M = Module number
T = Tutorial number
Case Scenarios
Tutorial
1. Difficulty in Swallowing
M1T5; M2T1; M3T3
2. Heartburn
M1T5; M2T1
3. Indigestion
M1T6; M3T3
4. Indigestion and Weight Loss
M1T6; M2T1
5. Painful Jaundice
M1T7; M2T2; M3T4
6. Jaundice and Weight Loss
M1T7; M2T2; M3T5
7. Jaundice Fever and Rigors
M1T7; M3T4
8. Acute Abdominal Pain
M1T1; M1T6; M1T8;
M1T20; M2T4; M3T3;
M3T5; M3T8
9. Chronic Abdominal Pain
M1T6; M3T5
10. Acute Abdominal Pain and Collapse
M2T5
11. Rectal Bleeding and Change in Bowel Habit
M1T9; M2T3; M3T6
12. Rectal Bleeding and Anal Symptoms
M1T10; M3T6
13. Vomiting Blood
M3T14
14. Diarrhea and Rectal Bleeding
M3T16
15. Diarrhea and Abdominal Pain
M3T16
16. Lump in Breast
M1T4; M1T11; M2T7;
M3T2
17. Nipple Discharge/Painful Breast /Soreness of Nipple
M1 T11; M2T7;
18. Blood in Urine
M1T2; M1T12; M3T12
19. Difficulty in Passing Urine
M1T2; M2T8; M3T12
20. Loin Pain
M1T2; M1T13; M2T13;
M3T10
21. Swelling in Scrotum
M1T13; M2T9; M3 T11
22. Painful Scrotum (Child and Adult)
M2T9; M3T11
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A Directed Self-Learning Course for Undergraduate Surgical Students
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23. Non-palpable Testis (Child)
M3T11
24. Tight Foreskin
M3T11
25. Head Injury
M1T16; M3T17
26. Motor Vehicle Accident
M3T17
27. Postoperative Pyrexia
M1T17
28. Postoperative: Wound Pain, Chest Pain,
M1 T18
Abdominal Pain, Leg Pain, Wound Discharge
Vomiting, Constipation, Breathlessness,
Low Urine Output
29. Passing Blood with Low Blood Count
M1T19
Postoperative Anemia
Reaction to Blood Transfusion
30. Pain in Calf on Walking
M1T3; M1T14; M3T7
31. Acutely Painful Lower Limb
M1T14; M2T5; M3T7
32. Postoperative Pain in Calf (DVT)
M1T17; M2T5
33. Ulcer on Leg
M1T15; M2T12; M3T9
34. Swollen Leg
M3T9
35. Varicose Veins
M2T12; M3T9
36 Lump in Neck
M1T4; M1T21; M2T6;
M3T1
37. Lump in Groin
M1T22; M3T15
38. Burns
M2T10
39. Fluid and Electrolytes
M2T11; M3T13
Module 1 History and Examination
Tutorial Symptom/Sign/Topic System Page no.
Questions Answers
M1.1 Symptoms and signs of gastrointestinal (GI) diseases Gastrointestinal 1 38 M1.2 Symptoms and signs of urological diseases Urology 2 41 M1.3 Symptoms and signs of vascular diseases Vascular 2 42 M1.4 Symptoms and signs of endocrine diseases Endocrine 3 44 M1.5 Difficulty in swallowing: Cancer of esophagus; Achalasia
Heartburn: GERD
Upper gastrointestinal 3 46 M1.6 Indigestion: Duodenal ulcer
Acute abdominal pain; Perforated duodenal ulcer Abdominal pain and weight loss: Gastric cancer
Upper gastrointestinal 6 49 M1.7 Jaundice: Obstructive
Gallstones (acute cholecystitis) Cholangitis
Pancreatic cancer
Hepatobiliary 9 51
M1.8 Abdominal pain: Acute pancreatitis Chronic pancreatitis
Gastrointestinal 11 53 M1.9 Rectal bleeding: Colorectal cancer Lower gastrointestinal 12 55 M1.10 Rectal bleeding: Hemorrhoids
Fissure in ano
Minor anorectal 14 58 M1.11 Lump in breast: Cancer of breast
Lump in breast: Fibroadenoma Pain in breast: Cyclical mastitis
Endocrine 15 61 M1.12 Blood in urine: Cancer of kidney Urology 16 63 M1.13 Loin pain: Pyelonephritis/hydronephrosis
scrotal swelling: Hydrocele
Urology 17 65 M1.14 Calf pain (chronic): Intermittent claudication
Leg pain (acute onset): Ischemic limb
Vascular 19 68 M1.15 Leg ulcer: Varicose ulcer
‘Infected’ foot: Diabetic foot
Vascular 21 72 M1.16 Head injuries: Road traffic accident
Boy falls out of tree; extradural hematoma Confused old lady: Chronic subdural hematoma
Neurosurgery 24 73 M1.17 Preoperative assessment and postoperative complications (1) General surgery 25 76 M1.18 Postoperative complications (2) 29 82 M1.19 Blood transfusion: Passing blood and low blood count
Low postoperative hemoglobin Low hemoglobin after RTA Transfusion reaction
Blood transfusion 30 88
M1.20 Acute abdomen: Pain/vomiting/abdominal distension (obstruction) Acute abdomen: Core knowledge
Gastrointestinal 33 91 M1.21 Lump in thyroid gland: Solitary thyroid nodule Endocrine 35 93 M1.22 Swelling in groin: Inguinal hernia
communication skills: Consent for hernia operation
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A Directed Self-Learning Course for Undergraduate Surgical Students
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Module 2 Investigations/Differential Diagnosis/Basic Management
Tutorial Symptom/Sign/Topic System Page no.
Questions Answers
M2.1 Difficulty in swallowing: Cancer of esophagus Difficulty in swallowing: Achalasia
Heartburn: GERD
Abdominal pain and weight loss: Cancer of stomach; patient consent for upper GI endoscopy
Upper gastrointestinal 100 152
M2.2 Abdominal pain and jaundice: Gallstones
Jaundice, abdominal pain, weight loss: Cancer of pancreas Communication skills: Consent for ERCP
Hepatobiliary Pancreas
104 156 M2.3 Rectal bleeding, change in bowel habit : Cancer colon and rectum
Patient consent for colonoscopy
Patient consent for anterior resection of rectum
Lower gastrointestinal 108 160 M2.4 Acute abdominal pain: Pain in young female: appendicitis
Large bowel obstruction
Acute abdomen 112 165 M2.5 Abdominal pain and collapse: Abdominal aortic aneurysm
Sudden onset calf pain: DVT Sudden onset leg pain: Ischemic leg
Vascular 116 167 M2.6 Swelling in neck: Thyroid adenoma
Neck swelling and weight loss: Lymphoma Patient consent for FNAC
Patient consent for hemi-thyroidectomy
Thyroid/Neck 120 171
M2.7 Nipple discharge: Intraduct papilloma Nipple soreness Paget’s disease, duct ectasia Acute breast pain: Abscess
Breast lump: Fibroadenoma
Cyclical breast pain: Fibrocystic disease
Breast 124 174
M2.8 Difficulty in passing urine: Benign prostatic hypertrophy Difficulty in passing urine: Prostatic cancer
how to perform a rectal examination patient consent for bladder catheterization
Urology 127 176
M2.9 Pain in testis: Torsion of testis Swelling in scrotum: Hydrocele Pain in testis: Testicular tumor
Urology 130 179 M2.10 Scald: Thermal burn
patient in house fire: Severe burns; Electric burn
Burns 132 183 M2.11 Perioperative fluid and electrolyte balance
Please write up IV charts, doctor
Fluid and electrolytes
135 186 M2.12 Painful legs: Varicose veins
Ulcer on leg: Varicose ulcer
Module 3 Management and House Officer/Intern Tasks
Tutorial Symptoms/Signs/Topic System/organ Page no. Questions Answers
M3.1 Lump in neck: Solitary thyroid swelling Lump in neck: Multinodular goiter
Lump in neck: Parotid tumor, submandibular swelling patient consent: Thyroidectomy
Endocrine 197 249
M3.2 Lump in breast: Cancer
Lump in breast: advanced and recurrent breast cancer how to record clinical findings of a breast lump patient consent: mastectomy
Endocrine 200 250
M3.3 Difficulty in swallowing: Cancer esophagus Indigestion: Duodenal ulcer
Acute abdominal pain: Perforated duodenal ulcer patient consent: upper G/I endoscopy
consent for emergency laparotomy writing a prescription for drugs reading CVP manometer
Upper gastrointestinal 203 252
M3.4 Jaundice and gallstones: Cholecystectomy jaundice, fever and rigors: Cholangitis
Hepatobiliary 207 257 M3.5 Jaundice and weight loss: Cancer of pancreas
Chronic abdominal pain: Chronic pancreatitis Acute abdominal pain: Acute pancreatitis
Panceas 207 259 M3.6 Rectal bleeding: Colorectal cancer
Postoperative fever: Anastomotic leak Pain on defecation: Fissure in ano Perianal pain: Anal abscess
Perianal soreness: Fistula in ano and pruritus ani Stoma complications
Anal cancer; Rectal prolapse; Pilonidal sinus
prescribing preoperative drug prophylaxis; marking a stoma
Lower gastrointestinal Minor anorectal
210 261
M3.7 Calf pain: Claudication
Acutely painful leg: PVD; Arterial embolus
Communication skills: Explanation of PVD and consequences
Vascular 216 265 M3.8 Acute RUQ abdominal pain: Cholecystitis
Acute LLQ abdominal pain: Diverticulitis Colicky abdominal pain: Small bowel obstruction
Gastrointestinal 219 268 M3.9 Varicose veins
Leg ulcer: Varicose ulcer Swollen leg; Lymphedema obtaining consent: vv operation
Vascular 223 272
M3.10 Acute loin pain: Renal stones drug prescription for pain
Urology 225 276 M3.11 Painful scrotum: Epididymitis; Scrotal gangrene
Enlarged testis: Testicular tumor Difficulty with intercourse: Phimosis Scrotal ache: Varicocele
Absent testis (infant)
communication skills: explaining testicular cancer to patient
communication skills: explaining retractile testis to a mother
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A Directed Self-Learning Course for Undergraduate Surgical Students
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Tutorial Symptoms/Signs/House/Topic System/organ Page no. Questions Answers
M3.12 Difficulty in passing urine: Benign prostatic hypertrophy Difficulty in passing urine: Cancer of prostate
Painless hematuria: Bladder cancer patient consent: cystoscopy TUPR
Urology 230 281
M3.13 Postoperative pain: Leaking anastomosis Fecal fistula
writing up IV fluid chart
writing a patient discharge summary
Gastrointestinal Fluid and electrolytes Nutrition
231 285
M3.14 Vomiting blood: Duodenal ulcer Esophageal varices
establishing IV line inserting a Sengstaken tube
Upper gastrointestinal 238 291 M3.15 Irreducible groin swelling
communication skills: speaking to the Anesthetist preparing a patient for theater
scrubbing up in theater patient consent: hernia operation
Hernia 240 296
M3.16 Diarrhea and rectal bleeding: Ulcerative colitis Diarrhea and abdominal pain: Crohn’s disease communication skills: speaking to a distressed patient
Gastrointestinal 242 298 M3.17 Motor vehicle accident: Multiple trauma
Pneumothorax Splenic rupture Fractured leg Head injury (child) performing a primary survey
performing a secondary survey
practical assessment of the Glasgow Coma Score post-splenectomy prescribing
Trauma/orthopedics 245 302
