2. Athirah: number 15 tp jadi 11. (team A) external, external, external ortho, dr.

thani
(dean ada meeting harini. sejam stupor clerk pt sbb igt dpt dia) SUMMARY aku
panjang gile xmcm summary. Mr Razali, 57 y/o male with mitral valve disease dx jun
2012 with hx of sudden cardiac death involving his 27 years old son was admitted
to HSB 2months ago following episode of prolonged fever and lethargy for 1months
PTA after having tooth extraction 2 weeks prior to onset of illness. Pt was dx with
infected valve in HSB, undergo 6weeks course of IV coxa and penicillin, and
discharge well with app with cardio uitm for stress test, ECHO and angiogram and
dentistry uitm next week. Pt is currently doing well, with no sx suggestive of heart
failure. Finding:splinter hmrrhg, and PSM murmur at mitral. 3/6,to axilla, expiration.
(dia ni pakcik prof sazli. so dia sgt prepare nk ckp apa kat student. xdpt prof sazli,
dpt pakcik dia pun jadilahh, baik sgttt) mcm Infective Endocarditis. kot. ntah. soalan
: what is ur differential? what is the dx that runs in family, related to heart? HOCM
setelah bfikir dgn bsungguh smbil main mata if the pt is female, what do u think of?
carditis in SLE. Dr nk nama power sebnanya- libman sack tu. go to pt, buat
pe.cardio respi utk exclude heart failure then ckp i would like to complete by doing
abdo. sbb xlarat dah. soalan: siapa y akan enlarge? liver is heart failure. in view of
mr.razali, spleen lah kot ada emboli ke spleen cause hypersplenism what else would
u like to check : cns for stroke. not really. what else? the eye for roth spot do u do it:
nope. haha! (padahal tfikir tp dah timekeeper ketuk 5minit, ketaq den)
5. Norbainun Che Hamid(31 34) Same macam kes athirah.. (uncle prof. sazli) IE
with underlying heart disease(MVP) Examiner: Prof. Izwan yang sangat baik(lead),
external(yg suke senyum), dr. param & dr. yahya (2 org ni senyap je..) Basically
first2 dia tanya berkaitan history yang kita bagi.. 1. What are the risk factor patient
develop IE? Valvular heart disease, dental extraction 2. Why dental extraction may
lead to IE? Huhu bantai jerk bleeding ?? (diorang buat muka pelik) Ohh maybe
instrument for dental extraction not clean (lagi buat muka pelik..) Dr. param
menyampuk.. oral is already dirty area lah. 3. What are the genetic heart disease
that the son might have? HOCM What abnormality we see in echo- hypertrophic
ventricle 4. What are organism you suspect in this patient ? Rase strep. viridans..
other organism?? Staph. aureus but unlikely because patient is not IVDU. What part
usually affected in IVDU?? Tricuspid OK.. what other organism that common(dia tnya
lagi)? Dr. external tu bisik jawapan tapi x dpat tangkap.. geramnya.. 5. What are
your differential?? 6. As a HO seen this patient for the first time, what Ix do u want
to do?? Pergi kat patient: 1. So, what examination you want to do? CVS examination
Buatlah CVS, tengok signs of IE(dia ade splinter hemorrhage kot) Dr. external tanya
how does splinter heamorrhage occur?? Jawab lambat2.. emboli?? dia buat muka
pelik.. microthrombi in blood vessel??.. what are the source of that? Dont know
Tgk ade x oslers node or janeway lesion definelah , Eye: roths spot, Oral: dental
hygiene Heart: PSM murmur at apex radiate to axilla, 3/6 MR 2. What complication
that patient might have? Heart failure but apex beat is not displaced, JVP not raised
& no crepitation, no hepatomegaly and ankle oedema. Thus patient did not have HF
3. What advice you want to give to the patient regarding his heart disease? dr nak
dengar pasal prophylactic antibiotic for procedure 4. What procedure usually we
give prophylactic antibiotic beside dental extraction?? Blurr sangat Dr. cube bagi
clue tapi kita x dapat jawab.. jawapannya surgery that can cause bacteremia.. 5.

Masuk balik bilik.. So what advice you want to give to this patient?? Control BP, diet,
low cholesterol diet, exercise, warrant about heart failure 6. Do you think patient
need surgery?? Slepas lame berfikir Yes.. Why?? Since patient has prev. history of
IE.. 7. How to monitor & advice about heart failure?? Owh.. f/up patient ask about
symptom, echo, f/up more frequently if has symptoms, consider to do surgery if Sx
worsen. 8. How to treat IE? IV antibiotic for 6 weeks ( kita tau cloxacillin je sebab
pakcik tu ckap.. penicillin x ingat langsung..)
PROFESSIONAL EXAM 2013 6TH BATCH DAY 3
CLINICAL EXAMS
9. How to monitor progress of patient in ward? Fever chart, ESR, CRP Short case: Mr.
A yang sngat menolong, Prof. MAR, dr. akmal, dr. wan haniza, external examiner 1.
Uterine mass. 2. Hepatosplenomegaly with Post Kasai procedure punye scar kot.. 3.
Bilateral inguinal hernia Kelam kabut sgt mase short case.. sampai mass pun salah
ukur.. Hernia pun blurr sangat.. nasib baik Mr. A guide.. ape2 pun tawakal pada
Allah.. bagi sesape yg blum exam doalah supaya dapt examiner yg baik dan tenang
supaya dapat berfikir.. Doakan kita sume same2 lulus k ameeen