I'm in surgery posting year 4, I'm having inactive osce questions. Prepare me please

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Here is your full Year 4 Surgery OSCE - 20 Question Intensive Prep Pack, covering all formats and major surgical topics. Each question includes a mark scheme.

🏥 Year 4 Surgery OSCE — Intensive Prep (20 Questions)

HISTORY TAKING STATIONS

Question 1 — Acute Abdominal Pain History

Station: A 28-year-old male presents to A&E with a 24-hour history of abdominal pain. Take a focused history. (8 minutes)

Key areas to cover:

Domain	Key Questions
Pain	Site, onset, character, radiation, severity (1-10), timing, exacerbating/relieving factors
Associated symptoms	Nausea, vomiting, anorexia, fever, change in bowel habit, urinary symptoms
Past medical/surgical history	Previous episodes, prior surgeries, peptic ulcer disease, IBD
Drug history	NSAIDs, steroids, anticoagulants
Social history	Alcohol, travel, sexual history (STI-related peritonitis in females)
Family history	Bowel cancer, IBD
Systems review	Last menstrual period in females (ectopic!), testicular pain

Model answer - key findings pointing to appendicitis:

Pain starting periumbilically, migrating to right iliac fossa (RIF) over 12-24 hours
Associated anorexia (classic)
Low-grade fever
No significant past history
No urinary symptoms (helps exclude ureteric colic)

Source: Sabiston Textbook of Surgery; Bailey and Love's Short Practice of Surgery 28th Ed.

Question 2 — Breast Lump History

Station: A 52-year-old woman attends the breast clinic with a 3-week history of a lump in her right breast. Take a focused history.

Mark scheme:

Points	Content
2	Onset, duration, change in size
2	Pain / tenderness
2	Nipple discharge (character, bloodstained?), nipple inversion
2	Skin changes (peau d'orange, erythema, tethering)
2	Axillary lumps / arm swelling (lymphadenopathy)
2	Menstrual history (premenopausal vs postmenopausal) - HRT use
2	Family history (1st degree relatives: breast/ovarian cancer; BRCA consideration)
2	Previous biopsies / mammograms
2	Systemic symptoms (bone pain, dyspnoea - metastases)

Red flags:

Postmenopausal + painless + hard + fixed + axillary nodes = malignancy until proven otherwise
Bloodstained nipple discharge = intraductal papilloma / carcinoma

Source: Schwartz's Principles of Surgery 11th Ed.; Bailey and Love 28th Ed.

Question 3 — Inguinal Swelling History

Station: A 65-year-old male has a swelling in his left groin noticed 6 months ago. Take a history.

Mark scheme:

Site - medial vs lateral to pubic tubercle (inguinal vs femoral)
Onset and progression
Reducibility - does it go back in lying down or with pressure?
Symptoms of complications: pain, tenderness, nausea/vomiting (obstruction), irreducibility (incarceration), skin discolouration (strangulation)
Cough impulse
Exacerbating factors: heavy lifting, chronic cough (COPD?), constipation, urinary symptoms (BPH - raised intra-abdominal pressure)
Prior surgical repair - recurrent hernia?
Fitness for surgery: cardiovascular/respiratory history

Key distinctions:

Inguinal hernia: above and medial to pubic tubercle
Femoral hernia: below and lateral to pubic tubercle - higher strangulation risk, more common in women

Source: Schwartz's Principles of Surgery 11th Ed.

Question 4 — GI Bleeding History

Station: A 70-year-old male presents with melaena for 2 days. Take a focused history.

Mark scheme:

Characterise the bleeding: colour (bright red PR = lower GI; melaena = upper GI), volume, frequency, clots
Associated symptoms: haematemesis (confirms upper GI), abdominal pain, weight loss, dysphagia
Drug history: NSAIDs, aspirin, anticoagulants/antiplatelets, steroids - major risk for peptic ulcer
Alcohol history (varices, gastritis)
Past history: PUD, liver disease, previous endoscopy findings, colorectal cancer/polyps
Family history: colorectal cancer
Systemic symptoms: dizziness, pre-syncope (haemodynamic compromise)

ABCDE approach for unstable patient: Note pulse, BP, pallor, capillary refill - this is often tested as a follow-up management question.

Source: Sleisenger and Fordtran's GI and Liver Disease; Bailey and Love 28th Ed.

CLINICAL EXAMINATION FINDINGS

Question 5 — Abdominal Examination Findings

Station: Examine this mannequin's/patient's abdomen. The examiner will give you findings as you go.

Findings given: Distension, generalised tenderness, guarding, rigidity, absent bowel sounds, no shifting dullness.

Q: What is the most likely diagnosis and your immediate management?

Model Answer:

Diagnosis: Peritonitis (likely perforated viscus - peptic ulcer or sigmoid diverticulitis)
Signs explained: Guarding = voluntary muscle contraction to protect inflamed peritoneum; Rigidity = involuntary = peritoneal irritation; Absent bowel sounds = paralytic ileus from peritoneal inflammation
Immediate management:
1. Resuscitate: IV access (x2 large bore), bloods (FBC, U&E, LFT, amylase, coag, G&S), IV fluids
2. Analgesia (IV morphine with antiemetic)
3. NGT + catheter (monitor urine output)
4. Erect CXR - free air under diaphragm confirms perforation
5. Urgent surgical review - likely laparotomy/laparoscopy
6. IV antibiotics (e.g., co-amoxiclav or cefuroxime + metronidazole)
7. NBM

Source: Sabiston Textbook of Surgery; Bailey and Love 28th Ed.

Question 6 — Thyroid Examination

Station: Examine this patient's thyroid gland. Findings: Midline neck swelling moving on swallowing and on tongue protrusion, smooth, non-tender, no bruit.

Q: What is the diagnosis? How would you investigate?

Model Answer:

Diagnosis: Thyroglossal cyst (moves on tongue protrusion = pathognomonic, midline)

Differentials of neck swellings - common OSCE list:

Swelling	Key Feature
Thyroid goiter	Moves on swallowing only
Thyroglossal cyst	Moves on swallowing AND tongue protrusion
Lymph node	Does not move with swallowing
Branchial cyst	Lateral, anterior to SCM, young adult
Submandibular gland	Bimanual palpation positive
Carotid aneurysm	Pulsatile, expansile

Investigations for thyroid swelling:

TFTs (TSH, free T4, free T3)
USS thyroid - cystic vs solid, single vs multinodular
FNAC (fine needle aspiration cytology) - for any solitary nodule
Radionuclide scan - "hot" vs "cold" nodule (cold = higher malignancy risk)
CT neck/chest - if retrosternal extension suspected

Source: Bailey and Love 28th Ed.; Schwartz's Principles of Surgery 11th Ed.

Question 7 — Hernia Examination Findings

Station: The examiner tells you: 55-year-old male, right groin swelling, appears on standing, reducible, cough impulse positive, lies above and medial to the pubic tubercle.

Q: Classify this hernia and name the repair techniques.

Model Answer:

Diagnosis: Right direct inguinal hernia (above and medial to pubic tubercle = inguinal; comes through the posterior wall of inguinal canal directly, medial to inferior epigastric vessels = direct)
Nyhus Classification (commonly asked):
- Type I: Indirect, internal ring normal (pediatric)
- Type II: Indirect, internal ring dilated
- Type III: Direct (IIIa) / Indirect large (IIIb) / Femoral (IIIc)
- Type IV: Recurrent

Repair techniques:

Technique	Type
Lichtenstein (tension-free mesh)	Open, gold standard for adults
Bassini repair	Open, tissue repair
TEP (totally extraperitoneal)	Laparoscopic
TAPP (transabdominal preperitoneal)	Laparoscopic
Modified Shouldice	Open, tissue

Source: Schwartz's Principles of Surgery 11th Ed.; Mulholland and Greenfield's Surgery 7th Ed.

Question 8 — Post-op Wound Examination

Station: A patient is day 5 post laparotomy. The wound is erythematous, warm, swollen with seropurulent discharge. Examine the wound.

Q: What is the diagnosis? How do you manage this?

Model Answer:

Diagnosis: Surgical site infection (SSI) - superficial incisional SSI (within 30 days of surgery)
Classification of SSI:
- Superficial: skin and subcutaneous tissue
- Deep: fascial and muscle layers
- Organ/space: body cavity involved

Management:

Open wound (release sutures at infected area) - allow drainage
Send wound swab for MC&S
Wound irrigation + regular dressing changes
Antibiotics only if cellulitis extending, systemic signs (fever, tachycardia), or immunocompromised
Negative pressure wound therapy (VAC) if large wound
Check for deeper infection (abscess - USS/CT guided drainage)
Note: Ensure dehiscence not occurring - check for burst abdomen (serosanguineous discharge = warning sign)

DATA INTERPRETATION STATIONS

Question 9 — Interpret This Abdominal X-Ray

Station: 78-year-old male, 3-day history of absolute constipation, abdominal distension, vomiting. AXR shown.

Findings described: Grossly dilated loop of large bowel in RIF, forming an inverted "U" shape, extending to the upper abdomen. Haustra visible.

Q: What is the diagnosis? What is your management?

Model Answer:

Diagnosis: Sigmoid volvulus (coffee bean/bent inner tube sign on AXR - though here showing caecal volvulus pattern in RIF)
For sigmoid volvulus: AXR shows "coffee bean sign" - huge gas-filled loop pointing to RUQ
For caecal volvulus: dilated loop in LUQ
Management of sigmoid volvulus:
1. Resuscitate (IV fluids, NBM, NGT)
2. First-line: Rigid sigmoidoscopy + rectal flatus tube (decompression) - 70-80% success
3. If gangrenous/fails: Emergency laparotomy - Hartmann's procedure or resection + primary anastomosis
4. Elective sigmoid colectomy after recovery (prevents recurrence)

AXR interpretation checklist (OSCE framework):

Gas pattern (small vs large bowel)
Bowel wall thickness
Free air (under diaphragm = erect CXR)
Soft tissue shadows (psoas lines)
Bones (vertebrae, pelvis)

Source: Bailey and Love 28th Ed.

Question 10 — Interpret These Bloods

Station: 45-year-old female post-laparoscopic cholecystectomy Day 1. Confused, pyrexial 38.8°C, tachycardic 115 bpm.

Bloods:

WCC 18.2 (↑)
CRP 285 (↑)
Bilirubin 45 (↑)
ALP 320 (↑)
ALT 280 (↑)
Amylase 1850 (↑↑)
Creatinine 165 (↑)

Q: What has happened? What do you do?

Model Answer:

Diagnosis: Post-cholecystectomy bile duct injury with acute pancreatitis, early AKI - likely CBD clip causing obstruction or retained CBD stone causing pancreatitis
Revised Atlanta Criteria for pancreatitis severity:
- Mild: no organ failure, no local complications
- Moderately severe: transient organ failure (<48h) OR local complications
- Severe: persistent organ failure (>48h)

Immediate management:

Sepsis 6 (bloods, cultures, IV fluids, O2, urine output, IV antibiotics)
IV fluid resuscitation - aggressive (3-4L crystalloid first 24h in pancreatitis)
Imaging: urgent USS + MRCP (assess CBD, exclude retained stone)
ERCP if confirmed CBD stone/obstruction
HDU/ICU if organ failure
Surgical review for possible bile leak

Glasgow criteria for pancreatitis severity (PANCREAS mnemonic):

PaO2 < 8 kPa, Age >55, Neutrophils >15, Calcium <2, Renal (urea >16), Enzymes (LDH >600, AST >200), Albumin <32, Sugar (glucose >10) → ≥3 = severe

Source: Bailey and Love 28th Ed.; Current Surgical Therapy 14th Ed.

Question 11 — ECG Interpretation Pre-Op

Station: 68-year-old male scheduled for elective sigmoid colectomy. Pre-operative ECG shown.

Findings described: Rate 88, irregular rhythm, no P waves, irregularly irregular QRS complexes.

Q: Interpret the ECG and what is the perioperative management?

Model Answer:

Diagnosis: Atrial fibrillation (AF)
OSCE must-knows for AF:
- Rate control vs rhythm control decision
- Anticoagulation: CHA₂DS₂-VASc score
- HAS-BLED for bleeding risk

Perioperative AF management:

Check if new or known AF - if new, treat reversible causes (electrolyte imbalance, sepsis, PE)
Rate control target: resting HR <110 bpm (bisoprolol/digoxin/rate-limiting CCB)
Anticoagulation: bridging therapy decision - for low-risk surgery, hold DOAC 24-48h; for high-risk (bowel surgery), hold 48-72h + consider LMWH bridge if high thromboembolic risk
Refer to cardiologist/anaesthetist pre-op
Post-op: restart anticoagulation when haemostasis confirmed (usually 24-48h)
Inform patient and document in consent re: increased perioperative risks

Question 12 — Interpret Chest X-Ray

Station: 60-year-old male presents with sudden onset severe epigastric pain, now generalised, HR 120, BP 88/60. Erect CXR provided.

Findings: Air under both hemidiaphragms (pneumoperitoneum).

Q: What is the diagnosis? What is the immediate management?

Model Answer:

Diagnosis: Perforated peptic ulcer (most likely perforated duodenal ulcer given age/sex profile)
Free air under diaphragm = pneumoperitoneum = surgical emergency

Resuscitation and management (ABCDE first):

A: Patent airway
B: O2 15L via NRB, SpO2 monitoring
C: 2x large bore IV cannulae, send bloods (FBC, U&E, LFT, coag, G&S, amylase, lactate), aggressive IV crystalloid, catheterise (target UO >0.5ml/kg/hr)
D: IV morphine + antiemetic
E: NGT (decompress stomach)
IV antibiotics (e.g., cefuroxime + metronidazole)
NBM, consent for emergency surgery
Definitive treatment: Emergency laparoscopy/laparotomy - Graham patch repair (omental patch) of perforation + washout

Conservative management (Taylor's method): Only in select cases - haemodynamically stable, elderly/high-risk, no peritoneal signs. NG suction + IV PPI + antibiotics. Rarely first choice.

Source: Sleisenger and Fordtran's; Fischer's Mastery of Surgery 8th Ed.

MANAGEMENT & DECISION-MAKING STATIONS

Question 13 — Appendicitis Management

Station: 19-year-old female, 18-hour history of RIF pain, anorexia, fever 38.2°C, WCC 14.5, CRP 78. Alvarado score 8.

Q: Walk me through your management.

Model Answer - Alvarado Score (MANTRELS):

Feature	Points
Migration of pain to RIF	1
Anorexia	1
Nausea/vomiting	1
Tenderness in RIF	2
Rebound tenderness	1
Elevated temperature >37.3	1
Leukocytosis WCC >10	2
Total	10

≥7 = likely appendicitis (score 8 here = high probability)

Management:

Resuscitation: IV fluids, NBM, analgesia (do NOT withhold - does not mask signs)
Imaging: USS abdomen first (female - to exclude ovarian pathology) → If inconclusive: CT abdomen/pelvis
Pre-op: IV antibiotics (co-amoxiclav or metronidazole + cefuroxime)
Operative: Laparoscopic appendicectomy (gold standard)
In females: inspect pelvis, fallopian tubes, ovaries intraoperatively
If perforated: Wash out, drain, IV antibiotics post-op, longer stay

Non-operative management (antibiotics only): Being studied (APPAC, CODA trials) - appropriate for uncomplicated appendicitis in selected patients, but informed consent regarding recurrence risk (~20-25% at 5 years) mandatory.

Source: Current Surgical Therapy 14th Ed.; Mulholland and Greenfield's Surgery 7th Ed.

Question 14 — Small Bowel Obstruction

Station: 72-year-old female, previous open hysterectomy, 48-hour history of colicky central abdominal pain, vomiting, absolute constipation. AXR: multiple dilated small bowel loops with valvulae conniventes, >3cm.

Q: Diagnose and manage.

Model Answer:

Diagnosis: Small bowel obstruction (SBO) - most likely adhesions (previous surgery = #1 cause)

Causes of SBO - "GET SMASHED" (modified):

Adhesions (60-70% - #1 in adults with previous surgery)
Hernia (incarcerated - #1 in those with no previous surgery)
Tumour (extrinsic/intrinsic)
Crohn's disease
Intussusception, volvulus

AXR features of SBO:

Dilated loops >3cm
Central position
Valvulae conniventes (go all the way across = small bowel)
Stacked coin appearance

Management:

Conservative (drip and suck): NBM, NGT (decompress), IV fluids, catheter, electrolyte correction, serial examinations
Water-soluble contrast (Gastrografin) study: diagnostic AND therapeutic - causes osmotic shift, reduces adhesion SBO
Indications for surgery: Strangulation (fever, tachycardia, peritoneal signs, lactate rise), failure to resolve after 48-72h
Operation: Adhesiolysis; bowel resection if ischaemic
Post-op: Early feeding, VTE prophylaxis

Source: Pye's Surgical Handicraft 22nd Ed.; Bailey and Love 28th Ed.

Question 15 — Trauma Management (ATLS)

Station: 25-year-old male, brought in by ambulance after high-speed RTA. GCS 13, HR 130, BP 85/50, RR 28, SpO2 90% on air.

Q: How do you manage this patient?

Model Answer - ATLS Primary Survey (ABCDE):

A - Airway with C-spine protection:

Jaw thrust, suction, airway adjuncts (OPA/NPA)
If GCS ≤8: RSI + intubation (anaesthetist)
C-spine immobilisation (collar + blocks + tape) until cleared

B - Breathing:

High-flow O2 (15L NRB)
Check for: tension pneumothorax (tracheal deviation, absent breath sounds, hypotension) → needle decompression 2nd ICS MCL → chest drain
Open chest wound → 3-sided seal
Massive haemothorax → chest drain, consider thoracotomy

C - Circulation:

2x large bore IV (antecubital fossa)
Bloods: FBC, U&E, coag, G&S cross-match, lactate, ABG
Permissive hypotension in penetrating trauma (target SBP 80-90 until definitive haemostasis)
FAST scan: pericardium, perihepatic, perisplenic, pelvis - free fluid?
Massive transfusion protocol if needed: 1:1:1 (PRBC:FFP:platelets)
External haemorrhage: direct pressure, tourniquet, haemostatic dressings

D - Disability:

GCS, pupils, blood glucose
AVPU scale

E - Exposure:

Expose fully, maintain temperature (warm blankets, warm fluids)
Log roll (spine precautions) - assess back, PR (sphincter tone, blood, prostate position)

Secondary survey: Head-to-toe examination after primary survey and resuscitation

Source: Fischer's Mastery of Surgery 8th Ed.; Rosen's Emergency Medicine; Sabiston Textbook of Surgery

Question 16 — Colorectal Cancer Staging & Management

Station: 66-year-old male, 3-month history of change in bowel habit (increasing constipation), rectal bleeding, 8kg weight loss. Colonoscopy: sigmoid mass. Biopsy: adenocarcinoma. CT chest/abdomen/pelvis: no distant metastases.

Q: Stage this cancer and outline management.

Model Answer:

TNM Staging:

Stage	T	N	M
I	T1-2	N0	M0
II	T3-4	N0	M0
IIA	T3	N0	M0
IIB	T4a	N0	M0
III	Any T	N1-2	M0
IV	Any T	Any N	M1

Work-up:

CT chest/abdomen/pelvis (staging - done)
MRI pelvis (for rectal cancer - T and N staging, CRM involvement)
PET-CT if metastases unclear
CEA (baseline - also used for surveillance post-op)
MDT discussion
ECOG performance status

Management:

Localised sigmoid colon cancer (Stage I-III): Laparoscopic sigmoid colectomy with adequate lymph node harvest (minimum 12 nodes)
Adjuvant chemotherapy (FOLFOX/CAPOX) for Stage III (node-positive) and high-risk Stage II
Rectal cancer: Neoadjuvant chemoradiotherapy (long-course) for T3/T4 or N+ tumours → then TME (total mesorectal excision) surgery
Stoma formation if low anterior resection or Hartmann's procedure

Source: Schwartz's Principles of Surgery 11th Ed.; Sabiston Textbook of Surgery

Question 17 — Acute Limb Ischaemia

Station: 70-year-old male, sudden onset of right leg pain and weakness 2 hours ago. Examination: right leg cold, pale, absent pulses from popliteal downward, power 2/5, sensation reduced.

Q: Diagnose, classify severity, and manage.

Model Answer:

Diagnosis: Acute limb ischaemia (ALI) - likely arterial embolism (sudden onset, AF history common)

6 Ps of ALI: Pain, Pallor, Pulselessness, Paraesthesia, Paralysis, Perishing cold

Rutherford Classification:

Category	Limb Viability	Motor	Sensory
I	Viable	Intact	Intact
IIa	Threatened (marginally)	Intact	Mild loss
IIb	Threatened (immediately)	Mild weakness	Rest pain
III	Irreversible	Paralysis	Profound loss

This patient = Category IIb (power 2/5 + sensory loss = immediately threatened)

Management:

IV heparin immediately (5000 units bolus) - to limit thrombus propagation
IV analgesia, O2
Urgent vascular surgery referral
Imaging: CTA (angiogram) if time permits - but do NOT delay surgery for IIb
Embolism: Surgical embolectomy (Fogarty balloon catheter)
Thrombosis in situ: Bypass or thrombolysis
Post-reperfusion: Watch for compartment syndrome (fasciotomy if needed), reperfusion injury, hyperkalaemia, myoglobinuria (AKI)
Category III = primary amputation (irreversible)

Source: Bailey and Love 28th Ed.; Schwartz's Principles of Surgery 11th Ed.

Question 18 — Post-Op Pyrexia

Station: Day 3 post right hemicolectomy. Temperature 38.9°C, HR 105, RR 22, BP 110/70. Abdomen mildly tender. WCC 19.8, CRP 340.

Q: Give a structured approach to this post-operative pyrexia.

Model Answer - "Wind, Water, Wound, Walking, Wonder drugs" + abdominal causes:

Causes by postoperative day:

POD	Common Causes
1-2	Atelectasis (wind), normal inflammatory response
3-5	Urinary tract infection (water), IV line infection
5-7	Wound infection (wound)
7+	DVT/PE (walking), anastomotic leak, intra-abdominal abscess, drug fever

For this patient (Day 3 after bowel surgery):

Primary concern: Anastomotic leak (dreaded complication, peaks Day 5-7 but can be earlier)
Also consider: wound infection, UTI, chest infection

Investigation:

Sepsis 6 (bloods including lactate, blood cultures x2, urine MC&S, wound swab)
CXR (pneumonia, free air)
CT abdomen with contrast - look for anastomotic leak, collection, free fluid
Amylase (pancreatitis)

Management if anastomotic leak:

Small contained: IV antibiotics, CT-guided drain, TPN
Free perforation: Return to theatre - Hartmann's procedure, repair with or without defunctioning stoma

Question 19 — Jaundice in a Surgical Patient

Station: 58-year-old male, progressive jaundice for 4 weeks, pale stools, dark urine, 6kg weight loss, painless.

Q: What is the likely diagnosis? What is your investigation pathway?

Model Answer:

Diagnosis: Obstructive (surgical/cholestatic) jaundice - most likely pancreatic head carcinoma (Courvoisier's law: palpable, non-tender gallbladder in the presence of jaundice is unlikely to be due to gallstones)

Courvoisier's Law: In jaundice, if the gallbladder is palpable and non-tender, the cause is unlikely to be gallstones (gallbladder fibrosed by chronic inflammation). Think malignancy (pancreatic head, cholangiocarcinoma, ampullary carcinoma).

Investigation pathway:

Bloods: LFTs (obstructive pattern: ↑ALP, ↑GGT, ↑bilirubin, ALP > ALT), FBC, U&E, coag (vitamin K malabsorption), CA 19-9 (tumour marker for pancreatic cancer), CEA
USS abdomen (first-line) - biliary dilatation, gallbladder, liver lesions
CT chest/abdomen/pelvis (triple-phase) - staging, resectability (SMA/SMV involvement = Borderline resectable)
MRCP - ductal anatomy
ERCP ± stenting (palliation or pre-op biliary decompression)
EUS + FNA (biopsy)
MDT discussion

Surgical treatment (Whipple's procedure = pancreaticoduodenectomy):

For resectable head of pancreas cancer
Resects head of pancreas, duodenum, gallbladder, distal CBD, part of stomach
Only ~20% are resectable at presentation

Source: Bailey and Love 28th Ed.; Schwartz's Principles of Surgery 11th Ed.; Sabiston Textbook of Surgery

Question 20 — Consent Station

Station: You are about to obtain consent from a 45-year-old male for a laparoscopic cholecystectomy. Perform the consent.

Mark scheme:

Domain	Key Points (2 marks each)
Introduction	Introduce, confirm patient identity, confirm understanding of diagnosis (symptomatic gallstones)
Procedure	Explain what happens: GA, 3-4 port laparoscopic approach, gallbladder removal
Benefits	Relief of symptoms, prevention of complications (cholecystitis, pancreatitis, cholangitis)
Common complications	Wound infection (5%), port site hernia, DVT, chest infection, urinary retention
Serious/rare complications	CBD injury (0.2-0.5%) - most important, bile leak, bleeding requiring transfusion, conversion to open (5%)
CBD injury specifics	Can cause prolonged hospital stay, ERCP/re-operation, long-term biliary stricture
Alternatives	Conservative (dietary modification), open cholecystectomy
Questions	Ask patient if they have any questions
Documentation	Explain they will sign the form, have time to think, can withdraw consent at any time

Key legal points:

Montgomery ruling (2015): Must discuss any risks a reasonable patient would consider significant
Mental Capacity Act: Assess capacity, best interests if lacks capacity
Patient must have: Information, Understanding, Voluntariness, Capacity

Source: Bailey and Love 28th Ed.; General Medical Council consent guidelines

Quick Summary Revision Table

#	Topic	Format	Key Learning Point
1	Acute abdomen	History	Systematic SOCRATES + red flags
2	Breast lump	History	Malignancy red flags + Triple assessment
3	Groin swelling	History	Inguinal vs femoral distinction
4	GI bleed	History	Upper vs lower GI + drug history
5	Peritonitis	Examination	Signs + immediate surgical management
6	Thyroid/neck lump	Examination	Differentials based on movement
7	Inguinal hernia	Examination	Nyhus classification + repairs
8	Wound infection	Examination	SSI classification + management
9	AXR bowel obstruction	Data	Sigmoid volvulus + decompression
10	Post-op bloods	Data	Bile duct injury + Glasgow criteria
11	Pre-op ECG (AF)	Data	Perioperative anticoagulation bridging
12	Erect CXR	Data	Pneumoperitoneum = surgical emergency
13	Appendicitis	Management	Alvarado score + non-op vs operative
14	Small bowel obstruction	Management	Drip & suck + Gastrografin challenge
15	Major trauma	Management	ATLS ABCDE primary survey
16	Colorectal cancer	Management	TNM staging + adjuvant chemo
17	Acute limb ischaemia	Management	6 Ps + Rutherford + Fogarty
18	Post-op pyrexia	Management	Day-by-day causes + anastomotic leak
19	Obstructive jaundice	Management	Courvoisier's + Whipple's procedure
20	Consent	Communication	Montgomery + common/serious risks

Sources consulted: Bailey and Love's Short Practice of Surgery (28th Ed.), Schwartz's Principles of Surgery (11th Ed.), Sabiston Textbook of Surgery, Fischer's Mastery of Surgery (8th Ed.), Mulholland and Greenfield's Surgery (7th Ed.), Current Surgical Therapy (14th Ed.), Sleisenger and Fordtran's GI and Liver Disease, Rosen's Emergency Medicine.

Good luck in your OSCE! Work through each scenario out loud - talking through your reasoning is what examiners are marking.

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