Sohag University
Sohag faculty of medicine
Surgery department
Time allowed: 1.5 hours
M.S.C General Surgery
Paper III commentary


Case (1)
A 68- year- old man has undergone laparotomy, urgent resection of sigmoid and hartmann's pouch
for perforated sigmoid volvulus and faecal peritonitis then admitted to ICU for ventilation.
1) What is hartmann's pouch? Why was it done for that patient? (12.5 marks)
2) What options you have for nutrition of this patient? What are the routes of each? (12.5 marks)

Case (2)
A 43- year- old man presented with a slowly growing painless firm mass antero-inferior to the left
ear, no LNs were palpable and facial movements were normal.
1) What is most likely the diagnosis? (5 marks)
2) How can you manage this case? (20 marks)

Case (3)
A 50- year- old female presented to you in outpatient clinic by pruritis and eczema of the nipple , she
had no history of lactation ,no previous breast masses ,no family history of breast cancer.
Examination revealed eroded nipple, no vesicles ,no oozing ,there was no breast masses on either
side ,no palpable axillary LNs.
1) What is your most possible diagnosis? (5 marks)
2) Wat investigations would you recommend? (10 marks)
3) How can you manage this case? (10 marks)

Case (4)
A 62- year- old female presented with severe abdominal pain started at epigastrium then became
generalized, she was on NSAIDs for rheumatoid arthritis. On examination:
General: pallor, sweating and rapid weak pulse.
Inspection: board like rigidity
Palpation: epigastric tenderness and rebound tenderness
Percussion: ↓liver dullness
Auscultation: absent intestinal sounds
1) What is your provisional diagnosis? (5 marks)
2) What is the investigation of choice? (5 marks)
3) Do barium meal and endoscope have a role in this case? And why? (5 marks)
4) What is the incidence of this case? (5 marks)