GS shorts: repaired ACL tear, thyroid mass, sebaceous cyst on head, colostomy with hepatomegaly
Examiners: Prof Ngoi (private consultant), Dr Tan SM (breast surgeon, CGH)
1. Pls examine this gentleman’s knees.
I freaked, 4 min how to examine both knees? wanted to measure for quads wasting prof ngoi said no time, pls do what u think is necessary.
The guy had a vertical scar over R knee + arthroscopic scars, I blurly blurted out TKR and the two of them said HAH!?!?! Quickly recovered, kowtowed and apologised fervently for my slip of tongue. Sigh. Pt looked very amused. Quickly did the ROM, ligaments… ACL a bit lax… Lachman was kinda effy. No McMurray or problems with the MCL/LCL.
Bell RANG. So I just blurted out, this man has had an arthroscopy and an open operation to reconstruct his ligament, probably ACL.
Prof ngoi seemed to breathe a sign of relief, said ok, gd, let’s go… Dr Tan kept asking me to squirt ie. use the alcohol.
I thought maybe next case can be a short one but….
2. Pls examine this man’s neck.
Thyroid mass… Happy like siao. They fired qns alternatively, like firing squad. They talked so fast…. then I also started talking v v fast. Hands were trembling as I poured water out for that guy to do his swallowing test. Haha poor guy, wonder if he needs to go to the toilet in the middle of the exam cuz everyone keeps asking him to drink water.
The QnA was so intense… It’s like once Dr Tan asked a qn, I just answer… A bit like spinal liao. Felt like I was playing ‘the pyramid game’ haha…
Why does it move up? Attached to pretracheal fascia
What problems can it give? Cosmesis, dysphagia, dyspnoea, malignant change, thoracic outlet obstr
What are signs of malig? Cervical LN, hoarseness, fixity. I felt, then said, dun have… meanwhile more questions…
Why hoarse? Infiltration of RCL
Then pause… awkward silence… I think they wanted me to ask pt if his voice changed… so I just asked, pt said no.. :)
What ix? US, radioisotope uptake scan (Dr Tan looked a bit off.. ) then FNAC (then she smiled).
3. Sebaceous cyst on head
This was easy, except that it was totally HAIR covered, no point hunting for punctum but just say attached to skin, not bony outgrowth fr skull, superficial. Then say excise with elliptical incision completely so as not to have recurrence.. . prof Ngoi was halfway out the room by then…
We all ran to another room…
4. Pls examine this lady’s abdomen.
Waa i was so happy cuz got colostomy. SPOT!!! Lemme share my song.
This is a middle aged lady, fairly cachexic. midline lapartomy scar, well healed, no keloids/hypertrophic scar with a stoma in the LIF. (asked pt to cough, looked and felt for herniation, Prof asked why so I explained). There’s no incisional hernia, no parastomal hernia. Stoma is a large calibre single barrel stoma flush to skin, no spout. Has a diaphragm below, unable to see the skin underneath, colostomy bag contains solid faeculent material.
I would like to do a digital examination of colostomy opening for any stricture, to check if anus is patent. I would like to palpate for abdo masses. Prof says: go ahead.
Barely felt the 9 quads when he asked: What do u feel? I blur… tried to chk again…
Vaguely got liver but not entirely sure… then ya, got liver… erm didn’t feel nodular or hard… percussed the upper border, then measured the span i think was abt 13cm… Damn scared bell will ring soon and didn’t want Prof to promt too much so…
Quickly said: I think this woman has a colorectal carcinoma or a rectal carcinoma for which Hartmann’s procedure or an abdominal perineal resection was done, (pause, it would depend if the anus is still present. Prof says yes, it’s there), so… it’s a Hartmann’s with a colostomy created, and might have liver mets cuz the liver’s enlarged.
I really got to thank my tutor Mr foo at CGH for teaching me abt stoma examinations!
I dunno why they rushed me like that, cuz I still ended up finishing abt a min plus ahead of time… felt so out of breath and spaced out when it ended.
And for the record NO ONE WAS ON THE VIVA LIST THAT DAY!!! YAHOOOOOOOOOOO!!! I hope no one gets called back for surgery viva this year!
