My long case exam (Mr Shukrimi, Dr Husin Imam, Prof Zalina, Dr Ramli, Prof How):
A case of 13-year-old Malay boy from Pekan, in his day 42 admission; presented with painful and erythematous swelling at the distal third of right leg for 4 days prior to admission which later progressively spread to the proximal third of the same knee and the patient was unable to mobilize. It was associated with high grade fever without UTI or URTI symptoms. There were constitutional symptoms and the patient were brought to hospital due to shortness of breath.
Debridements were done twice on him due to unsettling infection. He was treated with IV cloxacillin 1g QID.
He has no history of trauma, insect bite, diabetes mellitus type 1 or other chronic diseases.
On examination, there was wasting of the right quadriceps muscle and the right leg looked swollen. There were multiple clean incisional wounds over the medial part of the right leg. There was no bony tenderness or bone discontinuity noted. The power was 5/5 with intact sensation. The peripheral pulses were present.
DDx : osteomyelitis, osteosarcoma, DVT with pulmonary embolism
The discussion were mainly about the investigation and management of osteomyelitis.
- FBC, RP, se albumin, RBS, ESR, Blood C&S
- CXR, XR of right leg including the knee and ankle joint in AP and lateral view
- debridement
- IV antiobiotic
- prevention of fracture : splint, crutches
Alhamdulillah~
My short cases examination (Prof Hamizah, Prof Kyaw, Dr Marzuki, Dr Aye Aye, an external):
1. CVS (Paediatrics)
A young Malay boy with mitral regurgitation and not in failure. No other discussion~
Alhamdullilah.
2. OnG (Uterus larger than date)
A young Malay lady, G3PO+2 at her 34 weeks POA with uterus larger than of 48cm SFH and difficulty if palpate the fetal part and positive fluid thrill.
We discussed about MOGTT, ultrasound findings in polyhydromios and expected fetal anomalies in GDM mothers.
Alhamdulillah.
3. Respiratory examination (Medical)
An elderly and obese Malay lady with grade 1 clubbing and reduction on chest expansion as well as coarse crepitation at the left lung field.
Causes of bronchiectasis : recurrent pneumonia, pulmonary tuberculosis, pertussis
Alhamdulillah
=))
Thank you examiners for your trust to me. Most importantly, I have to work hard to strengthen my knowledge and skills.
25200 Kuantan
A case of 13-year-old Malay boy from Pekan, in his day 42 admission; presented with painful and erythematous swelling at the distal third of right leg for 4 days prior to admission which later progressively spread to the proximal third of the same knee and the patient was unable to mobilize. It was associated with high grade fever without UTI or URTI symptoms. There were constitutional symptoms and the patient were brought to hospital due to shortness of breath.
Debridements were done twice on him due to unsettling infection. He was treated with IV cloxacillin 1g QID.
He has no history of trauma, insect bite, diabetes mellitus type 1 or other chronic diseases.
On examination, there was wasting of the right quadriceps muscle and the right leg looked swollen. There were multiple clean incisional wounds over the medial part of the right leg. There was no bony tenderness or bone discontinuity noted. The power was 5/5 with intact sensation. The peripheral pulses were present.
DDx : osteomyelitis, osteosarcoma, DVT with pulmonary embolism
The discussion were mainly about the investigation and management of osteomyelitis.
- FBC, RP, se albumin, RBS, ESR, Blood C&S
- CXR, XR of right leg including the knee and ankle joint in AP and lateral view
- debridement
- IV antiobiotic
- prevention of fracture : splint, crutches
Alhamdulillah~
My short cases examination (Prof Hamizah, Prof Kyaw, Dr Marzuki, Dr Aye Aye, an external):
1. CVS (Paediatrics)
A young Malay boy with mitral regurgitation and not in failure. No other discussion~
Alhamdullilah.
2. OnG (Uterus larger than date)
A young Malay lady, G3PO+2 at her 34 weeks POA with uterus larger than of 48cm SFH and difficulty if palpate the fetal part and positive fluid thrill.
We discussed about MOGTT, ultrasound findings in polyhydromios and expected fetal anomalies in GDM mothers.
Alhamdulillah.
3. Respiratory examination (Medical)
An elderly and obese Malay lady with grade 1 clubbing and reduction on chest expansion as well as coarse crepitation at the left lung field.
Causes of bronchiectasis : recurrent pneumonia, pulmonary tuberculosis, pertussis
Alhamdulillah
=))
Thank you examiners for your trust to me. Most importantly, I have to work hard to strengthen my knowledge and skills.
25200 Kuantan
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