VIVA 2

FAMMED
GROUP B
GROUP 1 (DR SUDHIR KAMAT)

CASE 1: DM WITH NEUROPATHY

 Present case and physical examination

 How to manage this patient
o Advice pharmacological and non-pharmacological
 What investigations you will do
 Advice for patient with neuropathy
o Foot care
 Normal blood glucose level
 Symptoms of neuropathy
 Other name for peripheral neuropathy
 Complication of DM
 What is DKA
o Symptoms
o How to manage

CASE 2: HYPERTENSION

 Classification of HTN
 Drug for hypertension with example
 Clinical sign of secondary HTN
 What other type of HTN do you know
 Complication of HTN
 Investigation to be done

CASE 3: OSTEOARTHRITIS

 Present case
 What features of patient point to OA
 Other examination you want to do in this patient
 Investigations
 Ddx and character for each
 Pharmacological and non-pharmacological treatment
 Classical signs seen in tubercular arthritis
o loss weight, loss appetite, evening rise temperature
 Health promotion and prevention
CASE 4: FEVER

 Diagnosis and differential diagnosis

o Macam mana nak differentiate & rule out each
 Classical sign typhoid
 Investigation for typhoid fever
 Types of fever
o Explain with example each
 Investigation
 Treatment
o pharmacological & non pharmacological
 Complication of typhoid

CASE 5: ASTHMA

 Present case
 Features of asthma
 Examination finding in asthma
 Type of dyspnoea
 Status asthamaticus
 How to manage asthma
 Caution in prescribe prednisolone
 Advice in using inhaler.
 Most common steroid in India
 Benefits of inhaler

GROUP 2 (DR GEETA)

CASE 1: MULTINODULAR GOITRE

 Present case
 Signs for thyrotoxicosis
 Other relevant history
 Management
CASE 2: ACUTE PHARYNGITIS IN ADULT

 What are the causes?

 How to manage this patient
 If it is bacterial pharyngitis, what is drug of choice?
 What to give if patient have allergic to penicillin?
 Health education

CASE 3: PEPTIC ULCER

 What are the most important points as for history?

 Differential diagnosis
 Causes of chest pain
 Plan of management
 When to refer
 Advice to patient
 Use of triple and quadruple therapy

CASE 4: NORMAL PREGNANCY

 Present case
 How do you say this is normal pregnancy (based on HB and RBS)
 Purpose of ANC.
 How many ANC check-up needed based on WHO.
 What do we access in booking?
 Screening test done in booking.
 Advice given to mother?
 When we do RBS?

CASE 5: GESTATIONAL DM

 Why do you diagnose as GDM

 Management
 Maternal and foetal complications
 Preventive measures
 What advice given after discharge
 What food to eat/not to eat (refined carbs with examples)
 What is MNT
GROUP 3 (DR SMRUTI)

CASE 1: ASTHMA

 Can it be COPD? (Instead of asthma, based on history)

 Why do you say it’s not COPD
o Differentiating points COPD vs asthma (based on history and PE)
 Investigation
 Treatment
o MDI
o Drugs and etc
 Health promotion and prevention
 Asthma action plan

CASE 2: GESTATIONAL DM

 Read case (irregular antenatal check-up)

 Why irregular, why diagnose and not taken insulin, how you want to convince her
o Counselling
 Based on history, you know she is diabetic, what is the most important investigation
you want to do? Skip all the routine part.
 Positive findings in PE related to GDM
 Fasting and random blood sugar for GDM cut off
 Why anomaly scan is important in GDM.
 What is the possible complications of GDM to foetus that can be detected using
USG?
 How to manage this patient?
 Insulin
o What type and dosage
o How to calculate.
 Why do you say this is a high risk case?
 Colour coding system for ANC in Malaysia
 How much do you label as a short stature
 In obese case, how much weight gain is appropriate?
 Health promotion and prevention (counselling lagi)

CASE 3: ACUTE GASTROENTERITIS

 How to differentiate bacteria or virus in food poisoning (dlm kpark)

 Classification dehydration
 Investigation
 Treatment
 Health promotion and prevention
CASE 4: ANAEMIA IN PREGNANCY

 Present case
 Cut off point of anaemia (WHO)
 Grade of anaemia
 Investigations done at PHC level
 How to manage this patient (dosage)
 When to reassess HB level with oral iron therapy
 When to switch oral iron to parenteral iron
 Advices for anaemia in pregnancy

CASE 5: EARPAIN

 Present case
 Any important history to ask regarding earpain
 Investigation
 Treatment
 Preventive measure/ advice to the patient (future)
 How to differentiate otitis externa and otitis media
 Stages of ASOM
GROUP 4 (DR NILESH)

CASE 1: THYPHOID FEVER

 What do you ask for typhoid?

 What type of fever in typhoid?
 Other types of fever.
 What type of abdominal pain? Where?(diffuse)
 What can you find in physical examination? From vital signs (relative bradycardia) to
per abdomen.
 For each degree of rise in temp, how many rate of pulse increases?
 Why is there abdominal pain in typhoid?
 Where does the organism settle in the body?
 Differential diagnosis of typhoid fever.
 Investigation and explain findings
 Widal test result of number ratio
 Pharmacological treatment
 What class of drug is ceftriaxone?
 Name drugs under cephalosporin
 Non pharmacological management
 What is barrier measure?
 Preventive measure
 Types of typhoid vaccine and names.
CASE 2: OSTEOARTHRITIS

 Important history you will ask

 The common joint involve (5 example)
 Why woman have OA more
o Osteoporosis
o Obese
 Physical finding in OA
 GPE finding in OA ( fever)
 Differential diagnosis and how to rule out
o Reactive arthritis ( can involve small joint too)
o Rheumatoid arthritis ( morning stiffness)
o Tubercular arthritis ( unilateral)
o Gout (acute, painful)
o Psoriatic arthritis ( DIP, silvery skin)
 Investigation in OA
 Finding in X-ray
 Treatment in OA
 Non pharmacological treatment in OA
 Health promotion in OA
o BMI
o Diet
 What food rich in calcium
 Treatment in osteoporosis
o Calcium
o Vitamin D
o Bisphosphonate
 Role of Vitamin D
o Kidney
o Intestine
o Osteoblast
 Vitamin needed in formation of bone other than vitamin D
o Vitamin C
 Investigation in osteoporosis
CASE 3: ACUTE GASTROENTIRITIS

 What do you need to ask in history

 Important thing in physical examination
 What is the cause for diarrhoea
 What is grading of dehydration
 What important thing to see in dehydration
 What drugs can cause diarrhoea
 What is the component of ORS and how many grams per packet
 What antibiotic can you give in AGE
o Ciprofloxacin
o Ofloxacin
 What is the group of the drugs for antibiotic above
o Fluoroquinolones
 What is anti-motility drug and its example
 What investigation need to be done
 How to manage the patient
o According to level of dehydration
 What vaccine can you give for diarrhoea
o Typhoid vaccine- ty21a
o Vi polysaccharide
o Rotavirus
 Health promotion in AGE

CASE 4: NORMAL PREGNANCY

 What to ask in the history

 What to see in physical examination
o From GPE to per abdomen-generally
 Causes of anaemia in pregnancy
o Diet deficiency
o Lack of spacing
o Infection
 Investigation to be done
o Screen for TORCH (remember)
 Example diet rich in iron, protein, calcium and fibre
 High risk pregnancy
 What is definition of
o PIH
o Preeclampsia
o Eclampsia