Hi 6th years,
As promised, I’m bringing to you a sample of my case reports for the Internal Medicine rotation. Internal Medicine was my first rotation and none of us really knew what exactly was expected of us with regards to the case reports. It also didn’t help that the course description on NEPTUN asked for 2 case reports weekly, which after the 8 weeks would mean 16 case reports in total, and the departments themselves were saying something different. But after consulting with the secretary, I confirmed that only 8 case reports are needed and the course description document needs to be corrected.
Here you can find a SAMPLE of what some of my case reports looked like and here, I have added a template that you can download to use for yours if you would like to order your cases as so.
To be honest, I wasn’t asked much about my case reports and most examiners did not seem to care about it. It was used to choose topics for me once. I was in the nephrology department so one of the examiners skimmed through my reports, found a chronic renal failure case and chose the CRF topic for me as my third oral topic. But nothing really related to that patient case itself.
To talk a little bit about the exam itself, I do remember it being a bit of a nerve-wracking experience, I have to say, both the studying process and the exam itself; nerve-wracking for the amount of details you have to remember but somewhat satisfying being able to make connections amongst the different disciplines. I had mine in the 1st department and I actually had a B chance in internal medicine as I had a goal grade in mind for this course (which I achieved the second time around). I don’t necessarily recommend gambling like this with internal medicine if you’re not too strong in it or willing to study as hard more than once but it’s completely doable.
Anyway, to the exam.
My A chance
Practical exam in the haematology ward
Case: Microcytic Anemia
- Explained all the information obtained from the patient.
- Asked about co-morbidities (pt had DM, atherosclerosis, heart failure and a pacemaker and previously had a PCI procedure)
- Asked for the causes of microcytic anaemia
- Asked for first investigations in microcytic anaemia (be sure to mention DRE)
- Asked for symptoms in microcytic anaemia .
- Asked what one would look for in the DRE.
- Asked what lab parameters to check.
- Was quite particular about the full names of acronyms like PCI and PTA.
- Asked me to examine the heart on the patient, asked where I would hear murmurs, asked where I would hear the aortic valve.
Other students got T-lymphoma and TTP patients. The practical went great and I could answer all the questions.
Oral exam with a gastroenterologist and a cardiologist.
My Qs: Essential Hypertension and IBD + GI precancerous lesions (Easy enough or so I thought)
Was given time to write down everything I knew. I presented everything I knew before I was asked questions.
- Gastroenterologist wanted to know under what condition we give mesalazine in CD: only if colon is involved (This, I couldn’t answer).
- ALL indications for colectomy in UC (This, I didn’t give all the answers).
- Complications of both UC and CD, combined and separate( This, I didn’t give all the answers).
- Epidemiology was important for essential hypertension (This, I messed up).
- The cardiologist wanted to know the target of hypertensive treatment in essential HTN: I started to mention the different patient groups and different targets and could see we were not in agreement (which is weird as it is in the lecture).
At this point I could see I risked a low grade and opted to end the exam here and come back again. Overall, the examiners were quite patient and kind and let me talk, but take note of the details in 1st department.
My B chance
Practical exam at the GI ward.
Case: Alcoholic cirrhosis with ascites.
- Immediately started with the ECG which I did not expect as no one cared about the ECG up until now (so go through it, just in case- better safe than sorry). Asked for rhythm, rate, PQ interval analysis, axis, voltage- nothing more complicated.
- Asked about all the causes of ascites, cirrhotic and non-cirrhotic (He had to pull a lot of info out of me as I was nervous after the ECG).
- Asked for the most common cause of ascites in Asia.
- Asked for the puncture site of ascitic fluid.
- Asked for what we check for after paracentesis (for some reason, he was not happy when I said tumor markers even though Amboss and other academic sites state this, don’t forget cytology)
- Then I described all I knew about the patient.
- Asked me about metabolic causes of cirrhosis: hemochromatosis and Wilson’s.
- Asked which was which and then focused on hemochromatosis: what mutation, what it means for iron uptake, how we treat.
- Took me to the patient and asked me to percuss the lungs. Asked what we look for.
Overall, he was quite impatient and did not give much room to think but was fair in his grading based on my performance.
Oral exam with the endocrinologist and gastroenterologist.
My Qs (3 this time): Differential diagnosis of chest pain, GERD and Chronic Kidney Failure. (CRF was chosen based on one of my case reports)
Was given time to write down everything I knew. I presented everything I knew before I was asked questions.
- Mentioned all the possible causes of chest pain: pulmonary origin, cardiac origin, GI origin. They were quite happy that I organised it in this way so it was off to a good start.
- Asked about 2 acute causes that I forgot: Aortic dissection and Pneumothorax
- Asked the difference between angina and AMI: AMI lasts longer and is not relieved by pain killers.
- How we would manage AMI? MONA
- Reflux vs GERD: GERD is when reflux causes troublesome symptoms.
- Asked for how common it is.
- Asked for simple way to test it: PPI test
- Other diagnostic methods: 24hr pH measurement, barium swallow, manometry of LES tone.
- Complications of GERD.
- Pharmacotherapy of GERD.
- What kind of surgery can we do?
- Describe chronic renal failure, what is the GFR like?
- Causes of CRF.
- Symptoms: based on all functions affected, so glomeruli function, tubular function, EPO and Vit. D.
- What do we do? renal replacement therapy
- List the RRTs you know.
That was the end of the exam. Other students were waiting because they were asked to wait outside and told that we would all receive our grades at the end. 2 minutes after I came out, we were called in one by one and given our grades privately and congratulated.
The examiners were nice here and assisted with helping questions especially if you were already on the right track. Good experience overall.
That being said, for this exam I suggest you try not to be too hung up on getting a particular department. I know most students like to go for the 2nd department but you still need to study just as hard to succeed regardless of where you take the exam and these are pieces of information you must remember in your career anyway. For my first exam, I was the only one who had to come back for a B chance and the day I had my second exam, all of us passed with good grades (as I was told anyway). Both were in the first department as I already said.
Work hard, repeat learned material and be confident. You can do it- after all, you got this far. Good luck.
Author’s note: The content shared on this blog, including the project and any related materials, is intended solely for informational and educational purposes. No permission is granted for the use of my work in any form without explicit written consent.