the clinical exam and question...:)

assalamuallaikum....

alhamdulillah, both theory and clinical exam for pro III da pon abes...mmg lama kot x menjunguk blog ni...sbb sibuk gile2...cewah!hehe...

alhmadulillah clinical exam td dpermudahkan Allah...stakat yg termampu, sy da cuba buat yg tbaik...apepon tetap cuuuuakkk menunggu esok...samada ada rezeki nak dpt title doc @ kene menunggu bbrapa bulan lg kalau xdiiizinkan ALLAH...

my face during clinical exam td...senyum dlm gloomy...hehe

so, this is my case and the question that had been asked...kalau2 my junior @ my frens yg belum lg clinical exam tu blh la tgk2...:)

long case:
examiner: prof miah, dr Rusydan and 1 external lecturer from UKM---x igt nama

case:
uncle C,60 years old known to have DM,HTN and hypercholestrolemia for 10 years comes with sudden RHC pain for 2 days associated with fever, rigors, lethargy and loss of weight and on d day of admission, he had severe pan and symptoms of shock where he had generalized abdominal pain and SOB that relieve by oxygen therapy...on u/s scan, there's few stones noted in the bile duct. so, i did rule out for the complications of acute cholecystitis bla3 and also rule out the liver pathology such as liver abcess, hepatitis bla3...
on examination, pt is not jaundice, not pale and not in respiratory distress. abdomen is soft and non tender, no murphy sign, no hepatomegaly bla3....(basically sume normal)

so, my working diagnosis acute cholecystitis, liver abcess, hepatitis, acute pancreatitis and might be perforated peptic ulcer disease...

question:
1. causes of peritonitis
2. sign of liver abcess and perforated peptic ulcer
3. what basically u want to see in the gall bladder in u/s scan
4. regarding ERCP procedure (byk question tp yg igt just 2)

• what u want to exclude before do ERCP
• other than allergy, what can the dye cause to the patient

5. what investigation specifically will u order to suspect perforated peptic ulcer
6. what type of antibiotic u will choose in patient with acute cholecystitis
7. what organism can be found in the gall bladder
8. 3rd generation cephalosporin cover what organism
9. the most common cause for liver abcess in malaysia
10. what type of antibiotic u will choose for ameobic infection
11. symptoms of hyperglycaemia and hypoglycaemia
12. what is HbA1C?
13. if patient FBS is 4.7, is it normal? and if HbA1c is 13% what do u think?
14. how to consult on foot care of diabetic patient
15. just treat me as Uncle C, so plez consult me regarding my DM and HTN upon discharge

ok...tq...:)


short case
examiner: prof norashikin, dr rohani and prof wan ariffin(UM)

1st: gynae case
all i can say is a vague ovarian mass. discussion:

• differential diagnosis
•  management of endometriosis
• confirmative test for endometriosis
• how would u like to consult a single nulliparous lady with endometriosis

 2nd case: medical case
i'd seen this patient before...hehehe!most probably a right sided pleural effusion

• investigation that u would like to order
• if pleural effusion, what do u want to see on chest x-ray...
• kringggg....time up!

3rd case: paediatric case
6 months old down syndrome baby

• what do u notice bout this patient on inspection (basically sign of down syndrome)
• what is hypertelorism
• what are the complications of down syndrome

ok, plez auscultate the heart-----> it's VSD

• is VSD common in down syndrome
• confirmative test for VSD
• management of VSD
• criteria of surgery in VSD
• complications of VSD
• if patient come with VSD and cyanosis, what runs tru your mind---essenmengger!!*mcm slh eja..hehe*
• pathophysio of VSD

fuhhh...habis...

during my paeds examination, ramai btl doc2 stand by the side of the bed nak denga jawapan...and disebabkan restless dgn soalan yang byk and brain fatigue......byk jgk mengeluarkan jawapan sengal...that's all i can say....sorry doc.....hehe

moga2 esok dpermudahkan sume...moga semua dpt lulus PRO III ni...ameennnn....:)