ASSCC

Stem: young patient with RUQ pain and epigastric pain aggravated by fatty meals. His news score is 0

85-year-old lady living in care home. She uses a wheelchair and had a long-standing constipation. She presented in the A&E with abdominal pain, constipation, marked abdominal distention, vomting and dehydration. Labs: Na 120, ABG: PH 7.5, PCO2 4.2

COPD patient , on Apixaban , has severe Abdominal pain . Going for emergency Laparotomy because of sepsis, he is Febrile , hypotensive and tachycardic .

6 year old jehova's witness with 2ry HGE ( POD6) after tonsillectomy HR is 120 , but is stable now .

A 65-year-old man with DM2 on oral medication, presented with perianal abscess & went for I & D.

Patient had lobectomy, epidural at level of t3\t4, post op hypotension , Bradycardia & oxygen sat 92%.

RTA with suspected fracture spine. Low BP, paraplegia, and sensory loss both LL “ you’ll be shown a news chart”

A 38-year-old lady going for surgery. Pre-op bloods showed. High T3, high T4, low TSH

A 55-year-old male patient with abdominal pain and bloody diarrhea. His vital signs are: BP 90/60, pulse 130Bpm, temp 38. After admission had additional episodes of bloody diarrhea which stopped 6 hours later. Intial resuscitation done with IV fluids. Lab results:Hb 8.8, plt 666000, WBC 12000, Na 120. K 2.8, CRP 100, high creat and urea.

A 65-year-old lady , presented with long standing goitre, malaise & chronic fatigue. FBC & full biochemical profile reviewed as part of her assessment & showed low T3 & T4, high TSH along with macrocytic anaemia.

A 60-year-old male patient with history of old laparotomy, presented with central abdominal pain , vomiting & abdominal distension. You have been called by nursing staff because he became confused.

After insertion of CVP for a patient in ICU His oxygen saturation dropped and started To be tachycardic .

A 50-year-old- male, smoker with a long history of NSAIDs use for osteoarthritis, presented at A&E with acute onset abdominal pain in the epigastrium. On examination there was abdominal tenderness, rigidity and infrequent bowel sounds.

45 year old male patient alcoholic, presented with 3 times of hematemesis, Low BP, tachycardia& altered mental status .

Patient after major surgery ( Right hemicolectomy ) , the nurses noticed decrease in The UOP .

You was called at 22:30 for A 45-year-old ,whose weight is 90kg, post-laparotomy 9 hours ago for perforated diverticulitis. Complaining of abdominal pain. O/E he was conscious , alert & afebrile with BP 148/95 , HR 120/min. the surgical site was normal. Upon reviewing his medication charts , he didn't receive his paracetamol dose at 18:00.

A 45-year-old, diagnosed & managed for acute pancreatitis 2 weeks ago. Now presents with vomiting, SOB & epigastric pain which is not improved with PPIs. Examination revealed tachycardia & tachypnoea.

58 yrs. Female patient presented with persistent nonbilious vomiting Now is drowsy, hypokalemic, Hypochloremia and metabolic alkalosis .

A 50- year- old female presents persistent discharge just above the umbilicus following an exploratory laparotomy with adhesiolysis and resection anastomosis of small bowel done for acute intestinal obstruction.

Stem1: A critically burnt ill patient is in ITU and requires nutrition. In this station you will be asked the physiology of nutrition and its clinical application.

A 38-year-old lady going for surgery. Pre-op bloods showed. High T3, high T4, low TSH

A 43-year-old female presented with epigastric pain , nausea, vomiting & diarrhea. Labs showed increase bilirubin, ALT ,ALP,GGT & Urobilinogen is undetected in urine .

You are the SHO on-call & have been called to surgical HDU to review a 60-year-old male who underwent anterior abdominoperineal resection under GA 12 hours ago. You didn't attend operation & didn't see him before. The nursing staff are concerned about his low UOP . Physical examination was unremarkable & the catheter was patent. Upon reviewing his fluids & observation charts , he is NPO & he received only 1L of fluid over the last 12 hours.

A 74-year-old man underwent TURP under SA. His pre-op assessment was unremarkable & bloods were normal. During surgery , prostate was huge & surgeon took about 75 minutes to resect 35 gm of it, there was significant bloodloss even they have reasonable haemostasis. You have been asked to review him in recovery room because of hypotension, restlessness & agitation. You confirmed that then noted that BP was 80/50, HR 125/min & SpO2 87%. No new drugs or IVF given since surgery. The recovery staff ar

A 45-ycar-old female patient KCO RhA on steroids . now is going for surgery

A 70-year-old post-abdominal surgery male patient. Fluid chart + vitals chart inside the station. Patient has taken about 7 liters of fluids (4L of normal saline & 3Ls of Hartman's), now he is tachycardiac, hypertensive, desaturated, oliguric.

A 60-year-old male patient POD3 post sigmoid colectomy for cancer. He has tachycardia, tachypnea and fever. O/E pulse is 110, Po2 90% on room air, RR. 24 & BP: 110/70.

Young male patient came in motor cycle RTA .. Hypotensive and tachycardic.

Patient came in an RTA with GSC15 Vomiting twice& with amnesia then after admission to the ortho ward GCS started dropping now it’s 8

Patient after anterior resection POD4 .. RR is 28 per min BP : 80\50, PULSE 110 temp 38.5 and UOP -450 ml in 24 hours .

A 40-year- old lady post-total thyroidectomy for follicular carcinoma. POD4 her serum Calcium came 0.7 mmol/L.

Patient had abdominoperineal resection Under epidural anesthesia then develop Tachycardia and hypotension He was ASA 3

Young girl underwent polytrauma By her bicycle with possible Neck injury and fracture.

A 60-year-old chef involved in a fire. He was trapped in the kitchen For 30 min. When he was brought to the ER, his pulse was 120\min And BP:90\50 mmhg. He sustained burns covering his chest and abdomen, Right and left lower limb and Right upper limb. He was in severe pain & the burns looked erythematous with blisters. There was some soot around His mouth and nose (63%) .Upon asking his friends, they said that he was able to jump From the window of the 1st floor.

A 28-year-old-male patient, his leg was crushed for a few hours. The patient was left unobserved in the orthepedic ward. Bloods: increased creatnin, increased urea. Urine dipstick: blood+++

Patient post op received morphine 4 times Now presenting with RR 5\min .

 Stem: 34 weeks undergoing open chole for necrotising cholecystitis, BP is decreasing, HR is decreasing, reversed telendenberg position, Combined GA, Epidural, the operation is taking longer duration than expected).

Male patient with history of Aortic stenosis, going for TURP is found to have ejection systolic murmur in Preoperative assessment.

A 29-year- old motorcyclist has fractured his femur and tibia along with ecchymosis in the flanks, tenderness and pain in the lower abdomen with blood at the urethral meatus. The patient is pale ,hypotensive and tachycardic

A Pregnant lady 34 weeks undergoing open cholecystectomy for a gangrenous gall bladder under epidural anesthesia. Intra-op she developed tachycardia and BP drop.