So for you geeks, here are the questions asked by Mr.Nazli and Mr.Khadri. During session with Mr.Nazli, he was more like a teacher than an examiner. I like him! And Mr.Khadri, I used to be scared of him. But he was actually okay! Please let me have a PASS, doctors! I dont ask much, just a pass will do.
LONG CASE: Acute gastritis
Examiner: Mr. Nazli
Naga, 68 year old Indian man with no underlying medical illness, admitted two days ago, presented with 2 weeks history of epigastric pain associated with loss of appetite. The pain was sudden in onset, intermittent in nature, pain score 6/10, radiated to lower abdomen, relieved by lying flat, aggravated by food.
No other associated gastrointestinal symptoms like nausea, vomiting, hematemesis, melena, heartburn, dysphagia. No other respiratory, cardiovascular or hepatobilary symptoms.
He had similar episodes of epigastric pain two years ago, but milder. Went to KK, OGDS and colonoscopy were done. The result revealed inflammation of gastric lining. He was given medications and he took them daily for one year. The pain resolved after one year, but now he presented with worsening epigastric pain.
He did not smoke or drink alcohol, no history of taking NSAIDs and no family history of gastritis or malignancy.
On abdominal examination, tenderness at lower abdomen (right and left iliac fossa, hypogastric). PR was normal.
Questions (Most of them are Mr.Nazli's answers, not mine! Hahaha)
1. 5 differential diagnosis.
Gastritis, Gastric ulcer, Duodenal Ulcer, GERD, Bile reflux
2. Why diagnosis is Gastritis, not Peptic Ulcer?
Because there was no hematemesis or melena (ulcer causes bleeding). The patient also had history of gastritis and OGDS confirms the findings.
3. Difference between Gastric and Duodenal Ulcer.
Duodenal ulcer worsens when eating food. Patient drinks milk to relieve pain. Patient will have increased in weight.
4. Characteristic feature of GERD.
5. If this patient came with vomiting of blood, what are you thinking of?
Perforated gastric ulcer
6. How do you manage the patient?
Stabilize the patient, do blood investigations, stop the bleeding...
7. What should you do to stop the bleeding?
Operation. Do ERCP to treat the perforated part. Inject adrenaline.
8. What imaging would you do to confirm peritonitis?
Chest XRay to see air under diaphragm
9. If CLO test positive, what antibiotics would you give for Peptic Ulcer disease?
Triple therapy (Omeprazole, Clarithromycin, Amoxicillin)
SHORT CASE: Left Reducible Indirect Inguinal Hernia
Examiner: Mr. Khadri
Uncle Chinese presented with left groin swelling.
1. Inspect and do examination.
2. How do you do Occlusion Test? What are the two points?
ASIS and pubic tubercle. Put two/three fingers in the middle. After swelling reduced, ask patient to cough. If swelling is not prominent, it is indirect hernia. Occlusion test positive.
3. Your diagnosis.
Left reducible indirect inguinal hernia.
4. How do you manage this patient?
Do operation. Hernioplasty, where you reduce the inguinal content and put a mesh over it.
Thats all. Thank you.
WAAAAHHHH NOW THE EXAM IS FINALLY OVERRR, I HAVE ONE MONTH++ HOLIDAY BEFORE I AM GOING TO FOURTH YEAR!!!
SO MANY THINGS TO DO! I SHOULD PLAN MY HOLIDAY WELL!! :D
|I decide to be happy! :D|
|Everything happens for a reason.|
|The first to forget is the happiest!|
|Awwww... the royal baby is a BOYYY!!|
|Can I have a baby too? Hahahaha|
Yeahhh that's the spirit!!
Okayy. I'll be busy living my life!
See you later!
You take care!