I remember being a bundle of nerves, even felt faint-ish during the O&G MBBS in year 4. But somehow, things have toned down A WHOLE LOT today.

Still felt nervous, about 5 min before the exam.

Felt a bit nauseous when the bell rang, but told myself, ‘THIS IS IT! DUN BE SO WIMPY!’ and went into the room.

My examiners were really nice people. In fact EVERYONE’S examiners were very pleasant. No one out to sabo us today… Except hypoC who kena ’sabo-ed’ by a parent who made a joke he probably shouldn’t have made.

PAEDS long first for me…

Me: Hello SX, what medical condition have you been having that brings you to the hospital?

SX: Er, I got joint swelling…

Me: my heart sank to the depths of the Atlantic, maybe around the depth of the Titanic…

Anyway to summarise:

It was an adolescent with autoimmune pauciarticular arthritis of the big joints, mainly both ankles, knees and hips
p/w: recurrent joint swelling and tenderness
a/w:
- back pain (but not stiffness)
- morning stiffness
- irritation of eyes
- no systemic features, no skin lesions
with significant family h/o: sibling with back and hip pain with stiffness.
currently on NSAIDS, DMARDS and MTX.
main dx: juvenile chronic arthritis
differentials of anklylosing spondylitis, systemic lupus erythematosus, gout (not likely cuz young), septic arthritis (not likely but must rule out in 1st presentation)
PE: normal, just joint swelling.
Ix that are most impt: ESR, CRP, HLA-B27 (for AS) and ***autoantibodies: Rh, ANA, ANCA, anti-Ro/La/dsDNA.
Side effects of drugs: NSAIDS - dyspepsia, GI bleeding, ulcers; sulphasalazine: nausea, vomitting, rashes, oligospermia; methotrexate: bone marrow suppression… anyway then ran out of time.

Examiner said good, the other one still wants to ask questions about drug side effects when the bell finally rung. haha… She was like very bu gan yuan to let me off.

Anyway the 2 min of time where we can gather our thoughts was MOOT. Useless one la! I think I had time to read the findings, and just think of my first line in my summary. -_-

Adult long case. This one wasn’t very good. :(

Bronchiectasis on ventolin! Dubious history of chronic large amts of foul-smelling sputum being produced. Had some wooley lung disease when he was a child… -_-
Current functional status was definitely not good though he denied it. Effort tolerance was only 1 flight of stairs.
Claims he copes well. Not depressed. (A nice doc reminded us not to ask the patient ‘Do you feel like dying’ cuz that would be insensitive.)
Patient DENIED having had lung function test, any CT scan or been admitted. Followedup at the GP clinic, which is soooo odd, cuz how would he be recruited for the MBBS if he wasn’t followed-up in the hospital or been admitted? -_-
Good to rule out other causes of SOB on history (everytime I ruled out something, they tick the boxes haha…)
Anyway, asked on differentials:
1. Bronchiectasis
2. COPD
3. Asthma (but nah din sound like it)
got asked what my diff would be IF he din have sputum:
1. fibrosing alveolitis/pulmonary fibrosis secondary to other causes (no time to elaborate)
Causes of bronchiectasis:
Infx: measles, TB, pertussis; obstructive: retained FB, bronchogenic ca (guy has significant smoking hx)
Why you ask for family history?
- congenital causes eg. cystic fibrosis leading to bronchiectasis or passive smoking worsening his symptoms
Ix: high resolution CT scan (damn, I forgot about the high resolution part, din get the marks liao…
- GS and culture sputum
- lung function test, CXR (They asked me to describe tram-tracking… They just sounded amused, maybe should have just left out the stupid tracks)
Mx:
- chest physio, teach postural drainage
- mucolytics, ventolin (esp if the LFT shows it responds to bronchodilator)
- no smoking/stop smoking/discourage 2nd hand smoke
- make sure work env no pollutants
- if pt presents looking like he’s having infx, give broad spectrum abx, then change when culture results out.
- asked what abx to give: amox/augmentin PO (damn I went to say oral respiratory quinolone, think too much abt the pneumonia CPG liao lah. Sigh)
Bell rang, no time to change my mind abt the abx. Darn.

I hate the bell. >_<