C113 EMQ

Ears: Otitis Externa, Wax, Foreign body, Acoustic Neuroma, Acute suppurative
otitis media, Chronic otitis media, Cholesteatoma, Barotrauma, otitis externa,
acute otitis media with effusion (serous), chronic otitis media (effusion),
otosclerosis
1. 30 year old man, After swimming-complaints: deafness after swimming
2. Child, pulling-ear sign, autoscope see darkness, cannot visualise tympanic
membrane
3. Old man, with 1 year history of Deafness on both ears, right side more
than left, deafness more pronouced in nosiy background, rinne negative,
weber lateralise to right.
4. Discharge: Pus. Otoscope Examination:Attic perforation, Grey matter in
the ear
5. Something on pain on pulling the ear

Muscle weakness: Syringomyelia, Guillain-Barr syndrome, Tranverse myelitis

(lupus), Pott's spine, multiple myeloma
1. Progressive muscle weakness for past 4 days. Now on ventilator
2. Muscle weakness
3. A patient with SLE symptoms: arthritis, rash
4. Old man, pallor, back pain
5. HIV positive with night sweats, weight loss, paraplegia, limb weakness

Headache: Cluster, Tension, Migraine, Meningitis, Encephalitis, sinusitis,

Subdural hematoma, Subarachnoid hemorrhage, Giant cell arteritis
1. Sudden headache neck stiffness
2. Businesswoman feels like a tight bandage around the head
3. Headache with photophobia and vomits
4. Headache comes at night, lasted for 2 weeks. Had the headache every 3
months with tearing of the eye

5. Headache with jaw pain when eating. Scalp is tender on palpation.

Nerve palsy : CN III, IV, V, VI, VII, VIII, IX, X, XI, XII palsy
1. Tongue deviated
2. Facial asymmetry, unable to close eye
3. Unable to shrug shoulder and turn neck to one side
4. Affected eye is higher than the normal eye and when asked to turn to the
right side, the abnormaility is more pronounced, ptosis
5. Unable to abduct eye

Respiratory condition : which is the following investigation? Foul smelling

sputum, Reversible on lung spirometry, FEV/FEC
1. Asthma
2. Acute exacerbation of chronic bronchitis
3. Interstitial lung disease
4. Bronchogenic carcinoma
5. Lung abcess

Liver diseases (Primary sclerosing cholangitis, Chronic Hepatitis C,

Hepatocellular carcinoma, Cholecyt, primary bilary sclerosis, cholelithiasis)
1. Lady had blood transfusion 10 years ago. Now hepatomegaly
2. Lady with autoimmune antibody
3. Hep B man now with LOW and LOA. On palpation, a nodular mass is felt on
the lower border of the liver
4. Anti-mitochondrial antibody positive
5. Obesed, asymptomatic woman with hypertension, diabetes. Raised liver
function test: ALT: 80unit

Obstruction: Sigmoid valvulus, Incarcerated Indirect Inguinal Hernia, Obstruction

of indirect inguinal hernia, Obstruction of obturator hernia, Pyloric stenosis,
Intussusception, Rectal carcinoma, Paralytic ileus
1. Child presents with acute abdomen with sudden onset. Curls up when sit
and crying, after a whie no pain, then pain recur again
2. Male noticed the swelling become irreducle
3. Lady with vomiting. Percussion: tympanic, hyperactive bowel sound
4. Man altered bowel habit, blood and mucus in stool. Sudden inability to
pass bowel and flatus.
5. 80 year old man altered bowel habit. Suddenly cannot pass bowel and
flatus. X ray showed dilated loop of bowel

Swelling:Varicocele, Dermoid cyst, Dermoid tumour, Inguinal Hernia, Epididymis

cyst, sebaceous cyst, cystic hygroma
1. Bag of Warm
2. Transilluminate like Chinese lantern
3. Swelling that can be compressed
4. Swelling with slippery edge
5. Swelling with a punctum

Ulcer : Venous ulcer, Ischemic ulcer, Neuropathic ulcer, Pressure ulcer, syphilitic
ulcer, Rodent ulcer, Marjolin ulcer,
1. Painless ulcer
2. Leg ulcer with medial hyperpigmentation
3. Ulcer with rolled-in edge
4. Painful ulcer at toe?
5. A known diabetic diabetic presents with ulcer at heel