Saturday, March 17, 2007
Oh dear, oh dear oh dear!!!! Did badly for the adult medicine case, I think. KT and I got the same case, and he came up with a radically-different - and much more sane - diagnosis than me. At least, he got to see the CXR. I didn't. I got asked a load of crap that I don't even know what they mean (some people need to learn how to ask questions properly). OK, you judge.
Elderly, obese man. Background history of VERY long-standing DM, HTN, hyperlipidaemia, CHD s/p CABG. Now presents with leg pain.
Immediate thoughts:
Claudication
DVT/cellulitis (less probable)
Rheumato case
NOW. Leg pain has been there for 15 years, radiates up to knee. A/w joint swelling, pain and redness. Background of chronic pain, pain comes on when NOT walking. Man on crutches. No SOB/CP/orthopnoea/PND. Pain "spread" to both hands in last 2 weeks. Otherwise unremarkable.
O/E: kinda cushingoid. No striae though, but bilateral basal creps. No active joint disease, and NO MORE INFORMATION. (wtf ... they can't even give us proper significant negatives?!?!?)
My DDx was that of RA. OMG OMG OMG. KT said CCF. I feel so sad now, it was a total mess. Got asked possible reason for Cushingoid appearance (steroid Rx for RA?), how DM will affect him (possibly the reason for his CHD and CABG) and how the RA will affect him (WTF?!?!?? I said pain, disability with tendon rupture etc but it wasn't what he wanted apparently. Then he asked the SAME question at the end, I was like, "I'm not too sure of what you're asking", and he said pain and disability!!!! Exophthalmos ++++++++++) Totally fucked up, fucked up, fucked up.
On the bright side, I think I did pretty well for the paeds case though, it was a BA with jaundice 4 years post-Kasai, not listed for transplant. Plus progressive hepatic decompensation with thrombocytopaenia. Only thing was, I totally freaked out and was unable to tell her (OMG, I got D.Goh as examiner, wow!) the DDx of jaundice on D1, the definition of pathological jaundice, and TOTALLY forgot the values of bilirubin in a patient with BA. But was able to tell her possible causes of post-Kasai jaundice, and why Kasai patients are more prone to cholangitis. Phew! And other examiner (another nice neonatologist) asked about possible cause for thrombocytopaenia, said it was hypersplenism 2o to portal HTN. Feel quite ok. At least I got past Inx and Mx for this one.
Wenky
4:48 PM
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