… continued from previous post
(Physicians usually ask to comment at the end of the examination. They do not prefer running commentary like the surgeons do)
Station 1: Cardiology – Mitral Stenosis
(At this station, the examiner did not really ask questions, more to commenting on the findings)
– Oh, please practice a lot for diastolic murmur, it would be quite tricky sometimes~~
Station 2: Respiratory – Pulmonary fibrosis?
“Patient came in with chronic cough and blood-stained sputum. Examine patient’s chest.”
“What’s your finding? DDx? Management?”
“What is HRCT? What is its importance compared to the conventional CT scan?”
Station 3: Hepatobiliary/Gastroenterology
– Young girl with mild jaundice, prominent frontal ridge, and painless palpable liver.
– “DDx? What is the most likely diagnosis? What other features to support your diagnosis?”
Station 4: Neurology – end of 20’s gentelman, came in with weak lower limb. Examine his lower limbs.
Proximal myopathy, pseudohypertrophy of calf muscle.
Dx: Muscular Dystrophy (Probably Becker’s)
Station 5: Rheumatoid Arthritis, Scleroderma/systemic sclerosis
(Quite straight forward, remember the features, and just look for them! You’ll be fine! And don’t forget to be gentle!)
Idiopathic Thrombocytopaenic Purpura (ITP) in elderly.
63-year-old lady, a diabetic, came in due to petechial rashes throughout the body.
First time, never had this problem previously.
Is on Cardiprin since 1 year ago after stroke. Never had any abnormal reaction to the medication. No recent change in medication.
No fever, no history suggestive of dengue fever.
No History suggestive of haematological malignancy. (CLL & CML in particular)
No History suggestive of SLE.
No previous / family history of bleeding disorder / tendency.
No history of liver disease.
Patient is comfortable. However unable to communicate well with people due to mild expressive and receptive dysphasia.
HR, RR and BP normal. 1 pint of platelet is being transfused.
Petechia + purpuric rash on neck, trunks, 4 limbs. Gum bleeds.
No other signs suggestive of dengue fever. No other features of SLE or haematological malignancy.
Neurological findings – Right-sided hemiparesis & hemisensory loss + Right-sided cranial nerve palsy, both due to upper motor neuron lesion as evidenced by…. (fill in the blanks😛 ). Lesion at left side of the cerebral cortex supplied by anterior circulation.
“Dx? Other Dx to consider? Why they are less likely?”
“Do you think patient’s condition is drug-induced? Or could it be autoimmune cause?”
“What is Cardiprin?”
“If the patient has dengue fever, how would she present with?”
“How do you manage this patient, given that she came in with platelet = 0.”
“How do you manage patient with dengue fever? How it differs from management of ITP?”
“Would you transfuse platelet in patient with dengue fever?”
“What advice would you like to give to her?”