You are a medical research assistant. Using the medical library database (query_library_db tool), research the following surgery OSCE questions thoroughly. For each question, search the database for relevant content, read the relevant sections, and provide comprehensive answers. IMPORTANT: Always start queries with the medical library. Use paragraphs_fts and headings_fts to search. **Q1:** 32-year-old woman with swelling at the lower end of her neck on the right side (image shows "Thyroid Cyst Before Needle Aspiration") - 1. Name the differential diagnosis - 2. What are the investigations necessary for the patient - 3. Outline the management of the patient **Q2:** 43-year-old man with fever, generalised lethargy and weakness for 3 weeks. Swellings on right side of neck, other side of neck and both axillae — confirmed enlarged lymph nodes. - 1. What is the likely cause of the swelling? - 2. How will you confirm the diagnosis? - 3. How will you classify the cervical lymph nodes? - 4. What are the indications for surgery? **Q3:** 40-year-old woman with swelling in front of her neck for 3 months, palpitations, excessive sweating, loss of weight. Images show exophthalmos and "Diffuse Hyperplastic Goitre" - 1. What are your findings on examination? - 2. What is your diagnosis? - 3. Describe the tests to confirm the diagnosis - 4. What will a TFT reveal in this patient? **Q4:** 61-year-old woman with large neck swelling for 10 years, painless and growing (image shows large goitre) - 1. What is your diagnosis? - 2. Name the complications? - 3. What are the features of malignant change in the patient? - 4. What is the treatment? Search the database for: thyroid cyst, thyroid goitre, hyperthyroidism, Graves disease, cervical lymph nodes, lymphoma, neck swelling differential diagnosis, thyroid investigations, thyroid function tests. Use these SQL queries as starting points: 1. SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'thyroid goitre' ORDER BY rank LIMIT 10 2. SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 30) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'cervical lymph nodes classification' ORDER BY rank LIMIT 10 3. SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 30) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'Graves disease hyperthyroidism exophthalmos' ORDER BY rank LIMIT 10 Read the relevant file sections using read_file with the paths returned. Provide detailed answers with textbook citations.

You are a medical research assistant. Using the medical library database (query_library_db tool), research the following surgery OSCE questions thoroughly. For each question, search the database for relevant content, read the relevant sections, and provide comprehensive answers. IMPORTANT: Always start queries with the medical library. Use paragraphs_fts and headings_fts to search. **OSCE 5:** 45-year-old woman with a left breast lump (image shows a smooth, rounded swelling on the breast with no skin changes) - 1. Describe what you see on inspection - 2. What are the features that would suggest the lump to be benign in this patient? - 3. What are the investigations for the patient? **OSCE 6:** 45-year-old woman with breast lump for 1 month (image shows peau d'orange appearance of the breast — classic orange-peel skin texture with dimpling) - 1. What does it show? - 2. What does the change signify? - 3. How will you investigate this patient? **OSCE 7:** 27-year-old woman breastfeeding for last 3 months, painful swelling of left breast and fever for 2 weeks (image shows red, swollen, inflamed breast) - 1. What is most likely diagnosis? - 2. What is most likely cause? - 3. What is the treatment for her? **OSCE 8:** 57-year-old woman's breast (image shows multi-duct discharge from nipple — multiple ducts with dark discharge; hint on slide says "Multi-duct - Duct ectasia, infection; mono-duct discharge – papilloma, Ca") - 1. What would be most likely complaint of the patient? - 2. What are the possible causes? - 3. How will you investigate her? **OSCE 9:** 60-year-old nulliparous woman's breast (image shows dimpling and puckering of breast skin; hint says "Dimpling & puckering → Cancer") - 1. What is the sign exhibited? - 2. What does it signify? - 3. What is the best way to demonstrate the sign? Search the database for: breast lump benign, breast cancer signs, peau d'orange, breast abscess mastitis, nipple discharge duct ectasia, breast dimpling, fibroadenoma, breast triple assessment, mammography. Use these SQL queries: 1. SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'breast lump benign malignant' ORDER BY rank LIMIT 10 2. SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 30) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'peau orange breast cancer dimpling' ORDER BY rank LIMIT 10 3. SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 30) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'breast abscess mastitis lactating' ORDER BY rank LIMIT 10 4. SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 30) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'nipple discharge duct ectasia intraductal papilloma' ORDER BY rank LIMIT 10 Read the relevant file sections. Provide detailed answers with textbook citations.

You are a medical research assistant. Using the medical library database (query_library_db tool), research the following surgery OSCE questions thoroughly. For each question, search the database for relevant content, read the relevant sections, and provide comprehensive answers. IMPORTANT: Always start queries with the medical library. Use paragraphs_fts and headings_fts to search. **Q10:** 45-year-old man with right groin swelling for one month, noticed when lifting heavy object, painless, growing with time - 1. What is your diagnosis? - 2. What are the risk factors for its development? - 3. What are the differential diagnoses? **Q11:** 25-year-old man with pain and swelling over left scrotum for 3 days, no urinary symptoms or fever (image shows scrotal swelling) - 1. What are the differential diagnoses? - 2. How will you investigate the patient? - 3. How will you clinically decide it is an inguinal hernia or otherwise? **Q12:** Physical examination image shows Zieman's test (three-finger test for hernia — fingers placed over deep inguinal ring, superficial inguinal ring, femoral ring) - 1. What examination does this picture show? - 2. What is the purpose of the examination? - 3. Describe how it is done and how do you interpret the results? **Q13:** 6-month-old infant with transillumination of scrotal swelling (image shows transillumination — orange glow through scrotal swelling) - 1. What is the test called? - 2. Describe how is it done - 3. What does it diagnose? - 4. What is the treatment? Search the database for: inguinal hernia diagnosis risk factors, scrotal swelling differential, Zieman test hernia, transillumination hydrocele, scrotal swelling investigation, femoral hernia, hydrocele treatment. Use these SQL queries: 1. SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'inguinal hernia' ORDER BY rank LIMIT 10 2. SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 30) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'scrotal swelling differential diagnosis hydrocele epididymo-orchitis' ORDER BY rank LIMIT 10 3. SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 30) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'Zieman test hernia examination finger' ORDER BY rank LIMIT 10 4. SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 30) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'transillumination hydrocele infant' ORDER BY rank LIMIT 10 Read the relevant file sections. Provide detailed answers with textbook citations.

You are a medical research assistant. Using the medical library database (query_library_db tool), research the following surgery OSCE questions thoroughly. For each question, search the database for relevant content, read the relevant sections, and provide comprehensive answers. IMPORTANT: Always start queries with the medical library. Use paragraphs_fts and headings_fts to search. **Q14:** 42-year-old man with change of bowel habit and strong family history of colon cancer. Colonoscopy shows multiple polyps. - 1. What is your diagnosis? - 3. What is the significance of a strong family history of colon cancer? - 4. What is the treatment of this patient? - 5. What are the complications of this condition? **Q15:** 60-year-old man with epigastric pain for 3 days, no vomiting of blood, mildly pale. DRE revealed dark/melaena stool on gloved finger. - 1. What is seen in the picture? - 2. What are the possible causes of this finding? - 3. What investigations will you do for the patient? - 4. The patient's Hb is 5.6 gm/dl. Outline the management of the patient. **Q16:** 51-year-old man with weakness, lethargy and dull pain in right lower abdomen. Examination reveals a mass in right lower abdomen (image labelled "Causes of Lump in Stomach") - 1. What are the differential diagnoses? - 2. What are the features of the mass you will determine and why? - 3. What are the investigations you will do for the patient? - 4. What are the complications of this mass? **Q17 (first):** 40-year-old man with abdominal pain off and on for 1 month, last 3 days severe pain with constipation, abdominal distension and vomiting. Had appendicectomy 5 years ago. X-rays show dilated bowel loops. - 1. What do the X-rays show? - 2. What is the diagnosis? - 3. He was treated with the "drip and suck" regime. What is this regime? - 4. What is the possible cause in this patient? Search the database for: colorectal polyps familial adenomatous polyposis, melaena rectal bleeding investigation, intestinal obstruction adhesions, right iliac fossa mass causes, bowel obstruction management, colon cancer polyps. Use these SQL queries: 1. SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'colorectal polyps colon cancer' ORDER BY rank LIMIT 10 2. SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 30) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'melaena dark stool rectal bleeding causes' ORDER BY rank LIMIT 10 3. SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 30) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'intestinal obstruction adhesion drip suck nasogastric' ORDER BY rank LIMIT 10 4. SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 30) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'right iliac fossa mass differential diagnosis' ORDER BY rank LIMIT 10 Read the relevant file sections. Provide detailed answers with textbook citations.

You are a medical research assistant. Using the medical library database (query_library_db tool), research the following surgery OSCE questions thoroughly. Search the database for relevant content, read the relevant sections, and provide comprehensive answers. IMPORTANT: Always start queries with the medical library. Use paragraphs_fts and headings_fts to search. **Q17 (second - haematemesis):** 62-year-old woman with sudden onset of vomiting of blood and epigastric pain. Known case of ischemic heart disease AND osteoarthritis (on regular medication). Image shows fresh red blood vomitus. - 1. What other details of the history would you like to obtain? - 2. Describe the nature of the vomitus - 3. What are the possible diagnoses? - 4. What investigations will you do for her? - 5. How will you assess her status? **Q18:** Endoscopic image of patient with chronic epigastric pain, aggravated by spicy food and relieved by taking milk. Endoscopy shows a duodenal/gastric ulcer with a visible vessel. - 1. What is your diagnosis? - 2. List the etiological factors for the condition - 3. What are the principles of treatment? Note for Q17 haematemesis: The patient is on regular medication for ischemic heart disease (aspirin, clopidogrel, statins) AND osteoarthritis (NSAIDs). NSAIDs are a key cause of peptic ulcer and upper GI bleeding. The vomitus appears fresh red blood. Note for Q18: The endoscopic image shows a peptic/duodenal ulcer - the description of aggravation by spicy food and relief by milk is classic for peptic ulcer disease. Search the database for: haematemesis upper GI bleeding causes, peptic ulcer disease, NSAID gastric ulcer, Helicobacter pylori, upper GI endoscopy, Rockall score, haematemesis management, peptic ulcer treatment. Use these SQL queries: 1. SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'haematemesis upper gastrointestinal bleeding' ORDER BY rank LIMIT 10 2. SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 30) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'peptic ulcer NSAID Helicobacter pylori' ORDER BY rank LIMIT 10 3. SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 30) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'haematemesis assessment Rockall score management' ORDER BY rank LIMIT 10 4. SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 30) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'peptic ulcer treatment proton pump inhibitor' ORDER BY rank LIMIT 10 Read the relevant file sections. Provide detailed answers with textbook citations.