IMM TOACS (MAY 2009)

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;
1SCENIRIO
A young patient came with hypovolemic shock , transfused 12 units of blood in emergency.

2-

3-

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 ?
[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.
[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

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

5-

Scenario
A child who is 70 kgs of weight came with serum ph of 7.5 , serum Bicarbonate (slightly raised .. cant
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)

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)

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

8-

[interactive] counseling
A simulator, (perhaps some house officer) acting as patient
Scenario
Lump in breast , T3
Patient doesnt wants surgery , and apprehensive about surgery, removal of breast and side effects of
chemotherapy and radio therapy
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
[interactive] PICTURE Child with neck swelling
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
X-RAY of femur with knee joint showing sunray appearance and soap bubble
Scenario
A young patient with this x ray

9-

10-

11-

12-

13-

14-

Give diagnosis (perhaps Osteosarcoma of femur)

What are radiological findings?
How to diagnose
What are the treatment options
[interactive]
Chest x-ray with deviated trachea to left side, and collapsed lung, and diffuse haziness of left side of the
chest See the chest x ray and give the findings
What is it
What can be the condition?
How to confirm
Treatment
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
[interactive] Scenario
A 32 old woman undergoes laparoscopic cholecystectomy , and one day after presenting with pain

abdomen , and on post op day with jaundice

15-

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 )
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
What
What
What
What

is his BMI
is the caloric requirement
is the fluid requirement
is the nitrogen requirement
is the CHO and Fat requirement