EOP Surgery

Another EOP has just over.. Surgery.. This time a totally different one..

Previous Paeds & O&G i’m not too interested but this one i’m interested..

Got Prof Khin Tun & Mr Ashok for my long case..

Epigastric pain + hard epigastric mass (liver origin i suppose) + splenomegaly + fever + signs of chronic liver disease + signs of obstructive jaundice..

My provisional diagnosis: HCC since the epigastric mass is so hard..

Then Prof Khin Tun asked points against my diagnosis..

I knew something is wrong out there.. I said pain & fever.. He agreed & asked me how come fever & pain & chronic liver disease signs?

I remembered the nurse opened the case note & told me the current diagnosis they had at the moment.. It’s cholangitis with known case of Hep B..

So WTH, who cares, i shot cholangitis & said Charcot’s Triad matched..

Prof Khin Tun did not agree.. Tough Luck.. Didn’t went into investigations or management..

Kept on beating around the provisional diagnosis only.. sigh

As for short case, i was the last one to take the exam.. so imagine how much energy has been wasted during the waiting from 8am till 11.30am? Lol

I got abscess for the 1st one… Left lower back abscess.. With Dr Kyi & AP Dr Ong..

Everything went smoothly this time.. Thank God!

2nd one was Fibrolipoma.. With AP Dr Thaung & Dr Nyi..

This time was disaster!

On inspection, there is a 10x11cm swelling at right axilla region.. Looks like lipoma to me..

On palpation, WTH? Soft & firm consistency at the same time.. The firm one was like “fibroadenoma” in the breast.. So freely mobile.. LOL

In a man.. i was confused at that moment..

I kept on palpating the swelling and too nervous to speak out..

Dr Nyi guided me a while and at last i did slipping sign.. Lol

Dy Thaung asked me provisional Dx..

I said Lipoma due to skin can be pinched & slipping sign +ve

He asked me why cannot be hemangioma? I answered correctly

He asked what is lipoma? I answered correctly

He asked DDx? I said sebaceous cyst

He asked how to differentiate from lipoma.. I answered correctly again

Then he asked what are the places where lipoma cannot occur?

This time i mixed up with the sebaceous cyst and i said palm & sole.. LOL

They laughed..

They told me “you confused with another disease”

They asked me what is that disease that i’m confused with?

Luckily i said sebaceous cyst..

And the time is up..

However, Dr Thaung said there was scar and i didn’t mentioned inspection correctly.. sigh

I think i’m quite unlucky to get these cases but i hope I’m lucky enough to pass the exam..

Oh ya, that day Dr Kyi asked Jun Ing to take care of me.. LOL

And today she asked me to take care of Jun Ing.. LOL

Anyway, i really  like surgery than paeds & O&G..

surgery, paeds, O&G.. I really dislike O&G 😛

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About LWJ

A doctor in Hospital Sultanah Aminah Johor Bahru (HSAJB).