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Surgery Oral Exam Review

Surgery Oral Exam Review. Lori F Gentile, MD. University of Florida Department of Surgery. Oral Exam Review Outline. What to expect How to approach exam Important things, not so important things Facts. Case scenarios Diagnosis, Workup, Treatment, Follow-up 30-60 minutes, 2+ topics.

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Surgery Oral Exam Review

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  1. Surgery Oral Exam Review Lori F Gentile, MD University of Florida Department of Surgery

  2. Oral Exam Review Outline • What to expect • How to approach exam • Important things, not so important things • Facts

  3. Case scenarios Diagnosis, Workup, Treatment, Follow-up 30-60 minutes, 2+ topics Format

  4. Some Practical Tips • Goal: Demonstrate as much knowledge of surgery as possible in limited amount of time • Control/Guide the discussion – don’t be passive • Think of the differential • Most common • Most urgent • Don’t use eponyms unless you know what they mean • Perform multiple steps at a time • “Think out loud” • Know what to look for when ordering a test • Be quick • Practice, practice, practice

  5. General Outline • CC & location • Clinic, ER, etc. • Stable/unstable – ABC • History – CC, HPI, pertinent: PMH, PSH, Meds, (Allergies), SH, FH • Physical – Vitals, inspection, auscultation, percussion, palpation • Labs / Studies • Management – stabilize, consults, +/- surgery

  6. Example • 50M acute abd pain seen in ER • “First assess if stable/unstable, if they are stable…” • “Assess ABC if they are awake and talking, not pale or diaphoretic” • “Wide differential, narrow by OPQRST…” • “Concerned about dx1, dx2, dx3… therefore ask about x,y,z” • “A complete head to toe physical examination focused on…” • Vitals – Temp 102 • Inspect – sitting upright, leaning forward • Inspect – Grey Turner sign, Cullen’s sign, Fox’s sign

  7. Eponyms / Signs • Grey Turner sign • Cullen’s sign • Fox’s sign (inguinal)

  8. Sample case cont. • 50M acute abd pain seen in ER • Labs / Imaging – BMP (calcium), amylase, lipase, WBC • More labs? - Glucose, AST, LDH, HCT, BUN (Ranson’s criteria) • Imaging – RUQ US (stones, CBD dilatation), CXR (effusions), CT scan (severity, hemorrhage, gas) • NPO, resuscitate, Abx, ERCP/sphincterotomy, CT guided drainage of abscess, surgery only for infected pancreatitis

  9. Less important things to know • Intra-operative details • How to do colectomy, how to do cholecystectomy • Except melanoma (No shave biopsies) • Lists of numbers • Specific numbers in Ranson’s criteria • Percentages • Cancer staging • Except colon cancer, melanoma • Stage IV = metastatic

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