Long Case Paed

7/29/2019 Long Case Paed

1/21

Long case Paed

Mohammad Faaizzin Jamaluddin

1. lecturers; Prof MTK, Prof Saw, Prof Ikram

2. specialty; Paediatric (haematology)

3. chief complaint

Abdominal discomfort

4. brief history

16yo boy presented with intermittent abdo discmfrt and mild scleral jaundice. Was diagnosed with

thalasaemia at 13yo and need mothly blood transfusion. Had prvious history of intermittent fever,

pale and jaundice and diagnosed with G6PD deficiency. Other systems were normal.

5. PE finding

Hepatosplenomegaly, scleral jaundice. delayed puberty ( pubic hair stage 1, penis stage2). Height

and weight equivalent to 50th centile of 11yo boy.

6. diagnosis

Thalsaemia minor or intermedia, with delayed puberty.

7. questions asked by lecturer

Pathophysiology of G6PD

Pathophysiology of thalasaemia

Diagnose type of thalasaemia from histry alone

Examination of blood transfusion complicationAssess severity of anaemia

Pubertal stage

Investigation

Fadya Nabiha

lecturer: prof kf Chin, Prof Rokiah panjang, prof mk.Thong

speciality:paed

chief complain: coming 4 exam..(ha3)

brief history: 2year 10 month old girl. early childhood got history of eczema on trunk, allergy to

seafood-uricaria...nocturnal symptoms, daytimel cant assess as pt woke at 10 a.m. exacerbation at 1

y/o-not interfere with sleep , activity n eat pn...x severe...4 months, refer to a&e PPUM -inhaler

fluticasone n sabutamol...basically assess pt control..1 year later, change to seretide n
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2/21

salbutamol...partially controlled asthma

p.E-harrison sulcus, hyeperinflated chest..wt at 50th centile, length 90th centile

diagnosis-partially control asthma

question:1. what is aerochamber, differentiate with nebuliser...name of d noisy machine..function

2.signs of severe asthma

3.allergy rash-

4.how to diagnosed asthma-prof thong want the bronchodilator test

5.why hyper resonance in astma, the name?-air trapping

about a week ago Report

Fadya Nabihalecturer: prof kf Chin, Prof Rokiah panjang, prof mk.Thong

speciality:paed



seafood-uricaria...nocturnal symptoms, daytimel cant assess as pt woke at 10 a.m. exacerbation at 1

y/o-not interfere with sleep , activity n eat pn...x severe...4 months, refer to a&e PPUM -inhaler




diagnosis-partially control asthma

question:1. what is aerochamber, differentiate with nebuliser...name of d noisy machine..function


3.allergy rash-


5.why hyper resonance in astma, the name?-air trappingabout a week ago Report

Michelle Low
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3/21

Lecturers: Prof. Philip Poi (keep texting and jotting)

Dr. Cheah xx (external Paeds Consultant)

Prof Dharmendra (funny position)

Specialty : Paediatric

Chief complaint: breakthrough seizure

Brief History : 12 year-old Indian girl who has background history of Epilepsy since 9 months old,

on Epilin, carbamazepine, and ADHD on Ritalin, presented with breaktrough seizure. Compliance

problem, average student, attain menarche at 11 year-old, strong family history of Epilepsy, able to

join school activities...BMI 22.9

I forgot to take developmental history and Diet hx!

p/e: Demonstrate hyperreflexia on UL and presence of nystagmus.

Diagnosis : Breakthrough seizure

Questions

1. What physical signs would you like to show us to suggest to you that recurrent seizure is familial?

-neurocutaneous sign; what cutaneous sign? - cafe au lait, ash leaf sign, and sebaceous adenoma?

(tuberous sclerosis); what is the significance of cafe au lait- Neurofibromatosis ; what is the nerve

root of biceps?

2. How to monitor compliance besides asking history? - monitor drug serum level, which one?....

3. Are you satisfy with the current drug dosage? why? - puberty, side effect,

4. Pertaining to BMI... relation to drug...side efffect, must ask dietary history to rule out lifestyle

causes...

5. causes of pathological jaundice - ABO incompatibility, rhesus, g6pd

6. Since she is having multiple seizures despite on medication, based on p/e, are you happy with the

current drug pescription? how would you do? - investigate to rule out CNS pathology

Aidy Azuan Afifi

(patient same as fadya)

lecturer: prof kf Chin, Prof Rokiah panjang, prof mk.Thong
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4/21

speciality:paed



seafood-uricaria...nocturnal symptoms, daytimel cant assess as pt woke at 10 a.m. exacerbation at 1y/o-not interfere with sleep , activity n eat pn...x severe...4 months, refer to a&e PPUM -inhaler




diagnosis- control asthma

question:

1. what is aerochamber, differentiate with nebuliser.

2. ask about immunization schedule



5.advice to mother: 1st i tell about how to control asthma, the prof rokiah ask any advice regarding

developing eczema......(she want answer about avoid detergent)

6. ask what u can see in chronic asthma.... i jwb growth problem.... then he ask about the the chest, i

answer increase AP diameter n hyperinflanted lung....., he want chest deformity....


Hwang Ing Siong

MBBS(Malaya) 06/11 Final Exam Data Store

Hwang Ing Siong

1. lecturers who took u

external caucasian (sur), chan lee lee (paed), nik sharina? (pcm)

2. specialty

Surgery

3. chief complaint

gradual abdominal distention 1 month
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5/21

4. brief history

53/c/gentleman,underlying colon ca (caecal), c/o 1 month gradual abdominal distention, 2 weeks

lower abdominal pain, vomiting 2 days prior to admission.

pshx:acute appendicectomy find out to be malignant tumour. Thus, a midline open laparotomy

done. 12 cycle chemo. 2nd CT scan revealed stage 4.

5. PE finding

anaemia, scars, peritoneal drainage, ascites.

6. diagnosis

IO secondary to colon ca


- PE: show incisional hernia. do abdominal examination.

- in the room: investigations, what iv fluids chosen, electrolytes imbalance of vomiting. show

abdomen CT->small bowel obstruction and ascites, ix of acute IO, ix of ascites


Hapsah Aripin

1. lecturers:prof wan ariffin, prof bk lim, dr kl ng, dr chew

2. specialty:paediatric

3. chief complaint: electively come for exam

4. brief hx: 8y/o, malay, boy

Down's syndrome with congenital heart ds at birth..but the heart ds disappeared at 5month

old...has global developmental delay..diagnosed with epilepsy last year n admitted

twice..then,treated with lamotrigine. Other than that, he was also diagnosed with fatty liver.

PE:features of down's syndrome, short stature, other systems were normal, DA delay (ht n HOC

below 3rd centile, wt at 3rd centile- but he want me to said correspond to what age)

5. Question:

-what do u think the causes of cong ht ds in his case?PDA, small VSD-how do u diag down's syndrome antenatally?US-nuchal thickening, amniocentesis-chromosomal

study, he mentioned about 1 more test but i don't know

-problems a/w down's syndrome..all in sunflower book

-how duodenal atresia present in utero n after birth?polyhydramnios n bilious vomiting 2-3 hours

after feeding

-how long u want to treat pt with antiepileptic?until 2 years seizure free period
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6/21

-what is d name of association for Down's syndrome in M'sia? Down Syndrome Association of

Malaysia..

-what is d mx u want to do after diagn d pt having down's syndrome?genetic counselling, check

other ass prob such as hypothyroid

-what do u want to tell parents to ease their burden taking care of down's synd child? they want d

tve side of down's syndrome?they are adorable n funny-write the genetic for this pt's chromosome...47 XY

-did u explore the mother's understanding about down's syndrome?i didn't but shoudl do

-why do u think d pt is short?hypothyroid

-pt hv hypopigmented spot above the eye, is it significant since pt is also having seizure n down's

syndrome?i said yes..he asked what term can we use to classify it?i dunno, maybe neurocutaneous

sign kot

-can u classify this pt's IQ?moderate-severe

do u think he has bad down's syndrome?no becauce he doesn't hv any serious illness like tumour

Lia Lea

1. lecturers

Prof Lucy(Paeds)

Prof Mary Ann (external from United States-O&G)

Prof Sajar (PCM)

2. specialty : Paeds

3. chief complaint: nil

4. brief hx

3 y/o, malay, boy

diagnosed to hv Down syndrome, immediately after birth

together with PDA

h/o recurrent chest infection and admission to the ward

newly diagnosed to have hypothyroidism after presented with constipation

5. PE

all signs of down syndrome

developmental delayed

resolved PDA

6. dx: downs syndrome with hypothyroidsm


7/21

7. question asked:

-as he is having recurrent chest infection, they asked about asthma sx n med a bit

-hx of last admission: more detailed

-comment on development

-other sx of hypothyroidism-bring to patient: show signs of down syndrome

- do DA in front of prof

-go back to examiner room again:

-asked to how to dx down syndrome antenatally

-comment on growth chart: why weight not really affected, but height is affected: answer he's

having hypothyroidism, apetite good but short stature

-how to assess response to thyroxine, as he having hypothroidism

-i answer, then immediately, bell rings....finito


Nor Atifah

examiner: prof cheah, prof azhar, prof CT Tan

speciality: paediatric!

17y/male.known case of thal major since 2 years old. regular BT, desferal, vit c. also on testosterone

n thyroxine( miss these!!).

Q: how u want to ask about effort tolerance in ptnt..?

2) PE: assess growth. ptnt is short. how u know? assess thyroid fx, secondary sex characteristic.

3) Ix. explain about finding in Hb electrophoresis.

4) what is the mode of inheritance for thal.

last Monday

Zarith Natasha
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8/21

1. lecturers who took uprof wan ariffin

prof saw aik

Dr (external)

2. specialtypaeds

3. chief complaint

generalised edema 1 week prior to day of admission

4. brief history

generalised edema x 1 week- periorbital edema, ascites, UL & LL swelling, labia majora

swelling. associated with diarrhoea x 3days.

no sob,no chest pain, no jaundice, no fever no URTI symptoms.

PU-normal.

admitted to ummc for 2 weeks treated with steroid and albumin. achieve remission and

discharged. then after one week, patient came for follow up-develop abdominal distention-

re admitted.

5. PE finding

currently well.no edema.

6. diagnosis

steroid dependence nephrotic syndrome


-what is ur provisional diagnosis? and y?

-what are the differential diagnosis? -cardiac,liver failure

-do u think this patient is likely to have cardiac/ liver failure? - no, cause no symptoms

suggesting cardiac or liver failure.

-what is the correlation btw edema(in nephrotic) with diarrhoea?

-what is the pathophysiology of edema in nephrotic syndrome and cardiac failure? oncotic

pressure in nephrotic whereas in cardiac failure there will be increased hydrostatic

pressure.

-what other local causes of swelling? in the LL? - DVT cellulitis? in stroke patient? -

immobility.

went to patient's bed-where and how do u check for edema?

pitting edema in LL, shifting dullness, respiratory for pleural effusion.

others like periorbital edema, genital swelling and sacral edema.


9/21

back to discussion room:

-what diagnostic ix?

-what are the diagnostic criteria for nephrotic?

-what is the significance of creatinine to protein ratio?

-what autoimmune condition can lead to nephrotic?- SLE, IgA nephropathy in children

-discuss management-what are the indications to start on albumin-hypotensive.other than that? (i dont know)

-do u think this patient is steroid resistant. i said no. but prof wan gave me the 'are u sure?'

look.

-what advice would you give to the parents? - compliance to drug. diet control.

-what are the acute side effects of steroid? infection... ring!!!

Azzah Aris

examiner: prof mary, dr nuguelis, external

specialty: paeds.

2yrs/malay/boy. came with cough 2m ago. just newly diagnosed asthma 1m ago.

PE: no positive finding. dis child so irritable. cant do anything!

Q:

1. how to diagnose asthma (used bronchodilator relieved or not?)

2.PE: whut is harison sulcus? in what situation u see clubbing? where to look for eczema, in severe

asthma what u want to look for? (she want growth. so dun forget to plot chart)

3. if patient take steroid, did he will get cushing? what SE of steroid?

4. if patient have uncontrolled asthma, what u want to do? (asses compliance, mother know to used

chamber or not, add another drugs)

5. what investigation u want to do?

5.


10/21

Siew Li

1. lecturers who took u ( Prof Mary , external, Dr Nuguelis )

2. specialty ( paediatrics)

3. chief complaint- 23 months old Malay boy, diagnosed bronchial asthma 1 month + ago,

currently asymptomatic, on Ventolin and Flixotide

4. brief history

23 months old Malay boy, initially presented with runny nose, cough and post tussive

vomiting( green sputum), no fever for 1 week, a/w wheezing. Family member no URTI sx,

no hx of foreign body ingestion, no fever. Turns blue during attach, increased rate of

breathing, with intercostal recession, still can say mama, worst during morning and

nightime. No personal atopy history. Uncle on paternal side had asthma. Both parent and

only sister dun have. started on Ventolin and Flixotide, 2nd attack on 3 weeks ago. Same

presentation.

5. PE finding

- no respiratory distress: nasal flaring, looks pink, 100bpm, 24breaths/min

- growth : wt btw 25 - 50th centiles, height 3rd centile

- no eczema over NECK, FLEXOR

- chest: increased AP diameter, hyperinflated lung, harrison's sulcus, hepatomegaly 2 FB.

6. diagnosis- poorly controlled asthma


1) what is the occupation of the father? ( sorry prof, i forgot to ask)...:(

2) what is the importance of the type of transportation particularly in this patient? ( during

exacerbation, how fast can be sent to hospital?)

3) PE: - show me signs of respiratory distress, any growth failure( show growth chart), do

chest examination, what is harrison sulcus? where to look for eczema in this patient?

4) how to u convince that he had asthma in the first presentation?

5) what test u want to do?( FBC, RFT, CXR) what r u looking for in CXR?( she wants

foreign body). How the CXR looks like if there is foreign body?

6) how to manage chronic asthma?( patient education, father quit smoking, asthma action

plan, wash bed sheet avoid dust mite, avoid precipitating factors)

7) let say patient only on Ventolin, what would u do in his follow up in clinic?( any

indications of prophylaxis?)

8) if patient's mother said that she had learnt from internet that steroid has side effect, how

would u tell the mother? what r the side effects of systemic steroids?


11/21

9) if patient came in with acute exacerbation, how would u assess the severity of the patient?

That's all i think! A

Ong Yen-Yeung

1)Lecturer: Prof CT Lim, A/P Sofiah, Prof Azad

2)Specialty : Paediatrics loalways....as predicted...haiz

3) Brief history:20y/o Malay "gentleman"(he looks like 10-12 only), known case of Betathalassaemia major diagnosed 19 years ago, on monthly transfusion, S/c desferrioxamine,no active

chief complaint.Strong family history of B-thal.

Was diagnosed when he presented with pallor,lethargy(no jaundice) during 7 months

old.Hospitalized 5 days, transfused.

Last trasfused 2 weeks ago.

Pre-transfused HB:5g/dL.Post-trasfused level: don't know.

Each time transfused 3-4 Pack red cell...

Currently a bit of lethargy. But no other symptoms of anaemia.

Not compliance to s/c desferrioxamine.Why?Lazy. Financial problem.Not experiencing any side

effects.

Serum ferritin level??last visit was told HIGH but doesn't know the value.

Last ECHO and ECG:according to him normal.

Infectiive screening negative.LFT, TFT, LH&FSH all donno. No biopsy done before.

No changes of voices yet. Noticed himself shorter than his peer.

No hypothyroid symptoms.No signs of cardiac failure.

Not on vitamin C!

Offered splenectomy due to increasing tranfusion but defaulted many years ago due to financialconstraint...

Family HX: both FAMA are carriers.Father DM,HPT. Eldest sister also B-thal major requiring

monthly transfusion,on s/c desf. Youngest brother carrier.

Social: Not working,not studying(said due to illness). Below average student. Failed all his SPM

subjects.Hobbies: amazingly stilll can play sepak takraw, football post transfusion.stayed at


12/21

PJ.Come with Bus. Mother is the only breadwinner. Father not working(ill).smokes 2 stick/day. no

high risk behaviour.

4)PE:look darker, no frontal bossing, maxillary prominent.

short stature: height: 146cm corresponding to 50% of 12 year old....(Prof CT Lim expect me to plot

on growth chart leh...even though he is 20 years old!so plot on 18 y/o and extrapolate la...)below 3rdcentile!

palmar pallor, scleral jaundice, conjunctiva pallor, tongue also pale.

Hepatomegaly(13.5cm=7-8FB)...(show how to measure: tell all the 5 stars of liver:size, tenderness,

pulsatility, consistency-firm, surface, border)

Here i did a stupid mistake:what i thought was spleen was actually the left lobe of liver...DIE...

His spleen was pushed to the very lateral site...+splenomegaly...

I checked the s/c injection site at the right tigh but forget to present

Tanner staging: P0 no pubic hair at all,G0..balls not big gua.

Fasting plasma glucose:4.7mmol/L. Urine:dark-colourred, a bit reddish...small volume...

Here I did the urine dipstick...(very kelam kabut without wearing gloves...and did not manage to

present but able to describe the urine la)

5)Diagnosis: beta-thalassaemia major, complicated with hypopituitarism(?) with non-compliancy to

s/c desf.

6)Goreng time

-What do you think about the complexion of patient(darker lo)what is it called?start with

"H"(haemachromatosis?not sure)

-Why did the patient do ECHO?-Patient's pre-transfusion level: 5g/L, are u happy with that?

-So what is the normal pre-transfusion level that we want...

-What is hypertransfusion and what is the level....Why hypertransfuse the patient?

-If he is presented to you when he was 7 months old, how do you diagnose?

FBC-anaemia, hypochrom microcytic anaemia

PBF-look for what..

what is the differential diagnosis pertaining to this kind of picture?

-Do you know how to differentiate it?(yeah...MCV/RBC...dont know what name, but the cut off

point is 15) no need to calculate la...

-what else-i said ady serum electrophoresis but he want: HB electrophoresis

-Look for what?

-what else:baseline serum iron, ferritin, LFT....

RING RING~~


13/21

Yeo Siang Yew

1. lecturers who took u: Prof wan arrifin, Prof saw aik, external-dr chann

2. specialtypaeds...

3. chief complaint: 3 years old malay girl was admitted due to unresolved nephrotic sysdrome sincelast week.. (second admission)

4. brief history :

Problem 1: 1st admission- noted to have facial puffiness and periobital swelling progressively

worsening, and more severe in the morning. no history of URTI, urnation and bowel openings were

normal. admited to ward for management and discharged two weeks later. after

2nd admission: after 1 week post discharge, noted still having ascites and was referred from

paediatric clinic. first day of admision, urine dipstick still Trace, but O trace on 2nd day of

admission. Currently, the swelling was resolved, no periobital, abdomen and ankle swelling. No

SOB.

Problems 2: Missed 18th months' vaccine, DPT, Polio.

5. PE finding: no significant findings. NO SWELLING!!!Lung clear, cvs normal, no organomegaly,

no ascites.

6. diagnosis: Steroid sensitive NS currently on remission


1. Miss immunisation, how will you do?

2. How many type of vaccine?in this case, will you gv now? (hint: immunesuppressed due to NS or

on Steroid) - live, attenuated, died3.other differentials in a child with swelling?

4. Pathophysiology of swelling - from anatomical parts to ascites!!

5. what are the structures involve in leaking?

6. criteria for NS, value, - as he asked other test that you want do in this patient

7. Steroid complications,signs, symptoms in this child which can happend

8. bed side urine dipstick result

9. what is the status of this child now?

10. course of NS

last Tuesda


14/21

Huang Bao Xian

1. lecturers who took u- Prof Wan Ariffin, Prof Kamarulzaman, Ext (Respi), all of them are very

gentleman!

2. specialty-Paeds

3. chief complaint- fever, cough, SOB and noisy breathing

4. brief history- elaboration on chief complaint, patient also had CTEV, prolonged NNJ

5. PE finding- hyperinflated chest, prolonged exp phase, rhonchi, fine insp crep...

6. diagnosis- Acute bronchiolitis


- what do u think is the cause of the prolonged NNJ?

- what is ur provisional diagnosis?

- ur diffrential? why u think is not asthma?

- tell me sth abt CTEV?

-why patient had to change cast regularly?

- what is the grade of CTEV?

- what is the operation about?

- how do u differentiate a pathological liver from liver ptosis?

- common places for eczema.

- what investigation u would like to do?

- do u think u will do these investigations?

- what u can see in CXR?- what u will see in renal profile? what is SIADH?

- what is the prognosis of pt?

- what u will tell the parents if u said the prognosis is good?

- what vaccine?

- what is the most common aetilogical factor?

- when is the common season?

- other aetiological agent?

- among all these agents, which one cause most morbidity to patient?

- how type 1 repiratory failure become type 2?

- how u manage type 2 RF?

- what is the site u take ABG?

last Tuesday


15/21

Chai Jia-Ning

1. lecturers who took u: Prof Chan Lee Lee [Paediatric department], Prof Woo [O&G] and one

more forgot already.. XD

2. specialty - Paediatric [Respiratory]

3. chief complaint - 8 year old malay girl. Here for exam. Underlying Bronchial Asthma (BA)

4. brief history

Diagnosed at 6 year old during a BA attack. Defaulted follow up and treatment. 6 march 2011,

hospital admission due to an acute attack with shortness of breath, lethargy, talking in phrases,

fever, cough, vomiting. Discharged with oral prednisolone, MDI ventolin, MDI serotide.

+ eczema + allergy rhinitis + allergy conjunctivitis

No known food or drug allergy.

Father smoker, mother BA & allergy to seafood. Brother no atopy.

School performance excellent, but not good in sports (shortness of breath, chest tightness)

5. PE finding - growth normal. Vital sign stable. Harrison sulcus, loss of liver dullness. Chest clear.

abdominal skin & lower limb + eczema.

6. diagnosis

- BA

7. questions asked by lecturer (all by Prof Chan)

- Occupation of parents? (sorry I didn't ask)

- How do you diagnose BA? (clinically) (Prof nodded)

- During her first presentation, how would you come to the diagnosis of BA? (long history of

noctunal cough, atopy march, family history of atopy, clinically marked improvement with

nebulizer bla bla)

- Development milestone, she is 8 year old now, how do you assess? (whether she did well in school,

physically active/ active in sport) (Prof nodded)

- What is BA? (reversible obstructive airway disease)- [Bring to bedside] What physical signs you want to look for in this patient with history of 2 years

BA? (Growth, harrison sulcus, chest wall deformities, signs of eczema, signs cushing syndrome)

- What type of chest wall deformities you would expect in this patient? (Barrel chest because of air

trapping)

- Clinically how would you know whether there is any air trapping? (percussion, showed examiner.

hepatic ptosis)

- What causes Harrison sulcus? (chest wall indentation at insertion of diaphragm, due to


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underlying chronic lung disease)

- Why growth is very important in this patient? What would you look for? (stunted growth, as

frequent exacerbation will cause poor lung function) (Prof nodded)

- [back to room] What investigation would you do during her first attack back in 2009? Reasons.

(FBC and CXR, not further more Prof needed. Offered lung function test, she disagreed)

- Why a CXR at first attack is important? (to ruled out other conditions that can mimic asthma)- What condition mimics BA at age of 6? (pneumonia. Prof prompted:" other conditions that will

give generalized wheezing and shortness of breath") (foreign body, mediastinal mass, bilateral

lyphadenopathy that compressed on air way)

- Where will the foreign body usuallty lodge? at what level? (bronchus, at right - anatomy as right

bronchus is more vertical compared to left.)

- After acute management, how would you manage this patient? Who should be started on

preventive treatment?

- How do you assess the severity of attack?

- How do you assess control of disease?

(answer of last 3 questions can be found in GINA guidelines, so dry)

last Tuesday Report

Heah Sooches

Please present your long case following this format.

1. lecturers who took u: MT Koh (paed), Prof Pan (ortho)-external and Prof Singh(o and G)-

External:

2. Specialty: Alreally mention

3. chief complaint: Coming for Routine f/U at Paed clinic

4. brief history : 14 yo Chinese boy with the history of type 1 Dm.

HE was apparently well until 2 years ago he presented with polyuria, polydipsia ,polyphagia,

nocturia and lethargy. He had a good control of his DM. Never admit due to hypoglycaemiaattack..Actually, he had no much of problems and no complications.

His is a GOOD HISTORIAN and he had come for exam b4..

Ur history muz had a complete with the How he was diagnose, where and when..Advice given by

dr...Medication he took(INSULIN) muz mention everything who inject, when and where he inject,

compliance..any complication d2 to the dz..

Social history vry imp..Muz hv( His teacher and student noe about?? And muz ask travel history)
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5. PE finding..No much..Juz he had lipohypertrophy at the inject site( Bilateral lateral aspect of

UL)

6. diagnosis

7. questions asked by lecturer.-other history u need to ask according Hyperphagia? (he want to noe izit the pt put on many weight

or not?

-Travel history-why imp..(Miss the meal and injection...More imp is how he store the insulin)

-PE, what u want to check..(Height, weight, fundoscopy, hepatomegaly, testis, sensation,vibration,

hyporeflexia and pulse and dont forget Urine DIpstick)

-What u look for by fundoscopy( describe about preproliferative, proliferative and maculopathy)

-what the reflex u think he ll get( Hyporeflexia)...Show me how u do test the reflex..

-inteprete the result of urine dipstick

- when every time he come to clinic for f/L..What laboratory test u want to do? (FBS, HbA1c..Tell

me the level he need to achieve-(I said previously is 6.5% but now bcome 7% dt more of them ll

tend to get hypoglycaemia).THANKS to SHAREN coz telling the ans to me B4 that..HAHA

-Liver fx test..What liver enzyme u want to look for ( ALT, AST, ALP and 1 more ..i forget liao but

prof MT KOH start with G so finally I said GGT)

RingSSSSSSSSS..Yeah can relieve liao..prof MT koh like ok saja but i x sure he ll b silet killer

again boh..So..Muz pray Hard..Hopefully can PASSSS...hehe

Bender Fry

Same case with Sairy.


Prof Cheah (Paeds External), Prof KJ Goh (Medicine), Prof Azlina (Ortho)

2. specialty

Paeds

3. 17 year old boy (appeared like 10 years old), no chief complaint,well

4. brief history

Thin, short and low body weight till now

Birth - Failure to thrive without reason being identified, under follow up at private hospital. Born

via SVD at term with 2.73kg, no significant perinatal history

3 months old - Pneumonia, 6 days of hospitalization, no complication.

8 years old - Multiple episodes of abdominal pain after eating oily food, steatorrhoea. Referred to


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UMMC for sweat test, positive. U/S of abdomen, CXR (scarring), and liver biopsy (liver cirrhosis)

done.

9 years old - Dark and foul smelling stools for 2 days. An episode of haematemesis with multiple

huge blood clot. Hospitalised for OGDS and rubber banding.

10 years old - Started to have thick yellowish green sputum produced every morning, no fever.

15 years old - Easy bruising and epistaxis.Currently under f/up at UMMC, everyday on Vit. A,D,E,K, Pancreatin (Creon) 17 tabs, nebuliser,

chest physio, and acapella. Antibiotic tuning was done annually and oesophageal banding was done

once in 2 years.

No PMH, PSH, FHx of CF or liver cirrhosis.

5. PE finding (only positive findings)

Anthropometric chart - both height and weight are far below 3rd centile

General appearance-thin

Finger clubbing, leuconychia, absence of moustache, beard, axillary hair,pubic hair

Distended abdomen, flat umbilicus, spenomegaly (10cm below costal margin).

6. diagnosis

Cystic fibrosis with liver cirrhosis and malabsorption for 9 years

7. questions asked by lecturer (Prof Cheah keeps leading me to the answer he wants, I am like a fish

chasing the bait.. T.T)

History

- what other aspect u shud consider other than academic performance? sport

PE

- Show me how u do nutritional assessment. Does he look like a 17 year old boy? No,why? Do you

plot the growth chart? What do expect his height if he is normal?Back to room

- During the follow up, what will you do to assess his condition? By symptoms(steatorrhoea),

weight, LFT.

- Tell me the features of decompensated liver failure. Do u think he is having decompendated liver

failure? No,why?

- Why he has oesophageal varices? What other parts of body u can find portosystemic shunts? How

will u treat portosystemic shunts?

- Other than pancreatic insufficiency and malabsorption in CF, what other features u know? What

is bronchiectasis? Tell me how u diagnose. What will you do to investigate? Why u think the

sputum is yellowish green? What will u do for the sputum? What organism u expect to discover?

Tell me the features of pseudomonas lung infection in CF patient,something like that..I responded it

by showing SHOCK expression,zzZZ..

- This treatment is not used in Malaysia, if the bronchiectasis persists, what is the final treatment

for the pt? Lung transplantation gua...

P/S: I was in denial when getting this patient..but trying hard to get it through..hope examiners will

be considerate after seeing my petrified face and stupor. Was damn embarrassed and amusing as I


19/21

accidentally spoke "plancental insufficiency" instead of "pancreatic insufficiency",huhu.. Good

luck everyone! ^^

sheilaizrin

1. lecturers who took u: prof boey (paeds, main examiner), prof chee(cardio medicine), prof mary

ann(external O&G)

2. specialty: PAEDIATRICS

3. chief complaint: 2y/o girl. fever and 1 episode of seizure

4. brief history: fever 1 day, seizure 1 time 5 min. other normal.

5. PE finding: normal. DA normal

6. diagnosis: simple febrile seizure

7. questions asked by lecturer: differentials, how would you exclude.

bedside: child's asleep so present findings. what would you look for, how to do kernigs and

brudzinki's. what would you look for before ensure mother that this is simple febrile fit.

back in room: what investigation. take consent for lumbar puncture. what would you look for in

lumbar puncture. how would you advise mother for another seizure. management of status

epilepticus.

last Tuesday Report

Karen Koey HueyLing
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20/21

Karen KHL

1. lecturers who took u: prof honey (paeds, main examiner), prof Rokiah Ismail, ?? external

specialty: PAEDIATRICS

3. chief complaint: 5 months old, prolonged jaundice from birth

4. brief history: prolonged jaundice, pale stool, tea colored urine, Stage 4 VUR, biliary atresia

negative

5. PE finding: Hepatospleenomegaly. 4cm liver, 6cm spleen. DA normal

6. diagnosis: prolonged jaundice secondary to UTI? TORCHES? NEonatal hepatitis

7. questions asked by lecturer:

- normal value of bilirubin

- differentials

- Define TORCHES

- What is HIDA? findings in biliary atresia

bedside: child's asleep so present findings. abdomen examination. what syndrome present with

obstructive jaundice pisture ( I know is Alagille, but don't dare to answer cos forgot the features!)

back in room:

- what can ultrasound show?

- what is findings of liver in biliary atresia

then Prof Rokiah's turn. ( Let us back to basic)

- What is the histopathology of liver in this case?

- cirrhosis? What type of pathology u expect ( she wants MACRO/ MICRO)

-what advice will you give to the parents.

Ebner Yoon


prof philip poi, prof cheah (UKM PAED) and perak prof


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2. specialty paed

3. chief complaint periorbital swelling

4. brief historyshort history 2 days hx of periorbital swelling with abd and leg swelling, no scrotal swelling

5. PE finding. super well n playful boy.... outpt actually, currently in remission without proteinuria

6. diagnosis nephrotic syn

Documents

Long Case Paed