salam, sorry sbb lmbat, smlm laptop buat hal, sy cndidate ptg smlm

dr external yg lead..xingt nm dia tp dia baik,lg sorg dr externl gak tp prempuan,

dua-dua mlayu..dr kt plak, prof ismail & prof hashim
Long case: R heart F 2ndary to TR, currently in ascites & jaundice.
2004- had fever , on & off admitted, blood ix & echo was done, he was dx wt heart
F. Was on salt &water restrictn but not compliant to it. Was asymtomatic from 20062012. On 2012 suddently dev SOB, palpitatn, ascites. Not preceeding any hx of
chest pain. >> dx: R heart F 2ndary to TR most probably due to IE & not compliant
to fliud restriction .
PE: R heartF 2ndary to TR wt evident of ascites, jaundice, pulsatile liver & palpable
spleen currently in AF.
Dicussn: what r sympt R heart F & L heart F? What are the causes of his HF?what is
sympt of sudden wakening from sleep & catching breath in the night?( PND). Why is
that this pt has palpable spleen usually, R heart F wont have this?Show me the
finding (wt pt).If u are the HO incharge, how would U mx this pt, this pt come wt
SOB?(for tx say O2 & lasix 1st later on U can put other drug, those 2 thing are
crucial)is it important AF? Which is dangerous fast AF or slow AF? Why is it
impportant?

Zikri Ab Aziz
Candidate 14 (B)
salam, case mungkin mudah, tpi aku xde la boleh jwp sgt pon, byk jgk yg xleh
jawab.. jgn ambik 100% history ni, mungkin ade salah, doakan aku lulus ye tQ
sori lupe tny dia dtg lagi ke x utk hari len...
long case:
long case Prof tengku, Dato khairudin ngn 2 external
Yap ah seng, 56 years old Chinese gentleman was diagnosed with heart failure since
2004 was electively admitted for examination purpose. Currently he present with
abdominal distention and abdominal discomfort.
Patient mungkin ade IE diagnose 2004
P/E
- AF
- Mungkin ade collapsing pulse (xsempat nk angkat dah collapse kot) tpi xdpt
appreciate murmur for AR
- Cvs

o Mcm ade PSM at tricuspid area tapi xjelas sgt. 2nd heart sound bunyi len skit tpi
patient xde hx of valve replacement.
- Abdomen
o Hepatomegaly
o Ascites
Soalan (antara yg igt)
- Diagnosis?
- Cause of heart failure in this patient?
- Patient on transdermal fentanyl, indication for this patient?
- How to differentiate MR and TR?
- How do you measure JVP, how many wave,and details of each wave?
- How to manage this patient?
- How many fluid to drain in this patient?
PROFESSIONAL EXAM 2013 6TH BATCH DAY 2
CLINICAL EXAMS
- What are the causes of ascites?
- How liver can cause ascites?
- What medication can improve prognosis of heart failure in this patient?
- How to diagnose IE?

LONG CASE: Medicine - CCF

Examiner: Dr chandra, dr ravi, prof ann, dr faisal paeds

-most of the time i present the history fully non stop.

-sign and symptoms of right sided heart failure
-do examination cvs and abdominal examination
-how u investigate
-how u manage

LONG CASE: Medicine CCF

Examiner: prof hameed omar,dr syafiana,dr gerald,external examiner Ong

mr amat(sori x ingt nama),63 y/o malay gentleman heavy smoker with k/c/o
1)psoriasis since 1999 currently on topical steroid +shampoo
2)hpt+dm since 2003 currently on insulin and antihypertensive
3)tb-on 2001 complete treatment at IPR
4)ortho review???-due to bone pain at both forearm,femur???

currently under uitm respi/cardio follow up

came for exam purpose.no active complaint today.
In 2009 he had history of admission to CCU HS due to MI,discharge 1 week later and
was referred to IJN for angiogram.since then patient ada reduce effort tolerance with
orthopnea,with polyuria and polydipsia.
otherwise,no chest pain,PND,peripheral oedema,SOB.no complication of dm ,hpt .
strong family history of HPT,DM

o/e
bp-140/80 pr-88 regular/regular
psoriatic plague satu badan
lung-bilateral pleural effusion
cvs-apex beat x displace,jvp x raised,no bilateral pitting edema,psm at LLSETR(serious ak x dgr murmur.ni pun dr tolong aku)
sbb apa x dgr heart sound/murmur
a.ptn ada pleural effusion
b.ptn psoriasis-thickened skin
c.ptn obese
4.ptn heart failure

question
1.investigation nk buat-ecg,echo

2.apa yg dapat kat ecg/echo-ischemic changes,pathological q wave,st

elevation/ejection fraction