Exam Rants

Over and done with Paper A!! Woooootttttttttttttttttttttttttt!!!!!!!!!!!!!!!!!!!!!!!
It was a 3 hour paper and I started really slowly at the beginning, making my way through less than 1/3rd after the first hour. I then realized I had to speed up and somehow managed to finish the rest of the paper within the next 45 minutes.. -_-''. I have such crap time management skills....

Just 2 more papers to go now. Below is all that I can remember of paper A.

Anesthetics (5 marks)
List down the common methods of oxygen delivery in the ward. Compare their advantage/disadvantages

So basic nasal prong, hudson mask, venturi mask question.
Also we were told by kam Cyle this would be coming out :)))


Locomotor
This was more like an ED question rather than a orthopaedic question. A young male crashes into a passenger while on his bike and suffers a fractured right femur.
1. What is your immediate management? (5 marks)
2. He starts to develop fever & hypoxia. List down 4 causes.
3. Can't remember what 3 was... Oh investigations to rule in/out your differentials.

I don't think I did very well here... dang and I spotted red flags/yellow flags which have obviously been asked too many times.


Cardiovascular (10 marks)
Yay a repeat question I read up on right before entering the hall!!!!!!!!! Thanks Shalina!!!! And one that my buddy spotted right on :))

Explain the rationale of using ACE-Inhibitors, beta-blockers and spironolactone in heart failure patients.


Opthalmology
This was a mix of very hard and very easy questions.
1. A whole paragraph for us to fill in blanks!!!!!!!!!!!!!!! WOOTTTTTTTTTTTT!!!!!!!
Cataract is a disorder of opacification of the (blank). Patients usually presents with (blank) visual loss. Surgical treatment for cataract is normally performed under (blank) anesthetic.

Yeah you get the idea... until it got to this part - The most common cause of cataract is (blank). Erm.... is it aging???? Dieded.... its either aging or.... couldn't think of anything else so I said aging... -_-''

2. Explain each of these conditions and give an example of an ocular condition that illustrates it.
Variable expressivity, genotypic heterogeneity, phenotypic heterogeneity, limited penetrance.
4 marks ??????????????????????????????????????????????????????
And who said ocular genetics doesn't get tested!!!!!!!!!!!!!!!!!!!!!!!!!!!
Another -_-''

3. A diagram of an eye is given. Mark out the cornea, lens, optic nerve etc. Woottttttttttttttt!!!!!!!!!!!!

4. Clinical examination of strabismus. Explain your findings for a child with left esotropia.
?? Gave it my best shot... Hirschprung/red reflex and swinging torch light test?


General Surgery
A couple of repeated questions from osce and past years!!!!!!!!! Wootttttttttttt!!!!!!!!!!!!!!!!!
1. A pyloric obstruction question mixed with fluids I'm sure many would remember. Something about an immigrant from Hong Kong throwing up and losing weight for the past 4-6 weeks.
List your differentials (2 marks)
Pyloric obstructions secondary to gastric cancr or large peptic ulcer.
What would be his metabolic abnormality be (2 mark)
Hypokalaemic hypochloraemic metabolic alkalosis
What fluid would you use to replace/maintain him? (1 mark)
Normal saline with 20mmol K+
How would you monitor the fluid input? (2 mark)
Urine output, JVP, blood pressure, skin turgor etc

Can't remember what the last mark question was....

2. 4 scenarios about breast disorders e.g. fibroadenoma, breast carcinoma, abscess and gynaecomastia. The last question was funny. A 21 year-old guy presents with bilateral enlargement of his breast.
1. What is the diagnosis?
2. What would you consider before treating him surgically?
Erm.... Is he fit for surgery? erm... is he on hormonal therapy....? -_-''
Still don't know what the answer is. I'm guessing they're trying to elicit if the guy wants his breasts enlarged or not. Or maybe its something about liver disease?

Next was another pseudo-ED question. A motorcycle rider slams his bike against a lamp post. He had slurred speech and was confused etc
1. What is your initial management? (4 marks)
2. Hm... can't remember what this was.... I think it was about him getting fever and deteriorating with hypoxia. List 3 possible causes.
3. He is found to have both an extradural hematoma and significant intra-abdominal haemorrhage. Which one takes surgical priority?
4. How would you assess the level of consciousness in a comatose patient? What are the components in your assessment? (3 marks)
Tricky tricky.... I initially thought it was a neuro question. So my answer went something like this:

We could assess his brain stem reflex which comprises his pupillary reaction to light, dolls eye and caloric eye reflex. (hm... doesn't sound too suited to the question -_-''.... I better add something else.....)

Or alternatively we could obtain a Glasgow Coma Scale score. The components involved are eye movements, verbal response and motor movements.

Almost ran out of space on this one....... -_-''


Rheumatology
Again it wasn't SLE :((((((((((((((( I would have hammered that down to a T. What I thought was Reiters turned out to be AS instead -_-'' + :(((((
Well at least that's what some people said.

Part A: She presents with lower back pain and some arthritis.
Part B: Explain her diarroea. !!!!! (Enteropathic Reiters!!!!!!!!)
Part C: She presents with an acute red eye. What complication has developed and how would you manage it. (SCORE!!!!!!!!!!! Conjunctivitis as part of the Reiter's triad! Manage with ? Chloramphenicol).

Well in the end it wasn't Reiters so boo.


Endocrinology
You are a GP and you diagnose somebody with Impaired Glucose Tolerance.
1. What are the appropriate figures for this? Fasting and 2 hour Glucose Tolerance Test.
SCORE!

2. Name 2 clinical and 2 laboratory findings consistent with the metabolic syndrome.
I knew this one but almost tripped up. I didn't know where to put high blood pressure and initially had it under laboratoy findings with gout under clinical features -_-''. But then I changed that to hyperlipidaemia and hyperglycaemia so it was good. Clinical features truncal obesity and hypertension?

Next was a thyroid question. Someone presents with typical symptoms of hyperthyroidism.
1.What are the 2 most common cause?
Grave's and subacute thyroiditis

2.What two test would you do to distinguish between them?
Hm... I wasn't sure what they wanted so I had
a) Thyroid Function Test
b) Thyroid Peroxidase Antibody/ Thyroid gland isotope trapping rate
LOL I hope its not cheating...

3.What 2 classes of drugs would you start management initially?
CARBIMAZOLE & PROPHYLTHIOURACIL!!

These were all hinted (not too subtly....) by Braedvedt to be in our finals :))) Thanks!!!!!!!!!!!


Lab Med
Contrast the serology for hepatitis b between:
a. Acute vs chronic infection
b. Post-infection vs post-immunization.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Isn't this a 5th year question??????? And I'm just irritated cause I skimmed through this case a couple of days ago but couldn't remember the answer. ARGH!!!!!!!!!!!!!!!! And it was frickin 4 marks -_-''

2nd question was about anaemia. Go. (4 marks)
A middle-aged woman presents with low Hb and MCV.
1. List your differentials - Fe deficiency, chronic disease, dietary insufficiency, ?pernicious
2. Appropriate investigations to rule in/out your differentials - Gastroscopy, colonoscopy, antibodies to intrinsic factor, parietal cells.


ORL
I completely left out ORL and was relieved no SAQs was asked. Alan Fraser was a bit ambiguous regarding the form of ORL questions coming out earlier. Thank God............ :)


Pyschiatry
We got an email the night before from Tony Fernando informing us of the psych questions the next day. Thanks Lydia for letting me know!!!
1. Psychosis diagnosis and management
2. Anxiety disorder diagnosis and management
3. Primary insomnia diagnosis and management
4. Dementia/delirium diagnosis and management

And everything came out just as he said!!!!! Wootttttttttttttttttt!!!!!!!!!!!!!!!
A 10 mark question on schizophrenia (very vague question - just one! A 1/4 page history followed by what additional information would you like, what test would you do and discuss your medical and non-medical intervention.)

A similar 10 mark question on panic attacks

Compare and contrast delirium/dementia

Define primary insomnia and list the non-medical management.


MCQ
HEAPPPPPPPPSSSSSSSSSSSSSSSSSSSS of repeated MCQs from past years. I only hope I can remember the answers.....

***********************DISCLAIMER*************************
The answers given are mine and I refuse to be held responsible for their accuracy.