pallor&lethargy

ahmad,5 years old boy come to the clinic due to PALLOR and LETHARGY.Below are the result of investigation:

colour of urine sample

urine FEME -->

pus cell & RBC –nil,
epithelial cell - <5/ul,>

question

i-Comment about the appearance of the urine (2m)

ii- What are the most likely substance responsible for (i) (4m)

iii- 2 relevant questions to be asked on patient’s arrival (4m)

iv- 2 clinical conditions that can give rise to these findings (4m)

v- 3 other relevant investigations & state the expected result (6m)

p/s:sorry!answers are not provided

Identification data - Anterior neck swelling

70 years old, lady, complained of difficulty in swallowing and shortness of breath for the past 5 months with an anterior neck swelling for the past 20 years. 5 months ago she notice that the swelling starts to grow more rapidly compared to previous years. Patient also complains of hoarseness of voice, loss of appetite, loss of weight roughly around 6 kg and pain at the swelling.

a) State the abnormality seen in this photograph.

b) State FOUR (4) clinical signs you would want to elicit in this patient.

c) State TWO (2) tests to assess the anatomical origin of the swelling.

d) State the most likely diagnosis.

e) Explain the cause of hoarseness of voice in this patient.

f) List THREE (3) investigations you would like to do and give reason for each.

g) Patient had undergone total thyrodectomy the next day. what you would like to prescribe for patient post-op

The answers:-

a) bilateral anteror neck swelling

b) Fine tremor

Lid lag

Lid retraction

Exopthalmus

Fine tremor

Brisk reflex

Tachycardia

Clubbing (thyroid acropatchy)

Carotid bruit

Stridor

Raised BP

c) Tongue protrusion test

Swallowing test

d) Thyroid ca secondary to long standing MNG

e) Compression of recurrent laryngeal nerve from vagus nerve

f) Thyroid function test - to assess thyroid status

FBC - to asess anemia

ECG - hyperthyroid may cause arrythmia

Neck X-Ray - To assess retrosternal extension

CT scan - to assess extension of thyroid mass

FNAC of swelling - To confirm thyroid ca

g) L-thyroxine

Calcium gluconate

Vitamin D supplement

identification data-schizophrenia

Patient, is an ex-businessman, had history of hearing voices for 12 months, associated with loss of interest in his previous hobbies and disorganized behavior. 6 months prior to admission, he was presented with weird sustained posture, like in the above picture.

1. Name the posture in the picture above.
waxy flexibility/catalepsy


2. What is the most possible full diagnosis based on the history and finding.
schizophrenia with subtype catatonic


3. List the 5 criteria for the diagnosis from the question 2.
major symptom during 1month period,2 or more
i)delusion
ii)hallucination
iii)catatonic or disorganized behavior
iv)disorganized speech
v)negative symptoms


4. Give the medication you to prescribe on this patient.
atypical=clozapine,risperidone,olanzapine
typical =chlorpromazine,haloperidol,thioridazine,flupentixol


5. What is the difference between atypical and typical medication for the above diagnosis.
typical=better treating positive than negative symptom
s/e extrapyramidal symptoms,neuroleptic malignant syndrome,tardive dyskinesia

atypical=better at treating negative symptoms
=lower incidence of extrapyramidal symptom

trial id

berikut adalah soalan trial ID yang disediakan oleh pihak PSP.

1. ID-epigastric pain
2. ID-chest pain
3. ID-sob,cough,frothy sputum
4. ID-left forearm deformity
5. ID-anterior neck swelling

soalan 6 & 7 akan menyusul kemudian,harap bersabar=p

p/s:exco pengangkutan dan tugas-tugas khas PNM,kerja tak siap,nanti timbalan pengarah marah!!

identification data - shortness of breath,cough,frothy sputum

Soalan 3
a 63 year old lady presented with shortness of breath and cough with frothy sputum.

On examination she has displaced heart beat and bibasal crepitations. She was diagnosed as a hypertensive since 15 years ago but defaulted treatment.

You are shown her chest radiograph

sate 2 abnormalities seen in the radiograph

Loss of costophrenic angle
Increase cardio-thoracic ratio (cardiomegaly)
Increase pulmonary vascular markings

State the most likely diagnosis

Pulmonary oedema

Briefly explain how hypertension lead to this patient’s condition

Hypertension → increase systemic pressure → heart need to pump harder to overcome the resistance → left heart failure → congested flow → extravasation of pulmonary vessels → pulmonary oedema

State 2 complication to diagnosis above

End organ failure (sbb heart cannot pump out blood, tak cukup blood supply keorgan2, organ failure)
Cardiogenic shock

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p/s: gmbar xray ni bukan 100% sama tp lebih kurang sama dgn id trial hr tu.
maaf sbb lambat post

Identification data- severe left forearm pain together with deformity

A 75 year old postmenopausal lady presented to Casualty with severe left forearm pain together with deformity. She gave history of falling down while she was having a shower at home.

You are shown a radiograph of the patient's hand.

(a) Name the deformity shown in the radiograph

Dinner fork deformity

(b) State the name of this fracture

Colles fracture.. (zass snappp prappp.. aku x tau pun)

(c) State TWO(2) possible complications that might occur in this patient

• Nerve injury
• Vessel injury
• Malunion

(d) Outline the general principles of management of the fracture

• Reduction
• Hold
• Immobilization

"Allah Taala saja Berkuasa.. Makhluk LANGSUNG xde kuasa.. siapa makhluk?? Selain Allah, SEMUA makhluk..."

p/s: macam nak meletup dengar jawapan2 macam ini... ish3xx.. aku xde gambar promotion eh jack,, nnt aku carikan..

Identification Data-Chest pain

A 40 year old, male, teacher came to the casualty department complaining of chest pain, sudden onset radiating to left shoulder and jaw. He also had a history of being unable to lie flat and shortness of breath after walking for a few steps.


a. State one (1) abnormality of the ST segment shown in the ECG recording
St elevation- lead III, aVF, V3, V4, V5
ST depression- aVL

b. State one (1) other abnormality of the ECG recording shown
Deep Q wave at lead III

c. State the most likely diagnosis
Acute Myocardial Infarction

d. List two (2) other relevant investigations you would do and state your reason

Plasma biochemical marker - to detect any rise in the plasma concentration of enzyme and protein that are normally concentrated within cardiac cells. (in MI- rise in CK-MB, Troponin T and I)

Echocardiography- to check cardiac function and detecting important complication (e.g mural thrombus, cardiac rupture, VSD, mitral regurgitation, pericardial effusion)

~living well or living hell? Fighting for future!~

identification data-epigastric pain

A 60 years old malay male initially having history of epigastric pain for the past one year,reduced after taking male, and elevated when he skipped the meal.Patient refused to seek medical attention since he is tolerable with the pain,but patient realized the pain start worsen for the past few months.Patient also noted dark colour stool for the past two month.Currently,came to the emergency department with acute abdominal pain and broad like rigidity.

please interprete the chest x-ray

• present of gas underneath bilateral hemidiaphragm
• CTR:0.5
• poor lung inflation-the 5th passing the hemidiaphragm midpoint

give the possible diagnosis at this stage
perforated peptic ulcer

list the possible investigation

• endoscopy
• full blood count
• blood urea and serum electrolyte
• urease test
• ABG

p/s;all answers were provided by kak zahid,exco kebajikan