Post SAQ Exam (Int. Med)

Just finished my 1-hour SAQ paper for the Internal Medicine posting. There are 6 questions all together, and here's my contribution to the infamous "IMU Past Year Questions" archive.

Question 1
A man came in with right-sided pan-systolic murmur, fever, breathless. Multiple venous puncture scar on arm hinting on IVDU. Chest X-ray showed multiple cavitating lesions. Diagnosis is right-sided infective endocarditis, involving the tricuspid valve with septic embolisation resulting in pneumonia. I find the question "Describe the chest X-ray findings" a bit confusing. Is it asking for the cause of the pneumonia, or is it asking for other possible causes besides pneumonia?

Question 2
Middle aged Indian man came in with jaundice, epigastric discomfort, ascites, oedema. Causes of hepatitis? Viral, drug-induced, alcohol, biliary diseases. A LFT is provided, increased ALT. Two probable diagnosis? And give eight physical signs of liver disease.

Question 3
Patient came in confused, dizzy, vomited. Bilateral leg oedema. A BUSE result was given, showing hyponatraemia. What is the cause of confusion and vomitting? Answer: Hyponatraemia. Pathophysiology? Cerebral oedema. How would you manage the electrolyte imbalance (3 steps)? Answer: fluid restriction, diuretics, treat underlying cause, etc.

Question 4
A male executive came in to check his BP. It was raised la. Smokes ciggies for 15 yrs 10 sticks per day. Height 1.75cm, weight 90kg. His dad had DM and died of CVA at age 60. Give 4 investigations for his general well-being (again non-specific, tibai anything also correct I guess). What are the risk factors for development of CVA/CVD in this patient (give 3)? What are the side effects of hydrochlorothiazide he was given (give 3 also)?

Question 5
Old lady, collapsed at home. Another BUSE result given (normal range not given!). History of DM for 10yrs on Metformin. Random blood glucose on admission = Read: 60mmol/L! Diagnosis clinched - Hyperosmolar Non-ketotic coma (HONK)! Pathophysiology? Four other investigations you would perform on her? Management.

Question 6
Esha's question. Female came in with right-sided hemiparesis, history of two abortions, joints swollen and painful, with characteristic facial rash. Diagnosis - Systemic Lupus Erythematosus. Give four complications associated with the underlying disease (again, what is this question asking for?? I wrote the other manifestations of SLE). A syndrome commonly associated with SLE? Anti-phospholipid syndrome. How would you investigate her.

That's it guys. Overall, quite an easy paper la, since I never study that much also can answer >60%. If study more than average sure score kao kao one. Chiao, gonna makan. Can't go back KL coz Sunday got marathon!