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Problem Cards

(By Ansar & Naveen)

1. A middle aged man was rescued from the side of a road traffic accident was brought to E.R. in an
unconscious state. What should be the line oh management? (677-685)
Solution : Alcoholic intoxicant
Management : Gastric Lavage
I.V Fluid – Dextrose
Multivitamin
(Unconscious patient in emergency : Hypoglycemia, CVA, Cerebral Malaria, Head injury)

3. A 36 years old male was stabbed to his left side of chest. He was brought to E.R. with respiratory
distress. How will you manage the patient? (689-695)

4(a). An 11 years old boy was brought to E.R with a history of being run over by a motorcycle about 12
hours back and progressive pain in abdomen since then. How will you assess and subsequently manage
the patient? (677-685)
Solution : Blunt trauma of abdomen
Investigation : Straight X-ray abdomen
USG
4-Quadrant aspiration
Rx : Resuscitation
Monitor BP, Pulse, Rebound tenderness, Urine output
Laparotomy

4(b). An elderly male was brought to E.R. with bull horn injury of the abdomen. How will you manage the
patient? (695-699)
Solution : Penetrating injury
Investigations : Straight X-ray – To detect rib fracture
Solid organ injury – CT- scan : Single investigation
USG
Rx : Always laparotomy for penetrating injury

5. Grades of splenic trauma. How will you manage such patient? (699-703)

6. How will you manage a patient of liver trauma? (703-707)

8. How will you manage a patient with renal trauma? (713-716)

10. A newly married lady (weight 50 kg) sustained burn injury of a significant portion (40%) (719-726)
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11(a). A 28 years old lady, mother of one child was brought to E.R. with a history of severe pain in right
upper abdomen for last 12 hours. She is also having frequent bilious vomiting for the same duration and
low grade fever for last couple of hours. How will you assess her and what will be your line of
management? (726-729)
Solution : Acute calculus Cholecystitis
D/D: Acute Pancreatitis
Acute Gastritis
Biliary Colic
Acute MI
Peptic perforation

11(b). A 40 years old lady came with pain in the right hypochondrium and vomiting after attaining last
night party. How will you proceed to manage this patient?(726-729)
Solution : i) Acute Cholecystitis
ii) Acute Pancreatitis
iii) Acute duodenitis
Investigations : i) USG
ii) Blood for lipase ( If nothing found in USG )
iii) Upper GI endoscopy ( If lipase –ve )
Rx : Conservative management – Analgesic and sedative
Cholecystectomy ( Within 24hrs or after 36 days )

13. A 26 years old male came to you with history of fever, anorexia and pain right iliac fossa for last 2
days. On examination there is a lump in right iliac fossa. How will you manage the patient?(731-734)

15. A 60 years old male patient came to E.R. with sudden onset severe pain in epigastric region which
diffuses gradually to whole abdomen. He gave history of frequent analgesic intake. On examination of
abdomen you find cardboard rigidity. How will you investigate and manage the patient.(742-743)
Solution : Peptic ulcer disease followed by peptic perforation
Investigation : Straight X-ray, Erect posture , AP view showing both dome of diaphragm along with pelvis
USG
Rx : Exploratory laparotomy in midline incision under GA
3 bites to be taken for biopsy

16. What are the causes of acute intestinal obstruction? How will you manage a patient of acute intestinal
obstruction? (744-747)

19. A seventy two years old male presented with acute retention of urine for last 6 hours. How will you
manage the patient? (751-754)
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20. A 60 years old male came to E.R. with history of painless haematuria for last 2 week. How you
investigate the patient? (754-756)
Solution : Causes - Bladder carcinoma,
Renal carcinoma

22. A 50 years old male who underwent hemithyroidectomy developed respiratory distress in wards after
6 hours of operation. How will you manage the patient? (758-759)

23. A 45 years old smoker came to your with severe pain in right foot. On examination you find
gangrenous changes in right great toe and absent pulsation of arteria dorsalis pedis artery of the same
side. How will you manage the patient? (759-762)

A 36 years old male came to you with a history of fall astride in a manhole. Since then he is not able to
pass urine. On examination you find blood at the tip of penile meatus. How will you manage the patient?
Solution : Urethral rupture (MC site membranous part )
Rx : i) Per urethral catheterization at a single attempt by an expert surgeon
ii) If catheterization can’t be done then SPC (Suprapubic cystostomy )
Complication : Urethral stricture ( Rx – Urethroplasty )

A 40 years old alcoholic male reported to E.R. with complaints of severe abdominal pain and repeated
bouts of vomiting for last 36 hours. What is the most likely cause and how will you confirm that? How will
you make a day to day evaluation of the disease process?
Solution ; i) Acute Alcoholic Pancreatitis
ii) Acute Gastritis
iii) Alcoholic Hepatitis
iv) Acute Cholecystitis

A 68 years old female came to you with painless fresh bleeding per rectum for last 2 week. How will you
come to a diagnosis.
Solution : Bleeding PR can be of 2 types
i.Old (Black tury stool)
ii. Fresh ( Red ) : Anal fissure (Painfull - Drop by drop)
Haemorrhoids (Piles) Painfull
Polyp ( Oozing bleeding)
Growth ( Malignancy )
Rx : Primary – Change the food habit, fibre rich food and stool softner
Secondary - Sclerotherapy
Tertiary – Hemorrhoidectomy/Band ligation
Complication of surgery : Rectal stenosis ( Rx : Haemorrhoidal cushions is ligated at a time – Ligate either
½ not 3 )
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A middle aged male brought to hospital with history of fall from a coconut tree. What injuries he might
sustain and how to confirm them?
Solution : MC injury – Spine and Pelvic fracture

A middle aged male came to E.R. with sudden excruciating pain right groin for last 3 hours. How will you
evaluate the patient.
Solution : i) Testicular torsion
ii) Obstructive inguinal hernia
iii) Stone obstructed at uretero-vesical junction
Clinical features : Testicular torsion – Severe pain in right testis
No cord during palpation
Vomiting
Obstructive inguinal hernia – Severe pain, vomiting
If gut obstruction – Obstipation
Stone obstructed at uretero-vesical junction – Sudden onset of pain
Toching over the bed
Vomiting
Burning micturation
Haematuria

Rx : Stone obstructed at uretero-vesical junction –

A newborn baby was brought to E.R. with a history of bouts of choking and drooling of saliva on feeding.
What will be the possible cause and how will you arrive at a diagnosis?
Solution : Probable cause – Tracheo-esophageal fistula ( 4types)
D/D : Esophageal atresia ( Put a ryle’s tube through the nasal cavity,if it gose to the stomach then it
means no esophageal atresia )
Presentation : During feeding dribbling of saliva
Diagnosis : Endoscopy/bronchoscopy
CT-scan/ MRI
RX : Surgery

How will you manage a patient with massive variceal upper gastrointestinal tract haemorrhage?()
of her body surface. How will you manage the patient? (719-726)

Non variceal upper GI bleeding – Peptic ulcer disease (<50 yrs, MC)

Gastric malignancy (>50 yrs, MC)

Gastric polyp

Investigation : Upper GI endoscopy with biopsy for malignancy

A two years old male child was brought to E.R. with abdominal pain and passage of red colour jelly like
material from anus. How to assess and treat the child?