Sunday, November 25, 2012

Of The IM End Block Exam

Although the exam period (1 day for PMP/MCQ/OBA and 1 day for LC/SC) was very short, it was seriously unnerving. Here's a brief review on the exam questions.

Monday, 19/11/12

1) PMP @ 9.00-10.30am

PMP is like PBL. We had to answer three sets of questions based on cases given.

The exam was six days ago, I could not quite recall the exact questions, though. If I'm not mistaken, the first question was about Diabetes Mellitus.

There's this one question asking about 8 signs that you might want to look for, regarding the patient's long-standing DM. In other words, the complications of Diabetes Mellitus.

I mentioned about signs of Diabetic Retinopathy, Neuropathy, Nephropathy and Infections. That's all I could think of.

Then, the question asked about the modifiable and non-modifiable rick factors of DM, advice you would like to give to the patient and a few more.  

Second set of question involved Hepatitis/Chronic Liver Disease/Hepatic Encephalopathy.

Remember this pakcik?

Last one was on Rhematoid Arthritis. That reminded me of this makcik, seriously.

Z deformity/Swan neck/Boutonniere deformities, Ulnar deviation, Palmar subluxation, Joint erythema/swelling, Palmar erythema, Tinel's sign.... You have to remember those!  

2) OBA + MCQ @ 2.30-4.00pm

15 Multiple Choice Questions (MCQ) and 10 One Based Answers (OBA) were a bit tough. The questions were easy, but the answers.....not!!

This one question made me go... Wow. It was about the side effects of Anti-TB drugs! I totally forgot about those! Well, I did read about them, but I could not seem to remember.

Rifampin - Orange discoloration of urine, Hepatotoxicity
Ethambutol - Optic Neuritis (remember E for Eye!)
Streptomycin - Ototoxicity, Kidney damage, Skin complications
Pyrazinamide - Hepatotoxicity, Gout
Isoniazid - Hepatotoxicity, Peripheral neuropathy

Read more about them from reference here.

If you are so dedicated to answer past years questions, there's a few repeating questions asked like what are the causes of irregular pulse. (I was only sure about Atrial Fibrillation, the irregularly irregular pulse)

I did not do the senior's compilations much (with so little time and so much to read!), and now I kinda regret it. If only I was more hardworking back that time. 

And there's this question about the signs of hypothyroidism that made me smile.

You know why? The loss of outer third of eyebrows ;)

We had met this very similar-looking makcik before in the ward. The resemblance was amazing! :D 

The opposite of hypo, it's hyperthyroidism! 

Picture source: X'Press Revision in Short Cases, Aids to Undergraduate Medicine by Chew Nee Kong and Lim Kheng Seang. You can buy the book from Syarikat Kamal, KL.

Seriously I tell you, you should totally get this book as it is very very useful!

Wednesday, 21/11/12

1) LC with Dr. Yousuf Rathoor @ 9.00 - 11.00am

Long Case (LC) session was a bit hectic. I did not get my patient's diagnosis at first, since she came in with fever, sore throat, vomiting and diarrhea. I really thought it was a case of Acute Gastroenteritis. Pneumonia? But she had no cough.

On examination, there was no findings at all. I really wish she had bibasal crepitations at least. But she didn't. I thought she had mild splenomegaly?

I asked her whether had the doctors told her that she had big spleen, or she had lung infections of some sort? She said no.

I was like, Hmmm..... 

Half an hour before the time ended, she mentioned about her high glucose level on admission (it was 30 mmol/L), then I was like, that's it!! 

I asked her about polydipsia, polyuria and nocturia. Oh, it was Uncontrolled DM rupanya!

When I was busy constructing my sentences on paper, Dato' Sapari and housemen came to the patient for their round. I managed to hear Dato' mentioned that her lungs were clear and she told the makcik that she had acids collected in her body, due to her DM.

Oh, her diagnosis was Diabetic Ketoacidosis!

Dr.Yousuf came in to hear my case a bit late, so I had ample time to prepare and write my sentences carefully. I was thankful that I got an easy case to start with. 

I did okay in Long Case, I think.

2) SC with AP Dr. Khairul Azhar @ 11.15am

Well, I admit that I didn't do well in Short Case (SC). I was quite nervous, actually.

I had to examine a middle-aged Malay man with a 16cm sternotomy scar and 51cm scar from left leg up to thigh. On CVS examination, thrills were palpable at mitral area. First and second heart sounds were heard. No murmur. Other than thrills, no other significant findings were found.

What do you think this pakcik had?

I was not able to answer regarding his diagnosis, so I looked at his case file after the session finished. The diagnosis was Acute Coronary Syndrome.

By looking at his sternotomy scar, maybe this pakcik have had CABG or Valve Replacement before, and there might be recurrence of his heart problems. Ah, I should have think of that.

Here's a few tips when you have AP DKA as your examiner:
1) When you get a patient with scars, bring out our measuring tape and measure the scars!
2) Make sure you get your techniques right. Especially on how to do the Collapsing/Bounding Pulse!
3) Do not wait for doctor to ask you about your provisional diagnosis after you present the case, just mention them straight away! 

Since this was our first examination, we had a hard time adjusting. But I am sure we could do better next time. Once again, I'd like to wish you happy holidays!

Oh, and have a look at this:

Hehe ;)


  1. Assalamualaikum. Ini buku apa ye? Nampak best!

  2. Wslm. Buku X'Press Revision in Short Cases, Aids to Undergraduate Medicine by Chew Nee Kong and Lim Kheng Seang. Boleh beli kat Kamal Medical Bookstore.