Long Case, Short case
Many of our colleagues have asked me about the format of long and short case in Internal Medicine. These is what i can say regarding short and long case
- Each students will be assigned to a station with 2 cases. 10 minutes for each cases.
- Cases depends on your luck. You may get 1 CVS and 1 GIT, 1 Respi and 1 GIT, 1 Neuro and 1 Miscellaneous etc. Miscelaneoues here means Rheumato and Endocrine mostly.
- Each case is manned by 1 lecturer, meaning there are 2 lecturers in each station. READ the QUESTIONS properly, and Follow instruction. Some question may sound like dis,"Look at the patient and do the relevant examination," In this case, use your logic. E.g. dont la go do respi exam on a Cushing patient!
- Examination, do as fast and as complete as possible, ideal time will be 8 minutes. Start practicing now. Respi will take longer but usually the examiner will tell you to examine the front or the back only. Don't pandai pandai go examine 1 side only without instruction.
- Tips during presentation: Practice and more practice. Present to ur friends, although not perfect but still ok is ok. Look into the examiners eye, dont look at the patient. Look confident even though you don't know anything. Just crap something out. If not, you will only get marks for PPD, that is 1 mark for smiling :)
- Good examiner will guide you through the exam. If, for example, when u say a murmur is a mitral regurge, and the examiner ask you "Are you sure? Is it not, mitral stenosis?" you better agree with them, after reauscultation, and say its mitral stenosis, although u hear nothing! Because according to my supervisor, examiners cannot tipu tipu 3rd year students! They can tipu registrars only.
- During respi examination, if when you percussing, the examiner go near u and tried to listen to the sound, the diagnosis can only be pneumothorax and pleural effusion! How to differentiate? If you hear resonant, pneumothorax, if dull(don't care stony dull or water dull or dunno wat dull) its pleural effusion. Don't stick to this though. Remember law number 6.
- Just like the one in surgery posting except this time, it is bedside and you perform Hx and PhyEx in front of everybody!
- Practice. Hx is given around 5 minutes, after which the examiner may ask you to present and summarize, and give Diff Dx based on the History. That's y differential diagnosis for common symptom such as lethargy, cough, dyspnea, chest pain,headache is so important.
- Then the lecturer will ask you which system to examine(If he is cruel, he will ask you why, if not, proceed).examine follow the schematic, Tally version. Don;t do weird weird things and expect to get extra mark.
- After that, you must come to a provisional diagnosis. If no findings, just say that based on unremarkable physical exam, no differential can be excluded yet
- Proceed to Investigation. Know what investigation to do and what is your expected outcome and what are you looking for. If you stuck, just say FBC, LFT and say you need to assess the general condition for management of the patient.(depends on case)
- Management just go memorise the CPG la....Dosage, e.g 300mg aspirin loading dose and 75 mg subsequently for treatment of ischaemic stroke, if you can answer, will give examiner a good impression.
- Have to warn u all that some of the patients picked by the lecturer have no problem at all. Their problem is only ionic imbalance like hyponatraemia or uncontrolled diabetes. Keep this in mind