Ni smbg smula artikel by admin smlm...
The pt, 27 years old malay lady with c/o unproductive couh of 5 months.
Assc with right sided pleuritic chest pain,
Reduced effort tolerance (walks to toilet,climbs only 2,3 steps of stairs),
PND,
orthopnea,
bilateral leg swelling,
jaundice,
haematuria,
on-off fever,
LOA,LOW..
The findings were the same as what admin got in his shrt case...
Examiner: Dr. NNF
My Diff.Dx: All that i gave to her was at number 3 and below.....I only manage to get number 1 and 2 after she gave a lot of clues...................... ;(
Hercomment : "U dont know how to tie up all ur symptoms and signs into one complete dx.."
Me: Owh...
Dr NNF : who taught u PBL?
Me: U, doc.....
Dr. NNF : " after this, i want to cancel pbl...u all dont learn anything from PBL..It's just a a waste of my time..."
She looks so angry and irritated as i didnt give her the answer that she wants.........
So friends...tolong doakan kami semua berjaya dlm exam ni...exam IM susah sgt...
4 comments:
apa dx case tu? compliated nye!!!
...i think the main issue is the _lack_ of PBL, and hence less guidance in how to think like a clinician...especially in IM, where the possibilities are simply endless.
Dx eh sam? pjg sgt2 kata2 dr NNF tu, smpai kita blur2...yg kita ingat, the pt mmight hs CRHD, causing her to get CCF...CRHD predisposes her to get IE,and thus getting septic mboli to other parts e.g lungs, kidney etc.. Dgn penuh keseraman, sy mengangguk aje kata2 dr NNF itu coz i didnt giv her that dx....
Jau, lack of pbl?hmm...maybe la kot.tp,i dont know la....it was exam and i'm mentally blocked at that time ;(
plus doc ckp pt tu ade atypical pneumonia..causing haemolytic jaundice..
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