsed (1 Mark)
ii. Causes (4 Marks)
- Weakness of the anal sphincter muscle
- Long standing cough (chronic cough)
- Long standing constipation
- Malnutrition
- Prolonged diarrhoea
- Infestation with worms such as pin worm
- Previous surgery or trauma to the anus
- Pregnancy
4. A 10 years old boy sustained fracture of radius and ulna then closed reduction was done and POP applied. 10 hours later he was brought back to the health facility with pain on the forearm, swelling of hand and inability to move fingers. (5 Marks)
i. Mention two causes of above condition (2 Marks)
ii. How will you manage the above patient? (3 Marks)
Answer
i. Causes (2 Marks)
a. Tight cast
b. Tight dressings
c. External limb compression
d. Excessive exertion
ii. Management (3 Marks)
- Split the cast
- Place limb in neutral position; elevation may be harmful
- Support circulation with IV fluids or blood where indicated
- Observe carefully for improvement i.e. colour, pulse and pain
- If signs and symptoms persist, refer for immediate surgical decompression
(fasciotomy)
5. A 50 years old male presented to hospital with history of a rectal bleeding.
Mention five (5) differential diagnosis of above condition. (5 Marks)
Answer
DDX (5 Marks)
i. Anorectal carcinoma
ii. Proctitis
iii. Colitis
iv. Rectal polyps
v. Fissure in ano
vi. Perianal warts
vii. Haemorrhoids
viii. Rectal polyps
6. Mr. Kijiko was involved on crash accident and sustained injury on the left leg. On examination; alert, not pale, swollen and tender left leg. X-Ray done and revealed no fracture. 5 Marks
i. What is the most likely diagnosis 1 Mark
ii. How will you manage the patient 4 Marks
Answer
i. Diagnosis - Soft tissue injury 1 Mark
ii. Management (4 points, each 1 mark) 4 Marks
- Resting the injured part
- Applying ice packs to him it swelling
- Analgesics to reduce pain
- Application of a firm compression to support the limb
7. A 25 years old young man sustained injured on the scrotum while playing football 4 days ago, he used paracetamol for pain relief at home. Yesterday he started to experience painful swelling on the scrotum and decided to come to dispensary. On examination; swollen tender scrotum with hotness and redness. 5 Marks
i. What is the most likely diagnosis? (1 Mark)
ii. Mention one differential diagnosis? (1 Mark)
iii. How will you treat the patient? (3 Marks)
Answer
i. Diagnosis- Epididymo-Orchitis (1 Mark)
ii. DDX - Testicular torsion (1 Mark)
iii. Treatment (3 Mark)
- Antibiotics
- Analgesics
- Bed rest
- Scrotal Support
8. Mr. Bakuli was involved in motor traffic accident and sustained injury on left hip joint, and was unable to use the left limb. On local examination; the left limb is adducted, internally rotated and shortened. 5 Marks
i. What is the most likely diagnosis? (1 Mark)
ii. Mention investigation that you will carry out (1 Mark)
iii. Mention three features of anterior hip dislocation (3 Mark)
Answer
i. Diagnosis – Posterior hip dislocation (1 Mark)
ii. Investigation - X-Ray of left hip joint (1 Mark)
iii. Features (3 Mark)
- The hip is minimally flexed,
- externally rotated
- markedly abducted
GUIDED ESSAY QUESTIONS
(1) A 32 years old man present to the hospital with complaints of fever and painful thigh for 5 days. On examination, Temperature is 38.6oC, PR 112 6/min, BP 100/70mmHg. He has slightly enlarged fluctuant right thigh covered with disquarmed skin, very tender right thigh with reduced movement of both right hip and right knee joint movement. How will you manage this patient? Answers:
a) Diagnosis (2 Marks)
· Rt thigh abscess
· ddx – Cellulites/fasciitis
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b) Investigations: (3 Marks)
· FBP
· Blood grouping and X-match at least 2 units
· Blood for culture and sensitivity
· RBG
· Urinalysis
· PITC
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c) Management: (10 Marks)
· Start IV antibiotics: Inj Ampiclox 1gm 8 hrly; I.V Metranidazole 500mg 8hrly X 72 hrs then review and change according to culture result.
· Counsel the patient on the operative procedure and get consent.
· Alert the OT team
· Perform Incision and drainage of the abscess on Rt thigh under general anaesthesia.
· Leave open the incision to allow more drainage of pus.
· Transfuse blood if needed
· Dress the wound daily until the wound has no more pus and is pink with granulation.
· Perform secondary wound suturing after granulation
· Manage the risk factor found: e.g. if diabetic start on insulin regime if HIV positive refer to CTC on discharge for counseling ART
(2) A young man unknown is brought to the casualty after being involved in motor vehicle accident. On examination is unconscious with a bleeding laceration on the scalp. He opens his eyes on painful stimulation, flexes his limb on painful stimuli and gives incomprehensible sounds. Describe his condition and how is he going to be managed.
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- Answers:
a. Diagnosis: - (2 Marks)
i. Severe Head Injury
ii. Scalp Laceration
b. Glasgow coma Scale E2 V2 M4 GSC 8/15 (3 Marks)
c. Management (10 Marks)
§ Stabilize the cervical spine with cervical collar
§ Intubate and ventilate the patient
§ Open 2 IV lines with large bore cannulas and keep open the vein with Normal Saline or ringer’s lactate
§ Take blood sample for Hb level, group and cross-match and held at least 2 units
§ Start IV antibiotics; Inj Ampicillin 1gm 8hrly X 72hours then review Inj Cloxacillin 1gm 8 hourly
§ Surgical debridement of the scalp wound and suturing to arrest bleeding.
§ Give ant-Tetanus cover depending on immunization history
§ Take RBG and maintain glucose level with dextrose solution
§ After stabilization do radiographs.
o Skull X-Ray to role out maxilla-facial/dental injuries and consult a dental surgeon if present
o Chest – X-ray – to roll out rib fractures that may be missed in initial chest examination
§ Abdominal – Pelvic C/S
§ Continue with daily dressing of the scalp wound
§ Catheterize the patient to monitor urine output
§ Monitor GCS and vitals
1. A 50 years old man with 70 Kgs, was brought to you with history of thermal injury 3 hours ago. On examination you find that the anterior chest, abdomen and both upper limbs are affected with huge blisters and wounds. He is conscious but in severe pains. Explain the management of this patient based on estimation of percentage of burnt area, investigation, treatment and immediately complications. (15 Marks)
Answer
Diagnosis – Burn (1 Mark)
Percentege (2 Mark)
- Anterior trunk is 18%
- Each upper limb is 9% x 2 = 18%,
Total area burnt = 36%
Treatment (8 Mark)
Fluid resuscitation principles
- Insert intravenous cannula (16G or 14G) through unburned skin.
- Popular formulas: Modified Brooke (2 ml) and Parkland (4ml)/kg/%BSA).
In the first 24 hours post burn,
- Use Parkland formula.
- Give Ringer’s Lactate 4ml x % of BSA x body weight (kg). (if Ringer's Lactate is not available, you can use normal saline)
- 4*36*70 =10080 mls
- ½ of fluid in remaining 5 hours = 5040 in 5 hours
- ½ of fluid in remained in next 16 hours
- Insert a Foley’s catheter to assess urine output.
- If urine output is inadequate, increase infusion by 200ml next hour.
In the 2nd 24 hours
- Add 5% dextrose
- Electrolyte and fluid replacement will be guided by urine output
- Cardiac rhythm should be continually monitored for arrhythmia
Give
- Tetanus Prophylaxis
- Analgesics
Immediate complication of burn (4 Mark)
- Fluid and Electrolyte imbalance
- Hypovolaemic shock
- Acute Renal Failure-extensive burns
- Local wound sepsis-common-septicaemia
- Paralytic ileus-acute gastric dilatation.
- Anaemia
- Respiratory failure-smoke
- Curling’s ulcer with gastric erosions
2. Mr Limbu aged 36 years old mal is brought to you with history motorcycle accident and sustained injury on the right thigh. On examination; he is alert, pale, PR=110 beat/minute, BP=90/50mmHg with slow capillary refill. On local examination; swollen, tender and deformed mid third of right thigh. Describe the diagnosis and management of this patient at dispensary and complications of fracture. (15 Marks)
Answer
Diagnosis -
Fracture of right shaft of femur (1.5 Marks) Haemorrhagic shock (1.5 Marks)
Management (6 Marks)
- I.V fluids (RL/NS)
- Hb level, blood grouping and cross matching
- Immobilization of the Fracture
- Urethral catheterization
- Analgesics
- Refer with blood donor
Complications of fracture (6 Marks)
- Shock
- Mal union
- Non union
- Nerve injury
- Injury of blood vessels
- Inter position of soft tissue
- Injury to the surrounding tissues
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