Short Case Compilation Professional Exam 3 11/12
I hope these compilations would benefit fellow juniors in the
future. These cases were collected after the PRO exam and
seniors shared their own experience of their cases. The answer
inside might not be correct, it only for reference and to give a
general idea what question dr would ask in the exam.
“Sharing is caring”, hope every junior in the future would pass
the knowledge and experience to the next one.
From: Tan Kok Liang and all dedicated seniors batch 11/12
What happen in SHORT CASE exam:
- students will register at PPSP counter according to their own
time, and put bags over an appointed place.
- u will be divided according to surgical and medical via draw.
- for example: the group of 6 ppl will draw numbered cards which
will represent either medical or surgical (3 each).
- the MO will bring u to 3 examiners’ side, your number will be
asked and recorded by dr/prof.
- then follow dr to appointed bedside to examine pt.
- MO will record the time; the responsible dr for the case will give
u scenario and what system examination u need to perform.
- then pls do it well. From my experience doing PE in this time is
like a reflex, if u don’t used to it, u surely will be panic and stuck
in midway. Try to examine carefully the pt, every single little clue
is valuable to lead u to the diagnosis.
- as time is limited (to be honest, it is REALLY LIMITTED), pls try to
complete your examination in less than 6-7m, so that u don’t lose
your discussion points.
- present your findings, and dr will ask what ddx of this pt.
- if there is more time, ix and mx will be discuss in simple form.
- then u will bring to next patient, pls follow dr (walk faster, don’t
let dr wait u…)
- don’t let the previous case affect your next case performance (I
know this is really tough, but u need to overcome it, fast)
- when time up, u will be brought to quarantine room.
MEDDEN 07/08
# recommended to read these compilations via soft copy, GO GREEN.
Dato' from HKB..dunno his name (Hazwan)
Venous ulcer
1) describe the ulcer (medially located, well defined margin,
hyperpigmentation over the surrounding skin, bla..bla..bla)
2) what is your diagnosis
3) why do you say so
4) what is the cause of the hyperpigmentation
5) in your opinion, what is the cause of the ulcer (varicose vein)
6) what to do if you want to see not very prominent varicose vein?
(stand up)
7) you are the houseman in my department, so, what's your
management now
Dr Azman ortho
foot drop secondary to PID
examine this patient lower limb. after i examine the gait (high stepping
gait) and do the toe and heel walking, patient was unable to that, got
wasting over the flexor muscle of the knee, and weakness over the knee
flexion, foot dorsiflex and foot plantarflex. sensory reduced over
l4,l5,s1...
1) what is your diagnosis?
2) where is the level?
3) what investigation to do
4) after listing out the proper ix, i said nerve conduction study<------- i
gali my own grave
5) what do you expect from the report finding of the nerve conduction
study
6) what nerve you want to test?? <---- die -_-"
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 Short Case Compilation Professional Exam 3 11/12
Dr pazudin, O&G
47 year old malay lady with heavy menses, examine the abdomen. oval
shaped mass over the suprapubic area
1) what is you differentials and provisional diagnosis?
2) why you think it's fibroid
3) if it's ovarian tumour, why is it centrally located and cannot get below
the mass (adhesion to uterus)
4) what else you want to do (bimanual palpation)
5) what do you expect to find and how to differentiate te mass frm the
uterus
6) investigation you want to do (dr nak dengar ultrasound benar..-_-")
7) ultrasound findings of fibroid <------- blank time nih~~
My short case(most not even complete set like we learn, dr very rush as
we running commentary and keep on asking in btw)
ONG(handsome Dr Nik) (Chan Kam Veng)
- go straight to abdomen
- mass can get below(which I dig my grave say cant get below)
- mobile side by side and not up and down
-then start shooting me question…
-why u thnk it is an uterine mass
-how do u differentiate it with ovarian
-do u thnk (21 yo) common to get fibroid?
- what is the common ovarian tumour in young lady
-how do u differentiate it with malignant in ultrasound
-he keep on helping me, but I keep on disappointing him, coz read too
little and sad with the wrong diagnosis
Ortho(external examiner)
- see pt hand and check the pt
- luckily I see thenar muscle wasting for both hand
- I say I would like to check median nerve(the examiner keep quite)
-check as usual, then he start ask me question
MEDDEN 07/08
- what is the diagnosis(I say median nerve palsy, he like very shock, and
ask me are u sure, then I temporary tot I wrong nerve, then I add most
likely secondary to carpal tunnal syndrome(he sy yes, phew)
- what is the ix( nerve conduction study)
-what r the treatment
-he want non pharmaco 1st then pharmaco then surgical
Surgery(Dr. Yob)
- pt (boy) come in with a swelling over the right breast(unilateral)
-examine…
-I just do like normal breast examination than do the axillary and
suprclavicular LN.
- question start, what condition is this(unilateral gynecomastia)
-tell me the most likely causes( physiological puberty changes)
- what r the other causes example like drug, ( cimitidine), other than
cimitidine( I jz say all other estrogenous drug)
- I m a neuro surgeon, what can u thnk if it from my wad( polactinoma)
- that all……………..
Examiner – Dr. Pazudin/Dr. NorAzman/External(datuk) (Chiong Woei
Zhong)
1. This is a 46 years old woman come with abdominal distension,
post menopause, nulliparous, examine her abdomen.
a. Findings :
i. big mass located at central abdomen 21 x 46cm
ii. firm, well demarcated margin, can get below
border.
iii. Not fix to skin, mobile vertically and horizontally.
b. Questions:
i. What are the common scars that might be
found in this patient?
ii. What is the mass?
iii. Diagnosis?
iv. How to differentiate ovarian cysts and ca?
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 Short Case Compilation Professional Exam 3 11/12
v. Why you ask patient to flex her neck when
palpating abdomen?
vi. If this is a fibroid, how can it present with
broader transverse diameter?
vii. What are the other features of ovarian ca?
viii. How you manage fibroid?
2. Examine this abdomen
a. Findings:
i. Midline scar
ii. Left and right paramedian scars
iii. Drainage scars
iv. Incisional hernia from midline scar upper and
lower
b. Questions:
i. Indication of midline scar?
ii. What is that 2 oval scars on patient’s abdomen?
(drainage)
iii. What is the common injury in blunt trauma?
iv. How u confirm this is a hernia?
v. Why hernia more common in emergency
surgery?
vi. What is the complication of incisional hernia?
vii. Does incisional hernia covered by sac?
3. Patient has right lower limb weakness and history of right knee
instability, examine his lower limb, focus on knee
a. Findings:
i. Appearant shortening?? I comment no but
datuk said gt, dr norazman seem like doubtful
with datuk’s findings when I try to confirm with
galleazi test
ii. Posterior sagging
iii. Posterior drawer test positive
b. Questions:
i. Where u look for posterior sagging?
ii. What is the common mechanism of injury?
iii. What is ur diagnosis?
MEDDEN 07/08
iv. What are the possible findings in x-ray?
v. What is the common associated injury?
vi. What is the long term complication?
vii. How u manage this patient?
viii. If patient have fracture fragment in knee, how u
gonna manage?
AMIRAH HAYATI
Examiner: Mr Tarmizi(HKB), Dr Shaifuzain, Prof Nik Nasri
1) PCL injury – please examine this pt right knee
- Expose properly, then dr ask to comment on scar (surgical
scar on anterior thigh & lateral knee)
- Proceed with palpation – nothing much on palpation, forgot
patella tap
- Do varus & valgus test – dr ask would like to approximate the
legs( he wants me to look for posterior sagging...pt has
posterior sagging)
- Do anterior & posterior drawer test - (positive posterior
drawer test)
- Ask me what else want to do? - (i said mcmurray test)
- I did wrong for mcmurray - (i said 30 degree, should be 90
degree)
- Dr ask what more important during palpation? - (I said
patella tap)
- Then do patella tap – no findings
- U think is it acute or chronic condition? - (i said chronic)
- If chronic, what else u want to check? – ( muscle
wasting...show him the correct way...10 cm above superior
border of patella...he seems very happy, even volunteer to
mark the site for me)
- KRINGGGGG!!!!
2) Lymphadenopathy of inguinal area – please examine this pt
inguinal area(female pt)
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 Short Case Compilation Professional Exam 3 11/12
- Ask pt to cough – no findings actually, then dr ask to palpate
the inguinal area.
- Got a swelling there – describe the swelling
- What else u want to check? – (i said contralateral inguinal
area...got another swelling there, same as prev swelling)
- What other examination u want to do? – (need to check
abdomen & other LN)
- What about general examination? – (i said want to take
temperature & pulse rate)
- What about eyes? – (look for anemia & jaundice)
- What are the causes of pt lymphadenopathy? – (infections,
malignancy)
- If pt has jaundice & multiple LN, what are the causes? –
(maybe mets to the liver)
- Other causes? – (cnt answer, then he ask causes of
jaundice...i said pre-hepatic, hepatic & post-hepatic)
- Tell me hw u classify obstructive jaundice? – (cnt answer at
first, then he guide me...hv u heard intraluminal? then i cont
with extraluminal & intramural)
- So, in this pt what do u think the cause are? – (probably
extraluminal...such as?....ca of gallbladder, TB....doesnt
seem happy with my answer)
- Ask 2 questions to the pt – (family h/o malignancy &
constitutional symptoms)
- What are constitutional symptoms? – (LOA, LOW....hw u
assess LOW? Ask pt hw many kg loss or any looseness in her
clothes)
- Clinically hw u assess? – (look cachexic & muscle wasting)
- Then prof nasri interrupted, what are the most likely causes
in this pt? – (maybe from pelvic structures bcos of the
drainage)
- KRINGGGG!!!!
3) Oblique lie – please examine pt abdomen
- Do abdomen examination as usual in gravid uterus
MEDDEN 07/08
- Prof stopped me while i was listening to FHR – (said i took
too long listening to FHR...usually 15 sec only...ask me who
teach me to listen for 1 minute?)
- Present findings as usual – (i got longitudinal lie but he said
pt actually had oblique lie...are u sure??)
- I said i was sure...then he palpate the head – (tell me to
palpate again, do pelvic grip only....this time it was
oblique..huhu...)
- But he said actually just now, it was longitudinal lie as i said
– (feel so relieved....he tell it was bcos i push the fetal head,
so it become longitudinal)
- What do u think the problem? – (unstable lie)
- What are the causes? – (polyhydramnios, placenta previa)
- Hw u manage? – (i would like to admit pt & observe...until
when he ask? u wnt to keep pt until labour is it? I said if pt
already term then can wait for spontaneous labour...he said
pt is 32 weeks...so i said no need to admit, just observe at
home...why? pt is asymptomatic & only 32 weeks so the lie
might change again)
- KRINGGGG!!!!
- Short case – surgical based (Nurliyana Anuar)
- Prof Nik Nasri (O&G), Dr Shafuzain (ortho), Dr Tarmizi
(surgery HKB)
- 1. O&G
- Q : This patient, a lady come with a complaint of lethargy
and malaise. What are u thinking of?
- (patient has gross distended abdomen, even not exposed
yet)
- A : I said it is a constituitional symptoms
- Q : so?
- A : could be malignancy, infection.
(prof seems not satisfied, give clue..female patient)
- A : Anemic symptoms
Q : Ok. Please show how to asses in this patient
- Patient was not in pallor.
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 Short Case Compilation Professional Exam 3 11/12
- Q : please examine this patient’s abdomen - A : Left varicocoele
Abdomen is distended, with striae gravidarum, no skin - Q : What are the differential of inguinoscrotal swelling
discolouration, & presence of transverse scar at suprapubic A : inguinal hernia, hydrocoele bla bla..
area. There was an oval mass, about 20x23cm, non-tender, Q : how do u manage?
well defined margin, mobile, can get below - A : counsel patient for surgery
Q: what kind of surgery?
- Q : are u sure can get below? How to asses that? - A :I just said ligation
I repeat the palpation, showing the technique. Prof seems - Q : Ligation at where?
not satisfied. - Errr..i cannot answer, then dr ask the venous drainage. I
- Q: how do u do pelvic grip? said testicular vein into left renal vein. So the answer is
- I do it, and then conclude cannot get below the mass. ligation of testicular vein.
Q: ok. So how do u manage this patient? - Q : Let say patient refuse for surgery. What are u going to
- I mention investigations things, but prof said, “manage”. do?
A : prescribe tranexamic acid to control the bleeding bla - A : I would still counsel patient for surgery, to prevent
bla..then counsel patient for hysterectomy if patient had complication.
complete family - Q : what complication?
- - A : infection?
- Station 2 : surgery - Dr smiles and ask how varicocoele can cause infection? I
- Q : please examine this patient’s left lower limb stuck haha.
- I ask patient to walk. Dr said, no need. - Dr give clue, male patient. It is infertility…
- I ask patient to stand and expose the lower limbs. In my - Station 3 : ortho
mind, im thinking of varicose veins, so I inspect especially at - Q : Please examine this patient’s left upper limb
the medial part. But I cannot see any abnormalities. Then, - There’s a solitary swelling at medial aspect of left distal
dr check again the folder & change the question. forearm.7x8cm, well defined margin, smooth surface, firm
Q: examine this patient’s inguinal area. to hard in consistency, non tender, mobile.
- Patient is still in standing position. I ask him to expose both - Q : what structure could be affected ?
scrotums. - A : ulnar nerve?
- Inspection: no obvious swelling I think, except dilated veins - Q : Ok. Show me how to asses ulnar nerve palsy.
on the left scrotum. No skin changes. - All normal.
- Palpation : scrotum is soft in consistency, bag of worm felt, - Q : based on ur finding, what is ur diagnosis?
testes palpable. Transllumination test –ve - A : Ganglion cyst.
- Then, ask patient to lie down. I ask dr, should I proceed with - Q: u said just now the consistency was firm. Does cyst have
occlusion test. Dr said, no need. this?
- Then I said want to palpate the abdomen to detect if there’s - I think dr juz want to see if we firm or not. But I kalut
any mass especially the renal mass. already haha
- Q: What is ur diagnosis - Q : ok, other diagnosis?

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 Short Case Compilation Professional Exam 3 11/12
- A : lipoma. (dr prefer this answer)
- Q: how do u investigate?
- A : plain radiograph of upper limb.
- Then I said MRI..dr seems surprised and smile..end
ortho - prof imran (Kah Kin)
patient present with multiple wound, but examine right lower limb only.
external fixator on the tibia and on the medial maleolus.
inspect wound, ulcer and comment, test external fixator, neurovascular
exam, diagnosis, then x-ray. have radiolucency around screw
Surgery - plastic surgery
patient present with leg pain on prolonged standing, on inspection,
presence of varicose vein. inspect, torniquet test, possible complication
and the complication that has happened in the patient and finally
management.
O&G - prof adibah
Uterus with 3 poles, differential and investigation. mainly PE methods
only.
Prof. Shah (O&G), Dr. Zaidi (surgery), Dr. Nawfar (Ortho)
MJ
mine are surgical bases..so do in running commentary...
Case 1: O&G (uterine fibroid)
Prof Shah: This is a gynae case, i want u to examine her abdomen...so
today is ur 1st day as a HO in HKL huh...very busy...so pls examine her
quickly...
Q:
How much u wana expose?
what u scared u missed if u dint exposed enough?
MEDDEN 07/08
what do u mean by multiloculated?
describe the mass...
(actually he keep on interrupt me during my examination, keep asking
me wat am i doing...during my presentation of the mass we stuck quite
a lot of time...i was digging my grave because i said something im not vr
sure...so wasted quite a lot of time and the bell rang b4 we reach to
diagnosis...so i think im dead in this station...)
Case 2: Surgery (right indirect inguinal hernia)
Dr. Zaidi: Please examine his abdomen = > (found cough impulse
positive), proceed to inguinal examination (this is tricky...if u forget to
examine cough impulse...then bye bye...)
Q:
(normal presentation bla bla bla...)
what is landmark for deep inguinal ring?midpoint of inguinal ligament or
mid-inguinal point?
so what is ur diagnosis?
if i let u to ask question what u wana ask from this patient? (mainly
about risk factors...)
how u r going to manage this pt? (other
examination+investigations+treatment)
so what surgical treatment u want to plan? i said hernioplasty
so what is hernioplasty?
is the mesh u put absorbable or nt absorbable? why?
if ur hosp dun hv mesh, what surgery u wana do? i said herniorrhaphy
so what is herniorraphy?
what advice u wana give after operation?
Case 3: Ortho (ulnar nerve palsy)
Dr. Nawfar: observe his hand and tell me what u see...(smtg lidat)
left ulnar claw hand noted, then he ask: why u say so?
i said extended MCP joint and flexed IP joint at left 4th & 5th finger...he
then said: right finger also flexed!...i hv to stress again, the left MCP
joint hyperextended.
(he wil keep on challenge u...hv to stay firm...@.@)
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 Short Case Compilation Professional Exam 3 11/12
Then he ask me to examine his left ulnar nerve, and allow me to - Q: How u differentiate is it a mass or pregnant?..No pole I said, in term
examine from left side... of consistency..etc2
Q: - Ix: FBC to rule out anemia, TAS..(dr ask how want to differ frm u/s the
what u want to see in ulnar nerve examintion? mass is fibroid or cyst,cancer?..- I said based ob echogenicity..fibroid
is this a low lesion or high lesion?why? more hypoechoic,..and no fluid-if cyst.
how u know there is weakness? what is the term for weakness? (he - Mx: conservative and definitive..(hysterectomy n myomectomy).this pt
want to hear paresis.) prefer myomectomey.
how to interprete Froment test? - What do u afraid during surgery removal of the mass?..i said
so wat is the cause of ulnar nerve palsy for this pt? hemorrhage bcs the mass is big and many blood supply.
where u want to palpate for ulnar nerve?
what is the course of ulnar nerve? after i answered then he said: based 3. ACL/PCL injury
on ur knowledge, please palpate the ulnar nerve... This malay man had previous MVA.do knee examination.
(RINGGGG!!!) Do examinatuion anterior n posterior drawer test
i think i did quite bad in this station also, coz i think this is the 1st time i PCL-see posterior sagging, posterior drawer test..dr ask, if PCL most
saw an ulnar nerve palsy pt, not very smooth, and some technique likely cause, I said dashboard injury.
wrong also (he said i pinch the pt rather then palpate for muscle ACL- ant drawer and lashman test.
wasting...=.=) What other examination you want to do.i said if ACL, probably have
medial collateral injury and medial meniscus injury, then do
examination..
Surgery short case
(External examiner-surgeon, Dr.pazudin (ONG),Dr Azman (ORTHO) That;s all. All the best to all…dr mostly very helpful and kind..:)
(Quratu aina)
1. Venous ulcer. short case (Farah Hanan AL)
-There is an ulcer at medial side of the left tibia…present regarding the dato dr external examiner (the nicest soft spoken guy), dr norazman, dr
ulcer ramli
- What is likely the causes of this ulcer?
-I said venous ulcer. surgery
How do you ask patient how she get this ulcer? right inguioscrotal swelling, irreducible. from start, he interrupted me in
-I ask pt if she had previous history of DVT( swelling, occupation-long running commentary, literally. exp: look at the right inguinoscrotal
hour standing).. region, what do u see, what is the size, what else you would like to tell
me..where do you occlude..
2. Uterine fibroid
- This is p1 patient, examine her abdomen extra q: u are the Ho and patient is admitted, what do u do? consent for
- Do palpate the abdomen and explain regarding the mass( It was 23 operation an all those preop things
week size, firm in consistency, mobile, can get above,, round and smoth
surface)..etc2 ortho

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 Short Case Compilation Professional Exam 3 11/12
post MVA day6 multiple laceration on the face and right lower limb, w
laceration wound n the medial malleoli extending to lateral malleoli
on ext fixator of the right tibia extending to the metatarsal of ankle
q: interpret the x-ray, you are the Ho receiving this case at a&e, what do
u do
o&g
singleton fetus breech presentation
q: i kinda dug my grave i think, with saying the mx is csec or vaginal
breech delivery (frgot ecv) and he asked whats the mx for cord prolapse
take a deep breath after each station and do not lose focus, dr is very
very nice and is absolutely willing to help
Short case : Surgical Based - Dr nawfar, Dr zaidi zakaria, Prof Shah d
lagend. (Nur Izyani AH)
1)Ortho - Right PCL tear 2ndry to sports injury : Knee examination
- this gentleman came with hx of fall due to ?sport, he is an athlet. so
examine this pt knee. no gait needed. jus do the full knee exm.finding :
surgical scar on the right anterior thigh well healed scar. (i dont knoe
wat is d assoc btw d scar wt hx n positive finding) Posterior drawer test
positive, otherwise no shortening, attitude normal, -ve varus valgus
stress test, -ve mcmurray test. full ROM.
Question : give me dx, n how would u mx this patient at this level? if pt
didn complain pain, plus pt no need to reduced weight since he is an
athlet? so do physiotherapy to increase muscle bulk..apart from surgical
intervention.
2)Surgery- Right direct inguinal hernia
tricky: examine this patient abdomen. until i found that the hernia
during positve cough impulse..and i ask pt to stand. then procede wt
hernia examination.need to expose adequately but cover the genital
part. pt wore trouses n underwear. how would u mx hernia?what tx
MEDDEN 07/08
options got in hernia?anatomical locate deep ingunal ring? and what is
further hx u would elicit? what is the advice u would give to patient?
3)OnG- uterine fibroid : if ure a houseman at ONG at hkl u got patient
with abdominal mas. examine her. determine is it obs or gyne
problem(pt got suprapubic scar). assume pt deaf n mute. examine the
abdomen..findings: 27 uterine size, well defined margin, firm to
hard,mobile all plane, can get below, not attached to skin. determine
structures from superficial n deep? what is the possibilities mass inside
n how u differentiate? management as a housemen level not M.o (ix :
m.o can do us). jus wana cry TT)~ pray..................
surgical short cases (Ili Izyan)
A very nice surgeon; Dato'
Axillary mass/lump
1) describe the lump::Lump at inferior proximal of arm, round with
dilated vein+ purplish discoloration (dat0’ claimed angiogenesis) etc.
2) is it involving the shoulder?-->no y? no jt. Rom restriction
3) diagnosis? Benign soft tissue tumor, malignant soft tissue tumor,
lymphadenopathy.. Y benign? Y malignant?
4)further history to ask to the patient
5) what are the characteristic of lipoma?
6) how liposarcoma metastasize?(hemato or lymphatic?) and where's
the common site?
7) other examination? complete axillary LN examination (shud perform
dat earlier ==”) and breast examination
8) surgical management wide excision
Dr Pazudin O&G
47 year old malay lady with abdominal pain, examine the abdomen
1)describe the mass
2)diagnosis? Uterine massleiomyoma (fibroid)
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 Short Case Compilation Professional Exam 3 11/12
3) Ddx: leiomyosarcoma, ovarian ca etc. q: what is CT sd-entrapment of median nerve in carpal tunnel
4) what to look for in pt’s leg :: sign of DVT; calf tenderness / varicose q: dx by clinical or need ix?-clinical
vein q: if u want to ix,what ix?-nerve conduction study
5) investigation: abd u/s: to confirm blablabla q: mx - conservative by splinting the affected hands,NSAIDS, surgical-CT
6) how do u differentiate leiomyoma & leiomyosarcoma from the u/s? release
(errr,,n time’s up) kringggg
On the way to the next case Dato' ask: as a HO, how to mx pt?(stabilize
pt etc.) what surgery? surgery :
17 yrs old boy, pls examine pt chest
Dr Nor Azman ortho
finding : right gynaecomastia
MVA with foot drop
examine this patient lower limb. q : present ur finding
Gait: (pt need to use crutches)- ++Lt. foot drop + multiple small wounds q : dx?- rt gynaecomastia
over ant leg, etc. q: risk of breast ca in male?- rare,only 1 % of population ( he's satisfied)
Dr ask wat examination u want to do next?-->neuro q : if breast ca,what next u want to examine,show me - lymph node
Neuro deficit of L4 L5 S1 (motor and sensory) examination,axillary+supraclavicular
What nerve involved? q : so what do u think the problem is ? - endogenous hormonal therapy
Which level affected? He expect me to answer post. Hip dislocation (dr ( then prof ask me ask the patient regarding that), pituitary adenoma,
lead smpai i got the answer =S) CLD (usu bilateral ),hmmmmm
q : ix? - u/s + fnac ( do said usu not do biopsy!)
surgical short case : (NorHaida Ibrahim) q : mx? - s/c mastectomy
Prof Ziyadi,Dr Amran,Dr Ramli kringgg ( not really satisfied with this 1!)

ortho : O&G
43 yrs old malay lady cx of bilateral hand numbness for the past 2 yrs 42 yrs old lady,p/w suprapubic mass

hand examination ~> pls examine the abdomen!

thenar ms wasting + cannot do OK sign properly (cannot flex thumb,so
FPL weakness, FDP&FDS intact) + unable to do opposition of thumb ( so
opponen pollicis weakness ) + loss of sensory at median nerve
distribution + (+)ve Phalen,tinel & benedict test!
q : present ur findings
q: dx (bilateral carpal tunnel syndrome)
q: causes of CT sd
large,suprapubic mass, up to umbilicus, about 22 weeks of POA, regular
margin,smooth surface, firm to hard in consistency, non tender, mobile,
can get above but cant get below n etc
q : provisional dx~> uterine fibroid
q : ddx~> endometrial ca, ovarian ca, adenomyosis
q : ix ?

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 Short Case Compilation Professional Exam 3 11/12
q : mx ? medical + surgical mx
kringgggg
Dr. Zuhdi/Dr. Ismail Munajat/ Prof Shukri O&G
(Mohamad Solehin Bin Bakri)
Case 1:
Ortho (Foot drop secondary to PID).
Q: Patient had history of trauma..please examine the lower limb
first i ask patient for gait, he got high stepping gait. He can walk tip toe
but cant walk on heel.. Present of scar bilateral lateral thigh (Well heal)..
sensory: 1st web space impaired. for tibia and superficial peroneal
intact. so..more likely upper lession..
1- What id your diagnosis
2- What is the causes of foot drop in this patient
(i said maybe due to deep peroneal n injury, than Dr said no scar at leg..
so what other posible causes?? i blank gak.huhu.. than Dr guide so i said
it due to PID)...
3- Than he ask, what else you want to examine? ( he want to hear SLR n
sciatic stress test).. i did not do because bell rang already... ~Pasrah
saja~
Case 2:
Surgery ( Varicose vein)
Q: Examine this lady lower limb
Pt had dilated vein on both leg, but Dr just ask to concetrate on left leg
only.. present of dilated vein at medial aspect of leg.. no
lipodermatosclerosis, talengectasia,edema or ulcer. i do tonique test..
MEDDEN 07/08
there is filling on tonique test.
1- where is the usually site for venous ulcer?
2- What its indicate if on tonique still have filling?
3- what else u want to do? ( i said perform multiple tonique test to
locate which perforater incompetent.. do seem like agreed..huhu)
4- What investigation you like to do ( i said doppler.. Dr as me Doppler
or duplex? huhu.. berpeluh gak time nie)
5- How you manage this patient.. i said conservative 1st, then Dr said
let's say conservative fail... i said do surgical such as ligate the
shapeneous vein, use strip.. what to check before do strip and ligation?
~I blurrr~
Case 3:
Obstetric ( Smaller than date)..
Q: Prof give scenario which is pt G3P2 currently POA 30w ++...please
examine the abdomen.
On palpation the uterus size just 26w. longitudinal lie and breech
presentation.. ( when i said breech, prof re-examine pt and he agreed).
1- Why you said the head at fundus? (i said, ballotable,hard and round)
2- what is you ddx? (oligo,iugr,wrong date,PPROM)
3- how you investigate.. i said ultrasound..what to look? i goreng
sket2..than abis masa...
Surgical Based (External examiner, Dr.Nawaz, Dr Nik Zuky) (Ling Ai Soon)
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 Short Case Compilation Professional Exam 3 11/12
1. Inguinal hernia
Examine the abdomen, Look distended, hyperpigmentation around
umbilicus, then look for cough impulse. Negative? External examiner do
again. (Seems negative also) Then he change “examine the right inguinal
area”. “Wear glove!” – Dr Nik shouted. Fast fast ask patient stand and
do cough impulse again, Huge swelling extended down to scrotum!
Inspection then palpation describe. Then ask patient lie again to reduce
swelling.
Q: What you wanna do after reduced?
Q: If deep ring occlusion test is +ve, What it means?
Q: if reducible, what is your diagnosis? Differential?
Q: Any investigation to confirm?
Q: What is the surgery modality available for inguinal hernia? Elaborate.
Q: Where is the other part of body can have hernia?
Q: what is strangulation? What is incarcerated?
2. Cervical myelopathy
Ask 3 Q to pt first.
1. What problem she having? Parasthesia both upper and lower limb
2. underlying DM? No, but gastric.
3. Stunned???!!!
Ok, proceed to upper limb examination
Exposed by right up to shoulder, but only exposed up to elbow.
Look, Feel then I do Ulnar nerve examination.
Dr: What is pt complain???? Bilateral upper limb parasthesia?- could be
from the cervical spine!
Ok, then proceed to Tone, Power Reflex! All normal but Reflexes
exaggerated at right upper limb! Then do dermatome. Wow!! Then do
Hoffman! Positive both! Diagnosis: Cervical myelopathy.
Q: what further test you wanna do? – wazir? Spurling? NOPE.
He pointed the walking aid. GAIT?
Q: What is the gait look like in cervical myelopathy?
3. Fibroid
Examine the 56 year old lady with per-abdomen mass.
Ask chaperon, exposed. Then inspection, hyperpigmentation over the
MEDDEN 07/08
left lumbar region.
Q: can it be hypochondriac? Nope, should be higher up
Mass palpable around 24 week size of uterus, can get below, mover side
to side.
Q: can it be 26-28 week size? What is your diagnosis?
Q: If ovarian cancer, what history (1 Q) u asked patient?
Q: What is the differential diagnosis?
Q: if it is a huge fibroid, ultrasound finding? If cancer?
Q: Treatment?
----------------------------------------------------------------------------------
Short case: (Teoh Tek Jiunn)
Examiner: Prof Ziyadi (cardiothoraxix surgeon), Dr Ramli (O n G), Dr
Amran (ortho)
Station 1: A middle age man with awkward walking for 2months. Check
his right lower limb.
Findings: Patient with high-stepping gait, unable to dorsiflex ankle,
unable to extend big toe, loss of sensation over 1st webspace and lower
part of lateral right leg
Provisional : right common peroneal nerve palsy (however there was no
scar over the fibular neck region..n the lower limb as well..so dr amra
asked is thr any other possibility that causes the pt to have common
peroneal nerve palsy without scar)
wat investigation u wan2 do: nerve conduction studies and x-ray of right
lower limb
KRRING.........
Station 2: A 59yo Malay lady nulliparity. Check her abdomen
Findings: A 30 x 9cm mass over the anterior abdominal wall..more on
left side region, mobile in 4directions and able to get below the mass (i
think so)..no ascites..no lymph node palpale..
Provisional : Ovarian tumour
Ques: 1. wats ur differentials?
2. how u differentiate ovarian n uterus mass?
3. wat ix u would like to do?
4. hw do u stage the ovarian tumour?
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 Short Case Compilation Professional Exam 3 11/12
KRRING............ A: fibroid(oops!)
Q: prof repeat the Q. if patient, para 3 came to u with dysmenorrhea,
Station 3: A middle age woman with a left sided chest scar (duno wat menorrhagia, what is ur provisional!
scar..not like surgical ones). Pls examine the pt chest.. A: sorry prof, its adenomyosis..hehe..
Findings: I unable to appreciate any mass over the right side Tetttt.…
breast..axillary lymph node not palpale..I forgot to palpate for
supraclavicular lymph node Station2: inguinal hernia ;(
No provisionoal Q: ask patient what is his problem.
Ques: 1: wat abnormality u can find in the chest? He said, uluran( hernia)
2: wat skin changes u expect to see on the right sided breast? Q: so, proceed with ur inguinal examination.
3: Did u tink lymph node is important in this pt? yes...then y dun u Just examine as usual.
palpate the supraclavicular ones? teeeeeeeeeeeeettttttt.....sorry dr Patient got left reducable direct ingunoscrotal hernia.
4: if this pt come wif back pain..wil u worry? y? Discussion paart
5: if this pt come with right sided breast lump what shud u do?? Q: where is the deep inguinal ring
KRRING.......... Q: tell me border of hasselbach triangle and why is important.
Q: what risk factor for this patient( old patient)…Dr, want to hear BPH
Short case surgical based (Nor Ayuni) Q: so, how u manage this patient
Examiner: Prof Adibah (O&G), Dr. Ridhuan(paeds surgeon), Q: how did u do hernioplasty
prof …..(external examiner ortho). Q: what kind of mesh u put during hernioplasty(prolene)
Station1: adenomyosis. Tetttt….
Q: please examine patient abdomen. She is para 3( hint!!)
Prof keep on interrupting during my physical examination. Eg of Q: Station 3: non-union
striae graviddarum indicate what? How did u do shifting dullness..for Q: please examine pt’s left tibia(specific sangat..huhu)
the mass, I said its firm to hard in consistency then prof asking me, Very prominent deformity at distal tibia, surgical scar, painless mobile of
which one, firm or hard?? I said firm(ok!). affected area.
Discussion part: Then, ade limb length inequality, dr.ask me to do apparent and true
Q: present ur finding length.. argh, forgot to square pelvis..hehe..but, dr. give me hint to do
A: mass over suprapubic area, 22 weeks size, can’t get below, move side that la..haish..
to side..blablabla Discussion part
Q: so, what do you think the origin of the mass? Q: what do you think this patient has?
A: most likely from uterus A; non-union of left distal tibia with limb length discrepancy.
Q: other differential? Q; ok, interpret this film(xray)
A: from ovaries, distended urinary bladder, erk…sigmoid colon? A: fracture gap at distal tibia with fibula intact. In between fracture gap
Q: ok, if it is from ovary, what is ur differential. got soft tissue, hypertrophy over the fracture end(not so prominent :p )
A: fibroid, adenomyosis, Q: so, what do you think the cause of non-union in this patient
Q: so, what do you think of this pt? A: intact fellow bone(fibula intact)

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 Short Case Compilation Professional Exam 3 11/12
Q; so, how would u do? examine her
A: erk..ORIF( dr.gelak..huhu. lagi?) dr. nak dengar perkataan osteotomy The patient looked pale, no jaundice, multiple bruises on both UL & LL,
and bone grafting..ah both LL were swollen, edema up to knee level, tender,
Tettttttttttt……. hepatosplenomegaly which was tender, shifting dullness positive
Q: What is your findings?
Short case with AP Imran, Prof Adibah, Plastic surgeon Q: what other examination you want to do?
Surgical based (Yin Hoong) A: lymph nodes
Q: give me the causes of hepatosplenomegaly with generalized
Case 1 Ortho (29yo/M/man) lymphadenopathy
Q: This patient is having abnormal gait, examine him Q: what ix you want to do
Then I requested to ask patient to walk but dr said no need and he
changed his Q: please examine his lower limb. Case 3 O&G (28yo/M/lady)
Then I start from inspection, multiple small rounded scars over the left Q: this lady pregnant for 39 weeks, primigravida, examine her; running
anterior knee and the deformity is not so obvious. commentary
Then Dr asked the patient to dorsiflex his ankle, then ask me what do I Abdomen distended asymmetrically, linea nigra, no striae gravidarum,
see. So he ask me examine the ankle. no dilated veins, 2 poles felt, head in RUQ, buttock in LLQ, olique lie, FH
Left ankle is slightly plantarflex, unable to dorsiflex, weakness on present
plantarflexion, loss of sensation over the deep & superficial peroneal Q: what are you palpating?
region, reduced sensation on tibial nerve distribution, dermatome for L4, A: fetal pole to look for singleton or multiple
L5 intact. Q: give me ur dx? Where to listen for FH?
Q: present your findings. What is your dx? Where is the lesion? Justify. Q: what are the causes of oblique lie?
A: peripheral nerve, common peroneal nerve Q: what is the commonest cause of oblique lie in this pt?
Q: where is the commonest site of lesion? Q: how do you date the pregnancy? When is dating US done? When is
A: fibula neck quickening for primi?
Q: examine the fibula neck Q: what investigation you would like to do? What do u want to look for?
A: no abnormality, no deformity, no scar, no tenderness Q: how do you manage this patient
Q: other site of injury?
A: posterior hip dislocation **basically Qs are asked according to what I answered.
Q: Ix u want to order?
A: nerve conduction studies, EMG, XR Short case (Siti Fadillah Skh Ali)
Q: let’s say this patient come back 3 months with foot drop, what is
your mx? Examiners:
A: nerve repair, neurotization Dr Shalini (medical neurologist),
Dr Salmi (Paediatric neurologist),
Case 2 Surgery (34yo/M/lady) Dr Nandev Putane (Anesthesiologist)
Q: this patient has epigastric discomfort, LOA & LOW for 6 months,

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 Short Case Compilation Professional Exam 3 11/12
Case 1: Medical case
Please examine abdomen.
Findings:
-general inspection: no significant findings
-general peripheral: no gross stigmata of CLD, but have sparse axillary
hair (patient said, that’s normal for him), had bilateral pitting edema up
to below knee level (at 1st Dr Salmi enquiry why I chek pitting edema up
to knee level. I said pt had ones. She counter check and agree with my
finding- he had bilateral pitting edema up to just below knee level)
-per abdomen:
 hepatomegaly (17cm), splenomegaly (2 finger breath below left
costal margin), dull Traube space
Discussion led by Dr Shalini:
Q: tell Ddx of hepatosplenomegaly
Q: most likely diagnosis of this patient
- my ans: infection. But doctor said patient looks well. So other
Ddx possible for this patient? I answer myeloproriferative
disorder (Dr accept the answer)
Case 2: Medical case
Please examine cardiovascular system.
Findings:
-General inspection: overall well except had tinge of jaundice.
- General peripheral: irregularly regular pulse (I miss this findings), no
stigmata IE, elevated JVP (8cm), no pitting edema.
- Precordium examination:
- swollen precordium, visible pulsation, median sternocotomy scar
- displaced apex beat (7th left ICS, 1cm lateral to MCL), normal apex beat
- no parasternal heave, no thrill, no palpable heart sound
-Ausculatation:
 S1,S2 heard, but S1 is soft
 Pansystolic murmur, best heard at mitral area, radiated to axilla,
grade 3/6, murmur increased on inspiration.
MEDDEN 07/08
 No other murmur heard
 Lung crepitation
‘’So, puting this together, I think this patient had mitral regurgitation
most likely due to chronic rheumatic heart disease, currently in heart
failure. However, no stigmata of infective endocarditis noted.’’
Discussion lead by Dr Nandev Putane:
Q: why u said no infective endocarditis?
- Because no stigmata IE which I look for; Janeway lesion, Osler’s
node, splinter hemorrhage. Furthermore, I would like to do
fundoscopy to look for Roth spot, urine dipstick to look for
hematuria (Dr said OK.)
Q: is it possible to get MS in this patient?
- I said possible
Q: do you think patient have MS?
- No. because even in left lateral position (maneuver to detect
MS), I couldn’t detect soft diastolic murmur. (Dr said OK.)
Q: what causes of median thoracotomy scar?
- 3 causes: prosthetic valve replacement, valvular repair,
coronary artery bypass graft (CABG)
Q: what possible cause for median sternotomy scar in this patient?
- Valvular repair. Prosthetic valve replacement is less likely
because no prosthetic click on auscultation. CABG also less likely
because no scar at the lower limb.
-
Q: why currently patient develop heart failure even after long time ago
underwent surgery?
- I dunno what to answer. Then he changed question. Is it
possible to develop heart failure? I said yes, because there is a
chance of valve fails to function properly in this patient.
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 Short Case Compilation Professional Exam 3 11/12
1) What is ur differential diagnosis?
Case 3: Paediatric case 2) What is epidermoid cyst? How it happened?
Q: please do motor system examination for both upper limb, lower limb 3) What other examination u wanna do? Dr want to hear stretch the
in this patient. muscle...
4) Do u think this patient need surgery?
Findings:
- General inspection: 8 years old boy, elongated head, facial expression- Case 2: Examine the anterior neck
less, lying on the couch, (lots of findings I miss, one of that is, patient Tricky case- No obvious swelling, no skin changes, cant visualize the
less move both upper limb, lower limb) mass during drinking and protruding of the tongue. Examination reveal
-Motor system findings: the mass 2x2cm on both side of the neck. No carotid bruit, no skin
- tone: generalized hypotonia changes. soft, smooth surface, non-mobile.
-power: I’m not assess properly (Dr argue with my findings) 1) Present ur findings?
-Reflex: normal reflex ( my answer is brisk reflex. But doctor suggest me 2) What is ur differential diagnosis?
to review my technique. So I just agree with Dr’s finding, which is 3) What is the diagnostic investigation?
normal reflex) 4) Thyroid function test Normal, what else u wanna do?

Question lead by Dr Salmi: Case 3: Examine the abdomen

Q: tell me your finding:
lower motor neuron
Q: Ddx
- I try to answer by giving common causes at each level lower motor
neuron tract. Tapi awal2 lagi Dr dah potong jawapan i. sebab katanya, tu
kat adult bole la..kat paed, x sesuai..
- macam2 I sell my Ddx, but both Dr Shalini, Dr Salmi keep on gelak2 je..(
I pon gelak je la)
Q: look at the scar, look at the face. Tell me 1 diagnosis, if you want to
pass.
- me? (@_@) hahahaha
Prof wan faisham, Dr Andee, Dr Pazudin (Lim Kh)
Case 1: Examine the right upper limb
6x6 cm round mass on the right upper arm, no skin changes, no dilated
vein, no surgical scar, no sinus, no changes of temperature.
Slip sign +ve, non-mobile to all direction, fixed to the skin
Abdomen soft and non-tender, Mass felt at the suprapubic region. Size
26x 23cm, move side to side, unable to get below the mass.
1) Where is the origin of the mass?
2) What other examinations u want to do?
3) If it is an Uterine mass, what organs will it compress? And it lead to
what?
4) What other investigations u want to do?
Case 1- Uterine fibroid- Dr Nik Rafiza (Teoh Tee Ming)
I think the questions are the same as everybody else’s.
Case 2- Right femur fracture presented with multiple scars over the
lateral aspect of the right thigh complicated with shortening, delayed
union, osteomyelitis and anterior cruciate ligament injury with
intermedullary nail - Prof Imran
Prof: Please examine this patient’s lower limb
Introduce myself to patient. Expose the patient’s lower limb up to upper
thigh. Ask patient to walk. He was unable to walk on toes and heels due
to instability.

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 Short Case Compilation Professional Exam 3 11/12
Me: My patient has an unstable gait. Prof: What internal fixation is this?
Prof: What do you mean by unstable? Me: Intramedullary nail.
Me: Patient walks with his body swaying to one side and there is pelvic Prof: Examine this patient’s knee joint.
and shoulder tilt. I start by checking for effusion.
Prof: He has short limb gait. Where do you think is the shortening? Prof: Ok. Just examine the ligaments.
Me: At the femur because there are scars over the lateral aspect of the I ask patient to flex knees to 90 degrees and look for posterior sagging.
right femur. No posterior sagging. Proceed to anterior drawer’s test. Slightly positive.
Ask the patient to “rapatkan kaki” and inspect from the anterior, lateral Then posterior drawer’s test. Positive.
and posterior. Doctor saw that I was a bit confused.
Me: Anteriorly, there is genu varus. Prof: How do you check for posterior sagging?
Prof: Is this normal? Me: I look for the relation of the tibia to the tibial tuberosity. (I squat
Me: Can be normal. Laterally, there are multiple scars on the lateral down and check again)
thigh of my patient: a surgical very high up; another rough edged scar Prof: Is there posterior sagging?
which is hypertrophic and overlies a swelling- probably an incisional Me: Not that I can appreciate.
hernia; and another small round scar just above the knee joint. Prof: So if there is no posterior sagging…
Prof: What do you think the patient has? Me: It is anterior drawer’s test positive—anterior cruciate ligament
Me: External fixation. injury.
Prof: What is the middle scar? Prof: If this patient is an athlete, how would you like to manage this
Me: Probably an open wound. patient?
Prof: What else can it be? Me: I would like to offer this patient reconstructive surgery. In the
Me: Infected wound. meantime, I would refer the patient for physiotherapy for muscle
Prof: Osteomyelitis. strengthening.
Me: Oh… But usually I will see a sinus in chronic osteomyelitis. Prof: Which muscles do you want to strengthen?
Prof: Patient has shortening. What is your diagnosis? Me: Quadriceps and hamstring muscles.
Me: Right femur fracture with malunion or non-union. Prof: What do you want to take for reconstructive surgery?
Prof: Malunion or non-union? Me: Middle one third of the patellar ligament.
Me: Malunion Prof: Where else?
Prof: Examine the patient to confirm your diagnosis. Me: Er… I don’t know. Archilles tendon? (I think this was totally wrong.)
I test for mobility and continuity. Patient was in pain.
Me: It is immobile but no smooth continuation. Finish. On the way out, Prof Imran shows me the patient’s xray with
Prof: Patient is in pain. Do you think this is malunion? intramedullary nail.
Me: No.
Prof: Then what is this? Case 3- Left indirect inguinoscrotal reducible hernia- Dr Badrishah
Me: Delayed union. The basic questions are still the same as everybody else’s, so I just write
Prof: So what is the management? the extra ones.
Me: Internal fixation. Dr: If this patient smokes 20 cigarettes a day, how do you want to

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 Short Case Compilation Professional Exam 3 11/12
manage this patient?
Me: Conservative or surgical.
Dr: What are the conservative methods?
Me: Pelvic harness.
Dr: Pelvic harness or pelvic truss? (He asked the timer and the timer
answer truss.) If the patient is coughing, will you push in for surgery?
Me: No. Because the patient probably has COPD and chronic cough will
cause hernia to reoccur.
Dr: So what do you want to do?
Me: Refer to medical to treat the cough first.
Dr: What do you want to advice the patient?
Me: Stop smoking, consume high fiber diet, avoid straining or heavy
weight lifting.
examiners: dr.badrisyah (neurosurgeon), dr.nik rafiza (o&g),
prof.imran (ortho) (Oga Kiki )
Case 1: Left varicocele (dr.badrisyah)
At first i was thinking, is it neuro case?Looking hard at pt to see any
ptosis/neuro sign
Patient: malay boy around 17y.o
Instruction: This pt came with complaint of problem at perineal area.
Examine him.
Oh,perineal abscess or what. i think not appropriate if straight away go
to the perineal area.ok,i start with gait.
Doc: Patient complaint of problem at perineal area,not peroneal. ok,i
change my instruction.examine his inguinal area.
Ok,got it. Left scrotal swelling,about a pingpong ball size,no skin
changes,negative cough impulse,non-tender,no increase in temperature
MEDDEN 07/08
compared to right side,soft,both testes palpable,can be separated from
spermatic cord,can get above,BAG OF WORMS felt,translumination test
negative
Doc straight away asked for diagnosis.no need present the finding.
Why varicocele?left scrotum welling,soft,non-tender,bag of worms
felt,traslumination test negative…
Complications in this young man?Infertility,atrophic testes,infection…
What infection?orchitis,…(doc seem want more but i’ve no idea)
Management?conservative,surgical repair if not improve/causing pain…
Investigation to find the cause?ultrasound of scrotum,doppler..look for
the vein
Give me one condition that patient may come in emergency?testicular
torsion.
Ok,move to the next station even still got time.
Case 2: Intraabdominal mass (Fibroid i think) ~dr.nik rafiza
Patient: malay lady around 40’s
Instruction: Examine this lady. Running commentary
Pale palm and conjuctiva, firm non-tender mass at suprapubic area,20
week size,mobility cannot be appreciated because pt quite big body
built(thick abdominal wall)
Doc stopped me after doing deep palpation.
What to do next?complete per abdominal examination,check
LN,bimanual examination
How to differentiate uterine vs ovarian mass by bimanual
examination?much times spent here,doc seemed not satisfied with my
answer
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 Short Case Compilation Professional Exam 3 11/12
Then time’s up.On the way to next station doc asked what ix to
do?abdominal USG,FBC,GSH, to look for blablabla
Case 3: Right foot drop (prof imran)
Patient: malay man around 40’s
Instruction: This patient came with complaint of low back pain.Examine
him
High stepping gait on right side,cannot walk on right heel and toe.
Right LL: Cannot dorsilflex,cannot extend big toe,cannot do eversion,
can plantarflex. No scar/deformity/swelling/tenderness at area of right
fibular neck
Left side normal
Didn’t do the sensation part,doc keep interrupting along the way
Patient cannot walk on heel and toe,what does it mean?
S1 problem,what finding to search for at the foot?
What markers to say leg is externally rotated?
So which nerve affected?Sciatic or common peroneal?
Patient with common peroneal nerve palsy,where is the common site of
lesion?why?
Other than around the fibular neck,where else common?
In posterior hip dislocation,which branch of sciatic nerve commonly
affected,tibial or common peroneal?
If no lesion at peripheral,in patient p/w footdrop,where do you think
the site of lesion?
The causes of spinal root compression in this man?
If L4 affected,at which level of spine is the lesion?
MEDDEN 07/08
dr fahisham, dr andi and dr pazudin (Kokoland Kukus)
1.case short limb gait, left leg is shorter than right, with multiple scars
on in front and lateral sides with a sinus but no discharges...
q; what type of gait?---mestila short limb gait tapi susah gak nk detect
initially
q;what other deformity u see?--short left lower limb
q; what u want to do?---measure the apparent and true length..
q; what u want to advise the patient?
2. surgery
q; what u see? dilated vessels over the greater saphenous vein and
lesser saphenous vein distribution, no ulcer, hyperpigmented
bla2...goreng x masak
q; what test u want to do?---i want to see any varices, then palpate for
SFJ. locate the SFJ...2.5 lateral and 2.5 cm below the pubic tubercle...
q; where to put torniqut? slightly below the SFJ
q; where is the lesion?--if no varicosity sugggest the SFJ valve
incompetence
q; how to confirm--release the torniquet
q; what other test in the ward to confirm the diagnosis?---mestila
doppler us
q; what u want to advise the ptn?--elevate the limb, use compression
bandage, use danazol (ubat utk hemorrhoid---tetiba rasa hesittated)...
3. ong
grossly distended abdoment in gravida 3 at 38 weeks, linea nigra with
stria at the lateral abdomen, with fullness of the flank
present?---singeton baby,oblique lie, no other mass,
diagnosis?- polyhydramnios
q; what test u want to do?-- fluid thrills...buatla...is sit positive cakap jer
positive
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 Short Case Compilation Professional Exam 3 11/12
q; what u want o do? mestila us Q: What is your differential diagnosis of testicular Ca?
q; to look for what?---fetal condition...(siottulla tetiba thought block) A: Epididymo-orchitis, Epididymal cyst, Hydrocele, hematocele, .....
Q: What type of hydrocele u expect in this patient?
Examiner: Dr. Andee, A/P Wan Fahisham, Dr. Pazudin (Billy Tham) A: ..................
Q: So what is your management for testicular ca.
Surgical Case: A: Bilateral orchidectomy (depends on staging)
Patient 70 years old male, complain of heaviness of the genitalia. Do a Q: Other modalities?
relevant examination. A: Chemotx (Not so sensitive), Radiotherapy
- Inspection: Asymetrical testis, right side larger, some inflammatory
changes, no scar Orthopedic Case:
- Palpation: Testicular in origin (can't separate from testis), can get Examine the patient's left hand
above the border, well-defined margin .........etc
Findings: Claw hand, Unable to abduct little finger, unable to flex little
Q: What else u wanna examine? finger, Fromen's test +ve (I think this is the most important finding he
A: Lymph nodes wants me to elicit)
Q: Which lymph nodes?
A: Paraaortic lymph nodes (Testicular Ca will spread to paraaortic l/n) Q: Why do u wanna flex and ulnar deviate the wrist joint?
Q: So can u usually palpate the paraaortic lymph nodes? A: TRO FCU tendon rupture.
A: Nop. Q: Any other reason?
Q: So what investigation u wanna do? A: Weakness of FCU tendon due to ulnar nerve palsy.
A: Ultrasound testis. Q: So where is the lesion if it is weakness of FCU?
Q: Good. What is the typical features of Testis Ca in ultrasound? A: At medial epicondyle
A: Heterogenous echogenicity, solid area, multiple septation, well Q: Good. So now it is normal. What is your impression?
define margin, A: Left Ulnar nerve palsy distal to medial epicondyle.
(I miss out calcification, ish~~~) Q: Where exactly the lesion can be?
Q: What other investigation u wanna do? A: Around wrist
A: Biopsy (I screwed myself up). But it has to be suprapubic approach, Q: What is the causes of Ulnar nerve palsy in this patient?
not Transcrotal approach. A: Fracture dislocation at distal radio-ulnar joint.
Q: (Shake his head) U really wanna do biopsy Q: Ok other causes?
A: I think no lar, hehehe A: ..............
Q: So what next? Q: What about higher causes?
A: Staging the tumour by CT and MRI abdomino-pelvis A: Medial epicondylitis, Elbow dislocation....
Q: Ok. What else more simpler? Q: What causes other than trauma?
A: Blood investigation, such as FBC......... A:..........................
Q: Be more specific. Q: Tumour? (he disagree.. T.T)
A: Tumour Markers, eg AFP and beta-HCG

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 Short Case Compilation Professional Exam 3 11/12
O&G case 22 weeks size, uterine mass
Patient 30 year old lady currently at 36 weeks POA, examine the Q1: DD
abdomen Q2: what is the skin pigmentation called?..linea nigra
Findings: SFH: 44cm. Impression: uterus larger than date Q3: if i give u 1 question to ask this pt..wat u wanna ask?..

Q: Since u mention patient's abdomen is grossly distended, which I case 2

agree, what is the evidence on inspection?
A: Abdominal Striae
Q: What kind of striae?
A: Striae gravidarum. (actually what he wants is increasing number of
striae)
(Then i do Clinical Fundal Height after SFH, I present uterus term size.
He disagree. He ask me to redo it. Then he ask me if umbilicus is how
many weeks? I answered 22. Then it is 11 fingers above umbilicus which
is 22 + 2(11) = 44 weeks uterus size. He wants me to present 44 weeks
uterus size)
Then i presented it is singleton pregnancy, longitudinal and cephalic
presentation.
Q: What is the cause of uterine size larger than date?
A: Wrong dating (excluded), Polyhydramnios ( How do u rule out? -->
Fluid thrill), Macrosomic baby (Maybe), Ovarian tumour or uterine
fibroid (ok possible), Multiple pregnancy.....
Q: So do u wanna redo your palpation?
A: (I repalpate. Found another pole in the left iliac fossa.) There is more
than 2 poles
Q: (He recheck then agree) What is your diagnosis?
A: Multiple pregnancy
Q: Show me where is the pole. How do differentiate head of buttock?
A: I show him. He agrees
Q: What Ix u wanna do to confirm?
A: Ultrasound.
(He seems satisfy then walked away)
prof adibah, 2 external(surgery and ortho) (Jun Xiong)
case 1
: this is a single lady presented with abdominal mass...pls examine her
: solitary thyroid mass-->question as usual..DD, IX etc..
case 3
:dry gangrene of right 2-5th toes
Q1: wat is ur diagnosis?
Q2: wat is the causes for this pt to have it?.
Q3: wat ix u want to do?
Q4: if i giv u 1 question..wat u wan to ask this pt?..
External (dato uro HKB),Dr Ramli, Dr Azman (Chew Fui Lo )
1) Incision wound over right gluteal region young malay boy
a) Open this (dressing) and examine..
b) Just describe the wound
c) What do u think it is? Post incisional and drainage of
abscess?sebaceous cyst?
d) What abscess u call that? Gluteal abscess?
e) What are the risk factors?
f) If u are the HO in charge, how to manage abscess?
2) If this is abscess how u cut it?u think single incision like that
adequate? This 54 para 3, examine the abdomen
a) Dr ramli mainly wanna see technique of examination..
b) What is ur impression?and why?
c) This is 54 year old, u worry?
d) How u manage?
e) U think benign or malignant?
3) Swelling over right deltoid region dr nor azman
a) Also need a proper technique way of examination

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 Short Case Compilation Professional Exam 3 11/12
b) What do u think is it?lipoma
c) It is suddenly progressively enlarge..what is it?liposarcoma
d) What sign in lipoma?demostrate it slip sign
e) What investigation u wanna do?what changes u see in x ray
to suggest malignant?
f) In mri, can u differentiate lipoma and liposarcoma?
g) How u manage?
Dr Andy, Dr Pazudin, Prof Fahisham (‫)ع ثمان ف ري حان ن ور‬
Case 1
25 yo Malay male c/o inguinal swelling. Please examine this patient.
On inspection there is moderate swelling extending from right inguinal
area down to the scrotum. No surgical scar, skin changes, redness,
dilated vein or ulcer. Palpation reveal a soft, regular, non-tender mass. I
cannot get above the mass. The mass is separating from the testis. Size
not measure. Hmmm.
Cough impulse positive. Ring occlusion test also positive.
1. Where is the location of deep inguinal ring? Midpoint of inguinal
ligament.
2. What is the structure located at midinguinal ligament? Femoral artery
3. Your complete diagnosis? Right reducible indirect inguinal hernia.
4. What do your want to ask the patient? Risk factor s such as
occupation (heavy lifting type), H/o constipation, smoking
5. How smoking relate with this condition? Chronic cough.
6. In old patient, what underlying disease you would elicit? COAD
7. What do you want to advise the patient? Avoid the risk factor, do
surgery.
8. Do you want to straight doing surgery? No.
9. What else you can do? I said supportive brace. Dr Andy said Truss.
10. So what surgery you want to offer to this patient? Right herniotomy.
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Case 2
56 yo lady c/w SOB and ascites. Examine patient abdomen.
The abdomen is grossly distended. There's striae gravidarum (opss!), I
revised back and said puplish striae at the flanks (due to thinning of
skin). Present of dilated vein and hyperpigmented area at the waist area.
No surgical scar, visible pulsation or peristalsis. Umbilical is centrally
located and flat.
There is a huge mass below umbilical area extending from right iliac
fossa to left iliac fossa, irregular margin, firm to hard in consistency,
lobulated, non-tender, not attached to skin, mobile at all plane?, cannot
get below the mass. Clinically 26-28weeker. Fluid thrill positive.
1. What is you provisional diagnosis? Ovarian tumor
2. You differential diagnosis. Fibroid. Ok. Endometrioma. Are you sure?
3. Fibroid what type of tumour? Benign tumor. Oh, then it could be
endometrial carcinoma. Ok.
4. What investigations you would like to do? Ultrasound of the
abdomen.
5. Why? To look for the origin of the mass either from ovary or uterus.
6. what is your management? TAHBSO.
Case 3
25 yo gentleman c/w knee deformity. Please inspect this patient and tell
us what is the deformity is.
On inspection from front, there is bilateral genu valgus, more prominent
on left side. The left foot is rotated excessively. No shortening of limb,
no scar, no skin changes, no swelling.
Gait is normal. Hmm.
1. What test you want to do? Varus and valgus test.
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 Short Case Compilation Professional Exam 3 11/12
2. What is the cause of this deformity? OA
3. In this age? No.
4. What are conditions? Trauma, congenital. Ok
5. Others? Blank (Dalam hati rickkets...T_T) Softening of the bone? I
dont know still.
6. Ok, what age usually this conditions will present to you? 10 yo?
7. If you see this patient today, what parameters you want to write
down on the tickets, to look at the progression of the disease after 6
months? Angulation of the knee, medial joint line... lagi? he asked me to
go at the end of bed and look at the foot. I said distance between
medial malleoli?
8. What is the distance called? Inter-malleoli distance.
9. What advice you want to give to the mother regarding her child
condition (if he was a kid? To look for any abnormality of gait, sudden
weakness or persistent pain over the knee area, come to the hospital
immediately.
Short case (Dr.plastic surgery-dun know his name but rumour said
dr.shalini’s husband, anyw very nice doctor)-Hernia case (Tang Chin Shi)
1) Pls examine this patient inguinal region
2) How your perform deep ring occlusion test to differentiate direct or
indirect
3) Where is landmark of deep ring occlusion test
4) Treatment?
5) What advice u give b4 discharge
Short case (Dr.Pazudin)-Normal fetus with 2 previous scar
1) Pls examine this patient abdomen
2) What significant we want to heard fetal heart sound in this patient
have 2 previous scar?
3) What is your management on this patient
4) And what question u want to ask the mother
Short case Prof fahisham - Malunion
1) Pls examine this patient lower limb
2) Tell me the deformity you seen
3) How you measure apparent length and true length (just mention no
need perform)
4) How to know this patient have above knee or below knee shortening?
Dr. Amran, Dr Ramli, Prof Ziyadi (Syazani Zarif)
1. Ulnar nerve examination with typical low lesion presentation.
Muscles of the hand are impaired but the forearm muscles are intact.
Sensory impaired at the medial side
Q: ulnar paradox?
Q: where would you expect for the lesion
Q: investigations
P/S: can't really recall other questions. Sorry
2. 21 year old, non pregnant lady. Examine the abdomen: Non cachexic
patient with mass palpated at the right iliac fossa extending to the
suprapubic area. Vague mass. Can't get below, mobile laterally and
smooth surface.
Q: diff diagnosis for THIS AGE
Q: differences between ovarian and uterine mass
Q: investigations for ovarian mass
Q: staging for Ovarian Ca
Q: definitive investigation for Ovarian Ca (exploratory laparotomy)
Q: treatment
3. Breast Ca
Q: describe what you see (typical cancerous lesion)
Q: examine the breasts and lymph nodes
Q: investigations
Q: neoadjuvant chemo
Q: estrogen teceptor
Short case surgical, Prof Nik Nasri (O n G), Dr MNG (surgery), Dr
Norazman
(Henry Ngoo)
1) Malay woman, abdomen distended, findings just like describe fibroid

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 Short Case Compilation Professional Exam 3 11/12
Not much question, Prof ask wat type of fibroid u know and if less
bleeding is wat type
2) Surgical--left varicose vein ( long saphenous system). after describe,
Dr MNG discuss surgical management
3) Ortho--right lower limb shortening with posterior sagging of
knee( PCL tear), straight forward case. Last ques b4 i left, if there is
shortening of 3 cm, what will u do
Case 1 (O&G-Prof Adibah)--best doctor (Alex Fan Chin Siu)
This is a 46 years old lady. Please examine the abdomen.
Q-what are u doing?
A-i'm palpating the abdomen. there was a mass from umbilcal level till
below suprapubic region.
Q-what do u thing is that mass?
A-uterine fibroid,endometrial mass,ovarian mass,bladder
mass,colorectal mass
Q-continue palpating n tell me more findings
A-i told de features of uterie fibroid on PE
Q-is it possible the patient is pregnant?
A-no
Q-why
A-no striae gravidarum,no fetal poles palpated, no fetal movements, no
fetal heart heard
Q-good...tell me how u investigate her
A-Fbc (see anemia), uss pelvis (to identify the
mass,location,origin,benign or malignant)
Q-all right..did the patient need UPT?
A-nope
Q-jom,we go next case
Case 2 (General surgery-Dr Ridzuan)--best doctor
Q-please examine this lady lower limbs
A-by inspection, diated varicose veins......
Q-enough?
MEDDEN 07/08
A-i answer yes (but i know i miss one thing),then finally i figure out n
spoke.."no venous ulcer seen"
Q-he laughed and said ya loudly. luckily u can tell..relax..relax..
A-i ask patient to lie down on bed..
Q-prof adibah asked why u u want to move the patient from standing to
lying position?
A-cos i want to check the legs edema properly...as well as tornique
test,perthes test, n trendelenburg test
Q-please show to me n assked the nurse to bring me a tornique quick
A-then i applied it...then while applying it,
Q-dr ridzuan made sure i can do thing in two things or not?
A-i said yes
Q-please ask patient one important risk factors in her presentation
while doing tornique test
A-i said occupation but hands not moving (nervous)
Q-he said continue to do your PE n asking patient..
A-then i forget to empty n lift patients legs (too nervous)
Q-your technique is not correct.he n prof adibah helped me lift my
patient limb n said wahhh..we doctors also have to help u to carry
patiient legs..all doctors smiles...but anyway u continue..
A-(i am embarassed) i continue present case..
Q-then dr said why u didint ask patient to stand then comment during
the tornique test...it's more like a teaching session
A-i responsed to him by saying i was nervous so forgot..n i said dr, can i
redo the test..
Q-sure..
A-after perform n present
Q-ok..next case..while on the way to next station, he said how u manage
the patient?
A-i was shocked. no rest..take a deep breath...n answered medical
nsurgical mx..
Q-eg of medical?
A-nonpharmacological (reduce weight,changing jobs that need long
stand,wear compression stoking)
Q-medication?
A-Daflon
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 Short Case Compilation Professional Exam 3 11/12
Q-all right change your answer?
A-i said yes. it was non-union (actually i too nervous n i did not see the
Case 3 (external examiner--Prof alib) x-ray clearly)
Q-please examine the left hand of this young female patient Q-yes..u get it correct
Patient: she quickly grab a pillow n out her hands on it then i went off again after no Q from dr for 30 seconds
A-(i tot of peripheral neuropathy case) inspect first: multiples scars Q-suddenly dr ridzuan called me again n asked me what is type of non-
Q-how many u can see? union?
A-4 scars A-atrophied non-union
Q- did u see clearly? Q-u now really can leave the exam hall..
A-then i said sorry there were 5 scars
Q-what else u saw?
A-deformity of left mid forearm (cannot supinated)
Q-go palpate the patient
P/s: there are certain questions missing. We are sorry for the
A-i said there was obvious muscle wasting and small hand before inconvenience. We hope you will pass with flying colours.
palpating
Q-it is good u see it..many students miss it...(he seems happyn satisfied) InsyaAllah…
A-n this is peripheral nerve problem (wrist drop)
Q-no response from prof
A-i palpate the forearm n hand;i screen the nerve (radial, median,ulnar
nerve), i present the findings..
Q-he said assuming the nerves all were intact..what else Love,
A-(i think luckily no need perform,i hate the most;then i know what he
wants already)i move the hand n forearm, it is mobile n tender from Your friends and seniors, Medden 07/08
inside as i present to prof
Q-what do u think what had happened to her?
A-delayed union
Q-why?i didn't tell u the time when fracture occur?
A-i said because the fracture site is mobile n tender on palpation
Q-all right..

ring ring ring

then i went off
Q-then he callled me suddenly..he said lets us see the x-ray of the
patient
A-i went n viewed the x-ray.
Q-without 10 seconds, he tapped my shoulder n said do u want to

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