PakMediNet Discussion Forum : Surgery : Intermediate Module Course
Intermediate Module Course
Hi
i am appearing for the first time in the Intermediate Module of General surgery.
can anyone please tell me the new course.As i heard that for written paper only the general portion of Bailey will come.
is it true.
what happened last time in the IM exam .
as in the previous exam it was the revised schedule too.
thanks
Posted by: shami1978Posts: 12 :: 27-02-2009 :: | Reply to this Message
I Updated the reply
as i initially posted this thread , to find the knowledge of the previous persons ,,
which no body shared,
anyways , i appeared in the written examination held this year, and i passed, follwoing is my experience,
the written examination was too easy,,
if one divide bailey and love into three portions, then the exam is only from the first portion . (i mean till the disaster managment chapter)
i appeared on 25th March 2009
the first paper was of theory , and the second paper was of MCQs.
first paper composed of following questions.
all questions were supposed to be mandatory.
total time was 3 hours.
question no 1. a 30 year old woman is brought to the emergency department with a stab wound to the neck. she has no other apparent injuries,
(a)- what are the initial managment steps ?
(b)- what important structures you would like to examine?
(c)- what investigations will you order in a stable patients?
question No 2. a 45 years old man is brought to the emergency with burns . History reveals that he was trapped in his apartment when it caught fire, his estimated weight is 60 kg, and he appears to have suffered deep second and third degree flame burns over 30 % of his body surface areas
(a)- mention initial steps in evaluation and managment
(b)- give indications for transfer to a burn centre
(c)- how is the amount of fluid replacement estimated in this case?
question No.3. a 35 years old man with chronic liver disease presents in the emergency department with history of profuse upper GI bleed ing . after resuscitatin , he undergoes upper GI endoscopy which reveals esophageal varices.
(a) what initial steps you would take to control the bleeding ?
(b) if he stills bleeds after initial steps how will you manage this patient?
question No 4. what are the criteria for admission to intensive care unit?
question No.5. (a) what are different types of intestinal stomas?
(b) enumerate the associated complications ?
(c) discuss mangment protocol of reversal in a temporary stoma patient.
question No.6 describe the principles of Triple assessment and its significance in a clinically palpable breast lump?
question No.7 (a)- what are the benefits of effective post-operative pain relief?
(b)- give various methods to relieve the post-operative pain?
(c)- what is patient control anagesia (PCA) ?
question No.8 (a)- discuss briefly the role of laparoscopy in general surgical practice?
(b)- what are the complications of laparoscopic cholecystectomy?
question No.9 (a) what are essentials for safe bowel and vascular anastomosis?
question No.10
(a)- what are low molecular weight heparins (LMWHs)
(b)- describe their mode of action and advantages over heparins?
for MCQs i will not mention the names of the books from which about 20 Percent of the mcqs came, (as those will be black listed by the cpsp people), but what i want to tell you is this, the most commonly used two to three mcq books will pass your mcq paper.
i will also post the stations of TOACS after appearing.
Posted by: shami1978Posts: 12 :: 03-05-2009 :: | Reply to this Message
TOACS Stations
Total 15 stations , with three Four rest stations, therefore 19 persons of two batches in one time. Among those 7 were interactive and 8 were un-supervised with 6 six minutes at each station, and those six minutes included the time for change over. Paper provided at the station, and roll number had to be written , and the paper was supposed to be put in the drop box present at each station .
Result announce after four hours of TOACS..
Following is the sketch of the questions based on my memory;
Station No. 1
SCENIRIO
A young patient came with hypovolemic shock , transfused 12 units of blood in emergency.
What is massive transfusion
What are the immediate effects of massive transfusion?
What options do we have to treat those effects?
What if after three days of that massive transfusion, oozing starts from the wounds and what is its treatment ?
Station No. 2 [interactive]
Log book
And viva for one operation
Mine had for lateral anal Sphincterotomy (in which key questions were, how much of the length of internal sphincter is supposed to be cut vertically, what are the possible side effects of that surgery, and what precautions are required to overcome those side effects.
Station No. 3 [interactive]
Scenirio
Picture of abdomen with thorax, hand sketched)
Label all the laparoscopic ports,
What are their sizes
What can happen while insufflating the abdomen
Can one do laparoscopy in ca
What are the indications to convert into open
Station No.4
Gas under diaphragm x-ray
Scenirio
A young man with known history of acid peptic disease, came to emergency with complains of pain abdomen , and vomiting………..
What are initial management steps
What is the surgical procedure done (treatment)
What are the abdominal complications of surgical procedure
Station No. 5
Scenario
A child who is 70 kgs of weight came with serum ph of 7.5 , serum Bicarbonate (slightly raised .. can’t remember exactly), serum chloride level (slightly reduced … cannot remember), reduced serum potassium level (cannot remember), normal oxygen saturation, and about normal CO2 level (exact level cannot remember), after 4 days of admission his weight is reduced to 65 kgs, and urinary levels of Ph , bicarbonate, chloride, etc etc (values cannot remember) and serum sodium level is 136 mmol /liter.
What is metabolic disturbance
How much fluid is lost
How to treat decreased level of potassium
How less the sodium level has occurred
How much of fluid has been lost (sequestered)
Station No. 6 [interactive]
Scenario
Apply vertical mattress stitch, apply horizontal mattress stitch apply three continuous stitches with heberden knot.
(catch point, after applying first two stitches, if you think that , the length will not be enough for the heberden knot, then ask for the new suture)
Station No. 7
X ray showing barium meal follow through, showing dilated portion of terminal ileum or jejunum.
Scenario
a young patient came with history of vomiting and pain abdomen for the last 2 weeks
What is study
What is the disease
What Is the treatment (surgical option)
How to diagnose
Station No. 8 [interactive] counseling
A simulator, (perhaps some house officer) acting as patient
Scenario
Lump in breast , T3
Patient doesn’t wants surgery , and apprehensive about surgery, removal of breast and side effects of chemotherapy and radio therapy
Station No. 9
Picture, showing scrotal swelling
Scenario
Scrotal swelling , and pain
Name three causes, and support them.
What other investigation you would like to do
How to take the biopsy of testicular swelling
Station No. 10 [interactive]
Child with neck swelling (picture)
Give diagnosis (Tuberculus lymphadenitis)
What other systems to examine
How to confirm the diagnosis
What is the treatment
Doses of Anti tuberculosis therapy in this disease
Station No. 11
x-ray of femur with knee joint showing sunray appearance and soap bubble
Scenario
A young patient with this x ray
Give diagnosis (perhaps Osteosarcoma of femur)
What are radiological findings?
How to diagnose
What are the treatment options
Station No. 12 [interactive]
Chest x-ray with deviated trachea to left side, and collapsed lung, and diffuse haziness of left side of the chest
Scenario
See the chest x ray and give the findings
What is it
What can be the condition?
How to confirm
Treatment
Station No. 13
Scenario
A 60 year old man at admission with TLC level of 25 thousands, serum glucose level of 125 mg/dl, serum LDH of 650 , serum AST of 250, and after two days with blood urea of 4 grams, pao2 of 60, serum calcium (cannot remember), base deficit of 4 , and fluid sequestration of 2.5 litres
Catch point (they fu***d with the units )
Give Ranson scoring
Prognosis
Give indications to operate in this patient
What more investigations are needed
Station No. 14 [interactive]
Scenario
A 32 old woman undergoes laparoscopic cholecystectomy , and one day after presenting with pain abdomen , and on 4th post op day with jaundice
What is the cause
What procedure you want to do now, if the lesion was made at the common hepatic duct level
How to diagnose this complication
What investigation to confirm anastomosis three weeks after for the hepatico-jejunostomy anastomosis
(HIDA scan… and what is hida scan )
Station No. 15
Scenario
A 25 year old, 30 kg man, with 167 cm of height , who is malnourished and have some retro peritoneal pathology admitted in surgical ward
(catch point == too less time )
What is his BMI
What is the caloric requirement
What is the fluid requirement
What is the nitrogen requirement
What is the CHO and Fat requirement
Posted by: shami1978Posts: 12 :: 12-05-2009 :: | Reply to this Message
Re: TOACS Stationsthanks dear shami for detail information about i.m.m exam.this will help me and other candidates a lot in future.
Posted by: masoomroPosts: 7 :: 21-05-2009 :: | Reply to this Message
Re: I Updated the reply
can u plz mail book of MCQs for IMM on khalid2170@yahoo.com
thanks
Posted by: khalidhPosts: 11 :: 20-06-2011 :: | Reply to this Message