PAED finale 'runaway' 2012

LONG CASE (Dr. ABG Nagi)

My patient adik AS/3 years old/Malay/girl presented to HTAA with complaint of 1 episode of seizure prior to admission.

• witnessed by her mother
• sudden in onset (during sleeping)
• generalized and lasted about 10 minutes
• occur once only within 24 hours
• associated with uprolling of eyes, stiffness of limbs and vomiting of milk
• no post-ictal complications 

preceded by fever, runny nose and diarrhea

• fever was 38 degree celcius noted at home
• diarrhea occured 3 times with no foul smelling
• in contact with sick people at home

P/E: noted only febrile (38) and tachycardia (148 bpm)

provisional diagnosis : Simple febrile seizure secondary to viral fever/AGE

Questioned ask by Dr.ABG Nagi :

1. Definition of high grade fever
2. Cut point for tachycardia and tachyponea in this age
3. Prognosis of simple febrile seizure
4. Why did you mention viral fever not bacterial?
5. Signs of meningeal irritation
6. Definition of Kernig's and Brudzinki's signs?
7. Classification of seizures (maybe yg ni Dr nak based on ILAE)
8. Definition of simple and complex febrile seizure
9. Comparison of management between simple and complex febrile seizure (yg ni aku ckp xthu)
10. Complication of complex febrile seizure
11. If patient presented with complex seizure what are the investigations you would like to send
12. Management of status epilepticus
13. Examples of anti-convulsant (diazepam, phenytoin, phenobarbitone...etc)
14. If patient with seizure was given all types of anti-convulsant but the seizures still occur, what you want to do (inducing coma)
15. etc..

SHORT CASE (Dr.Aye Aye)

Adik SNF/ 6years old/ facial puffiness

Please inspect this patient, DON'T TOUCH

Questioned asked by Dr.Aye Aye:

1. Is this moon face? Why? (prolonged used of steroid)
2. Examples of diseases that treated with steroids?
3. What are steroid toxicities?
4. What do you think the disease that the patient had? NS
5. Patient has already performed renal biopsy, what are the indications for renal biopsy?
6. What are the types of nephrotic syndrome? and what do you think about this patient?
7. What is the prognosis of focal segmental glomerulosclerosis (FSGS)?

p/s:

- Dgn yaqeennye duk present dalam bilik ber-aircond sempat pulak Dr. ABG Nagi tidur dgr presentation aku....hampehhhh

- Masa session CP ngan Dr.ABG Nagi aku present kes sama simple febrile seizure, alhamdulillah dpt jgk idea mcm mn nk buat ayat dan prepare soalan yang bakal Dr tanya...tp balik2 dia p pusing soalan laen...mak aihh

- Patient nephrotic tu aku dh clerk last week, so nsb bek la ad jgk idea nk present...

aku bermonolog sendirian sebelum keluar pergi exam:

[Allah dah tetapkan rezeki aku, walau apa pun terjadi jgn sedikit pun pertikaikan rezeki Allah]

Muka2 DR kesayangan (termasuk yg xde dalam gambar, Dr.Nargis, Dr.Taufiq & Dr.Fadzillah)
haha..gambar aku pun masuk!!!

InsyAllah mudah-mudahan apa yang aku usahakan hari ini menjadi bukti untuk hari yang akan datang.. Doa dan tawakal kepada Allah semoga ilmu yang diperolehi mendapat keredhaan-NYA.

Semoga mendapat PASS untuk paed posting..ameen