PRO 3 EXAM 2017

2017

PRO 3 EXAM
UPM MD X-VIBRANT 12/17
Clinical cases for long case and short case, excluding psychiatric cases (exempted in PRO 3 2017). Do fill in the
questions and answers for future references

" Exam
0 is all about LUCK..The more your READ, the LUCKIER you will be"
(Mr. Nik Qisti et. al, 2017)
7/31/2017
PRO 3 EXAM 2017
SBAQ MEDICAL BASED b) DTaP, Hib
c) hep B, DTaP, Hib c
21) 2 y/o boy still cannot walk however he can stand momentarily with frequent d) MMR
falls. He had a mature pincer grip, can flip single page at one time. He is able
to talk in 2 word-phrases and obey 2 commands. What is the next step of 26) 8 years old boy p/w GTC seizure preceeded by neck pain and headache. o/e:
investigation? T: 40C, BP: 138/66, PR: 60, RR: 38. He had hypereflexia What is the most
A. Audiology assessment appropriate initial ix?
B. Brain imaging finding A. Blood CNS
C. CNS assessment B. CSF analysis
D. TFT C. CT brain
E. Bilateral LL imaging modalities D. EEG
E. CNS examination
22) 3 y/o boy p/w unremmiting fever 9 days, refused feeding ass with
erythematous lips, conjunctival injection, macular rash@trunk, swollen feet 27) Paeds, with forceful vomiting non bilious, undigested food, epigastric mass,
a. Antihistamine normal bowel opening and dehydrated
b. IV antibiotic A. GERD
c. Iv fluid B. Pyloric stenosis
d. PR PCM C. Intussusception
e. IVIG D. Malrotation with volvulus
E. tak ingat ???
23) 9 y/o girl presented with fever n bilateral ankle swelling for 1 week duration.
She also had sore throat 2 weeks prior to that. upon p/e, pansystolic murmur 28) 5 month old female infant presented with 2 days history of diarrhoea. She had
was heard at apex area radiate to axilla. bp : 110/60, pr : 106, rr : 30, t : 38. vomited once one day before but she was fed fairly well. On examination, she
what is next appropriate ix? was alert, active and afebrile. She had dry lips and mucous membrane.
a. asot Anterior fontanelle was normotensive. Her abdomen was soft and non tender
b. cxr with hyperactive bowel sounds. What is the most appropriate management in
c. echo this patient?
d. bilateral ankle xray A. Administer intravenous bolus with isotonic solution
e. tak ingat B. Administer loperamide (antidiarrhoeic medications)
C. Administer oral rehydration solution D.Diet restricted to fluid only
24) Newborn delivered via instrumental delivery. Which one is the sign who most E. Stool culture
suggestive of benigh swelling?
a) Cross midline 29)A 4 year old boy presented with staring spell and right flexion of neck for 40
b) tender on palpation minutes. He had history of vomiting for 1 day and was given antiemetic. He
c) Indentation on pressing had no underlying medical illness. On examination, he was alert with upward
d) soft on palpation gaze and fixed neck flexion to the right. There was no bruising noted. Whats
e) the cause?
A) encephalitis
25) 4 months old came to your clinic. Only received vaccine on birth. What vaccine B) hypocynotic spell
you want to give? C) hypocalcemic tetany
A) hib only D) focal seizure
E) oculogyric crisis
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PRO 3 EXAM 2017
34)Brought to clinic for agressive behaviour.. he believes that he is the true leader
30) 10 months old boy brought to emergency department by his father presented of malaysia and the government plans to kill him. He also hears voices that
with 2days lethargic, irritability, intermittent cry and blood stained stool. He tell praises him. He also has reduce sleep. Which one best differentiate the
was previously well. Vital signs ; temp: 37C, BP: 74/40mmHg, HR: 170bpm. patient had manic episode instead of schizophrenia
Abdominal examination: right abdominal mass palpable. What is the initial A. he is a leader of malaysia
investigation should be done? B. he believes the government want to kill him
A. Abdominal radiograph C. He hears people praising him
B. Abdominal ultrasonography D. Aggressive behaviour
C. Barium meal E. lack of sleep
D. Barium enema
E. CT abdomen 35)25 year old gentleman presented to the hospital following aggresive behaviour
and delusion. He was in a rehabilitation program for the past 6 months due to
31) 35 year old man admitted to psychiatry ward due to aggressive behaviour. substance abuse. However, after 4 months he started the develop the
During interview he claimed that he believed that news reporter on tv was psychotic symptoms. What's the most probably diagnosis
talking about plotting to murder him. On admission, he was anxious. given
repeated Im haloperidol. During ward round you realised he suddenly 38) A 30 year old lady presented with 2 weeks of major depressive episode post
developed muscle rigidity, high grade fever, excess sweating, siallorhea, partum. She6 no longer care for her son and refused to carry him. What is the
dehydration, impaired consciousness. What can u elicit from the symptom most appropriate management for this patient?
experienced by patient? A) Cognitive behavioural therapy
A. Visual hallucination B) Electro Convulsive therapy
B. Delusional of reference C) Interpersonal psychotherapy
C. Delusional of prosecution D) Quetiapine
D. Thought broadcasting E) Sertraline
E. Auditory hallucination
39) Patient had anorexia nervosa bmi 15. dehydrate. low mood, depression and
32)He was given repeated dose of IM haloperidol. In the ward, you are the low motivation to increase the body weight??. which is the best initial
houseman in charge, the pt suddenly developed muscle rigidity, high grade management
fever, excess sweating, siallorhea, dehydration, impaired consciousness. A start ssri
what is most likely diagnosis? B start antipsychotic
A. Acute dystonia C nutrition restore
B. D Psychotherapy
C. Neuroleptic malignant syndrone E) Motivational interviewing
D. Malignant hyperthermia
E. Serotonin syndrome

33)what is the best next treatment?

A hydrate the patient
B
C
D start bromocriptine
E start muscular relaxant

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PRO 3 EXAM 2017
SBAQ SURGICAL BASED
4. 40 yo female presented with upper abdominal pain, vomit and low. The pain is 24. 40 yo female para 7, just gave birth to a 4kg baby 2h ago. She was mild IDA
worse at night and after meal. The pain did not radiate to other place, vomitus prior to delivery. She was pale and bed soaked with blood while transferring to
was the food she ate with no blood and not coffee ground. She has no melena. ward. The most likely cause is
PE of abdo was normal. What is the most useful investigation. A. bleeding d/o
A. CT abdo B. cervical tear
B. Gastrograffin intestinal C. DIVC
C. OGDS D. retained placenta
D. Abdo USS E. Uterine atony
E. Urea breath test
25. A 14 year old female presented to ED with symptomatic anemia. She had
21. 60 y/o woman para1, PV spotting 6 months, cachexic, pale. no abd findings. irregular menses before. On examination she was pale, obese. Otherwise
speculum examination 1cm lesion hypervascularity, bleeding contact. what hemodynamically stable and no pelvic mass palpable. What is the most
immediate ix? appropriate management?
a. biopsy A. COCP
b. ct B. GnRh analogue
c. colposcopy C. Hematinics
d. ultrasound D. Tablet mefanamic acid
e. pap smear E. Tablet transxenamic acid

22. 35 year old para one with 3 month of amenorrhea. She has been having 26 . G3P2 monochorionic diamniotic twin with GDM on insulin, previous csearian
irregular mense since her last birth and 7 years of secondary infertility. She section 2 yrs ago. On US, leading twin is breech. Currently presenting with
was recently diagnosed with type 2 dm and bmi is 33. What is the best initial contraction 2 in 10 for 20 seconds. Os open 3 cm and membrane is intact.
management? What is the next management?
A. Dihydroandrosterone A. Push to labour room and do arm
B. Tft B. Push to labour room and give oxytoxin
C. Upt C. Monitor in normal wars
D. Testosterone D. Emergency Csect
E. Lh E. Complete Dexamethasone

23. 28 yo g3p2 currently at 36 weeks came to maternal and child health clinic for 28) G1P0, 32 weeks POA presented with high BP of 158/99. There is good fetal
chronic iron def anaemia. she was non compliance to oral hematinic. movement, she is not in labour. No symptoms of impending eclampsia,
presented with pallor and palpitation. abdo examination noted 32 weeks. hb ultrasound is normal, no hypereflexia. Protein dipstick 1+ What is the
noted 7.0g/l. other examination unremarkable. subsequent management?
bp 120/70, pr 102, temp 37 a) MgSO4, give IM dexamethasone and deliver
what is the initial mx for this patient? b) Oral labetolol and reassure
a. fluid resuscitation c) IV labetolol, repeat BP after 10 minutes
b. parental iron d) Oral labetolol, IM dexamethasone, BP monitoring
c. hematinic e) Oral labetolol, admit for 24 hour proteinuria monitoring
d. iv 1pint whole blood
e. iv 2 pints packed cell

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PRO 3 EXAM 2017
29. A 43y/o para 4 lady complained about milky whitish discharge with fishy odour. D. Posterior dislocation of hip
There was no history of vaginal itchiness or chronic pelvic pain. What is the
likely diagnosis? 35. After reduction on left hip, patient unable to dorsiflex, weakness of knee and
A. Bacterial Vaginosis lost of sensation at left foot and leg. What nerve injury?
B. PID a) cpn
C. Trichomoniasis B)spn
D. UTI C) sciatic nerve
E. Vaginal candidiasis D)tibial nerve
E) dpn.
30) 37 week G1P0 presented with gushing of fluid, os not open, membrane intact,
AFI 6, no sign chorioamnionitis. what is the best management? 36. 6 years old boy presented with bilateral bow leg. X ray of knee showing
a) admit, emergency lscs if 24h not in labour metaphyseal cupping and widening.
b)admit ,expectnt mx ,ab n discharge What is the most likely diagnosis?
c)admit, ab n allow labour a) achondroplasia
d)admit, ab n plan amio-fusion then labour b) Blount’s disease
e)admit ,give ab induction of labour after 24hr c) Osteogenesis imperfect
d) Rickets
31) 25 yo gentleman experienced first dislocation of shoulder. What is appropriate e) Scurvy
immediate tx
A. Analgesia and immobilize 37) 60 yr old women fall on buttock, pain radiate to the leg, x-ray show loss of
B. Arthroscopy to look for Bankard lesion lumbar lordosis, claudication of 50m
C. Cmr and neutal cast A. Cauda equina syndrome
D. Cmr and arm sling B. Prolapse intervertebral disc
E. C. Lumbar spondylosis
D. Degenerative disc
32) 65 y/o gentleman, U/L DM, on TCM for joint pain, came with right calf pain and E. Spinal stenosis
swelling. On examination, there was central necrotic patch with cellulitis.
Patient generally ill looking. Upon I&D, there was fluid coming out with 'water 38) 36 year old lady came with left shoulder pain, swelling and restricted range of
dish' appearance. There was also sloughy fascia noted. movement. Hx of cellutitis for 3weeks treated with antibiotics. PE: left shoulder
A. Calf abscess tender, warm, severe restricted ROM. Dx?
B. DFU A. Acute gouty arthritis
C. Gas gangrene B. Humeral fracture
D. Necrotising fasciitis C. Left gleno humeral osteoarthritis
E. Pyomyositis D. Left frozen shoulder
E. Left shoulder septic arthritis
33) 40y.o men, MVA, lf knee hit the dashbord. Pain at lf knee. unable to move. On
examination, short limb, internally rotated and abducted. What is the 39 Select the next initial investigation
diagnosis? A. Left shoulder bone scan
A. Anterior dislocation of ahip B. Left shoulder CT scan
B. Fracture of neck of femur C. Left shoulder MRI
C. Fracture of midshalf D. Left shoulder Radiography
D. fracture of tibia E. Left shoulder ulrrasound
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PRO 3 EXAM 2017

40. a 28 year old lady presented with recent bilateral hip pain of 6 months. She
had gouty arthritis for the past 5 years which she self-medicated. She had
previous history of left femur fracture 10 years ago. She was obese with BMI
of 38, with central obesity and abdominal striae. X-ray of the hips showed
bilateral femur head necrosis. The most likely cause of the bilateral femur
head necrosis is
A. Exogenous steroid
B. Exogenous NSAID
C. Gouty arthritis
D. Morbid obesity
E. Previous femur fracture

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PRO 3 EXAM
MEQ
O&G
[MEQ 1]
30 year old women, G4P1+2, 40 week of POA, had 2 previous surgical history of
evacuation, admitted due to contraction and leaking liquor with previous history of
PPH and ELSCS due to footling breech presentation 20 months ago.
She was reviewed at clinic at 34 week POA and was planned for trial of scar
(vaginal delivery).
1. What physical examination to perform? (4m)
2. Investigation and state reasons. (3m)
3. Describe the following CTG. (3m) Deceleration, baseline Fetal heart rate of 80
beats/min, no acceleration. Pathological Non-reactive CTG.
[MEQ 2]
During labour, fetal head is STILL 5/5, os 6cm, blood stain urine noted, abdomen
is soft but tender, liquor is also blood stained, and the uterine contraction become
weak and irregular.
4. Diagnosis (1m)
5. Management (6m)
[MEQ 3]
She was then diagnosed uterine rupture and blood loss of 4L. She was given 4
pints of DIVC regime and 10 packed cell.
6. 4 complications of massive blood transfusion (2m)
7. 1 long term complication (1m)
Peadiatrics
[MEQ 1]
7 year old boy presented with 10 days of persistent cough with fever. He has seek
private practicioner on Day 3 of illness, was prescribed with paracetamol,
amoxicillin and cough medications. However, the symptoms worsen and reduced
oral intake. The child appeared lethargy. On examination, he has dry, cracked lips.
Temperature 38.5, Pulse 110/min, Respiratory rate 35/min. BP 100/60 mmHg. He
has subcostal and intercostal recession. Tracheal centrally located. Lungs finding
showed dull percussion notes and bronchial breathing over the right middle zone.
1. What is the provisional diagnosis? (3marks)
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2017
2. List 4 investigations to help in diagnosis. (4marks)
[MEQ 2]
FBC showed leucocytosis. Renal profile showed hyponatremia. CXR showed
homogenous opacity over right lower zone.
3. State the abnomality in the renal profile and state the possible cause. (3 marks)
4. List two investigations to confirm you diagnosis. (3 marks)
5. Outline your management for this child. (7 marks)
Surgical
[MEQ 1]
50 yo lady presented to emergency department with Fever, vomiting, epigastric n
hypochondriac pain, associated with backache 3 days ago. Backache started
recently. She also noticed of dark colour urine for 3days, clay like stool for one day
1) 4 relevant hx (4 marks)
2) most likely diagnosis(1mark)
3) differential diagnosis(3marks)
[MEQ 2]
Patient is obese with BMI 30. Epigastric and right hypochondriac pain was
intermittent, worsen by meal for 2 years. Fever was on and off with no chills and
rigors. Noticed jaundiced by relative. No contact of hepatitis and no previous
history of gallstone. No past medical or surgical history. No prev admission PE:
she was jaundiced, no mass, no hepatomegaly. has only tenderness on rt
hypochondriac
4) investigations (4 marks)
5) outline mx (4 marks)
[MEQ 3]
Examination revealed tender rt hypochndrium. No palpale gallbladder no bruising
List of ix- Raised WBC Amylase 100++ High urea 15 High creatinine 180 High
AST,ALP Bilirubin High Direct Bilirubin Us abdomen: gall bladder fill with multiple
stones. Dillated common bile duct 12mm. No thickening of the gall bladder, no
pericholecystic fluid
6)significance of bruising on the abdomen (1 mark)
7) state diagnosis based on ultrasound findings (1 mark)
8) State treatment (2 marks)
PRO 3 EXAM
Orthopedics
[MEQ 1]
20 years old gentleman presented with acute back pain. He had a history of heavy
weightlifting prior to that and he heard ‘pop’ sound.
1. State THREE (3) relevant history (3 marks)
2. State THREE (3) Differential Diagnosis (3 marks)
[MEQ 2]
On examination, he had tenderness over the lower lumbar region. Straight Raising
Leg Test (SLR) was positive over the extension of the right lower limb. It was also
associated with weakness of the extension of right big toe. Sensation was loss
over the lateral aspect of the right lower limb.
3. List FOUR (4) investigations (4 marks)
4. State your provisional diagnosis (2 marks)
5. Outline your management (4 marks)
[MEQ 3]
He was discharges well after a week of hospitalization with no pain and no
neurological deficit. However, he presented back a month later with similar back
pain and unable to pass urine.
6. State your provisional diagnosis (2 marks)
7. State your treatment (2 marks)
Psychiatry
[MEQ 1]
24 years old gentleman was admitted due to infected femoral artery. Upon further
questioning, patient had been use substance 4 years. Initially he use it by
inhalation (chase). 1 year ago, he started to use the substance intravenously. A
psychiatric consultation was requested.
1. List FIVE (5) diagnostic criteria to diagnose substance use disorder (5 marks)
2. What is the most likely substance (1 mark)
[MEQ 2]
24 years old gentleman wad admitted due to infected femoral artery. Urine was
taken and it was positive for opioid.
3. State FIVE (5) withdrawal symptoms for the above substance (5 marks)
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2017
4. List SIX (6) investigations including (psychosocial) for this patient? (3 marks)
[MEQ 3]
24 years old gentleman was admitted due to infected femoral artery.He showed
interest on stopping the opoid use during the interview. Liver function test and
renal profile was normal. Blood investigations show he was positive for hepatitis C.
5. Outline psychiatric treatment (4 marks)
6. Briefly discuss the benefits of ‘harm reduction’ (2 marks)
OSCE
Station 1-11 (Interactive OSCE)
Station 1
Young gentleman came to ENT clinic presented with sudden hearing loss.
1) Assess his hearing using the tuning fork
2) Answer examiner questions - (name the test and interpret the finding. Give
cause for the hearing loss)
Station 2
1) Identify and name the suturing instruments.
2) Perform a surgeon knot using shoelace provided with the instruments.
Station 3
Counsel patient regarding asthma control at home. (explain how to eliminate
triggers)
Station 4
50 year old Indian gentleman, presented with cough, fever and shortness of breath.
He was treated as pneumonia with antibiotics. After 1 month, patient came in with
cough and shortness of breath. Serial X-ray was done to assess patient’s condition.
As the attending houseman, you are to present the serial X-ray findings to the
specialist. There was 2 chest X-ray shown on screen, and we was guided by the
radiologist to describe the main findings of the X-ray and was asked regarding our
impression:
CXR 1 - Hilar haziness with patchy consolidation, Loss of costrophrenic angle
CXR 2 - Hilar haziness with patchy consolidation, Loss of costrophrenic angle with
the addition of cavitation described as central radioluscent with surrounding
PRO 3 EXAM 2017
radioopaque consolidation Diagnosis: - abscess due to partially treated pneumonia e) Complications (3m)
- pulmonary tuberculosis
Station 16
Station 5 Given a fibroid picture. (Few types)
Paeds: Counsel parents regarding simple febrile fit 1. Name the types labelled on the figure above. (3m)
2. List 4 typical presentation symptoms. (4m)
Station 6 3. Name 3 degenerations. (3m)
Patient recently diagnosed with T1DM, explain and counsel
Station 17
Station 7 POP
Perform Snallen chart
Station 18
Station 8
Suicide risk assessment
Station 19
Station 9 ECG
1) CPR adult
2) Demonstrate how to use AED Station 20
3) answer question: What condition cannot use defibrillator? Partogram

Station 10
Surgical station: Patient diagnosed with colorectal carcinoma, planned for APR.
Perform pre-op counselling

Station 11
O&G:
1) Patient complained of post menopausal bleed, state 2 causes
2) Perform bimanual examination

Station 12
Paediatrics chest x-ray showing Tetralogy of Fallot (TOF)
a) Describe the x-ray (2 m)
b) Diagnosis (2m)
c) Expected ECG findings (5m)
d) Complications of this condition (3m)

Station 15
Given a instrument (spinal needle)
a) Name the instrument (1m)
b) Name the procedure using this instrument (1m)
c) Indications (2m)
d) Contraindications (3m)
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PRO 3 EXAM 2017
CLINICAL EXAM Day 4
LC - Miss Limi, Dr Ting, External ong
AMALINA ZAINUDDIN Obstructive jaundice with constitutional symptom
2° to head of pancreas tumor?
59yo lorry driver presented with tea coloured urine for 1month, subsequently
DAY 2 2months after noted jaundice n thin by friends.
Long case: Had LOW + LOA 20kg in 2months.
AEBA secondary to CAP (prof shikin, dr habibah, fms), same case as yan jun Had pale stool +pruritus during admission
26 y/o , chronic smoker, p/w sob and noisy breathing after fever and runny nose. Referred to hukm for ercp with stent insertion
Told me he had nebulised few times during childhood (he remembered this when Defaulted follow up then had recurrent right hypochondriac pain with fever?
the clock showed 15 minutes left!!!, luckily !) , i was thinking asthma bcoz of strong Had recurrent left reducible indirect inguinal hernia
family history of asthma, but no eczema, no allergy. Question:
The pt never sought proper treatment for the sob episodes during childhood. -history
Otherwise, other questions are about CAP like yan jun's -what is charcot triad? What it is for?
Dx: aeba 2 to Cap -why this patient had recurrent rhc pain + fever? Ascending cholangitis? Infected
Ddx: Aeba 2 to urti, copd, tb (not really relevant as this is acute) stent?
Did PEFR , so low for a 26 year old. They don't have the chart but they should -how long a stent cn last? 6months
have reading of 600. Pt's was 350 only. -why tea coloured urine come first?
Ix: usual things. Blood: fbc, rp, abg non-blood :cxr -differential diagnosis of obstructive jaundice, constitutional sx with no palpable
Types of respiratory failure. gallbladder
Mx: augmentin,acute asthma mx -go back to patient do PE (took long time here)
-investigation
Short cases: -what is ercp? Full name? Endoscopic retrograde cholangiopancreatography
1) Dr Zurina ( so nice, keep on calming me and padding on my back during the
other two short cases. Short case
peads cardio: Acyanotic cong heart disease as evidenced by psm on ulse, not in Medical Dr chieng
failure. -bilateral palpable kidney with fistula
Ix, Mx How do u know the fistula is functioning?
2) Mr Paisal (acl tear, medial collateral ligament) Ddx?
Do gait, examine knee. Patient cannot flex knee, acl positive, cannot do mc Surgery External examiner
murray, positive med collateral ligament tear. -diffuse palpable thyroid
What if pt come with open fracture? Mx Differential, investigation
What do you check clinicallly-peripheral pulses. What do u want to see in TFT? TSH, T3, T4
3) ) Thyroid surgical (Prof Faisal) solitary thyroid nodule, clinically euthyroid. What do u want to see in ultrasound? What malignant features can be seen tru
Why won't you do biopsy - dangerous structures US?
Ddx of solitary thyroid nodule in 30 year old female, euthyroid If FNAC result come back normal, what type of histology cn be seen?
What if fnac came back normal Obstetric Dr amilia
Ix, mx -uterus larger than date
Differential
SITI MUSFIRAH JAHRI Investigation, what u want to see?
This pt had fibroid in pregnancy,
-complication of fibroid to pregnancy
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PRO 3 EXAM 2017
-mode of delivery in 2previous scar with fibroid. LSCS 1. Stoma
-preop consent? Im anticipate of PPH, will take consent for blood transfusion & - examine the abdomen
hysterectomy + BTL as this is the 3rd scar - ileostomy at left iliac fossa with midline laparotomy scar
-would u remove fibroid in pregnancy? Why? No because risk of massive - purpose of this stoma( diversional stoma) Other purpose of stoma?
haemorrhage, myomectomy is a big surgery + uterus is vascularised during - Complication of stoma
pregnancy - what possible surgery that have been done to him?and your reason - Anterior
-what u would do if the fibroid located at lower segment during csec? I'll avoid from resection.location and scars
cutting on it. - Types of stoma
2. Neuro-
PAVITRA BALASUBRAMANIAM -55 y/o gentleman, equinovarus deformity with motor loss (l5 and s1),sensory
intact
- Lower motor neuron lesion( poliomyelitis)
Day 3
Long case - Investigation
Mr Khairuddin, Dr Joseph, Prof Nazri - ddx
3. Multiple preg
23 year old Malay gentleman, ex smoker, MVA in 2013, intubated for 5 days,
- POA 26 weeks, examine abdomen
external fixation and plate was inserted in his left hip. Current complaint abnormal
- uterus larger than date,multiple poles felt
gait and occasional hip pain . On physical examination, equinovarus, foot drop,
-Other causes of uterus larger than date
high stepping gait, and trendelenburgh gait multiple scar at inguinal, buttock and
bilateral knee, limb length discrepancy for 10cm, fixed flexion deformity, above -Complication of multiple pregnancy
greater trochanter shortening. (TTT- which chorionicity, pathophysiology)
-date of delivary for dcda, mcda
Questions:
Mcda(36 elective delivery), dcda(37 elective delivery)
1. Describe the foot deformity, gait, how to measure apparent length, true length,
- investigation - US
Allis test
Num of fetus, if 20week what you expect to see (twin peak sign, lambda)
2. Diagnosis- malunion 2ndary to trauma complicated with nerve injury
3. Which hip dislocation is common for this patient - how would you monitor the pt
4. Complications of hip dislocation and hip fracture - Parameters you monitor in serial growth chart
Hc,fl,ac,bpd,afi,efw, and so on
5. What will X-ray shown if the patient had AVN- crescent sign-
Pt coming in at POA 37, mcda, both fetus cephalic presentation
6. What is the cause of foot drop in this patient- dislocation complicated with sciatic
- How you manage
nerve injury
Rule out ttt,and Induction of labour
7. Investigation for avn - xray, mri
8. Features of avn in xray - how you counsel before induction?
Complication of induction and delivery in multip
9. What is the management for this patient- realignment osteotomy
- one drug to control uterine hyperstimulation
10. Why not hip replacement - too young for hip replacement
Terbutaline
8. Prof Nazri- is dislocation common in paediatrics? How would you screen or
All the best! Dont worry, doctors will definitely prompt you till you reach the
confirm?- Yeah common( explained why), ortolani and Barlow test
9. Dr Joseph ask if young patient walk halfway and suddenly fracture of neck of expected answers..
femur, what is this fracture called? - pathological fracture- causes? renal failure,
HON SHU TIAN
Hyperthyroidism, hyperparathyroidism, hypogonadism
Day 3
Short case
Long Case (Dr Zurina, External OnG, Mr Mazre)
Dato khairul, dr wan alia, dr maiza
2.5 months old baby boy with u/l down syndrome, congenital heart disease and
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PRO 3 EXAM 2017
hypothyroidism presented with fever for 1 day preceded by runny nose for 2 weeks 2. Paeds Neuro LL and UL
and cough for 2 days. hypertonia more on UL than LL, hyperreflexia, babinski upgoing
After presenting case , go to bedside: -Where the lesion can be
Dr Zurina: - Dx
-Describe down syndrome features in this patient 3. Adult CVS
-Other features of down syndrome MR radiated to axilla, very weak pulse
-what is clinodatyly -Ddx
-P/E findings: -How to differentiate MR, TR and VSD
RS: tachypneic, tachycardic, gen crepts, -Dx and causes
CVS: ESM at left upper border of sternal edge -Ix
-What do you think it is? ( ASD -down syndrome) -Long term management
-Other possibilty (PDA, PS)
-Is this patient in failure as he is tachypneic and tachycardic (No, the apex is not MARCOS POPEY JARITH
displaced)
- Signs of failure
Day 4
CNS: hypotonia, normal reflex
Long case (Dr Hoo fan kee, Prof Norlijah, Mr Ashraff)
- Impact on this patient (gross motor delay)
Pn. N a 60yo Malay lady with underlying hx of polycystic kidney disease with
-Mx ( physiotherapy)
hypertension for 20 years complicated with esrf currently on 800ml fluid restriction
Dr Zurina is very encouraging and mentioned excellent. She is so angel. and few anti hypertensive and antifailure medications (i cant remember how many
Back to discussion room: types of them). She just came for exam btw. The only symptoms she had 20 years
- Ix
ago was just headache. Since then, diagnosed to hv polycystic kidney in pantai
-Mx (ABC, antibiotics)
medical centre, subsequent follow up under nephro HKL and H. Serdang.
- what choice of antibiotics (penicillin)
Currently eGFR 5ml/min. Current active presentations were lethargy, loss of
-if child remain fever, what do u consider to give? (add aminoglycoside -
weight, loss of appetite, pruritus, dry skin, on and off ankle edema. She had
gentamicin) underlying asthma good control on ventolin Mdi only. Also has hx of urolithiasis
- she said good but she asked why? (i answered bactericidal but she wants underwent pcnl, gouty athritis on colchicine and subfertily. On pe, fistula was kept
synergistic effect
in situ. Sallow looking, etc sign of uremia... kidneys were ballotable. Family hx of
-what advise you can offer? (pneumococcal vaccine)
kidney dz (the mom)..
- follow up
1. What is pckd and pattern of inheritant
External OnG:
2. What are other features of pckd, how to look for the complication
-If mother wants to have anoher child, what advise u will give? (prenatal 3. Ix relevant to current presentation
counselling - genetic study)
4. Mx (pharmaco and non pharmaco)
-when is the best time to have another child? Mother is 37 y/o currently.
5. Causes of secondary hpt in young pt
6. Commonest cause of secondary hpt in young malaysian generation?
Short Case ( External OnG, Dr Ting, Dr Foo)
7. Mechanism of action of drugs that she took
1. uterus larger than date 8. Complication of uremia
-Ddx 9. If pt has abdo pain, what could it be? Give a few causes
-Ix
10. Do pe, identify features of uremia, ballot the kidney
-Best time for dating scan
-Second best time
Short case (dr ooi, prof mano, prof nazri)
- Discrepancy allowed for third trimester

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PRO 3 EXAM 2017
1. Poliomyelitis pregnancy?
- differentials of lower motor neuron lesion etc...
-what further hx you want to illicit
-ix SC:
-mx External O&g- uterus smaller than date
-how to improve quality of life Dr Joseph- mitral prosthetic heart valve
2. Proximal median nerve lesion Mr Hadi- thyroid
-actually screening maneuvre i couldnt find any, wasting of thenar only
-causes of high lesion median nerve compression CHUA YAN PING
-how to differentiate high of low lesion
-ix
Day 4
-mx conservative how long wear splint in a day
Long case (Prof Shikin 95%, Dato Gee 5%, Dr Maliza FMS)
-type of splint 63 year old ladies, with newly diagnosed DM, presented with fever and cough for 3
-surgical mx months prior to admission.
3. Multiple pregnancy
Diagnosis: Community Acquired Pneumonia
-differentials
1. What is the relevant history must be mention? Pleuritic chest pain
- two important hx in multiple pregnancy. Just two.
2. What is the BMI? (please bring ur own calculator to exam hall )
-complication of multipregnancy throughout pregnancy
3. Differential Diagnosis? TB, lung cancer, lung abscess
-why ultrasound is important? When is better to do it 4. Ix- interpret the CXR on the spot
-how to determine chorionicity 5. Management. What antibiotics ? after discharged, patient still has no
- how to determine time of delivery
improvement even after antibiotics, suspect Lung Cancer.
- how to determine mode of delivery
Short case
MEI LING 1. Prof Faisal- varicose vein. ( Please explain every step to the patient) How u
want to complete ur examination? What is the investigation?
DAY 1 2. Prof Roohi- RA. Management
LC: Placenta Previa type 3 posterior, wif u/l mild anemia, 1 previous scar (Dr 3. Dr Zurina (most benign, like an Angel)- Cerebral Palsy. Causes, management.
Zulida, Dr Ting, External surgeon) Do your best and GOD will do the rest !!! NEVER x3 give up. Good luck and all the
- do u satisfy with this pt hb , what u wanna gv to this pt best
-Which supplement will u gv to this pt, why
-when u wanna gv blood transfusion
ANIS NADIRAH
-what is the cx of PP
-How to look for placenta accreta (ix), what to look for
-How u wanna deliver this time Day 4
- What u want to counsel this pt after this delivery Long case
- What contraception do u preferred (Prof Shikin, Dato Gee, Dr Maliza FMS)
-For next pregnancy, how u want to deliver this pt 52 y/o Malay lady, with underlying hypertension and hyperlipidemia 15 years ago,
- If u are the surgeon, what u wanna do to prepare this pt to CS and polycystic kidney disease.
- Who is going to conduct this CS C/o: cloudy urine for 1 week duration
-If this pt saw online alot of ppl wanna try natural birth will u gv her VBAC after this Hopi: intermittent loin to groin pain for the past 1 month, then started to have UTI
symptoms such as frequency, dysuria and cloudy urine a/w 2 episodes of
hematuria 1 week prior to adm. No fever, chills and rigor.
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PRO 3 EXAM 2017
Multiple admissions to hospital previously due to UTI. - why in this pt unlikely to be colon CA
PE: Ballotable kidneys bilaterally, epigastric mass - why altered bowel habit occur in colon CA
• Any investigation done when she was first dx with hypertension (in view of young - other signs of anemia and what does that indicate
hypertension) - grading of haemorrhoid (he wanted to hear the word prolapse bcos this pt is
• Any family members with polycystic kidney dz? grade 3)
• Specify what screening that had been done by the family members - how to ix for colon CA
• what gene affected - what if there is no family hx of colon CA, when is the cut off point of age for
• other organ that can be affected by this dz screening
• ddx, what is the most likely dx worried of if patient has fever, chills & rigors? - - describe how to do proctoscope (steps and is it informed consent or written)
Pyelonephritis - complication of proctoscope
• What ix want to do - why need to do PR
• List the parameters in UFEME - mx according to grade
• what findings in UFEME suggestive of presence of infection - what to do if cant do banding or ligation (he wanted to hear open
• What do you want to see in ultrasound? - polycystic kidney etc, any cx such as haemorrhoidectomy)
pyelonephrosis/ hydronephrosis - what to do if pt presented with thrombosed prolapse haemorrhoid
• how to mx, what antibiotics want to give to patient - medication for haemorrhoid, MOA (he wanted to hear the word laxative, not stool
softener)
Short case - if this pt presented with per rectal bleeding in primary care setting, what comes to
1)Prof Faisal your mind
• Inguinoscrotal hernia *sorry cant recall much
- deep ring occlusion test etc, how to elicit bilateral hernia w/out standing the
patient up? Short Cases
- how to mx 1. Median N - carpal tunnel syndrome (Prof Roohi)
2)Dr Zurina - causes
• 1 1/2 y/o baby, Consolidation - if pt comes to clinic, how to mx
- dx: bronchopneumonia, 2. Hepatosplenomegaly with jaundice and pallor (Dr Zurina super super super
- ix: chest xray angel)
- possible organism for the age group - ddx
- how to mx, what abx want to give - how to mx
3)Prof Roohi - she pointed to hyperpigmentation around the umbilicus and ask what is it
• Both hands got Z deformity, swan neck deformity, MCP joints subluxation, thenar 3. MNG (Prof Faisal)
wasting, limited ROM - Rheumatoid arthritis - ddx
- ix: xray and what to look for - ix

AMIRA SYAHIRA AZMI ARSHAD ABD GHANI

Day 4. Day 1
Long Case (Mr Gee 90%, Prof Shikin 5%, Dr Maliza 5%) LC - meningitis
Haemorrhoid. 2m baby presented with less active n reduce feeding for 1/7 PTA. Mild fever on
- risk factor of haemorrhoid admission.
- clarify about diet hx (exact portion of vegetables and fruits) (Prof intan, prof dev, dr maliza)

13
PRO 3 EXAM 2017
Q&A Retracted Stoma @ left iliac fossa w Stoma bag filled w solid feces. The Stoma is
• ddx - meningitis, uti, NAI (ask about caregiver), shaken baby syndrome(did a loop stoma, 2lumen, no continuity of skin bw lumen, healthy Stoma
mother use cradle) (xgangrenous tissue), xparastomal hernia
• go see pt, check fontanelle, offer to do funduscopy to check retinal haemorrhage, Dx: retracted stoma
neuro examination A. Type of stoma?
• ix (fbc, rp, blood culture, urinalysis n culture, us cranium, lp) B. How to differentiate ileostomy or colostomy
• if meningitis, mx? (Cover broad spectrum Ab) C. Complication of stoma(early, int, late)
• feature of lp for viral n bacterial? 2. Medical (dr Bahariah)
• how to do lp? Do respi examination
• Contraindication for lp? Dull on percussion,
• common organism for this age group (GBS) Reduce breath sound, bronchial breathing
• what you know about shaken baby syndrome? Dx: pleural effusion
• pt discharge n f/up at clinic, what important to monitor? (Developmental 3. Obstetrics (prof nazri)
milestone) Uterus larger than date
Dx: pelvic mass in pregnancy, polyhydramnios, multiple pregnancy, macrosomic
SC - baby,
(Dr zainab hs, dr anim, prof nizlan) A. if this pt has fibroid diagnose at 20w, what do u want to do?
1. Uterus larger than dates+transverse lie - probably multiple pregnancy B. Cx of fibroid in pregnancy? ( Each trim)
2. Gen. Rhonchi - asthma?
3. LLD+interpret x ray Long case
Ortho (prof mano, ext paeds um, dr amilia)
VELAN SUBRAMANIAM 57y/o Indian gentleman, ul dm, hpt, w prev h/o polio, right THR, presented w left
knee pain for 3y.
At first, when I ask his problem, he told that prev he had polio, undergone right
Long Case:
2 years 8 months old Indian boy presented with rapid breathing 1 day POA THR, n didn't told about his current complaint. 30min later, during PE( I do neuro of
associated with 2 days of fever, cough and 4 episodes of post prandial vomiting. lower limb(xfinding) n suddenly he told that he had pain on the left knee. Then i
asked him to stand up. Then, taraaaa..there was varus deformity of left knee.then I
There's a 10 previous similar episodes exacerbated by infection and cold with
history of atopy (eczema) and family history of regular nebulisations. quickly ask further regarding his knee pain (fuhhh..nasib baik 😂). Actually the
Dx: Broncial Asthma examiner wanted to know about the OA.
Examiners: Prof Intan, Prof Dev, Dr Maliza (FMS) Q:
1. Differential? How to rule out from history
Short case: -OA
Dr Anim: CVS (midline sternotomy scar, irregularly irregular rhythm, raised JVP, -gouty arthritis
displaced apex beat, PSM murmur) -rheumatoid arthritis
Dr Zainab (external): O&G (uterus larger than date - polyhydramnios) -tb
Prof Nizlan: Knee examination (secondary OA, PCL injury) -neoplasm
2. PE done in front of examiner: varus, left knee swelling, ms wasting(measure),
NURUL AMIRAH RAMLI +ve effusion, +ve patella grinding, crepitus present, limited flexion.
3. Why there is +ve patella grinding
4. Compartment of knee (2)
Short case 5. Ix u want to do? Weight bearing X-ray,...
1. Surgery (ms tong)
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PRO 3 EXAM 2017
6. Features of OA on X-ray presented with right hip pain for 3 days a/w stiffening, reduce range of movement
7. Management of OA and adl dependent.
Dx: right hip # secondary to osteoporosis
NGU SIE TIEN Q1: this patient has hpt so what do you want to do before dx him?
Q2: what is phaechromocytoma?
Q3: do hip examination infront examiner, in general apperance why you assess
Day 3 :
alert and conscious? This patient have esrf most probably can have uraemic sx or
Long cs : Dr Chieng, Dr Ching, Prof Faisal
ADPKD (same as Adele) due infx from HD
Q4: what ix u want to send?
Pt on phendil. What is phendil ?
Q5: describe this xray
How is ADPKD inherited, from who and how many percentage
Q6: what is ur management?
Would u investigate further if this person presented to you for HPT at the age of 40
What are the dff for secondary Hpt?
What r the complications of ADPKD? Short case:(Dr anim, external, Prof nizlan)
What would u expect to find in USG of kidney? 1) hepatomegaly, how do u know its liver? What is the causes?
2) uterus smaller than date,
What would u find in CT for tis pt?
What are the causes? How do u know it is oligo? What ix u want send? What u like
If this pt need contrast CT, would you be worry? Justify ur ans.
to see in us? What is causes of iugr? What is the type? What is the difference?
How would u prepare tis pt before contrast? What medication you would like to
Which one is severe?
give?
Show me how you examine abdomen and what's r ur findings (bilateral ballotable 3) pcl
kidney) Do sagging +ve, post drawer test +, negative ant drawers test, -ve lachmann test.
Why u can get positve ant drawer test in pcl?
If a different person presented to u with two mass in abdomen, what would you
think of?
This pt hv hb 9, how u manage? What r the pathophysiology of anemia in tis pt? NURUL HUDA
If this pt come to you at night in ED with sudden acute abdomen pain, wat's come
first to ur mind and how u manage? day 4
Do you thk you r able to detect these kind of secondary Hpt earlier in primary Long case : prof norlijah (main) , mr asyraf (ortho) , dr hoo ( med)
setting? How? a 5 y 9 m old malay boy u/l nephrotic syndrome dx last year presented to hosp due
Did you assess the emotional and psychosocial status of this pt? What did the pt to periorbital and scrotal swelling for 2 days prior to admission. swelling persistent
thk abot her illness ? through out the day. 5days hx of frothy urine and preceeded with urti PTA..he had
Do renal transplant have a role in this pt and why? frequent relapses with 7 relapses this year and dx with frequent relapse nephrotic
syndrome. no sign n symptoms of steroid toxicity
Short cs : P/e-normal
Prof liew (stoma) - all common stoma questions Diff dx - acute glomerulonephritis sec to post strep gn, anaphylaxis, insect bites,
prof norlijah (respi) - what pneumonia can cause ronchi? CRF, CLF
Dr Ummi (prostetic valve) - But I hear no clicks .... And barely able to feel the Quest (prof norlijah n dr hoo)
peripheral pulse 1. differential dx during 1st dx(last year)
2. criteria of NS and how do you know it is NS in first presentation
HADRI HAMID Go to patient and perform abdo and respi examination..but no findings.
prof asked me to show the patient daily albumin monitoring book to look for the
relapses.
Long case(Prof Dev, Prof intan, Dr maliza)
44 y/o Indian male with u/l esrf, hpt, hx of parathyroidectomy and hx of fall 3. ix for NS - creatinine: protein ratio

15
PRO 3 EXAM 2017
4. different NS and AGN -tell the findings-only reduce chest expansion, intensity of breath sound, left lower
5.specific group of streptococcus for PSGN zone creps(not very sure about the creps :(
6.significant protenuria to dx NS in paeds -ddx
7. significant proteinuria to dx NS in adult -ix-CXR
8. what to look for during ophtal follow up- cataract -she showed the CXR and asked to deacribe the findings- left sided lung field was
9. others ix tro diff dx for this patient reduced. tracheal centrally located.
10. how to mx
AMANINA FITRIAH
Short case
prof nazri
scenario: 50 yo lady para 1 presented with menorrhagia. examine abdomen only Day 4
Quest: Lc: mr ashraf prof lijah dr hoo
-tell all positive findings (suprapubic mass, correspond to 22wks gravid uterus, 23 Left hip Avn secondary to post trauma 2 years complicated with chronic
cm, can get above not below, dull to percussion, moves side to side) osteomyelitis .currently was no active complaint
-ddx -ddx
-bimanual examination -bring to pt findings: short limb gait,fixed external rotated abducted hip ,limb length
-ix discrepancies of 3 cm shorten of left hip (braynt triangle)-ddx?
-mx-conservative n surgery -investigations
-if HPE result was normal, how u mx- TAHBSO bcoz size too large(22weeks) -wht u want to do for this pt as he is still young:arthodesis
How u manage If patient dont want surgery? -Uae -any psychological findings:depression ,lost of interest
Who will do it n how it is done? Radiologist
if pt is 30 yo how to mx? myomectomy Sc
Prof mano Dr ooi:lobectomy with lobectomy scar posterior chest wall-ix
examine patient left hand Prof mano:RA examination of hand:classical signs of RA-explain all joints
findings: deformity-wht is RA? Extraarticular manifestations? Management?
- numbess and tingling sensation at left radial 3 1/2. no thenar wasting. postive Prof nazri:fibroid in pregnancy-us findings-conplications after 20 weeks
tinel and phalen test. reduce sensation at the palmar triangle. lesion is at proximal.
i forgot to do the movement :( HAMIZAH KAMARUL
Quest:
- which ms supply by median nerve?-pronator teres (MP: median-pronator) if radial Hamizah day 4
nerve, supinator (RS: radial-supinator) LC - Dr Kalai, Prof Liew , Dr Hana (all participated intge case discussion)
- dx: left proximal carpal tunner syndrome / pronator syndrome Erny, 37y/o presented with sudden onset left sided weakness in Sept 2015. No
-what is carpal tunnel syndrome? prior headache or LOC after the event. No known medical illness such as DM and
-how to ix-nerve conduction study HPT. Presented to HS at day 3 of illness. Diagnosed to have hyperlipidaemia.
-how to mx-splint n surgery Warded to rehab ward for a month and had more improoved muscle strength and
-other dx that had similar presentation to the CTS- all the peripheral neuropathy functional status. On neuro and rehab follow up since then. Echo done in 2017 and
such as DM, B12 def,alcohol etc found valvular disease.
Dr ooi 1. Ddx for young stroke?
resp examination on young malay gentlemen with lobectomy scar and chest tubes 2. What will be the cause in this patient?
scars at the left of his back 3. What is the cardiac pathology?
Quest: 4. How it can happen?
5. What drugs is she on? Aspirin only
16
PRO 3 EXAM 2017
6. Is aspirin enough? What else would you like to add? Warfarin Day 3
7. Anticoagulation score? Short Case: Thyroid (graves i think), Right ACL and Peads AEBA
8. How to investigate?
9. How to manage? When to do valve replacement? Long Case: external surgeon, prof chris, prof adibah
10. If patient come earlier to HS, what can be offered? Colorectal Ca:
11. Complication of thrombolytic therapy -Investigation
-Management
SC - Mr Khai, Ms Tong, Prof Intan -Staging
ACL and LCL tear, usual questions -Benefits of CT scan
Solitary Thyroid Nodule , discussed on benign thyroid -findings of DRE
Spastic Quadriplegia in 13 years old *get to know specific name for the posture -Examine stoma
-metastasis symptoms and signs
ADILAH ZULKIFLI -Adjacent organs in the pelvis (Prostate, Bladder, ureter, spine)
-How to investigate for bladder spread (cystoscopy)
-symptoms of bladder mets (hematuria + pneumaturia + feces in urine)
Day 4
How to investigate for ureter involvement (US to look for hydronephrosis. Or u can
Long case : external (paeds), Dr zulida, Mr mazzrie
do CTU)
Fawwaz a 3 months old malay boy
-Finding in CTU (Obstruction)
- fever, ass with lethargy and reduce feeding for 8 days.
Dx: meningitis -What to monitor in follow up (symptoms, colonoscopy, CT, CEA)
Quest : -What to do if CEA increases during follow up
-What to do if tumour too bulky (neo-adjuvant)
how meningitis occur in this pt..bacteria or viral?
-radio or chemo?
named the bacteria ?
alot more question but forgot
ur differentials ?
Ix?
mx? name the antibiotic ? ZALIFAAH
contraindication for lumbar puncture
day 4
Short case Long case : prof norlijah (main) , mr asyraf (ortho) , dr hoo ( med)
Datuk khairul: multiple sebaceous cyst Aqeel a 5 months old malay boy presented to hosp due to cough for 3 days and
describe lump? rapid breathing on the day of admission. The cough was induced by cold ( mainly
diff dx aircond) and urti symptoms . Sick contact with his brother. Strong atopy hx. Patient
differences between s.cyst and lipoma dx with pda but currently on f/up
Dr habibah: suprapubic mass P/e resp distress but lungs intermittent generalized rhonchi . And eczema on
dx-fibroid flexures and cheeck
diff dx Diff dx - multiple trigger wheeze , viral induced wheeze , acute bronchilitis , heart
Dr fadh: respi failure
Dx-bronhiectasis- clubbing n coarse crepitation Quest
Diff dx Can it be asthma ?
Pathophysiology of bronchiolitis ?
FAIZ MD SOM Differentiate all ur differentials ? How they usually present ?
Went to patient to perform physical examination .

17
PRO 3 EXAM 2017
She asked to recheck back @.@ 37 yo Malay Lady G3P0+2 ( 2 miscarriages) 14 weeks POG, referred from Kk
Went back to room . Salak for insulin optimization after impaired OGTT at 13weeks. In ward
Organisms of pneumonia Transabdominal ultrasound scan found fibroid.
If you are the ho in the ward , how u manage Diagnosis : Early pregnancy with type 2 diabetes mellitus , hx of 2 miscarriages
Scenario patient resp distress and has crepitation . and fibroid .
Last quest : what do u do b4 start anbx Question asked :
ans : blood culture 1. What is your diagnosis ?
2. Is that a T2DM or GDM ? What is the insulin used ? Type and when to use ?
Short case 3. What is your management ? (I answered normalized Blood sugar , but they ask
1) prof nazri: Uterine fibroid mainly regarding fibroid)
How u manage ? If patient dont want surgery what to do ? Uae 4. What is the complication you should counsel? DM control , diet , body weight ,
Who will do it ? Intervention Radiologist ! lifestyle .
Benefit of gnrh analogue in this patient 5. What about complication of diabetes mellitus for 14 weeks pregnancy ? (
2) Prof mano: Patient had a very big lump on his upper arm . structural abnormality )
Examine his hand 6. Are you worry regarding the fibroid ( 20week size ) ? How you manage ? (
Actually non union -> you check for this by moving the distal and proximal. myomectomy ? ) Ms Limi added on question regarding what is the fibroid will
He got wrist drop. So i did usual screening and told prof that i wanna proceed with cause on fetus ? ( I couldn't answer )
radial nerve examination 7. What other problem you should anticipate ? BMI ( I gave the height and weight ,
Each step i did he asked what muscle am i testing no bmi calculated , they skip )
Quest : 8. Long term management ? ( I answered when to scan when to deliver but doctor
What is the cause of that deformity ... non union said it's just early trimester so we shouldn't set for that )
How to manage fractures
Types of non union atrophic hypertrophic Short case :
Explain Medical - Dr Chieng Jin Yu
Hypertrophic also known as ... elephant foot Pt come with abdominal discomfort , examine his abdomen .
Causes of mal union and non union Finding : hepatosplenomegaly with jaundice , mild pallor with no sign of chronic
How do u manage wrist drop in this patient liver disease .
Ans: tendon transfer Dx : Thallasemia
What if patient doesnt want surgery .. splint Question asked : Present finding , give diagnosis , what other bedside test you
If dont want splint but want hand to lift up ... athrodesis would like to do ? What are the signs of chronic liver disease ? Other investigation
3) Dr ooi: Prostetic mitral heart valve not in failure to rule out causes ?
Sign of failure Surgery - external examiner
Signs of mild failure Examine this lady's neck and present with running commentary .
Indication of prosthetic heart valve Finding : thyroid left lobe swelling.
Question asked : what ddx ? ( simple , dominant nodule, carcinoma ) what normal
PAN KOK ONN investigation Will be done ( tft, ultrasound , fnac) , what type of thyroid ca ? (
papillary, follicular , medullary ) how to differentiate ( calcitonin and fnac)
O& G - Dr Amelia
Day 4 Stream 1
Examine her abdomen
Long case : External examiner O&G doctor , Dr Ting, Ms Limi
Finding : uterine mass 20 weeks size with one transverse scar
Question asked : present finding , what bedside test to investigate , what is other
examination to do ( bimanual) , how to do bimanual ? How to manage and confirm
18
PRO 3 EXAM 2017
( ultrasound , control bleeding ) ? If patient 45 years old , and bleeding on stop , Low fibre diet, occasionnally eat red meat. No other risk factor. Loa, low (8 kg in
what management ? ( myomectomy , tabhso) if patient refuse surgery , what 2month), lethargic. No symptoms of anemia.
hormone can be given ? ( .... dr Amelia then told can use Milena) ... and lastly .. 1) why this patient have diarrhea? How does it happen?
what is the scar indicated for , in what surgery ? ( lscs, tabhso) 2) clarify on constipation way before she started have diarrhea, and regarding fluid
intake. Need to quantify
KESHOV CHABRA 3) right and left ca presentation
4) why no diarrhea at right sided, and all the why why questions...
5) ddx with points for and against
Long case : Dr Ting, Miss Limi and external O&G dr
6) when u see this patient in Kk setting, what are u think of? Crc. Ask about
Beta thalassemia major.
amsterdam criteria.
- differential diagnosis for rapid breathing
7) investigations at Kk setting?
- types of anaemia
8)if you do colonoscopy and saw a tumour there, what will you do? Will u continue
- causes of anaemia
- how to investigate for thalassemia until caecum or stop or do something ?
9)and then management and
10) pre op assessment as this patient have comorbid asthma, what to assess for
Short case: Dr Amilia (angel), Dr Chieng ( another angel) and exterrnal surgeon
her specifically?
1. Fibroid
*sorry cant recall all questions
- differential diagnosis of uterine mass
- how to differentiate uterine and ovarian mass
- investigation Shortcase
-what options treatment 1. Prof roohi - acl with LCL or lateral meniscus. Unsure which one.
2. Dr zurina - 6 years old hepatosplenomegaly
2. Lobectomy scar
-ddx
- respi examination
-common viral infection in his age : EBV
- left side: reduced chest expansion, dull, reduced vocal resonance and breath
-ix to send
sound
- differentials -what is your management
- indications of lobectomy -when to start blood transfusion
3. Prof faisal - multinodular goiter
4.stoma ( external surgeon was really nice, he was guiding all the way)
how to examine trachea in a patient with big goitre
- most probably ileostomy
What more to assess in pt with big goitre
- and midline laparotomy scar
Ddx
- what surgery probably would have been done
- what is incisional hernia and its risk factors Thyroid status?

LIM CHIN LI
AQILAH REHAN

Day 4
Longcase - colorectal carcinoma
Long case (Dr Mazarre, Dr Zulida, external examiner)
Dato Gee. Prof Shikin. Dr Maliza
Left limb discrepancy secondary to AVN
52 / indian/ lady
*33y/o, MVA 2 years ago, hip dislocation with head of femur fracture
u/l controlled intermittent bronchial asthma
1. What is depression, criteria for MDD (cause my patient admitted for 2 months,
C/o 2months of diarrhea and abdo distention prior to admission on july 2016.
Currently patient is asymptomatic. with depressive symptoms, ADL dependent on others, develop pressure sores but
Associated with vomiting, abdo pain on day of admission. No family history ca. improved after 3rd operation)

19
PRO 3 EXAM 2017
2. Brought to perform PE of hip. - ACL and LCL tear
3. What is your diagnosis 2. Dr. Anim
4. What investigation you wanna do? - prosthetic heart valve
5. Interpret X-Ray - drug patient must take
6. How you gonna manage this patient? - what advice to give to patient
7. What is the cut off length that indicate the need of surgery for this patient? 3. Dr. Zulida
8. Patient post infection, sustain left hip pain, what you can do to relieve the pain? - uterus larger than date
- ddx
Short case (Dr Habibah, Dr Fahlina, Prof Khairul)
Case 1: Diffuse toxic Goiter secondary to Grave disease KON JIAN FANG
- palmar erythema, bruit, diffuse swelling
- which artery supply thyroid? Day 3
- diagnosis? Why say it is a diffuse toxic goiter? Long case (Ms Limi, Prof Nizlan, Prof Intan)
-investigation Right Breast CA with mastectomy and axillary clearance done 2 months ago,
-management coming for follow up
Case 2. ESRF secondary polycystic kidney Qns:
- ballotable right kidney, functioning fistula, pallor - risk factors for breast cancer (don't miss a single one)
- why do you say it is a kidney? - brought to demonstrate breast exam at bedside, asked abt groups of LN, what
- what is the diagnosis? other systems to check (RS for pleural effusion, abdo for hepatomegaly, bone
- causes of unilateral ballotable kidney tenderness) was asked to demonstrate bone tenderness
- investigation to be done? - types of breast ca
Case 3: ovarian cyst (central mass, able to get below? - if seeing pt for first time, what to proceed (triple assessment - usual qns like what
- 30 weeks size feature to look for in mammogram)
- patient nulliparous and dysmenorrhea, what kind of cyst is it? Endometrioma - if pt comes back 1 year later complaining of SOB, what ix to do (chest X-ray to
- other differential of the mass? look for meniscus sign n cannonball appearance, CT TAP)
- why not ca? Not cachexic, no wasting, no pallor, regular margin, mobile - if pt comes back with bone tenderness, what ix (serum calcium), how to manage
- what other test can be done to differentiate ovarian or uterus origin mass? hypercalcaemia (I'm not sure other than hydration)
Bimanual - since pt is on dabigatran, how to prepare for op (ix - FBC, RP, LFT, Coag, GXM,
- what condition that during bimanual, uterus origin mass, but cervix not moving ECG, CXR)
when you move the abdominal hand? Ca of uterus, fixation to other structure - post op cx (lymphoedema, nerve injuries) what nerve n sign (long thoracic nerve
- what management? Why you wanna remove (cystectomy)? with winged scapula, got others also but I couldn't recall)
- laparotomy or laparoscopic? Laparotomy cause mass too big
- advantages and disadvantages of laparoscopic Short case
Dr Zulida - uterine mass (rmb to demonstrate get below mass)
TAN JANE JANE Dr Anim - bronchiectasis (ddx for coarse creps, ix)
Day 3 Prof Dev - ACL&LCL tear (pt has fixed flexion deformity) (what's the cause of
Long case stiffness)
- same as jian fang ( breast ca)
SOON HIE YING
Short case
1. Prof Dev

20
PRO 3 EXAM 2017
Long case: Rectal CA(prof liew, dr khalai, dr hana) biopsy)
A 48 years old malay gentlemen with no known medical illness presented with -if i tell u this is multiple lipoma.. can u name me one syndrome assoc with this
abdominal pain for 6 months duration prior to this current visit. Assoc sx: altered condition
bowel habit, tenesmus and loss of weight. PE: stoma at the right lumbar(just - if the pt opt for surgery.. can or cannot
beside the umbilicus.. i tot is ileostomy, but actually is transverse colostomy) - what u need to advice for this pt presented with multiple sebaceous cyst
- why there was mucus seen in the stool..how does it happen - how do u manage. What is the name of the procedure
-sx of right and left colon Ca - if these cyst are infected.. how do u manage
-Any familial syndrome assoc with colon ca tat u knw of
-what do u think about this stoma (done under emergency) and why SYAZWANI SAHAK
-pt presented with severe abd pain.. what do u think is the cause. Are u worry?
Why
Day 1
- during PR examination..if u found tat the mass is at ur fingertip, which is around
Short cases
5cm from the anus.. what do u think. How to manage 1. Dato Gee: multiple sebaceous cyst
-this pt actually had the stoma with the mass still inside the rectal.. what u want to -running commentary
do and the mx
-do all the tests for sebaceous cyst (mobility, fluctuation, etc)
-neoadjuvant vs adjuvant therapy
-why got scar at the sebaceous cyst?
-how to assess operable or non-operable
-ddx
-preop assessment
- many lipoma- what is the dz called?
-liver function test is important for wat other than looks for metastasis - what is carbuncle?
-if the albumin is 30.. would u wan to proceed to do the surgery? Why? -ix
-features of ileostomy and colostomy
-tx for sebaceous cyst
-how do u prepare the patient for operation
2. Prof Norlijah
*many more..cant rmb
- examine this boys's CVS (1y2m, wt:5kg)
- finding: dysmorphism, cyanosis, clubbing, small for his age, normal pulses,
Short case: systolic murmur (I heard ESM loudest at ULSE), no failure signs
1.MCL tear(Mr Khai):this patient presented with left knee pain..pls examine her left - grading of murmur
knee
- ddx for cynotic heart dz
- ask to summarize the finding(stress valgus +)
- what's the features of TOF
-investigation
- features of TOF in xray
-mx
- complications of TOF
-if this pt is a national athelet, how do u manage her 3. Dr Ng
2.hepatospleno(prof intan):this is a 6y/o boy.. pls examine his abdomen
- examine this gentlemans LL
-wat is ur diagnosis(thalassemia)
- findings:
-what do u think his growth
I: bulky thigh muscle, no fasciculation
-state one diagnostic ix
T: spastic, clonus
- wat can u find from Hb electrophoresis P: 0/5 for all LL mvmnt
-wat is the inheritance of thalassemia R: hyperreflexia, babinski upgoing
Multiple sebaceous cyst with multiple healed scars(ms tong):pls examine tis
S: no sensation at all..
patient's back
Proprioception: impaired
-wat is ur dx and why
- I said I want to end exam by checking CNS, UL and spine. Dr asked to check the
-what do u think about those scars.Are they traumatic scar or surgical scar ( some
spine
is due to previous infected sebaceous cyst, one of the scar is due to the previous
21
PRO 3 EXAM 2017
- findings: spina bifida (meningocele), got hyperpigmentation at the back don't NSAID for hip pain, taken only when needed. Currently no active complain.
know what.. P/E: short limb gait, trendelenburg was positive, limited ROM, limb length
- full dx? discrepancy and significant bryant’s triangle.
- what is the spinal level? Hv to check sensory above L1.. that pt spinal level:T7 1. What happened if dislocation is left more than 3 weeks? AVN
And time's up 😂 2. Risk factors for AVN
3. Differential dx for limb length discrepancy
Long case (Dr shahril(kajang), prof Fazli(CVS), dr Hana(FMS)) 4. Physical examination (hip) – present relevant findings, show and demonstrate
Case: 35 y/o lady, G3P2, natural contraception, menarche at 16yo with issues: landmarks for true and apparent length, bryant’s triangle
1. Ovarian cyst during pregnancy detected at first trimester, size at first 4cm, then 5. Investigations. Describe Xray of hip – posterior dislocation and evidence of AVN
5cm (last scan during first trimester) (Ficat Arlet)
2. GDM on diet control dx at 31 wks POA 6. Show shenton line on xray
3. Untreated vaginal candidiasis from 26 wks till 32 wks 7. Management of each Ficat Arlet classification
4. Reduced fetal movement 8. Final diagnosis (as mentioned above)
5. Breech 9. Complications of total hip replacement – Secondary OA
After present hx, dr bring to pt, do general exam, obs exam n present findings..
then masuk bilik balik for QnA session Short Case (Ms Tong, Dr Bahariah, Prof Nazri)
Only Dr shahril qns me.. other Drs just keep quiet. Qns: 1. Surgery (Examine the neck: Solitary thyroid nodule)
1. How to mx cyst during pregnancy - differential dx for solitary neck swelling
- at 1st trimester - management for this patient (detail history & examination, ultrasound, FNAC)
What situation need op ? How to prevent miscarriage? - If HPE came back as follicular what to do next?
What situation no need op? Why usually we don't remove asymptotic cyst during - Complication of thyroidectomy intra-op (recurrent laryngeal nerve injury)
1st trimester? - Clinically, is patient hyper or hypothyroid?
- at 2nd trimester 2. Medical: Visible displaced apex beat, MR and midline sternotomy scar
What situation need op? 3. Gynae (53 y/o para 2 menorrhagia, Fibroid correspond to 24 weeks)
What situation no need op? - Explain how to perform bimanual examination and what to expect if mass is
If asymptotic but want to op when is the best time in 2nd trimester? uterine in origin
2. Regarding GDM - Differential dx for mass
- what u worry? So just say the cx of GDM since 1st trimester till post partum.. - Types of ovarian cyst. Investigation and management of fibroid
- since I didn't mention PPH, dr asked what is the cx after deliver for pt having - Difference between hysterectomy and TAHBSO; and why TAHBSO for this
macrosomic baby and polyhydramnios? -lax uterus-PPH patient?
So he asked how to prevent? Active mx 3rd stage labour, synto 40unit - What to offer if patient refuse surgery and medical treatment? UAE
Then that's the end. All the best!

AMY FURZANE SUM JIA EN

Day 2 Day 1
Long Case: Orthopaedics Long Case (Dr. Fadhlina 50%, Prof Faisal 30%, Mr. Fahrudin 20%)
(Prof Mano, ext examiner UM, Dr Amilia) 23 y.o with underlying thalassemia intermedia presented for jaundice since small.
42 y/o gentlemen, hx of MVA 18 years ago, presented with right hip dislocation Diagnosis
and AVN. He had previous history of twice hip reduction and twice redisclocation, Ddx of jaundice
hx of physiotherapy for one year and ambulating using walking stick. Was on if this patient is an elderly, what do u suspect other than the ddx above
22
PRO 3 EXAM 2017
(malignancy) intraoperative complication u expect?
Investigation 6. Contraception counsel in this patient is preferably before operation or after op?
What do you expect in a thalassemia patient's full blood count? 7. Tell me about what u understand about maternal mortality in malaysia?
What do you look for in full blood picture? 8. What is the top 3 maternal mortality in malaysia and how to prevent it
What is target cell?
Pathophysiology of hepatosplenomegaly in thalsemia pt Short case ( dr amilia, dr chieng and external)
What is exjade? 1. Multiple pregnancy and larger than date
Tell us how do you investigate the complication of iron overload? Question : what is the dd for larger than date? What u want to confirm from patient
Management (long term) larger than date? What u understand by tttts and twin acardia? Staging for tttts?
If this patient marries with a carrier, what is the % of the child having thalasemia How to treat ttts? If t sign, what type of multiple u aspect? How to deliver twin?
major? Why we need 2 specialists to deliver twins? Briefly descride me the procedure to
What is the indication of splenectomy? deliver second twin?
Do you think this patient needs regular transfusion? Why? 2. Leaking prosthetic valve with heart failure and af. ( i miss af and displaced heart
Complication of iron overload beat initially but dr very nice and ask me to do again) What is causes of
Pathophysiology of iron overload on the heart? pansystolic murmur? Other than AF, what is other cause of irregularly irregular
Genetic caunselling pulse? When we start warfarin? Why there is scar at the chest? What is your final
how do you counsel for genetic screening to the family? diagnosis?
if pt want to get married, how do you counsel the patient? 3. Indirect inguinal hernia and irreducible (hernia super small, only prompt for one
thousand time only say out diagnosis..haiz)
Short Case (Dato. Khairul, Mr. Paisal, External UM PEAD Prof.Tong) What is the management? If patient doesnt want surgery, how u wan to counsel?
-thyroid Why large bowel never get strangulated by hernia??
-LLD All examiner very good but the external for short case very fierce. Inguinal no
-CP swelling but external keep stressing is indirect..haiz.

NG BOON LEE ABDUL RAHIM AWALLUDIN

Day 3
Miss limi , dr ting and external um (o&g)
Placenta previa type 3 with gdm on diet, anemia and threatened miscarriage. One
previous scar and 39 y/o and previous baby with edward syndrome
Question
1. Do u think is appropriate to do detail scan at 28 weeks. Why we need to admit
placenta previa patient at 34 weeks poa? Why progesterone pill is given to this
patient during the bleeding episode?
How you manage this patient, from antepartum, intrapartum and postpartum.
2. If there is accreta, what sign u will see in doppler ultrasound during placenta
mapping?
3. What is the dose of heparin used for dvt prophylaxis? Which level of risk this
patient is categorised for dvt?
4 placenta previa used regional or general anaesthesia? Why?
5. Tell me what u understand about mandelson syndrome? What is the
Day 2
Long Case (Dr Amilia, Prof Tong External Paeds UM, Prof Mano)
Madam Norliza 39 y/o malay lady G5P4, currently at 36 weeks of POA, EDD is at
17/8/2017. Her LMP was 10/11/2016, sure of date, regular menses, not on ocp or
breastfeed. She was electively admitted to HS due to placenta previa type 3. She
had history of painless pv bleed during 18 weeks of POA. Currently she also
having, GDM, anemia in pregnancy, UTI and had history of 1 previous scar. In the
ward fbc was done twice a week. She had history of edward syndrome child and
already passed away.
Dr Amilia
1. bring back to patient for examination, and present at bedside. Then go back to
exam room.
2. Why blood ix was done twice daily?
3. What are the complication of PP?
4. interpret serial US.

23
PRO 3 EXAM 2017
5. She gave scenario : if u were the HO at ed, and patient come with pv bleed at So hx started from 20 years ago how she presented and diagnosed with HPT,
18 POA, how u manage? Hypercholesterolemia and Polycyctic Kidney... along the way since diagnosis until
6. Pt will undergo ELLSCS, how would u consel the patient? now clerk as usual as she had several times of changing med and hospital for f/up.
7. What do u anticipate in PP patient with GDM and 1 prev scar? She also had left renal calculi diagnosed with 4 times PNCL done (3 times
Prof Tong UM unsuccessful). In between she is asymptomatic until 4 months ago did fistula just
1. What is edward syndrome? in case she requires dialysis as kidney deteriorating.
2. what is the postpartum complication for the baby in diabetic mother? For her asthma was well controlled.
Prof Mano She has allergy to Ampicillin where she will hv lips swelling and generalized
1. What is the complication of macrosomic baby during labour? itchiness.
Mother previously had most probably ESRD on dialysis before she passed away.
Short case (prof nazri, ms tong, dr bahariah) Questions (some were asked in between of presentation)
Prof Nazri - 40 y/o malay lady presented with chronic pelvic pain + dysmenorrhea 1. Which anti-HPT causes cough and asthma attack (reason why pt had frequent
+ subfertility for 2 years, come with abdo swelling. Examine her abdomen changing of med)
Dx : Endometrioma - ACEi = coughing
1. What is your ddx? - Beta blocker = asthma attack
2. What kind of ovarian cyst that u know? 2. Since pt currectly on Enalapril and Felodipine, do you think is appropriate for
3. What is chocolate cyst and where to find it? this pt?
4. if pt had tumor, u think it is benign or malignant? why? If pt cannot tolerate ACEi, what else can you offer - ARB
5. How u ix? What to look on US? 3. what are the complications of ADPKD
6. How u manage? - liver cyst, pancreatic cyst, splenic cyst, Berry's aneurysm, MR, polycythemia
Ms Tong - Examine this patient upper trunk. 4. What is the pathophysio of how ADPKD causes HPT?
Dx : lipoma 5. I mentioned no fam hx of ADPKD then Dr asked if it is confirmatory no fam hx of
1. what is your ddx? ADPKD?
2. what is the complication of this lump? He wanted to know if all the family members screened
3. how u ix the lump? 6. Is there any relationship between ACPKD and bowel polyp?
4. what features u want to see in US neck? 7. in history i presented pt had cramping of legs, dr asked what is the cause
5. if pt insist to remove it, what method? i said uremia then asked how uremia causes the cramping - hypocalcemia
Dr Bahariah - examine this patient lower limb On PE, pt was pale, raised JVP of 4.5cm, fistula felt and left arm, bilateral
findings : left club foot, left lower limb weakness, cannot dorsiflex her left foot, ballotable kidneys, MR heard
UMNL features at left lower limb. 8. Why patient is pale
She did not satisfied with my neuro examination technique and have to redo back. 9. so how to manage.
Only discuss about ddx. I said give Erythropoietin. Then Dr asked why Erythropoietin instead of oral
Hematinics?
10. Which type of anaemia in the pt?
ADELE LAU
Normocytic normochromic
11. what other causes of anaemia in this patient?
Day 3 12. Can pt afford Erythropoietin?
Long case (Dr Chieng, Prof Faisal, Prof Ching-FMS) need to ask pt about financial support and social support in hx
60y/o, Malay lady with underlying polycyctic Kidney Disease, HPT and Was asked how much pt needa pay a month if undergo HD?
Hypercholesterolemia for 20 years as well as Childhood Asthma currectly with no 13. For the murmur, how to differentiate functional murmur and pathological
active complaint (She came just for exam only and she insist that she has no murmur?
complaint for me) Functional murmur usually is continuous flow murmur
24
PRO 3 EXAM 2017
Investigation. - what many types of systolic mumur
mentioned all the neccesary blood, urine and imaging - what murmur is most likely in this patient
14. i mentioned abdominal ultrasound then Dr asked whats the criteria to dianosed 3. Dr Ummi (ADPKD)
ADPKD this pt come with young HPT complain of abdominal pain
15. i mentioned Chest X-ray to look for cardiomegaly then they asked why? - on examination, pt had fistula at left forearm, ballotable kidney on the right side
since pt has MR and if in failure causes cardiomegaly and pt has HPT. - was asked for diagnosis
16. what to counsel the pt - what investigation
counsel for a screening for the family members and child due to the inheritance
pattern CHEW HAN JIA
17. was given a scenario, if i am the Neurologist in charge, what is the long term
management for this pt as she has ADPKD and HPT
Day 3
Look for DM which may worsen the condition, fluid restrict, salt restriction and
Long case
protein restriction Mr Khairuddin, Dr Joseph, Prof Nazri
18. what drug that can cause worsening of the kidney function? 23 year old Malay gentleman, MVA in 2013, intubated for 5 days, external fixation
NSAIDs, Antibiotic
and plate was inserted in his left hip. Current complaint which is occasional left hip
19. What do you think about Renal transplant in this patient?
pain, ADL independent. On physical examination, equinovarus, foot drop, high
stepping gait, multiple scar at inguinal, buttock and bilateral knee, limb length
Short case
discrepancy for 10cm, fixed flexion deformity, above greater trochanter shortening.
1. Prof Liew (Varicose Vein) Questions:
examine the pt left leg 1. Describe the foot deformity, gait, how to measure apparent length, true length,
- inspect, palpate, trendelenburg test
Allis test
- which vein is involved = Great salphenous vein
2. Diagnosis
- what does trendelenburg test findings indicate= SFJ incompetence
3. Complications of this patient
- i mentioned i wanna complete examination by abdo exam and check peripheral
4. What will X-ray shown if the patient had AVN- crescent sign- what is crescent
pauses. So he asked why wanna so abdo examination (to look for pelvic mass) sign
and peripheral pulses ( to prevent ischamia if pt given compression stocking) 5. How do u wan to confirm whether the patient had foot drop - check sciatic nerve,
- What pelvic mass to look for
common peroneal nerve- mention all sensory and motor examination
- what ix to do = Duplex ultrasound to look for which incompetence and any
6. If patient come to clinic with foot drop, what do u wan to check - take history, do
occlusion
x ray- what u wan to see from X-ray
- what other cx of VV besides ulcer = DVT, lipodermatosclerosis
7. What is the management for this patient- total hip replacement - other choice-
- what are the causes of VV realignment osteotomy
- How to manage
8. Prof Nazri ask what is the test to check hip problem in newborn and if positive
- Do you think surgery is indicated in this pt
what is the disease (Barlow and Ottolani)(CDH-congenital dysplasia of hip)
2. Prof Norlijah (Down Syndrome)
9. Dr Joseph ask if young patient walk halfway then suddenly fracture of neck of
look at the child and tell what i saw (running commentary)
femur, what is this fracture called? - pathological fracture- causes? Carcinoma,
- described all the features of down from head to toe osteoporosis, renal failure - endocrine problem? Hyperthyroidism,
- what is brachycephaly, hypertelorism, clinodactyly hyperparathyroidism, hypogonadism
- what is the cause of clinodactyly? what can you see on X-ray for clinodactyly?
- what is the cause (etiology) of DS (translocation, non-dysjunctional, mosaicism)
Short case
- was asked to assess the eye to look for other features seen in DS
Dato khairul, dr wan alia, dr maiza
- asked to just auscultate the heart as baby was irritable = heard systolic murmur
1. Thyroid - check thyroid status also, diagnosis

25
PRO 3 EXAM 2017
2. Respiratory examination - left pleural effusion - investigation Day 1
3. POA 30 weeks, examine abdomen- uterus larger than date, causes, how to Long case: Paediatrics
investigate GDM, normal value of MGTT Prof Intan, Prof Dev, Dr Maliza.
Ulya, a 1 year 8 month old girl with history of ill contact presented with first episode
RAYMOND TEOW BOON KEAT of lower respiratory tract symptoms for 1 week with lethargy and poor oral intake
for a 1 day presented with rapid breathing 1 day prior to admission. On
examination, she was irritable, appeared lethargic and in respiratory distress as
Long Case: Prof. Norlijah, Prof. Lee FMS, Mr. Hadi
12 y/o girl known case of uncontrolled severe persistent BA presented with severe evidenced by tachypnoea and supraclavicular, intercostal and subcostal
recessions. Auscultation revealed generalised crepitatons.
exacerbation. Non-compliant to medication and positive family history of atopy.
My working diagnosis:
Physical examination revealed state of respiratory distress, inspiratory crepitations
Broncho pneumonia
and reduced air entry at lower zone.
(But I'm thinking of atypical too)
1. Ask on patient's emotion
2. What are the other associated mental conditions apart from depression? Was asked on:
3. How to differentiate severity of exacerbation? 1. Difference between viral induced and multi trigger wheeze
2. Types of organisms that cause pneumonia
4. What is pulsus paradoxus?
3. Investigations for my patient
5. Acute management of severe AEBA
4. General management
6. Purpose of performing ABG
5. Complications of pneumonia
7. What to do when ABG shows respiratory acidosis?
8. Why usage of aminophylline is not routinely used in management of AEBA? 6. Investigations for SIADH
7. The use of anti tussive in paediatric age group
8. Pneumococcal vaccination
Short Case: Dr. Zulida, Mr. Chris, Dr. Ooi
1. Uterine fibroid
Short cases
- Characteristic of uterine and ovarian mass
Orthopedic, gynecology, medical
- What are the reasons for a fixed uterine mass?
- Ix Prof Nizlan, Dr Zainab (HS gynae HOD), Dr Anim
- If patient presented with bleeding, what to look for in U/S? 1. Right Wrist and finger drop with POP cast on the right arm and an arm sling.
-Examined the radial nerve.
2. Right reducible indirect inguinal hernia
-rule out median nerve and ulnar nerve involvement.
- Where to occlude in ring occlusion test?
-most probable cause of the lesion:
- Relation of deep ring and inguinal ligament?
Proximal humeral fracture
- Advice for patient
- What to do is patient refuses surgery -investigations
-management: focusing on physiotherapy
- Complications of hernia
2. Large abdominal mass (53 yo, P5, last child birth 13 years ago)
- Type of repair
- uterine or ovarian mass
3. UMNL of left LL
- was led to ovarian mass
- Causes of UMNL
- Causes of young patient presented with stroke - causes of ovarian mass
- types of ovarian cancer
- investigations for ovarian cancer
LEE ROY - definitive treatment - TAHBSO
3. Mitral valve replacement with a mechanical click and heart failure
- pallor, systolic click at mitral region, cardiomegaly, pedal odema
- causes for pallor
26
PRO 3 EXAM 2017
- name on drug patient was on: Warfarin - Ddx: NAI (must ask fall/injury)
- the Targeted INR - PE: Mainly inspection!!! No abnormal movement, dysmorphism, look for
hydrocephalus (Dr asked to demonstrate measuring head circumference, palpate
KHOO WAN TING anterior frontanelle), hydration status (demonstrate skin tugor), proceed with UL,
LL (just describe what to do)
- Discussion: ix (RBS, FBC, LP, RP, blood culture, urine culture) (how to get urine?
Day 3
Suprapubic aspiration)
Short case
1) Gynae (External) - Complications of LP
- LP what to send for then interpret
Pls examine the abdomen
- Mx: what antibiotics? What organisms?
- How can you tell it's uterus from physical examination?
- Monitoring- all the charts, daily neuro monitoring (be specific, head
- How do you want to ix? (Complete hx, bimanual examination, transabdominal
circumference)
US)
- How to differentiate uterus and ovaries in bimanual examination? - Complications of meningitis
- pt is 53 y/o with menorrhagia, how do you ix? (Endometrial sampling for cytology)
CHOW ZHEN YEE
- differential for postmenopausal bleeding
2) CVS Paeds (Dr Ting)
Long Case (Dr Joseph, Prof Nazri, Mr Khai)
Pls examine the CVS of this pt
51-year-old Malay lady, underlying hypertension, gastritis and
3 y/o Malay female with no clubbing, not in respi distress, COULDN'T really get the
pulse, no signs of failure, I thought got cynosis, apex x displaced, no parasternal hypercholesterolemia, presented with right intermittent flank pain and dysuria 1
heave or thrill, PSM at left lower sternal edge, no bibasal creep and hepatomegaly week prior admission. She also had haematuria, urinary frequency, passing of
cloudy urine and nocturia, otherwise no fever, chills and rigor. 1 month prior to this,
- anything else to complete examination
she had been having mild abdominal discomfort. She completed 1 course of
- asked about radiation
antibiotics for 5 days and the symptoms resolved. No constitutional symptoms and
--> I offer TOF but dr wondered, but at last I mentioned VSD (then I think it's pure
bowel symptoms. She had been having syncopal attacks 2-3 times per year for the
VSD)
3) Medical (Dr Foo) past 2 years and she was still unsure of the cause though there were multiple
Pls examine the abdominal system admissions and investigations done. 1 year ago, she started to have palpitations,
reduced effort tolerance and orthopnea. However, examination and investigations
23 y/o Malay man
revealed normal cardiology findings during admission to HS 1 week ago. For family
- no stigmata of CLD, jaundice, conjunctival pallor, thalassemia facies, no cervical
history, both of her parents succumbed to acute kidney injuries in their middle age.
lymphadenopathy
Physical examination
- No scar, splenomegaly, ?hepatomegaly
- What is your clinical dx? 1. Bilateral ballotable kidney
2. Epigastric mass
- What are the causes of splenomegaly?
Issue:
- If this is thalassemia, what ix you would like to do? (Describe the findings in each
1. Right flank pain, dysuria, haematuria
ix)
2. Polycystic kidney disease
- What is the genetic predominance?
3. Hypertension
Long case: paeds (Mama zu, O&G external, Mr mazzre) 4. Syncopal attacks under investigation
5. Undiagnosed cardio issue
1-m-18-d-old Malay girl, fever for 1/52
Questions:
- Multiple episodes of uprolling of eyeballs, generalized stiffness of all limbs
Dr Joseph
- reduced oral intake, urine and stool output
1. Provisional and differentials
- Dx: meningitis
2. Why do you think she was given antibiotics?
27
PRO 3 EXAM
3. Why do you think she has multiple syncopal attacks for the past few years?
4. Bedside:
a. Show me how do you ballot kidneys
b. Show me how do you palpate for liver
c. What signs to look out for in a patient with ESRF, including peripheries?
5. What are the investigations you would like to do?
6. How do you manage polycystic kidney disease on first encounter?
7. List out the management specifically for polycystic kidney disease.
8. Tell me about haemodialysis, peritoneal dialysis and renal transplant.
9. Would you recommend renal transplant for your patient? Justify your answer.
10. How do you assess renal function?
11. How do you calculate eGFR.
12. Name me the three formulas to calculate eGFR.
13. List out the stages of chronic kidney disease.
14. Define hypertensive crisis, hypertensive emergencies and hypertensive
urgencies.
15. What organs are likely to be involved in hypertensive emergencies?
16. How do you manage heart failure?
17. If patient came to you with BP of 220/110 mmHg, tell me your approach and
management.
18. List out the antihypertensive medication that you know.
19. Patient is having ESRF, which anti-hypertensive would you start off with?
20. Tell me what do you know about polycystic kidney disease?
21. What are the complications of polycystic kidney disease?
22. If you were to do MRI brain on patient with polycystic kidney disease, what
specific findings would you look for?
23. What is the gene affected in polycystic kidney disease?
24. How does ESRF lead to hypocalcemia?
25. Describe the vitamin D and calcium pathway in the kidney.
Prof Nazri
1. List out the possible issues if a physician refers a patient diagnosed with
polycystic kidney disease to a gynaecologist.
Mr Khai
2. List out the possible reasons if a patient with polycystic kidney disease is
referred to an orthopaedic surgeon.
Short case (Dato Khairul, Dr Wan Alya, Dr Maiza)
Dato Khairul: Examine the right groin of the patient
1. Right reducible indirect inguinal hernia
a. How would you like to end your examination? State the reason for doing per
rectal examination, abdominal examination and respiratory examination in a
patient with hernia.
28
2017
b. What are the possible contents of hernia?
c. How do you differentiate clinically the contents of hernia?
d. What are the complications of hernia?
Dr Wan Alya: Do a neurological examination on the lower limbs. And also inspect
both her hands.
2. Charcot Marie Tooth disease???
a. What are the possible pathological site for her condition?
(LMNL, bilateral calf muscle wasting, motor power was 4/5 on both thighs and
knees, power 0 on dorsiflexion and plantarflexion on the ankles. Pinprick sensation
was not intact for the lower limbs, proprioception was normal. Coordination was
normal. Genu valgum over right knee)
b. Tell me the medical term you use for polyneuropathy which has both sensory
and motor deficits.
Dr Maiza: She is G2P1, currently at 28 weeks POA. Examine the abdomen.
3. Multiple pregnancy
a. How do you differentiate and make sure that the fetal heart rates you obtained
are belong to each fetus?
b. What is the minimal difference in fetal heart rates you obtained so that you could
say they are from different fetus?
c. Ultrasound in early pregnancy, what signs were you looking for?
d. What is lambda sign? What is inverted T sign?
e. What else is important in ultrasound while assessing multiple pregnancy?
f. How do you perform a CTG on multiple pregnancy?
g. What are the complications for multiple pregnancy?
h. What do you understand by MCDA?
i. When do you plan to deliver a MCDA twins?
j. What is your concern if MCDA twins is delivered after 38 weeks of POA?
k. If you found out there is a big and a small fetus in twins pregnancy, what is the
condition called?
l. Patient is not having labour symptoms or signs at 36 weeks. How do you
proceed?
m. After you successfully deliver a twin baby, how do you deliver for the second
twin?
HAFIZ AZIM HALIM
D3:
long case: bilat. knee OA
mr mazree, dr zurina, external examiner
Q: ix, mx
dr gave x ray of that pt, describe: usual oa finding + kissing bone, subluxation
PRO 3 EXAM 2017
(femur bone slightly displaced to medial) - Since it is a young male patient, what differential you will think of? Ankylosing
Hallux valgus spondylitis (AS)
wind swept deformity - What physical examination you would do to confirm its AS? Sacroiliac
if pt stable, no knee pain, what mx tenderness?
how they do TKR & what we should tell pt, lifespan of the implant, pt cannot get full - What is your approach to patient in clinic setting?
ROM, why? - What investigation you would like to do?
if young pt, 43y/o, what mx- arthrodesis - What do you expect from the chest X-ray in ankolysing spondylitis?
advantage of arhtrodesis vs arthroplasty - What clinical signs you supposed to elicit in A)
I did not reach management questions
Shortcase :
1. Fibroid Short case
Ix: US Panel: Prof Nizlan, Dr Zainab, Dr Anim
if pt come with menorrhagia, what other ix to do? Endometrial sampling 1. Orthopaedic short case
What advantage of hysteroscopy? Not a blind procedure. “Please examine the knee”, “Please do running commentary”
2. Bronchial Asthma 2nd pneumonia Patient: Young man, with anterior drawer test and lachman’s test positibe
3. Prosthetic valve replacement During the PE,
Indication? MR MS - What you look for in this manuveer? Genu recuvatum
Causes for MS? - Which test is better for detecting ACL? Lachman’s test; Why? Because it is more
What medications pt on? Warfarin for long life sensitive
PE was done,
PAUL LAU UPM PRO 3 EXAM (2017) - Present the relevant positive and your impression on this patient
Long case PDx: Right ACL tear
Panel: Prof Dev (leading), Prof Intan, Dr Maliza - How would u like to investigate and manage this patient?
Young ≈28 years old gentleman, with chief complaint of lower back pain with right - What u look for in knee X-ray?
unilateral sciatica pain of 4 months in duration. He also had numbness of of right - When and why u do MRI?
leg (medial side of calf) and had problem with working. He changed his job from - What anatomical part you inspect on MRI? ligament, meniscus, ??
mechanic to admin. Otherwise, no other positive history. - What are the surgical option?
My Diagnosis: PID with L4/L5 radiculopathy - When do u do ligament reconstruction surgery (indication)?
Note that I forgot to perform straight leg raising test and fabere’s test (I told Dr is - What graft u will use in surgery? patellar ligament and tendon (gracilis and
due to time constraint) semitendinosus)
Questions: 2. ONG short case
- What is the events that triggered the back pain? “This is a ?? (young) woman, G?P?, with 26 weeks POA presented to u in the
- What are the characteristics of the back pain which points towards spinal clinic, please perform an abdominal PE”
pathology? Patient: Adult woman, with distended abdomen with linea nigra and striae
- What is your provisional and differential diagnosis? gravidarum, CFH = 28 weeks, SFH = 31cm, singleton fetus with transverse lie.
- How is the patient occupation is related to the back pain? I was unsure of findings but the findings I supposed to get are transverse lie and
I was being brought to beside to demonstrate relevant findings of the patient uterus larger than date (my friend say it’s a multiple pregnancy case, I didn’t
I missed loss of lumbar lordosis on inspection and was asked what is the most manage to palpate 3 poles)
relevant PE to be done next, I went for straight leg raising test instead of fabere’s During PE,
test (I think that’s why I fail) - Dr comment on my technique on palpate the clinical fundal height
Other stuff I was asked to demonstrate is the limitation of ROM (extreme limitation) - I was asked to redo clinical fundal height and symphysiofundal height because I
and neurological PE (motor and sensory) to localize the level of pathology cannot get uterus larger than date
29
PRO 3 EXAM
- I say this is uterus larger than date is because the abdomen looks distended, full
flank, clinical fundal height > weeks in POA and symphysiofundal height > clinical
fundal height,
- What are the causes of uterus larger than date?
3. Medical short case
“Please examine this man cardiovascular system. I will stop you after 7 minutes”
Findings: old man, borderline bradycardia (60 bpm), weak volume, regular rhythm,
midline sternotomy scar with keloids, unable to palpate apex beat, S1 and S2
heard with systolic click, loudest at left lower sternal edge with no murmur
- Give your impression
PDx: Prosthetic heart valve replacement, most likely mitral valve, not in failure
- Why do u say its prosthetic heart valve? Systolic click, midline sternotomy scar,
no saphenous scar harvesting
- If given the change to ask history from the patient, what would you ask? CVS Sx,
Complication of Prosthetic Valve and Warfarin
- What are the signs of heart failure u look for?
- What is the main drug given to these patients? Warfarin
- What do u elicit from the patient to see if the patient is taking adequate warfarin?
Say both overwarfarinised and underwarfarinsed signs and symptoms
- What is the target INR for prosthetic heart valve patient?
- What u would advise the patient regarding his medication?
Dr told me to be more gentle with the cardio patient
Modified long case (remedial)
Panel: Mr Fahruddin, Dr Fadhlina, Prof Faisal
I was given 30 minutes to clerk the patient in front of all the Drs without any
interruption or clerking sheet. I was to summarize the patient history at the end of
clerking. The patient was a classical rheumatoid arthritis case with the obvious
classical signs on hands and feet under follow up for both orthopaedic and
rheumatology. She had multiple joint pain for past 8 years. Mr Fahruddin asked
orthopaedic questions, Dr Fadhlina asked medical questions of RA.
Most of the time is wasted as Dr gave many clues but I cant answer. Most of the
answer is what I found after the exam based on the hints that I failed to understand
during exam.
- Summarise the patient’s history
- What is your differential diagnosis? (must be specificly chronic joint pain)
OA, RA, Psoriatic arthritis (cannot say septic arthritis etc)
- What is the clinical symptoms of joint pain in RA? Why u did not ask all these in
history?
- Please examine (mostly inspect) the patient hands? I was too obsessed with RA
findings and missed obvious thenar and hypothenar wasting
- How do u assess the functionality of the patient hand? I really dunno, answer is
30
2017
grasping, writing, unbutton and button cloth, hold comb,
- What is the systemic involvement of RA?
- What is the common complication of RA in lungs? lung fibrosis
- How do you investigate?
- What is the specific and nonspecific blood investigation of RA?
Answer is ESR (nonspecific) and serum Rheumatoid factor (specific)
- What is the differences in findings on X-ray of Knee in OA and RA?
Please, its not the ulnar deviation stuff on hand. Its knee so its genu varus,
reduced joint space, erosion, soft tissue swelling, soft tissue swelling, osteopaenia
(osteopenia is opposite of sclerosis)
- What is your management? (only 90 seconds left for this question, I din make it)
Extra notes: After post exam discussion, it seems like I had misdiagnosed
Ankylosing Spondylitis case as PID. I did notice he was a young patient but I failed
to detect his loss of lumbar lordosis and failed to understand his abnormal posture
during his gait (it seems like it mimic the question mark posture in ankylosing
spondylitis). I was probably misled by the unilateral sciatica pain, it is probably just
refered pain. Prof Dev had already hinted me several times it is ankylosing
spondylitis but I failed to take the hints as I did not bother the remember most of
the clinical features of ankylosing spondylitis. The point that Prof Dev decided to
fail me was I choose SLR test instead of Fabere test when he ask me to
demonstrate the most important step in the physical examination in front of him on
patient. My second case was also rheumatology case which is rheumatoid arthritis,
I failed the case is probably due to I did not trained myself to do modified long case
(paperless clerking) and I never had a proper long case discussion with any Dr on
rheumatoid arthritis. This is all my guesses as to why I failed the exam because I
tried to meet Prof Dev after the exam but he asked me to take a rest instead for
the holidays.
For both of my rheumatology long cases: although they are very rare to be found in
the ward, they are textbook cases which means they will be brought to the exam.
This is probably the first year that the undergraduate exam have a ankylosing
spondylitis long case but it wont be the last. My prediction is the patient will
become a regular customer for the Prof Exam from this year onwards. Please ask
your seniors to find out all the “regular customers” of the Prof Exam, I lazy to list
them out here.
PRO 3 EXAM 2017
if young pt, 43y/o, what mx- arthrodesis
SARVINI KANDASAMY advantage of arhtrodesis vs arthroplasty

Day 3 short case:

Short case(Prof dev,dr zulidah and dr anim) 1. uterus larger than date
1st case: "examine patient's left hand" external O&G
tenderness noted over thenar and she unable to do '0K'sign so I proceed to medial Q: causes, ix+what to look for in US
nerve examination is it common to get wrong date here? no
Dx: Carpal tunnel syndrome why?
questions asked: why u think this patient has this problem,how you will investigate, 2. thalassemia paeds
management for this pt. dr ting
Second case: uterus larger than date Q: features of liver & spleen on examination
questions: causes of uterus larger than date(give wrong date as ur first 3. UMNL? w loss of sensation until above T10
point),management for this patient Q: causes
Third case:" patient presented with palpitation examine him"
findings: AF with MR OLIVIA LING JING
questions: differential for MR, causes of his MR,Investigations
Day 3
long case: prof Nizlan,miss limi and prof intan Sc: miss tong - inspect the ptn abdomen~
patient who underwent right THR presented with left knee pain for 3 years Stoma case: after inspection, palpate abdomen, no hepatosplenomegaly, kidney x
they brought me to the patient and asked me to do hip and knee examination(since ballotable,
this patient has OA the important examination need to do is stress varus and midline laparotomy scar, stoma at right iliac fossa, single lumen, spout, ddx- end
valgus) ileotomy
How you investigate this patient Ask about cx, what to monitor in the ward after ptn done stoma ~
management Dr fah: inspect ptn left knee.
complication of the surgery Dx : acl tear( probably mcl tear as well as ptn complain pain- i m not sure)
What u think if patient come back to you with sob after the surgery? pulmonary Prof tong(external) : paeds- examine ptn cvs
embolism and hosp acquired pneumonia - cyanosed, clubbing, systolic murmur at left lower sternal edge,
Dx tof
SHAFIQAH AMIRAH
Long cs : prof chris , one family med, one external.
D3: Fluid overload secondary to chf (with hepatomegaly)
long case: bilat. knee OA Ix, mx
mr mazree, dr zurina, external examiner How does heart failure cause jaundice and hepatomegaly~~
Q: ix, mx
dr gave x ray of that pt, describe: usual oa finding + kissing bone, subluxation TEE SIEW LI
(femur bone slightly displaced to medial)
wind swept deformity Day 3
if pt stable, no knee pain, what mx Long case- thalassemia intermedia
how they do TKR & what we should tell pt, lifespan of the implant, pt cannot get full Prof chris (lead), prof Adibah (FM), external
ROM, why?
31
PRO 3 EXAM 2017
23 y/o Malay gentleman, U/L thalassemia for 17 years, on regular blood ethambutol on what ix need to do.
transfusion and oral desferiprone. No active complaints. P/e hepatoslenomegaly. 6. Before start the tx what u want to advice to this pt? Ms tong said just one word.
1. Features of thalassemia facies Compliance!
2. What vaccine u will like to offer?
3. What's the complication of iron overload? SHORT CASE
4. Approach to anemia- ix u would like to do. (From A to Z for different type of Knee examintion by Mr Khai
anemia) instruction: examine lower limb
5. Counseling for partner? i start with gait 1st. Inspection on standing n walking.
6. Percentage of inheritancy- thalassemia with normal ppl, carrier and thalassemic Clarify back the instruction and told to examine knee.
1. how do fluid displacement test
Short case 2. dx
Miss tong- lipoma (ddx, will it be malignant? Do u wan to keep or surgically 3. how to mx
remove? What is the surgical procedure?(excisional biopsy), what lymph node u DA by Dr Zurina.
will like to palpate? 53y/o presented with menorrhagia. Abdo examination by Prof Nazri.
Mr Fah- RA with median nerve palsy ( all on inspection and feel for sensation) - Huge suprapubic mas uterine in origin.
ulnar deviation of metacarpophalengeal joint, Z like deformity, swan neck 1. Beside from abdomen, what u want to do? Bimanual
deformity, thenar muscle wasting.. test for daily living function- hold pen, button, 2. Ddx
cook.. 3. Ix
External UM- paeds thalassemia ( pallor with jaundice, hepatoslenomegaly) 4. If pt is 30y/o how u mx?
5. If pt is pregnant, what are the cx (maternal n fetal)? Mode of delivery?
WAN NOOR FATINI 6. If pt refuse surgery what other choice that can be offered? uterine a.
embolization.
Day1
LONG CASE Dr Ummi Dr Bahariah Ms Tong HAMIDA FADILAH
24 yrs old man presented with worsening chest pain + whitish productive cough 5
days prior ti admission in January this yr. Illness actually started on December last DAY 1
yr. It is worsen in term of the score of the pain, increase in frequency if cough + LC: Prof dev(ortho), prof intan(paeds), dr maliza(fms)
addedd syptoms ( LOA, lethargy, bodyache,nausea vomiting n diarhhea. No sob, PID:
abdopain, mucosal bleed n rash - i rule out dengue. Pt also had on n off fever with 28y/o p/w low back pain which associated shooting pain over posterior thigh, calf,
night sweats sometimes. sole of foot n ass with weakness and loss of sensation. work as mechanic
Admited to hosp ampang for 1months. Put on chest tube(got pneumothorax from whats change in his life throughout 4months of illness?
chest tube insertion). Condition improved but slow progress. Ct thorax done. Refer ddx
to hospitatl serdang turn out to be empyema. Done with thoracotomy + demonstrate spine examination
decortication. Result from the procedure turn out to be tb. measure muscle bulk on calf by mark the point 1st
1.ddx if u 1st time see him in clinic with chest pain n cough. what other condition can have gibbus? tb spine , old age
2. Ix u want to do + clarify what ix?
3. Dr ask expected finding in CXray based on ddx. describe MRI
4. What u want to know from pleural effusion? what mx?
What are the light's criteria? When we say it exudate? Example exudate young patient, had stiffness, 1st encounter in clinic -think about ankylosing
transudate. spondilitis other than pid
5. Tx of Tb? List of drugs. Ix need to done before start tx. Ask specific about

32
PRO 3 EXAM 2017
SC: Day 3 stream 4 short case
1) acl tear- ix? mx? swelling in acl tear indicate what? (Prof Khairul, Dr wan Alia, Dr Maiza)
2) lung fibrosis-how to confirm? -right indirect inguinoscrotal hernia
3) polyhydramions 1. What is your diagnosis?
2. What are the complications of hernia? Please explain.
MARYAM RAMLAN 3. What is the surgical option you would like to offer?
4. What is the complications for the surgery?
-UMNL of bilateral lower limbs
Day 3:
1. How would you like to complete your examination ?
SC prof liew,prof norlijah,dr ummi
2. What are the possible causes?
1.colostomy and midline scar:
3. What are the other examinations to do?
-mention that you want to finish examine abdomen by palpate,percuss and
4. What are your differential diagnosis?
auscultate,mention that you want to open the stoma bag
-Why you said so,what procedure that leads to colostomy and name a Please do sensory level!
few,complication of stoma -uterus larger than date
1. Differential diagnosis?
2.down syndrome
2. How to make sure correct date?
-Features of down syndrome head to toe
3. What is the rule?
-Do cvs examination and state findings(PSM at LLSE),check tone,other
4. How to differentiate poly and macrosomic baby?
examination you would like to do,complication of down syndrome
3. APKD 5. How to induce this patient if she comes at POA 38 weeks?
Said that I cannot appreciate liver border because dull from right lumbar,ballotable
Long case stream 1
kidney,other relevant system besides abdo for APKD,complication
(Prof nazri, Dr Joseph, Mr Khairuddin)
Case: pleural TB
LC prof faisal,dr chieng (gastro), dr chein (family med)
1. What are your differential diagnosis?
Bone mets prostate Ca. Pt come with lower back pain,then few months later
urinary incontinence bowel incontinence paraplegic,admit then detect prostate Ca 2. What is akurit 4 and 2?
What you see in xray to suspect mets(pathological fracture) is it radiolucent or 3. What is the mechanism of action of the drugs?
4. What are the investigations u need to do before starting anti TB
opacity,osteoblast or osteoclast,more about features of bone in xray for suspected
5. What are the side effects of antitb?
mets,about bone study,any other initial ix,features of LMNL(specific),ddx for
6. How long to treat an empyema?
LMNL,how to check level of cord affected besides from sensation,in this pt
7. If patient comes back with jaundice how to manage? What is the cut off point to
expected findings earlier (when having cauda equina),if in ED you see pt
presented with sudden paraplegic urinary and bowel incontinence what you expect stop antitb?
8. If the patient come back together with his wife in the future what do u think is the
to see(pt will still be well,haemodynamic features normal and other features),what
problem?
examination that you would like to do,how to assess anus and what you want to
9. What investigation to do for tb spine?
find,ix that you would like to do,before refer to ortho what you can give to the
Brought back to patient and demo respi examination.
patient (dexamethasone)
Modified LC (miss limi,prof intan,prof nizlan) All the best!
Breast Ca
NURUL ADHA RAZIF
LOH JIA LING (DISTINCTION)
Day 1 Stream 5
Long case : Community Acquired Pneumonia (same patient as Aiffa Amir) with 1

33
PRO 3 EXAM 2017
episode of hemoptysis commentary.
Examiner : Dr Bahariah, Ms Thong, Prof Saz -trendelenburg test ,duplex ,cx, mx and acute mx if bleeding
- clarify the HOPI Mitral prosthetic heart valve please examine the ptn chest
- differentials for chills and rigor - scar, s1 or s2, types of heart valve, cx then time up
- fever for almost 3 weeks (1 week PTA + 2 weeks in ward) despite antibiotic Paeds hepato spleno idk what dx. - please examime the patient abdo.
treatment so what it is called? Sempat ask dd for hepatospleno only. No jaundice not thal looking.
- what is pleuritic pain
- what are the cause for pleuritic pain (infection, inflammation as in serositis - SLE) SYAFIQ JAHARI
- ddx : pulmonary TB, pulmonary embolism, ACS (rejected)
- present PE, patient was obese. she was surprised that I can feel for the apex
Long Case : External sebaik-baik manusia (main), Dr Zurina, Mr Mazree
beat
dx : Threatened miscarriage with gdm, fibroid n 2nd subfertility
- see patient and show how to examine for apex beats and JVP
Q - Types of miscarriage
- ask what is acanthosis nigricans and the cause for it -insulin type
- what can atherosclerosis do to the brain, heart and leg and their presenting -how to monitor bsp
symptoms
-all ultrasound finding
- what stage of pneumonia is he in (red/grey hepatization/resolution)
-gdm effect on pregnancy n vice versa
- ix
-who to consult in multidisciplinary approach
- how do you want to check if he's diabetic (HbA1c)
-how to define preterm labour
-ddx for 29 weeks with contraction pain : UTI, do UFEME
Short Case -gdm complications
1) PCL tear with multiple scars (Mr. Khai)
-h when n how to deliver
- investigation
- management (does PCL usually need surgery?)
Short Case
2) Acyanotic heart disease (Dr Zurina)
1) External OnG sebaik2 manusia jugak - Intrauterine Fibroid
- differentials -diffrential of mass
- investigation : what are the findings that you expect to see in CXR and ECG -mobility in both ovarian and uterine mass
3) Fibroid in post menopausal woman (Prof Nazri)
-if got bleeding what to do : endomet sampling
- findings in bimanual examination
2) Dr Ting (paeds) - Pansystolic murmur
- ddx
- differentials
- investigation
-manouvre to accentuate murmur
- management TAHBSO -signs of failure : please palpate the liver
3) Dr Foo - Massive Splenomegaly (thalassemia)
CHAI MING RHEE -causes of splenomegaly
-why splenomegaly
Long case (prof faisal, dr ching fms and dr chieng) post op left sigmoid ca with ud -iron overload complications
asthma. Ask about tenemus, io, acute management, pre op management, post op
dvt prophylaxis. Ask about asthma, xray finding for acute io, dehydration and HAZIMAH
family screening for colon ca.
Lc: Dr habibah (main), prof shikin, Dr Cheng (fms)
Short case( prof liew prof norlijah dr ummi) 32y/o, g4p2+1(complete mc), 38w POA, underlying GDM on diet control
Varicose vein - ptnn came v left leg cramp and pain. Examine and do running

34
PRO 3 EXAM
complicated with polyhydramnios and macrosomic baby, +1 previous scar
Having hx of GDM for 1st n 2nd pregnancy, hx of pph in 2nd pregnancy
Q:
from hx, what type of mc? (pregnancy already confirmed by us, after bleeding and
passing out poc, us revealed empty uterus)
Complication of GDM, is the pt control for gdm good or poor (it was poor as she
got 2 cx even the bsp results were normal)
As she has all 3 condition and prev hx of pph..how should u manage her? (devide
it into in clinic, ward n ot)
As this pt having scar..how should u rule out scar dehiscence?
How to know if this pt having uterine rupture (hx, vital signs, per abdomen, ve, ctg)
What will u do if u notice uterine rupture in this pt?
If uterine rupture happened in ambulance, will the baby survive? (surely iud).. Will
u still send her for surgery? (of course, to prevent shock)
Sc:
Prof faisal- post triangle swelling
-ddx points for points againts n ix
Mr paisal- acl tear
For acl, betw ant drawer and lachman, which one is more sensitive
If pt came to the emergency with swelling knee, what will u do..
after 2w, pt come to clinic n sx improve..what is the next mx?
Dr zurina- pneumonia
Type of pneumonia for that 7y/o child
ix n antibiotic
KHAW JU LEONG
Day 1
Short case (dato gee, prof norlijah, dr ng)
Inguinoscrotal hernia- difference between direct and indirect, ix, mx
TOF - 4 components of tof
Polycystic kidney disease - mistaken as spleen, dr guide towards ballotable
kidneys
Long case (prof fazli- dominant, dr hana, dr shahril)
43yo indian gentleman presented with 3 weeks productive cough associated with
intermittent fever and progressive worsening sob with 1 course of outpatient
antibiotic from hospital putrajaya with hx of smoking 24 pack years, past
medical/surgical- hemetemesis 1 year ago and hv liver disease from chronic
alcohol intake, # right tibia 8 years ago due to trauma # right femur 3 years ago
35
2017
due to mva with occasional right knee pain
- differential diagnosis (CAP, TB, lung ca, bronchiectasis, heart failure,
decompensated chornic liver disease)
- bring back do PE respiratory system
- lymph nodes right supraclavicular region ( virchow's node, significance? Which
cancer can spread there)
- ix for patient (what is acute phase reactant, how does it help? To see respond to
tx and if just one value very high what does it signifies ? X know answer
- expected x ray findings
- mx for cap (class of antibiotics)
- tb culture result how long, what could be faster (sputum AFB, montoux test)
- tx of tb ( EHRZ, what ix before start tx, complication of EHRZ, duration, DOT)
- if hematemesis , acute mx ( terlipressin - MOA)
- WHO recommended limit of alcohol intake
- dr shahril only question ( decompensated liver disease as differential but what
makes it unlikely for this patient? Unilateral pleural effusion)
H'NG LEAD KERT
Day 1(All the doctors were very nice, no pressure, keep motivating)
Short cases:
Mr. Khai: examine the hand (ulnar nerve, median nerve, radial nerve) - explain
ulnar paradox, causes of nerve palsy, what investigations
Dr. Zurina: examine this 4months old respiratory system - acute bronchiolitis -
signs of hyperinflated chest, investigations
Prof. Nazri - smaller than date - differentials, investigations
Long cases:
Dr. Bahariah, Ms. Tong, Prof Saz (FMS)
chief complaint: lower backache associated with leg pain
Spine metastases secondary to advanced prostate cancer, history of cauda equina
syndrome, improved with radiotherapy
1. Ms. Tong: what is PSA? When to use PSA? What causes PSA to rise? What is
LUTS? Show me how you clerk patients with LUTS? Describe the treatment for
advanced stage cancer patient in a word. Palliative. Please explain what is
palliative care.
2. Dr. Bahariah: if ur patient is anemic, why? Explain pathophysio. Chart we use in
the ward to assess oncology patient care. She gave the answer. *ecox chart.
Never heard. Please double check. If yr patient has t10 sensory level, where is the
lesion at spinal cord?
PRO 3 EXAM
3. Prof saz: where do we send patient with advanced stage, non-curative,
asymptomatic patients to in the community? Hospice.
Bedside: perform lower limb neuro examination, landmark for t10,t4 dermatomes,
where is c1, c2 c3, c4 dermatones... show radiotherapy scar at the spine, drugs
can be given simultaneously at the abdomen since patient got an injection mark on
the abdomen (castration drugs, clexane - dvt prophylaxis cause prolonged bed
bound) all doctors kept laughing smiling motivating... I experienced culture shock.
TAN CHUN HAN
Long Case:
Examiner: Prof Norasyikin(Med), Dr Habibah (main O n G), Dr Cheng Ai
Theng(FMS)
Case: Menorrhagia secondary to Fibroid with underlying primary subfertility
Case: Pn Azizah, a 43 year old Indonesian lady, married for 12 years, P0+2 with
u/l of 1 prev myomectomy surgery 6 years ago, recurrent fibroid 2 years ago and a
known defaulter for past 2 years, presented to us with chief complaint of per
vaginal bleed 2 weeks prior to admission. The PV bleed occurred almost everyday,
used about 7-8 pads a day, fresh red in colour, occasionally blood mix with clot.
The PV bleed was associated with symptomatic anemia such as palpitation,
reduced effort tolerance and pallor. The reduced effort tolerance worsened on the
day of admission where pt experienced tiredness climbing one flight of stairs.
Upon further questioning, she had subfertility whereby she was married for 12
years and no children yet. She and her husband was never on contraceptive pills,
barrier method and on family planning. She also experienced 2 times miscarriage
at first trimester, approximately at POA of 4 weeks. She also had 3 Hospital
admission which was 6 years ago for the myomectomy at the Indonesia, 2 years
ago due to symptomatic anemia at Hospital serdang and detected recurrent fibroid.
But she refused to accept treatment due to family issues. The third admission was
2 years ago as well at Indonesia for second myomectomy. However, noted there
are adhesion of the fibroid to the small intestine, hence, the operation was
cancelled.
Otherwise, no fhx of malignancy and thalassaemia, no constitutional symptoms, no
symptoms suggestive of HF, No symptoms suggestive Intestinal obstruction and
no urinary symptoms.
DHx: Allergy towards Tranxenemic acid (i didnt manage to ask this T.T)
Family History: Suspicious of malignancy as pt was unsure the cause of death of
her sister and brother inview that her sister passed away due to a lump located at
the neck region.
O/E
On peripheral exmination, pt was nt pallor. but koilonychia noted. This is not a
36
2017
gravid uterus as there is no linea nigra and stria gravidarum. Mass was noted at
the suprapubic region and the mass was suggestive of uterine origin in view that
the mass was able to be moved side to side but not up and down, The mass was
non tender, hard with smooth surface but irregular margin. Uterine mass of size
that corresponds to 22 weeks POA,
Question asked:
1) What is your differential diagnosis? What is the commonest uterine carcinoma?
2) Is tranxenemic acid and mefenemic acid the same? Nope
3) If the mass is tender on palpation, what is ur ddx? Adenomyosis and Red
degeneration of fibroid.
4) If there is malignancy transformation of the fibroid, what is the name of that
maligancy? Uterine sarcoma
5) What is the name of disease when adhesion in the uterus? Ashermann
syndrome
6) What is the name of the disease where adhesion occured outside of uterus?
Fitz-Hugh-Curtis Syndrome.
7) How do u manage this pt if he presented to u in ED?
8) What is the medication we used to control the PV bleed? Do u know the dosage
of the tranxenemic acid?
9) Do u know what is the latest version of the drug that act like the tranxenemic
acid?
10) This pt had now been stabilised and sent to ward for monitorng. What is ur
further management before discharge this pt?
The issue with this pt at presentation are symptomatic anemia, recurrent fibroid
and primary subfertility. Anemia had been resolved and the fibroid is related to the
subfertility. Hence,
the option that i would like to offer to patient is Start pt on GnRH antagonist to
shrink the fibroid and then myomectomy. 2nd option is Hysterectomy. But the pt
are keen to have a children. Hence the preferred method is GnRH antagonist then
myomectomy.
11) What is the definitive treatment for fibroid? Hysterectomy.
12) (Prof Syikin) Since u were saying that koilonychia is the pathognomonic
feature of IDA, what are the features that will suggest of IDA? Angular stomatits
etc
**There are others but i cant recall.
Short Case
Examiner: Prof Faizal (Surgical), Mr Paisal (Ortho), Dr Zurina (Peads)
1st Case: Rheumatiod Arthritis
Examine the hand of this pt.
**Look: Describe the typical presentation of RA on the hand, Z deformity of the
finger, swan neck deformity.
PRO 3 EXAM
** Feel: Feel for tenderness and warmness
**Move: On opening up the hand noted pt was unable to flex the forth digit at MCP
only.
Q1: What is the possible cause? Tendon rupture of the lumbrical.
Q2: What else u wan to examine? (Mr paisal dun wan peripheral nerve and
sensory that time, he direct me to assessing pt's daily living function)
Hence, I assess pt's ability to comb hair, rotate the door knob, drink from cup,
unbutton, use spoon, and also scratch back.
Q3: What is other place u wan to look for in RA pt?
Auscultate lung in view of possible Lung fibrosis, check for other joints, especially
other small joints. (he didnt ask me on the RA criteria although i hint him that i wan
to tell that)
Q4: What is the investigation that u wan to do? Xray
Q5: What is the difference in xray finding between OA and RA? Reduced joint
space, absent of osteophyte and osteopenia at the juxtaarticular.
Q6: What is the complication of the RA? OA
2nd Short Case: Peads Respi (Pneu)
8 y/o girl, reluctant to remove the short and refuse to hav eye contact with me.
Generalized crep with reduced breath sound at bibasal.
DDx: Pneumonia (too nervous that didnt notice there might be pleural effusion)
IX: FBC, Xray and one more she didnt tell
3rd Case: Non toxic Solitary Thyroid Nodule
Q1: What else u wan to do? Thyroid status examination
Q2: What Ix: U/S to look for nodule and U/S guided FNAC.
Q3: Why not biopsy? (he asked cause i accidentally slipped my mouth and said
biopsy :P) Cause can cause injury to nearby structure.
Q4: If result come back colloid, what is ur diagnosis? MNG
Q5: If result coma back follicular, what is ur next step of management? Due to the
fact that FNAC cannot differentiate between follicular adenoma and follicular
carcinoma, Hemithyroidectomy or Total Thyroidectomy are more preferable
depending on the hosp setting.
NICHOLAS KOAY
LC: viral-induced wheeze + FTT (prof Thong ppum, dr Amelia, prof Mano) Prof
Thong is very nice and dominated the session 100%.
Yasmin, a 1y4m Malay baby girl with past history of ICU admission, presented with
recurrent wheeze and cough for 2 days duration. No personal or family history of
atopy and asthma. No triggers noted. Symptoms mostly preceded by runny nose
and fever. Suspected ill contact in nursery. Physical examination revealed signs of
respiratory distress, generalised rhonchi and failure to thrive.
37
2017
1. Why u say this is a viral-induced wheeze?
2. What is an inhaler? (MDI) what does the colour represents? What type of inhaler
that u know of? How to use an inhaler in a child? Why use reliever 1st but not
controller 1st?
3. How to diagnose wheeze/asthma? (Clinical diagnosis/asthma predictive index)
Do u assess peak expiratory flow in children? Why?
4. What investigation u would like to do? What are the components in FBC that u
wanna see particularly in this case? (Eosinophil)
5. How to manage this patient? (Especially parents education)
6. How to know whether it's an acute exacerbation through physical examination?
(Respiratory distress, conscious level) How to know whether it's a severe/life-
threatening exacerbation?
7. Why u say this patient has FTT? Why do u think she has FTT? How to ask hx in
a FTT child? (Focus on dietary hx)
SC:
1. Stoma (miss tong) - running commentary
2. Thalassemia (dr bahariah) - end commentary
3. Left Endometrioma (prof Nazri)- end commentary
All SC questions are typical questions that can be found in textbook. Prof Nazri will
give hint a lot so listen carefully. Good luck!
YONG SHERN
LC: Dr Anim(main), Prof Sazlina, Prof Liew
Beta Thalassemia –
Mr. Muzakir, a 23 y/o Malay gentleman, with underlying blood d/o, presented to
Hospital Serdang for exam purposes. Patient was previously well until 4 years ago,
where he had sudden onset of anemic symptoms (reduced effort tolerance,
lethargy, fatigue and feeling of fainting) for 1 month duration. He was also being
told of yellow skin discoloration by his family and friends. He was referred from
Klinik Kesihatan Bangi to Hospital Serdang for urgent transfusion with Hb level
detected of 4g/dL. Subsequently, he had multiple follow ups and requires blood
transfusion every 6 months. He is currently well and asymptomatic. He has
positive family of anemia over his paternal side.
Questions:
1. Any side effects of iron overload detected in the patient?
2. How to differentiate spleen from kidney via physical examination?
3. Consequences if patient not complaint to blood transfusion?
4. Procedures when giving blood transfusion (consent, documentation).
5. Complications of blood transfusion.
PRO 3 EXAM 2017
6. Future aspects for the patient. (impact of thalassemia towards patient’s life, his Surgery(datuk gee) - stoma examination
life expectancy? – still can reach average of 70 years of age) - describe scar and stoma(inspection only)
- Superficial palpation only to look for tenderness
SC: External surgery, Dr Ummi and Prof Intan - Many previous scars.describe one by one
Colostomy- Description of stoma and surrounding surgical scars (midline - What type of stoma?
laparotomy & surgical drainage scar), complications of stoma, what if anus is still - Complication?
patent? – Hartmann’s procedure, possible scenario of patient to end up with stoma - What surgery will hve this type of stoma(hartman and apr)
if it is an emergency surgery (recto-sigmoid CA – large bowel obstruction – end - No content in discharge bag.what do u think ? (I told obstruction or failed stoma)
colostomy for bowel decompression) - How to look fr obstruction through pe?(i dont knw d answer..he said auscultation)
CVS - Mitral Regurgitation; midline sternotomy scar without harvest scar noted on Dr ng - mr with hf
bilateral lower limbs, ddx, Ix -what diagnosis?
Cerebral palsy - types of CP, causes & Mx -causes?
Prof norlijah- cp
AZLANSHAH - running commentary
- What diagnosis?
- Causes ?
Long case(dr shahril, dr ahmad fazli , dr hana)
A 40years old indonesian lady with underlying fibroid for 5years presented to
Hospital serdang due to excessive menstrual bleeding for 2months prior to MOHD ESMAIL
admission.
-History in chronological order(went through myomectomy 7years ago) LC Prof liew prof sazlina Dr anim: Pt 52y/o indian lady, post op since 2016 on
Current presentation-menorrhagia, subfetility, compressive symptoms ,anaemic follow up previously presented with hx of diarrhea w blood, abd pain, abd
symptoms, transfusion done distension and vomiting for 2 months duration. No constipation. And had multiple
- ddx visit too ED H. Slyang before refered to HS but no tx given. Only iv fluid and
- Points for and points against painkiller. But she already undergone surgery and regular customer for exam.
- Rule out each differential by history and investigation 1. He ask what may be reason pt had multiple admissions ed? Told him mybe d/t
- Perfome pe infront of hm partial obstruction since she didnt have constipation.
- What is the significant of doing peripheral examination in this patient?(look fr 2. Ddx for diarrhea in this age group?
anaemic signs and check scars-healed ,no discharge no tenderness, no keloid 3. He ask what are risk factor for colon ca? In particular regarding HNPCC but pt
formation , cachexic?) didnt have any family history.
- Patient is old and previous myomectomy done and fibroid recurred..what is the 4. What surgery do you think they did for this pt? (Pt didnt have stoma)
best treatment?( i told hysterectomy) 5. How do you prepare this patient for surgery?
- How you counsel your patient? 6. What investigation would you do b4 that and why would u do the investigation?
- Give me few surgical ways of removing uterus(i told laparoscope,laparotomy, 7. How u do bowel prep for this patient?
transvaginal) 8. Show me how you take consent from pt for the surgery?
- If u were the surgeon what method do u prefer and state ur reason?(i told i prefer 9.What are the cx of the surgery and GA?
laparotomy due to previous surgery and adhesions 10. What do you do during follow up?
- What complications?
Soalan2 lain x ingat.. SC Prof intan, dr ummi and external prof um
1. Down syndrome
Short case (prof norlijah, datuk gee, dr ng) -describe what u see?
-What is down?

38
PRO 3 EXAM 2017
-how u dx down snydrome? -where is location of the cancer and its different sx
-what are the pathogenesis? -route of mets
-which type is common in advanced maternal age mother? -why rectal ca more likely to spread and what is the venous and arterial
- wht r the cx? -define tenesmus
- why they have protruding tongue? -what is IO and its causes
-what is clinodactyly and low set ear -if in ed, what is the ix & mx for this pt
-assess patient gross motor of DA -type of surgery
-how u follow up pt and what u want to see? -why need to put stoma and must put it permanently or temporary
- what is their prognosis? -cx of stoma
2. abd examination. I think thalasemia because able to palpate hepatospleno only -pre op assessment and what ix anaest want to know
before she stop me from continue. *i took so much of time. -when to follow up patient and need to do what ix
-grade the hepatosplen (massive is extends over the umbilicus) -why need to do yearly colonoscopy post op (polyp)
-what do think the cause
3. Thyroid. SHORT CASE
-ddx for solitary thyroid nodule Dato Khairul
-how u differentiated each causes 1) reducible indirect inguinalscrotal hernia
-type of thyroid ca -show how to do deep occlusion test
-how to differentiate anaplastic from PE -need to auscultate the hernia to know the content
-from wht cell medullary arise and how to rule out medullary from 1 ix? Calcitonin -ix and mx
maybe Mr Paisal
-which type spread via lymph n blood? 2) wrist drop radial nerve palsy
-wht ix would u like to do? -where is the lesion and its causes
-how u treat? Surgical or non surgical? -what is non trauma causes of radial nerve palsy
-if i allow u to ask 2 ques from pt what would it be? I told the thyroid status ques, -ix and mx
he said why would u want to know that. Just ask wht is her age and hw long she -type of splint for wrist drop
had been having the thyroid -seddon classification
Ext examiner paeds.
AMYRAH KAMILY 3)hepatosplenomegaly
-look and proceed, pt got jaundice no thal facies
-causes of hepatosplenomegaly
LONG CASE (colorectal ca)
(prof faisal, mr fah, dr fadh) -where to look for spleen (traube space)
-what scar pt had (chickenpox scar)
43y/o man p/w sudden intense suprapubic pain for 2day duration. He had change
-ix
in bowel habit for 4months, diarrhea 10x/day with mucus secretion and tenesmus
sensation. Had anemic sx and constitutional sx. He was a chronic smoker. Due to
pain, went to ed and operation done to put stoma. AIFFA AMIR
PE
Colostomy bag at right lumbar. Long case : Dr Bahariah (main), Ms.Tong (surgery) & Prof Saz (FMS)
Huge suprapubic mass, hard and immobile Pt came with chest pain a/w SOB, non productive cough for 3weeks, hemoptysis,
Patient cachexic LOW, night sweat, fever with chills&rigor, fatigue. 2nd episode. No hx of sick/TB
QUESTION contact. 1st episode, pt admit. This admission is 3 weeks later after 1st admission.
-diff dx

39
PRO 3 EXAM 2017
1)Give me your DDX 5)Let say pt dont want to remove, what you do? (UAE)
2)I said TB, pneumonia, bronchial CA etc 6)Who will perform do UAE? intervention radiologist
3)Dr focus on pneumonia. What do you think type of pneumonia in this pt. I said
CAP, but she said it is HAP bcs of the hx of previous admission which is less than AMANDA KOE
a month.
4)What is the def of HAP
Day 1
5)What is other Ddx that can present with the same symptoms especially the
Long Case ( Dr Shahril, Dr Hana, Dr Ahmad Fazli)
hemoptysis? (pulmonary embolism, since pt obese) G5P4, 39 years old, came in at 34 w for expectant management for placenta
6)Is there any signs of metabolic syndrome in this pt? (Acanthosis nigricans)
preavia type 3, GDM on diet therapy and anaemia of pregnancy on oral therapy.
7)What is the lung changes that can happen in a chronic smoker? (COPD)
She has past history of baby with Edward syndrome and the baby passed away.
8)Is there any percentage of normal people to have trachea deviation? How many
Went back to pts for running commentary short case
percent? (Since vocal resonance is loudest at the unaffected side, upper zone. But
Ques:
the pathological side is at the left lower zone) -Definition of placenta previa
9)Give complete Dx (HAP with underlying COPD) -Why only admit at 34 weeks
10)Give ix
-What you worried about in the surgery for this pts? ( one previous scar + PP)
11)Interpret the CXR
-Who do you think should do the surgery
-Because i said the head was 3/5 palpable, then Dr ask do you think it is likely?
Short case :
No. Why?
TOF - Dr. Zurina -So what shoud you do then?
ESM loudest at Pulmonary area, pt is cyanose -What is Edward syndrome?
1)What is the ddx?
-What is the difference of detailed scan and normal ultrasound?
2)What ix you want to do?
-Why need to do detailed scan for this patient
3)How you manage?
-Complication of GDM
Ulnar nerve injury - Mr. Khai
-How to do counsel this patient for surgery?
Hypothenar wasting -If the pts postpartum came for KK, what should you counsel?
Ulnar guttery -If she does not want BTL, what contraception would you give?
Tinel sign positive, negative Phalen sign
-Types of contraception? ( Dr Shahril said he wants patient dependant and patient
Reduced sensation at ulnar side
non-dependant contraception)
Otherwise, the hand is perfectly normal.
- Just now you say massive haemorrhage, what are the complications of massive
1)What is the dx?
haemorrhage
2)What is the causes?
3)Explain about ulnar paradox
Short case
4)How you ix?
1) Dato Gee ( recurrent sebaceous cyst)
Fibroid - Prof. Nazri
Ques: I want you to examine the back and do a running commentary
50 y/o presented with menorrhagia, very big per abdominal mass. (Size of 26w
There is many many lumps with punctums and many many scars all over the
gravid upper and lower back
uterus) After describing and pointing all the scar, Dato ask to pick the biggest to do the
1)What is the dx?
rest
2)How to confirm your diagnosis clinically? And explain.
Types of consistency: soft, firm, hard, cystic
3)What ix you want to do and why?
Types of cystic??
4)What is the mx in this pt?
How to do fluctuation?

40
PRO 3 EXAM 2017
Why you say it is sebaceous cyst? 2. Mr.Paisal ( running commentary )
If the pts has multiple lipoma, what is the name of the disease? > ACL and LCL tear with short limb gait
How to contract the mass, what is the muscle involve? > why Lachman is reliable ( more sensitive than anterior drawer )
Differential? > in ED, pt comes in with open fracture near the knee, what u fear the most ? (
How to manage sebaceus cyst and infected cyst? neurovascular injury )
Why you think the sebacous cyst will recuurent? 3. Prof Faisal
2) Prof Norlijah ( CP) ( running commentary also) > examine the neck ( elderly gentleman ) : mass in the posterior triangle
- Inspect and tell me what you see > Ddx : lipoma , liposarcoma, scm tumour ( prof wanted AV malformation )
- Do peripheral neurology examination > in younger pt, ddx cystic hygroma
- UMNL or LMNL? > one invx : imaging ? Usg of neck ? I'm not sure
- Why say UMNL?
- Diagnosis? JIA SIN
-Definition of CP Day 2
-Types of CP Long Case (Prof Norlijah, Prof Lee, Mr Hadi)
- Causes of CP ( she wan many many. I adr said 8 causes, but she wants more) Paeds: 6 years 8 months old Malay boy presented with less active and walk
3) Dr Ng ( MR with HF) unsteadily for 1 week duration. Further questioning the child was picky eater and
- Do you think it is mild or severe MR possible issue of failure to thrive.
- Causes ( He also wants a lot) Discussion:
1) history suggestive of severity of anaemia in this particular patient
JARSHANA ~Day 2~ 2) peripheral signs of anemia
LONG CASE : Prof Ashikin Medicine (dominant), Prof Habibah OnG, Dr Chieng 3) differential diagnosis
FMS 4) investigations:
> 23y/o male with underlying beta thalassemia intermedia with regular blood - what investigations that want to offer
transfusion and iron chelation therapy came for blood transfusion - what is the importance of reticulocyte count
> Chronological history - interpret full blood count
> PE : Thalassemic facies, jaundice, slate grey appearance (excessive iron 5) whether to transfuse the patient if hb is 8g/dL : no if the patient not in failure
deposition on skin) - explain the pathophysio briefly
> Working diagnosis : Symptomatic anaemia Short case: Dr Ooi, Mr Chris, Dr Zulida
> Invx : everythinggg related to thalasemia ( must know finding in full blood picture 1) cardio: AF and MR
) and how to monitor iron chelation therapy ( serum ferritin ) - causes of MR and investigations
> Mx : Prof very concerned about screening for thalassemia in the family and Dr 2) surgical: swelling at posterior triangle (lipoma)
Chieng asked more on genetic counselling, must know how to explain pattern of - differential diagnoses
inheritance - investigation and management
- where is the common site of liposarcoma
SHORT CASE : 3) Obs: uterus smaller than date (oligohydramnios)
1. Dr Zurina ( she was VERY nice ) - differential diagnoses
> Down syndrome - investigations
Inspect and tell me what you see.. please remember allll the features head to toe - causes of oligohydramnios and investigations to rule out the causes
> Investigation after the child is delivered and based on clinical features of Down
syndrome (send for karyotyping and chromosomal study ) WAN SIN
>What is the mechanism of mutation (translocation, mosaicism )
> Complications
41
PRO 3 EXAM 2017
3) ix
Day 2 4) mx
Long case (Prof Roohi, Dato Gee, Dr Ng) 5) monitoring of pt in detail
57yo indian gentleman, complain of right hip and left knee pain, has 2 previous
history of right hip replacement SC ( Dr Zurina who was an angle, mr paisal and prof faisal
- Dx: OA of right hip 2° AVN and degenerative OA of left knee 1) spastic diplegia Cp
- What do you think is the cause for both pathology? Inspection, neuro examination
- Bring back to patient, demonstrate limb length discrepancy, bryant triangle, - causes
trendelenburg test - mx
- What Ix? 2) acl and lcl tear and pt has short limb gait
- Interpret knee X-ray Knee examination modified..coz he has 20° flexion deformity
- Mx Pt actually came in with open fracture
- What is the name of AVN in childhood (Perthes disease) How to mx and wat important examination u shud pergorm and why
- Pathophysiology of DM patient have loss of weight initially and gain weight after External fixation and nv examination..i wanna noe the viability of limb
treatment? Cx of ex fix and wat cx u think pt has..vomit all the cx and for pt ex fix cause his
flexion deformity
Short case (Prof Chris, Dr Maiza, Mr Ashraf) 3) inguinalscrotal hernia
1) Respi exam (unsure dx, patient has thoracotomy scar and 2 chest tube scars, Diff btw direct and indirect
minimal lung findings) I cud not occlude the deep ring..he ask why..
- Causes? - maybe it pantalon hernia
- Specific name of pleural effusion drain? Dr don’t want underwater seal drainage - hernia big and cause streching of opening
2) Uterine fibroid
- Causes of uterine mass KHAIRINA SULAINI
- Why is fibroid instead of adenomyosis? (Patient is pale from menorrhagia,
whereas adenomyosis usually presented with dysmenorrhea) DAY 2
- How to confirm mass is from the uterus by examination (bimanual) Lc (prof liew, dr anim, prof saz)
- Ix Colon ca (ady done colectomy, but no stoma)
- Mx for young and old patient Pre op history: presented with diarrhea for 2 months a/w abdominal distension loa,
3) Knee examination: OA low.
- Ix 1 week prior to colectomy, she had hematochezia. Underlying asthma.
- Grading for severity Question:
- Mx according to severity What ddx?
What ix?
MYTHILI DAY 2 What to look for in pe? (See patient back and describe findings)
LC prof syikin, prof habibah n fms dr Since pt ady done colectomy,what to look during follow up? What tumor marker
15 years old boy dengue fever day 7 in recovery phase) typical dengue used to detect recurrent mass?
presentation.. during my exam, patient developed urticaria after being given iv What preparation that u need to do before colectomy?
ranitidine Bowel prep?
1)Was questioned on probability of ranitidine causing urticaria - it does not usually Post op complication
cause..other causes (Mostly questions regarding what your action in the wards)
2) Important sign n sx of dengue esp warning signs Prof saz oso ask how to assess asthma control since pt had asthma

42
PRO 3 EXAM 2017
3) Paeds cardio (Mama Zu in super angel mode) pt had clubbing, no cyanosis,
Sc (prof intan, dr ummi, ext examiner) PSM at LLSE, no chest scar. I was selling pdx of VSD but mama was more agree
Down syndrome - describe features, what complications, causes (translocation, with TOF. She asked me why no cyanosis in TOF, I dunno hahaa then she
non disjunction, mosaicism), what management n follow up proceed with ix, if pt wanna do dental extraction, what you need to give (bac
Hepatomegaly with apckd endocarditis prophylaxis)
Scenario: this woman comes with abdominal discomfort please examine her abd
system. MEI YING
(Dis one not sure apckd right or not, just mention ddx for hepatomegaly only) thats
all :( Day 2
Solitary thyroid nodule at left ant neck Long Case (Mr Hadi, Prof Norlijah, Prof Lee).
What ddx? Why check lymph node? For spread - which type of ca can spread thru Abd pain 2/7 with history of suprapubic mass, diarrhoea for 4/12 assoc with LOA
LN? LOW, tenesmus, d/c anaemic symptoms, in ed, colonoscopy done showing and
Then ix n mx? Why hemithyroidectomy? Why not total? emergency operation with stoma done.
He asked me bout each type of thyroid ca oso. (Papillary, follicular, medullary, 1. ddx? bed side investigation to differeniate colonic mass and suprapubic mass?
anaplastic) 2. benefit of colonoscopy.
3. how to categorised stoma. differentiate double barrel and loops toma.
YAN JUN 4. common site of colon mets
5. cause of IO
6. symptomatic anaemia how to manage
DAY 2
7. consent of blood trnasfusion
Long case:
8. complication of blood transfusion
AEBA secondary to CAP (prof shikin lead, dr habibah, FMS dr I think)
summary:
Short case (Dr zulida, Mr Chris, Dr Ooi)
26 y/o chronic smoker 13 pack years, presented with dyspnoea, preceeded by 3
Thyroid nodule
days of cough, runny nose and fever. Last attack of dyspnoea was 10 years back
-ddx, 3 investigation, if FNAC show follicular what to do, u/s find of malignany
ass/w fever, cough as well. No triggering factors, no eczema, siblings with
uterus larger than date ( if suspect macrosomic, EFW go according to clinical
dyspnoea as well but no clear trigger, not diagnosed, not on inhalers. Patient was
fundal height)
well in between previous n current attack, still can smoke so much.. (so-not-
poycystic kidney
asthma picture)
p/e mild tachypnoea, generalised crep n rhonchi. No hyperinflation sign at all.
SUZANNE
Question: I was selling pdx of CAP. Examiners lead to AEBA. Questions were
mainly regarding BA typical presentation, management of AEBA, interpretation of
day2
ABG and pneumonia (antibiotics)
Short case-usual Q&A
Uterine mass(dr zulida)
Short cases:
MR and AF (dr ooi) very hard the hear the heart sound and the pulse is so difficult
1) Thyroid surgical (Prof Faisal) solitary thyroid nodule, clinically euthyroid.
to palpate.
asked on causes solitary nodule ddx, ix, mx if FNAC came back as follicular
Stoma )Mr chris
(possibility of follicular ca, papillary, lymphoma), why hemithyroidectomy etc typical
thyroid questions
Long case- Prof Norlijah, Prof Lee, Mr Hadi. didnt go back to patient cuz no finding
2) Ulnar, Median nerve injuries (Mr. Paisal)
Epilepsy, 6 y/o Malay, presented with history of fitting with stiffening of right UL for
patient screening test normal, only test against resistance then obvious nerve
3 episodes on the day of admission. Afebrile. No reduce oral intake, no irritabiity,
injury. If he didn't hint me, I couldn't find any sign. Asked on causes then rringgg
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PRO 3 EXAM
no trauma, no drowni.. ng event, no sensorium changes, no precipitating factors.
does not regain full consciousness for more than 1 hour. PR diazepam given at
home. Development normal Has family history of epilepsy 2 counsins, one with
febrile fit another with epilepsy. brother has hydrocephalus with shunt done twice.
Fundoscopy was done. cranial nerve and peripheral nerve normal.
1.why do you say this patient is having epilepsy.
2. what are the things you want to think of if patient has focal seizure. space
occupying lesion.
3. what are the causes that can think of? causes of epilepsy.
4. what are the electrolytes abnormalities that might cause fit?
5. can potassium cause fit?
6. if you are the houseman of the wards, what you would do with this child?
7. other than epiepsy cause by SOL what do you think of? haemorrhage and
aneruysm.
8. IV phenytoin given what you want to do? cardiac monitoring. why? arrythimias.
9. what is the definition of status epilepticus.
10. what is the long term counselling for this pt.
11. what is the medication that you want to give for long term?
12. how do you want to investigate this child.
13. how do you want to diagnose a child with epilepsy? what is the test that can
inflict fit?
14. if an EEG is normal, can it still be an epilepsy?
15 what are you worry of in a child with epilepsy in future?
16. in terms of social, what are you worry of in a child with epilepsy? school, peers
17. epilim and carbamazepine which one is your choice
18. side effect of both drugs and what blood investigation you want to do before
starting these drugs.
19. what do you want to tell patient when you start carbamazepine?
20. if patient come with fitting, started with medication, what do you want to
enquire?
21. if patient say compliant to medication, what investigation do you want to do to
confirm it?
22. if patient say very confirm compliant but drug level is not within therapeutic
level, what could be the cause?
23. if patient say not taking any other drug, what is your concern?
24. what kind of activities you should be concern in this patient?
25. how long do you want to continue the drug?
actually a lot more. straight drill for 30 minutes. but cannot remember.
all the best.
2017
Short case
Gynae:-"examine this ladies andomen (dr already tersasur say gynae case haha)
Huge mass at suprapubic region, more on the left and no linea nigra or striae
gravidarum.
"Would like to complete my examination with bimanual palpation, and see if i can
get below (forgot to do!) -(explained bimanual straight away)"
Questions:-
- cervix doesnt move away with bimanual palpation, whats your ddx? Whats u/s
findings for malignancy for ovarian cyst?
- she is nuliparous with infertility (i think thats what she said), with bilateral cyst,
ddx? endometrioma
- how would you manage?
- management for infertility
- Imaging used for infertility
Acl-"this is a girl with sport injury, examine her left knee" her's pretty straight
forward, no scar, accidentally thought sag test positive, mr ashraf frowned so i
redo and changed haha
(Do running commentary guys)
Questions
- what grade do you think it is (acl)?
- you said stress valgus was positive, at which angle (pls specify)
- dx (acl, mcl)
- how would you manage her if you see her during the first presentation (pain,
swollen, just injured)
- (i answered conservative mx stuff and tca 2 weeks) what muscle group do you
target in physio? how would you manage her then, after 2-3 weeks?
- what are the indications for surgery? How do you ask in history for chronic
instability?
- what are the options for acl repair? Which ligaments do you use? Muscles of your
hamstring
MR with AR (collapsing pulse, diastolic murmur accentuated with manoeuvre i
think but i scared to commit, rugi) with pulm hpt (palpable p2, loud p2)and AF(i
thinkkkk) guys rmbr to do your manoeuvres and listen when you do haha
-pt had midline sternotomy scar
Questions
- How would you describe the apex beat,
- Dx? (I said mr with no signs of HF) Complete dx? Do you want to include your
other findings? (Sincerely i dunno what he wanted, i bantai all inside)
- How would you mx? At what size of valve do you do repair? Tak tahuuuuu

LYDIAR KAUR Long case

Obstructive jaundice
44
PRO 3 EXAM 2017
59 year old malay gentleman with history of pale stool, tea coloured urine for 2 1. Differential diagnosis
months. refered from GP to HS; Hydrated, given antibiotics and when stabilised, 2. ECG interpretation - inferior STEMI
was referred to hukm for some precedure. Pale stool and teacolour urine resolved. 3. Acute management of MI
Discharged, electively redid the procedure 3-4 months later. 4. Anti HPT of choice and antiplatelet therapy
he had LOW (80 to60 over the span of 1 year since onset of symptoms), constant 5. Post MI rehab
pruritis. 6. Like term management for him
Otherwise: has recurrent inguinal hernia. Newly dx hypercholesterolaemia, not 7. Patient had peripheral neuropathy what would you advise him
compliant to treatment. No RHC pain
Questions:- SHORT CASE (prof intan, dr ummi, ext examiner)
- Summarise "pt was presented with symptoms of obstructive jaundice and 1. Peads murmur - systolic murmur at ULSE
constitutional symptoms" Differentials (PDA, P.S.)
- Explain the pale stool Investigations & management
- Explain the pruritis 2. Ballotable kidney with hepatomegaly
- Brought to bedside to demonstrate physical findings. Jaundice, scratch marks - Differentials, investigations
epigastric mass with hepatomegaly, what is the mass? (Left lobe of liver)- pt got 3. Solitary thyroid nodule
bilateral scars for hernia repair: demonstrate cough impulse of hernia, what hernia Diff, questions on medullary thyroid ca
is this? why? tell me the difference of direct and indirect, from history til findings. 1. What biochemistry investigation to confirm - calcitonin (raised in medullary ca)
Whats the pathophysio of direct hernia? 2. Mode of spread of thyroid .ca
- What are you ddx? if the epigastric mass was not liver, which of your ddx could it 3. Investigations
be? if there was another mass also at the RHC, what could it be? what is the law 4. Management
associated with it? what are the exceptions? Explain
- What do you think the procedure at hukm was? Why stent the block? Whats the HAYATI SHAMSUDIN
complication of obstructive jaundice
- What is significant LOW? (5% BW in one month, 10% in 6 month)If you're in KK, Short case
what are basic investigations you would send to attach with your referral? how -MR with AF and bradycardia- dr bahariah
much is urobilinogen in UFEME for this pt? Q: she asked about ix, then causes of af
- Tumour marker for this gentleman? -multiple sebaceous cyst- ms tong
- If you're a dr receiving him at hospital, what would you do? What can the U/S Q: a lot of describing. Then, ddx, what to do if cyst not infected, what to do if cyst
visualise? what to look for? infected.
- You mention ERCP,tell me why that instead of MRCP? why wanna visualise? -uterine mass ( 53 yr old, menorrhagia) - prof nazri
- Do you know the definitive procedure? (Whipple) explain Q: ddx, investigate, manage, if refuse medical tx and surgery what other options, if
*guys, tell full term for all procedure and ix ( alt,ast bla bla its endo ca- how to manage, if it was a ovarian ca, what type.

LITYA NAGARETNAM Long case- external peads, prof mano and dr amilia (viral induce wheeze)
Questions abt ix and management, how to use aerochamber, how to follow-up
LONG CASE ( prof liew, dr anim & prof Syaz)
A 52 year old Indian gentleman with underlying DM, HPT, prev hx of ACS & ALYA NASUHA
bronchial asthma presented with chest pain.. had 2 prev episode and angiogram
done in 2011 & 2013.. uncontrolled DM on insulin and metformin. Asthma on LC : cholangiocarcinoma
ventolin PRN.. examination - unremarkable Mr gee, Prof Ruhi, Dr Ng
Questions SH : bronchiectasis, oligohydramnion, acl and collateral ligament tear

45
PRO 3 EXAM 2017
Prof chris, dr maiza, mr asyraf scar presented with PP type 3, anemia in pregnancy and unstable lie.
Questions:
YONG LER 1) What is significant result for MGTT
2) What is complication of unstable lie
LC: dengue 3) what is the most worried complication of unstable lie that need to be anticipate?
Dr Ng, Prof Rohi, Mr Gee ANS: birth asphyixia secondary to cord prolapse
4) how do you manage PP. Explain more about Mac Caffe Regime.
SC: PCKD(Prof Chris), Polyhdramnion(Dr Maizal), 5) which PP most dangerous for this pt? anterior or posterior
ACL + Meniscus Tear(Dr Asyraf) 6) what do you worried for the pt with underlying scar came with PP? ANS:
Placenta accreta
QAMARINA 7) So what consent do you want to take from this pt before go for OT. ANS:
consent for possibility of hysterectomy due to uncontrolled PPH
Lc: non union fracture of humerus 8) How do you anticipate the pt with PPH in OT?
ANS: Start from massage uterus, ergometrine, rule out causes 4 T'S , uterine
Sc: dr maiza, mr asyraf, prof Christ artery ligation, b lynch and last resort answer hysterectomy
Endometriosis, Oa, Lower limb( CNS) 9) how do you manage pt at ward before discharging her?

SHAALINA NAIR SHORT CASE

LC Prof Saz, Prof Liew, Dr Anim 1) HEPATOSPLENOMEGALY (DR ZU)
- Hypertension secondary to autosomal dominant polycystic kidney (APKD) - give causes
- what diagnostic ix for thalassemia
SC Prof Intan, Dr Ummi, External surgery 2) ACL tear (MR PAISAL)
1) End colostomy + wound dehiscence - Which one more sensitive, lanchman or drawer test?
2) MR (adult CVS) - how to manage this pt in ED
3) Spastic diplegic CP ANS: focus on RICE (rest, ice, compression, elevation)
3) LUMP at midline of frontal head. firm, round, 2x2cm, non tender, surrounding
FARAH erythematous, non mobile, attached to skin, slip test negative, no fluctuation, no
puntum and no lymphadenophaty (PROF FAISAL)
long case- haemorrhoid - give differential
Mr. Hadi, Prof Norlijah, Dr. Fam. Med - provisional. i answer sebaceous cyst eventhough no puntum. dr said ok but just
defend yourself.
Short case - what do u want to do for this pt? i tell i want to admit pt to ward. from my finding
1. Uterine fibroid ( Dr. Zulida) there is eryhthematous skin (sign of inflammation) so i worried there was infected
2. Respiratory- lobectomy scar (external examiner - Dr ooi) cyst.
3. Surgery-ant neck swelling (mr chris) - so what do u want to do? i will start with antibiotic and excised it if it is infected.
THATS ALL WHAT I HAVE BEEN ASKED. GOOD LUCK
NADIAH AZMAN

DAY 2 SAIFUL
LONG CASE (DR HABIBAH,PROF SHIKIN & DR FAMILY MED) LC : Acute Bronchiolitis
A 39 years old malay lady G2P1 @ 37 week POA with underlying one previous Prof Intan, Miss Limi, Prof Nizlan

46
PRO 3 EXAM 2017
Was on warfarin since his dx in 2007 before switching to oral anticoagulant two
SC : Thalasemia (jaundice pale hepatosplenomegaly), Fibroid (suprapubic mass, days ago due to over and under warfarinization. In 2014, he underwent emergency
very obvious very big, cannot get below), MVA knee examination (tah apa2 finding pulmonary embolectomy following sudden onset of SOB.
prof dev suruh cari) *my patient had no active complaint. He came just for the exam.
Dr Anim, Dr Zulida, Prof Dev
Dr hoo and prof norlijah asked most of the questions
KHAIRUL Questions
 this patient's recurrent thromboembolic episodes were provoked or
LC : Cholangiocarcinoma + Direct Inguinal Hernia unprovoked ? Are we worried? It is unprovoked
 What is one condition we should rule out in young patient with DVT? Anti
SC : Diffuse Anterior Neck lump + Hyperthyroidism (Graves' Disease) , ACL injury phospholipid syndrome (APLS)
, Hepatosplenomegaly (B Thalssemia Major)  What do we look for APLS investigation? Anticardiolipin antibody, lupus
anticoagulant
NATRAH  Risk factors of DVT in this patient
- obesity
LC- Prof Faisal,Dr Chieng & Dr Ching - occupation ( long hours of drive)
Left hemiparesis with u/l cardiac problem  How do you assess diet history for this patient? Acquire patient's 24 hour
food consumption and count its calories
*SC*Prof Liew,Prof Norlijah & Dr Ummi  How do you manage this patient's obesity? Refer patient to a dietician
-Dermoid cyst,Down Syndrome & Hepatosplenomegaly (Thalasemia)  Pharmacological and non pharmacological management of obesity
 examples of oral anticoagulants and it acts on which clotting factor
YIN YEE
 Do we monitor oral anticoagulants? Yes but we don't do it in our country
Long case
(External surgeon/Prof Chris/Prof Adibah)  Investigations for deep vein thrombosis
protuding mass at anal region a/w per rectal bleeding D-dimer
specific factor assays
Shortcase factor V Leiden
1. Ms Tong: examine the back - Multiple sebaceous cyst
2. Mr Fahruddin: examine the right knee - ACL and MCL tears Short cases
3. Prof Tong (ext) : examine the neurological system of this child - UMNL
secondary to spastic quadriplegic cerebral palsy Prosthetic heart valve ( Dr ooi)
Kumu  present the findings
 Which valve is involved?
 How do you investigate? What do you look for?
Day 4  Complications of prosthetic valve

Long case (Dr.hoo, Prof Norlijah and Mr Ashraf)
33 y/o malay gentleman, a heavy vehicle driver for more than 10 years with
multiple admissions since 2007 (4 times for DVT and twice for pulmonary
embolism ) initially presented with right leg swelling and pain for 1 week in 2007.
47
Radial nerve injury with hypertrophied non union( Prof Mano :) )
 running commentary
 A quick hand examination, peripheral nerve screening and radial nerve
examination
 How do you investigate? What do you look for? X-ray : to look for evidence
of fractures , nerve conduction study : for viability of nerve
PRO 3 EXAM 2017
 When do you do nerve repair ( within 6 months)
 When do you do tendon transfer? ( after 18 months) why? That's when the
acetlycholine receptors and neurotransmitters will degenerate to facilitate
tendon transfer

Gynae : endometriosis ? ( prof Nazri)

 prof gave a scenario : 40 y/o , nulliparous lady presented with
dysmenorrhea and pelvic pain
 There was a huge mass corresponding to 24 weeks of gestation
 Did gynae abdominal examination and presented
 Ddx
 What other examination would you want to do ? Bimanual examination
 How do you differentiate a mass originating from uterus or ovary ?
 How do you investigate?
 What do you look for in ultrasound?
 What are the features of malignancy in an ultrasound ?
 What is the other investigation would you do apart from imaging? Blood
investigations.

48