● HJH: Meet at the lecture hall.

l. When you enter turn right and walk down the corridor then
go down the stairs and walk to the end of the corridor. If you’re lost you can find Anna’s
GEMP4 2021 Advice and Tests: office on the 6th floor (outside Ward 17). She is the secretary for surgery.
● Bara: 2nd floor, Friends of Bara building, Surgical Department boardroom, opposite
Ethel’s office (the secretary)
Psych:
● Helen Joseph - 9am. Psychiatry OPD on 2nd floor.
Hi Everybody, welcome to this shared document. Just a few quick rules to make sure this runs ● Tara: 9am at OPD, meet Dr Vahed
smoothly. ● Bara: ward 88
● First and most importantly, please contribute what you can. It doesn’t help if everyone comes
Emergency Med:
here for information but no one adds things that haven’t been said. I really hope this can be as
● HJH - meet Dr Saffy outside resus room of accidents and emergency for a round at 7h30
concise, complete and informative as possible to help out as many people as we can.
([email protected])
● Please don’t mention any Drs names for obvious reasons (eg. Dr so and so is horrible at tuts)
● Thelle Mogoerane Hospital- 8am. Emergency Department outside Dr Hart's office. Day
● Please don’t be redundant. Read over the section you want to add to and make sure you aren’t
finishes at 3pm
repeating what has already been said before.
● Bara - in MEU, next to trauma. Handover ward round starts at 8AM. Second handover
● Please don’t delete anything that has already been added. If you disagree with what has been
(and after which students may leave) starts at 2PM.
said, rather put your reason for disagreeing afterwards in red so people can get different opinions.
●
Try be as detailed as possible, if you are uncertain of something put a question mark afterwards eg. (?) so
people can be aware and maybe add in the correct information.
Trauma:
● Also not really as important, but if you could stick to the same format throughout this document ● Bara: 7h00 at trauma resus. Join the ward round.
to keep everything neat and tidy that would be great.
Anaesthesia:
If you have any issues or problems please send me an email at [email protected] . Thanks
● HJH - anaesthetic department on first floor, opposite theatre entrance.
Guys who :)
● Go in your casual/civvies clothes and change into scrubs in one of the rooms in the
____________________________________________________________________________ departments
_ ● CMJAH: meet Dr Hendricks in the Anaesthetics seminar room
● CHBAH: meet Dr Nyimbana in the anaesthetics tea room at 8am

Where to meet: Public Health:

● lecture room 5 on ground floor of public health building (best to contact Dr Nika
Internal Med: Raphaely first in case any changes)
● Bara: Jean's office between ward 13 and 15 at 07:45
● Helen: outside wards 8 and 9 on the 4th floor at 08:00, meet Dr Ingratta. Obs:
● Cmjah
Gynae:
.Paeds: Starts with an orientation session at 7:30/8:00 at CMJAH red block 7th floor in the obs and
● Bara : Outside Metabolic Unit at 8:00 gynae department regardless of placement. Ensure to collect logbook and protocol book (R60 or
● Helen print soft copy at lesser price) from here
● Cmjah: outside the office in area 278. Dr White & Dr Goodwin will orientate you in the
meeting room in the office.
● RMMCH: in the tea room in B Block or in the second floor lecture room, down the hall
from the tea room

Surgery:
● Cmjah: Dept of surgery opposite 396 ward (orange block), Ask for the secretary Thembi
 Forensics 11) What distinguishes a hanging ligature from a strangulation ligature? Apex point of the
ligature mark
____________________________________________________________________________
_ 12) Man commits suicide with a plastic bag attached via a hose to a canister later revealed
to be filled with helium. What type of annoxic death is this?
2021 Test:
13) Female commits suicide by putting a plastic bag over her head and tying it closed? What
1) A 26 year old athletic female is found recently deceased and was taken to the Mortuary type of death is this? Suffocation (other option= Strangulation, Traumatic anoxia)
and put in the fridge. The next day it was noticed that her muscles were very stiff. Why is
that? 14) What act does sexual assault and rape fall under?
-Because she was in a cold place
-Actin Myosin bonds 15) Man’s body needs to undergo an exhumation, what law allows for this body to be
-She was athletic exhumed? Inquest act.
-Protein agglutination(?)
16) Imam dies after receiving blood in transfusion and according to muslim law needs to be
2) Baby found in a shack dead, family member had illegal electrical connections, what buried within a day so family doesn’t want post mortem to be done. What should be
signs on the baby indicate electrocution? done? According to the Inquest act consent is not needed for a postmortem

3) Burned body found with extradural haematoma which was brown and looked like an 17) Lead snowstorm x-ray, what causes this? High velocity bullet
aero, what caused this? The fire itself, no trauma
18) Picture showing a bullet wound through skull. What type of fracture was this? Keyhole
4) Baby died in their sleep, what signs on the baby would indicate that it was an unnatural fracture
death?
19) A 6-year old comes to casualty with a broken arm and multiple bruises that are not
5) 60 year old lady “injured at home and died en route to the hospital”. Noted with satisfactorily explained by the parents. What is the most likely cause? Non-Accidental
petechiae and ligation mark higher at the back than the front(?) Hypostasis of abdomen injury syndrome
and lower limb. Hanging vs Ligature
20) Baby has subdural hemorrhage and was found to have traumatic axonal injury. No signs
6) Women killed in home invasion with lesions on her scalp, blood hammer left nearby was of outward trauma. What is the cause? Shaken baby syndrome
the murder instrument. What type of injury would you see? Not penetrative incision
wound, possibly Puncture Laceration? 21) Under which act is rape prosecuted? The Criminal Law (Sexual and Related Matters)
Amendment Act
7) Man got in a bar fight,got hit in the head and briefly lost consciousness. Friends said he
was fine afterwards and his friends put him to bed. Next moment he woke up dead. What 22) Under which act are you allowed to take the blood of a person without their consent if the
kind of intracranial injury was this? Intracerebral, Subarachnoid, Subdural, Ruptured police requires it for a blood alcohol level?Criminal Procedures Act
Aneurysm
23) Body builder is lifting a weight and it falls on his chest, no one is there to assist him and
8) Motorcyclist gets in an altercation and ij he dies. What type of anoxia was this? Traumatic anoxia
9) s shot. It was argued in court that the man was drunk. If you have his age and weight.
What formula will you use to calculate blood alcohol level? 24) Person found in a bathroom dead with drug paraphernalia. Questions around toxicology.
-Toxicology report not to be done since person clearly died of drugs
10) Case of a minor who has been sexually assaulted came to court. Issue is consent, the -Toxicology report difficult to interpret due to tolerance and personal variation
child was too young to give it. W.hich one is true?
-under 19 year old male engages in homosexual act 25) Body found in a very hot climate and has dry leathery skin. What kind of decomposition
-under 28 year old female engages in homosexual act is this? Mummification
-under 16 female who engages in heterosexual act u
-under 12 year old engages in any sexual act(?)
26) Decomposed body found and blood sample could not be taken. What other sources can
be used to obtain a sample? Vitreous humour Internal Medicine
27) Person has been tortured before they died and has multiple injuries (slashes, cigarette ____________________________________________________________________________
burns and tram tracking). What is an indication of blunt force trauma? Tram tracking _

28) Body of a woman who has been raped is found. What is correct about rape?
-If hymen is intact rape didnt happen Rotation 1
-If there are no signs of rape on the genital area then rape didnt happen
-If there are injuries on the genital area then rape definitely happen Bara
-Often times signs or rape are not evident on post mortem

29) Question about characteristics of an entrance wound from a bullet.

call every 5 days with your unit. Make sure to call Prof Ally and Prof Parbhoo and arrange times
to have tuts with them (they don't have dedicated time slots in the timetable Jean gives). Prof
Parbhoo had his tuts in the car park outside friends of bara on Tuesdays 10AM and had another
30) What causes the characteristic boxer stance (pugilistic attitude) of a burnt body? Heat
online tut (Microsoft Teams) on Thursdays 3PM.
causes contraction of the larger muscles
Prof Huddle ECG sessions are really helpful.
v
31) Definition of viability in south african law. 26 weeks viability onwards
GO TO PROF PATEL’s tuts!!!! He is a living legend! Listen to everything he says.
32) Fisherman lost at sea, police investigated and no body was found. Under what
MiniCEX: 10 needed by end of block, try to get them in the wards and in tuts, don't rely on calls.
conditions can an Inquest be held?
OSCE: Week 5 of rotation, 2 short cases and 3 extra case if student doesn't pass a short case.
a) What causes a Cadaveric Spasm? Intense emotional distress just before death
At Bara, we were given 30 mins to clerk and 15 mins to present to two consultants.
33) Bruises present on the body. What is true? Bruise depends on each person
Cases we got:
● Malignant Pleural Effusion (asked on Lights Criteria, treatment for recurrent effusion is
34) How long after a subdural haematoma does it deveSeelop a fibrous capsule around it?
pleurodesis, sudden onset SOB? worry about cardiac tamponade, learn TB treatment
weight, S/E)
35) Question asking about what you see in a babies lungs who breathed (position of
Young Stroke (pt had Chronic Venous Sinus Thrombosis, asked to elicit signs, investigations
diaphragm, appearance of the lungs etc etc)7
(non contrast ct), LP if not C/I, learn ischaemic vs haemorrhagic stroke and risk factors for both,
8
learn approach to young stroke)
● Acute exacerbation of COPD + digital clubbing - TB Mx, Emergency Mx of hemoptysis,
Cx of bronchiectasis.
● Stroke - know the localizing of the lesion. They asked to show the reflexes.

Helen Joseph

● 10 MiniCex : try get them done within 4 weeks. Don't rely on tuts and calls to get them
done. You may need to organize extra tuts and beg registrars. It is tough to get them
done but it is doable if you start from day 1. (Can be completed in 3 weeks depending on
Registrars/Consultan
● ts)
● Calls are every 4 days from 4pm to 8pm weekdays and 2pm to 8pm weekends. They
can be very quiet so bring some stuff to study.
● Monday afternoons are online ECG tuts with Prof Huddle as mentioned above.
 ● Chem path tuts are online every Friday but you must submit answers to them every 7. Online tutorials: neuro on a Thursday with Prof Parbhoo, ECGS with Prof Huddle and
Thursday on sakai. chem path on the Friday afternoon of each week (make sure to submit your chem path
● Renal online zoom tuts every Tuesday at 10. the previous day online before 5pm!)
● The OSCE is done in week 5 but it is unit dependent so your consultant will tell you the 8. Tip: make sure to organise tutorials with Prof Ally to get “pearls of wisdom”. He has a
Friday of week 4 which day your OSCE will be. Some units split the OSCE over 2 days great way of approaching any clerk and will genuinely make you feel better about
while others did both cases on one day. If you don't get an average of 60% between the internal medicine and life in general :)
two cases you will have to do a third case. Same format as Bara (30 mins clerking and 9. Skills and procedures: there’s space in the logbook for this. If you spend time in the
15 mins to present and questions to be asked) cases from unit 2: COPD, DCMO, wards or just get involved in any call, you will easily complete skills and procedures but
Massive ascites and pleural effusion. don’t leave it to the last minute.
10. Derm clinics: were not compulsory for our group but just check with block coordinator
and head of derm what is expected from the final years. We decided to only worry about
dermatology in December :) but it’s important… especially for the “general” stations in
Rotation 2 OSCE, e.g. scleroderma could easily be a case in the OSCE.
HJH 11. OSCE: takes place in the last week. 2 cases. If you don’t pass the first two cases with an
OSCE average of 60%, you get offered a 3rd case. If you get offered a third case, your mark for
Cases 1 person received in Unit 3 - Ingratta's unit: the OSCE will be 60%, provided that you pass the third case. Details of the OSCE:
● TB Spine (Pott's disease) - Neuro exam 30mins to clerk the patient in which you are expected to take a history and do a focused
● COPD with unilateral leg swelling - Resp + limb exams examination (including vitals and CAJCOLD) and then come up with an assessment (pt
● Ascites due to either extrapulmonary TB or biventricular heart failure - Abdo (primarily), details, pathology/condition, aetiology/cause, complications, scoring system, risk factors
Resp and Cardiac exams where appropriate). Make sure that the examiner directs you to the system to be
examined. The 30mins goes by quite quickly so break it up (suggestion - 10mins hx,
Cmjah: 10mins examination, 5 mins to formulate an assessment and then 5 mins to get your
Osce Cases: thoughts and presentation in order - and to take a deep breath in…). You will then get 15
Day 1: SLE, Pleural Effusion, Pleural Effusion secondary to SLE, MCA Stroke mins with your examiners (2 consultants) to discuss your clerk as well as the
Day 2: DCMO in cardiac failure, Hepatomegaly secondary to alcoholism, Liver Nodules management of the case. CASES WE RECEIVED: pleural effusion, COPD, stroke x2
secondary to colon cancer, Drug induced hepatomegaly (cortical and subcortical/internal capsule), thyrotoxicosis, generalised lymphadenopathy,
approach to CLD/portal hypertension. If you study approaches to the main conditions
CHBAH from each system, the OSCE will be fine. Again, Prof Ally will help with this.
1. MINI CEXs: minimum of 10 12. If you have any admin questions, Jean is the secretary of internal medicine and will
2. Ward mark: spend time in your unit’s wards with your interns and registrars. gladly answer all your questions. Her office is next to ward15 on the surgical corridor.
3. Mid block assessment: NB to address any issues. Hand in at least 2 discharge Good luck!
summaries to your unit doctor at this point(see below).
4. Discharge summaries: don’t leave it to the last minute. Have a total of 5 to complete by
the end of rotation. Ask the interns which patients are getting discharged. Good patients
to complete discharge summaries on are those who have had additional investigations
Rotation 3
above the standard formal investigations and patients who have a lot of TTO meds. It is Everyone at HJH for this rotation.
easy marks and counts a significant portion of the theory mark. Unit 3 OSCE: pleural effusion (possible heart failure), transverse myelitis, gout, CVA,
5. Calls: every 5 days with your unit. Weekday calls are from 4pm to 8pm. Weekend calls UNit 2: CVA (chronic, post partum cardiomyopathy presenting in heart failure, pulmonary
are from 2pm to 8pm. PIWR happens the next day. There are usually a minimum of 2 effusion, liver failure.
PIWRs so make sure to join the one where you see the patients from your call. Make
sure to get signed off for PIWR even if you have morning tutorials. We were not sure
what takes preference - PIWRu or morning tutorials? Confirm with block coordinator.
6. In person tutorials: generally one each day usually outside the wards at around 12pm.
Rotation 4
Additional tutorials on top of the standard 1 tutorial per day include Tuesday afternoon Unit 4 osce-subcortical stroke,? heart failure/mitral regurg/something cvs
endo tutorials, Tuesdaymk9 morning neuro tutorials in the parking lot and Thursday Unit 3: GBS, stroke, malignant pleural effusion, massive ascites, COPD cx by cor pulmonale
morning haem tutorials.
Rotation 5 5. Heart failure
6. COPD
HJH 7. Stroke
For Unit 4 (Greenstein): Present patients you've clerked on a ward round during PIWR for your
CEX. The same patient can be clerked by another colleague for a ward tutorial (This counts as a
CEX for them as well, provided the consultant is a different one)- just check who is the PIWR Rotation 8
consultant. At Helen Joseph
Unit 3 got:
1. Pleural effusion with constitutional sx
2. Atrial fibrillation with MR
HJH OSCE 3. Ascites due to renal failure
4. Complicated neuro case: mix of UMN and LMN from stroke
Held during the last week of the block. 5. COPD

Unit 2: 2 stroke cases (MCA infarct and subcortical hemorrhage), hepatomegaly (with
splenomegaly?), infective endocarditis, COPD NBL, pleural effusion
Internal Medicine Written OSCE (30 Nov 2021)
Unit 4: Examined by Unit 3 consultants
Station 1 - HHS
Stroke, HCC (Don't put it first as your diagnosis even if it is obvious), COPD with a NBL,
Hodgkins lymphoma, 65 year old woman in coma, had seizures.Given the electrolyte blood results - high urea, high
glucose etc.
1. What is the dx?
Rotation 6 2. What is the criteria that supports that dx?
3. Why did she have seizures
OSCE 4. Immediate Mx?

Prepare well and clerk lots of patients Station 2 - Obstructive Jaundice LFT
Cases we got:
1. Post TB bronchiectasis
1. Describe the abnormalities seen on the LFT
2. Lynphoma/ TB LNs
2. What complications can occur
3. Portal HPT-GIT
3. Sx
4. RHV
4. What is your Differential
5. Marfans with mitral and aortic stenosis
6. Pleural effusion
Station 3 - Hypercalcemia
7. Rheum arthritis with pleural effusion
8. BVHF with VSD
9. CVA 1. Immediate Mx
10. Pleural effusion with Rheumatoid arthritis and other extra articular manifestations of 2. What drug to use in long term
disease 3. Two most common causes of this presentation
11. Heart failure with pulmonary hypertension 4. What investigation would you request to determine the diagnosis (out of the above two)
5. Other Qs cant remember

Rotation 7
At Bertha Gxowa: Station 4 - DERM 1 - picture of violaceous nodule on forehead: Discoid lupus?
1. DCMO Cutaneous Tb? Cutaneous Sarcoidosis?
2. Post TB bronchiectasis 1. Hx Qs
3. Jaundice 2. Mx
4. Cor pulmonale
 3. Ix 5. Tenofovir side effect - fanconi anemia or RTA?
6. Know that pyrazinamide causes hyperuricemia. Know that ethambutol causes RED
Station 5 - DERM 2 - picture of purple plaque on back with smaller macules - Lichen GREEN color blindness. RHZ can each cause hepatitis. Just know all the Tb drug side
Planus? Psoriasis? effects
7. Know the clinical presentation of lateral medullary syndrome
1. What to ask on Hx
8. Lupus pernio is in sarcoidosis
2. Ix
9. Know how to Dx CML/CLL/ALL/AML on blood results
3. Mx
10. Klatskin tumor presentation
11. HCC - is AFP specific to it or does it occur in background of cirrhosis (it’s cirrhosis)
Station 6 - CXR 1 : Pulmonary TB (milliary)
12. GBS clinical presentation
1. Describe the xray 13. Gentamycin causes nephrotoxicity
2. Ix 14. RTA (renal tubular acidosis) causes NAGMA
3. Drugs used in Mx and for how long 15. Use amoxicillin-clavulanate as broad spectrum ABs for CAP
16. Know how to calculate CURB 65
Station 7 - CXR 2 : tension pneumothorax 17. Cats and toxoplasma gondii
1. Describe xray 18. Anal fissure clinical presentation
2. Immediate Mx 19. Next most appropriate Ix in small bowel obstruction picture? CT abdo? Erect AXR?
3. Further Ix ? (pancoast tumor present in left upper zone) Supine AXR? U/S?
20. Woman has vesicular rash in perinuem - organism or virus responsible?- ? Herpes
Station 8 - ECG1 : Inferior STEMI 21. Worm that causes very itchy perianal area-Enterobius Vermicularis
22. Woman started ARVs 3 weeks ago - abdo U/S shows diffuse abdominal LAD - least
1. Abnormalities on ECG
likely cause? Cryptosporidium? Toxo? EBV? IRIS? Or Kaposis sarcoma?
2. Mx
23. Know blood transfusion reactions - anaphylactic reactions/ whether we need to warm the
3. Contraindications to fibrinolytics
blood before we give it or not / platelets need to be at room temp or not before giving it
4. What will you do if cant use fibrinolytics?
etc.
24. Graft vs host disease
Station 9 - ECG2 : AFib
25. Mesenteric ischemia clinical picture in pt with Afib
1. Axis 26. Amyloidosis causes anasarca, hypoalb and something else-nephrotic syndrome causes
2. Rate 27. Gave LFT results and had to make Dx of alcoholic pancreatitis
3. Abnormalities 28. AST>ALT in alcoholic hepatitis
4. Causes 29. Austin Flint murmur / steele murmur of Pulmonary stenosis, Carey Coombs murmur,
5. Mx principles 30. TTP clinical picture
31. ITP clinical picture
Station 10 - Obstructive FLOOP 32. ITP Mx
1. 4 demographics that are important 33. TTP Mx
2. Dx? 34. Obese guy with intermittent hoarse voice and glossodynia. Non smoker. Cause? Acute
3. Sx that ppt will present with laryngitis? GERD? Vocal abuse? Hypothyroidism?
4. 2 classes of drugs to use in Mx 35. Know that N.meningitidis is gram negative diplococci
36. Know how to tell apart fungal from bacterial from TB based on CSF results
37. Non bullous rashes? Erythema marginatum (other options included TENS, SJS,
Internal Medicine MCqQ 30 November 2021 (120Q) erythema multiforme i think)
38. Presentation most common with drug allergies? Pruritus or cough or vomiting or diarrhea
1. Syringomyelia clinical presentation 39. Know the clinical and biochemical findings in acute tubular necrosis-granular casts
2. Dermatomyositis management 40. Know which auto-antibodies in RA/SLE
3. Which drug causes lupus- Hydralazine 41. Know that in Tx of asthma, salbutamol causes hypokalemia
4. Obese pt came for advice - what causes his obesity? High fat content ? high carbs? High 42. We use PEFR to monitor Mx outcome for asthma
fat to carb ratio? High carb to glucose ratio? 43. Know Mx of STEMI vs NSTEMI WELL!!! (and know the difference between the two)
44. Is sarcoid associated with pleural effusion?
45. Post knee op woman has bloody pleural effusion. Cause ? PE? 75. Definitive Mx for lady with massive hemoptysis, byt hemodynamically stable. Has Hx of
46. PE ECG features - simple tachycardia ? TB - definitive mx is: Bronchial artery embolization? Oral tranexamic acid? Blood
47. Know treatment of severe asthma transfusion?
48. Know how to calculate CURB-65 from given scenarios 76. TSH is most sensitive test for hypothyroidism
49. Know the ECG features of electrolyte imbalances! NB 77. Osteomalacia biochem picture
50. Know the ECG feature of pericardial effusion 78. Irritable bowel syndrome clincial pic
51. Man had ⅖ power in lower limbs sudden onset and 5/5 power in upper limbs - immediate 79. Calculate corrected Calcium
Mx? Know Mx of spinal cord compression (blue book) 80. ITP has increased megakaryocytes on BM sample
52. Which rash is photosensitive? (On exposure to sun, burns the skin, which rashes have 81. Allopurinol to pre-medicate to prevent tumor lysis syndrome
that characteristic? Which arent? -Psoriasis. Porphyria Cutanea tarda? Pellagra? 82. Phenytoin adverse effects? (Other than gum hypertrophy)-Megaloblastic Anaemia due to
Phenylketonuria? lupus? folate deficiency. Just know the anti-epileptic drugs and their side effects well
53. Infective Endocarditis Dx and Mx 83. Drain pleural fluid if there’s bacteria growing in it
54. Acute renal failure Dx 84. Know that Adenosine deaminase in pleural fluid is assoc. With TB Dx
55. What causes death in eclampsia ? Intracranial hemorrhage? Cardiac failure ? 85. Retinitis pigmentosa is not associated with psoriasis?
56. RBBB ECG 86. Know how to Dx Cushing Syndrome - Preferred screening test: 24 hr cortisol urine
57. LBBB ECG levels? 9AM serum cortisol levels (technically its 8 am which is why this answer may
58. Conn’s syndrome biochemistry pic have been wrong)
59. Cushing syndrome biochem pic 87. Cushing’s causes hypokalemic alkalosis
60. SIADH biochem pic 88. HIV RNA to monitor
61. Know that HCTZ causes high Ca in blood 89. Know ARV regimen and when to initiate ARVs
62. CCB first line in black pts for HT Mx - hydrochlorothiazide has also been said to be 90. PCP pneumonia clinical presentation - ground glass opacities bilaterally ; low sats.
treatment of choice for black patients? 91. Picture of fundoscopy - Hx of headache and visual problems - papiledema?
63. Vascular dementia Clinical Pic - hx of two strokes, now struggling with daily activities, 92. Enalapril if hypertension with intracranial haemorrhage
also very irritable now but full marks on mini mental exam. Other options included fronto- 93. Cranial nerve 3 palsy clinical presentation
temporal 94. Contraindications for thrombolysis (absolute vs relative)
64. Know causes of high and low SAAG 95. Diabetes and furunculosis/carbuncle
65. NAGMA causes 96. Which drug not to give in a thyroid storm? Beta blocker, digoxin, luguls iodine, steroids
66. Know Lights Criteria and causes of pleural effusion and carbimazole
67. Features of sarcoidosis 97. Severe gastroenteritis with renal dysfunction management - NB asked for initial step: so
68. Features of SLE options included resus, haemodialysis
69. Features of RA 98. Bleeding tests for haemophilia
70. Features of amyloidosis 99. 18 yr old with suspected asthma not responding to treatment, chronic cough now has
71. Features and how to Dx Systemic sclerosis (antinuclear Abs) pale stools and new onset diabetes- Cystic Fibrosis. Churg Strauss, aspergillosis,
72. Crohns disease clinical picture hypersensitivity pneumonitis
73. INR suitable for metal valve? 1-2, 2-3? 2.5-3.5? - apparently 3 100. Guy with previous stemi now in LVF what drug to give- ?prenalipril, never beta
blockers
101. Guy who is dehydrated, polyuria, polydypsia, fatigue but with sneaky history of
having sarcoidosis, which electrolyte abnormality is the cause- hypercalcemia due to the
sarcoid history. (Granulomatous disease causes increased Vit D i think) Hypernatremia,
hypokalemia, hyperglycemia etc.
102. Portal hypertension SAAG and venous blood flow direction
103. Deep inverted T-waves on an ecg in a 78yr old man found unconscious- i thought
it was cerebral T-waves due to intracranial hemorrhage, other options were a stroke,
digoxin toxicity (could have been this but were very deep t waves and the history fits the
intracranial hemorrhage better) can't remember the other options
74. 104. Acute stroke Mx and know the cutoffs of BP and when NOT to lower the BP.
105. Guy had epigastric pain. No other clinical findings. He thought he had “the bug
that caused ulcers” Mx? PPIs
106. Which therapy in SLE or RA (can’t remember) has been shown to decrease
mortality ? Gave a whole bunch of options with different combinations of corticosteroids, Paediatrics
methotrexate, cyclosporine and other immunosuppressants. Choose the one that has
been proven to reduce mortality. ____________________________________________________________________________
107. Lady with fatigue, amenorrhea for 3 months and tingling in fingers at night- _
Hypothyroidism, other options were anemia and stuff I can't remember
108. Know the Mx of melanoma - wide local excision or chemo etc.
Rotation 1&2
General:
- 4 weeks of gen paeds, one week is spent in neonates
- 4X Formal Assessments:
- 1. Neonates
- 2. Single System
- 3. 3Ambulatory
- 4. Open Book
- You will be assigned to an MO/Reg/Consultant for these examinations, message them to
arrange a time and place. Marking is done online on a link the doctors have. (you can do
exams from week 3 so try book early with your examiner. We had many on leave in
March and April and often had to reschedule a few times. They then complained we
were leaving it to week 5)
- Informal Assessments:
1. 2X Discharge Summaries
take pictures of the blue/pink book discharge summaries when you prep them and send it to
your reg so they can mark you online → you do more than 2 so choose ones you know you’ve

done well (marks for jam)

2. 2X Ward presentations, can be done on PIWR or a normal ward round
3. Neonatal Ward Mark
4. General Ward Mark - to be filled in by your unit consultant in week 5
5. Skills Sheet
6. Online Interactions on Sakai

Procedures:
-Blood culture is just a single yellow top culture bottle
-Blood tests are done in the small yellow and purple tube. INR is in the blue tube with the clear
covering over the blue lid. It needs to be filled to the top line
- Drips are hard! Make sure you have everything ready before hand. Including strapping (bring
scissors to paeds). Ask one of the interns or Regs how to strap a drip (you have to secure it well
in children). Top tip for drips: children's veins are tiiiiinnnny. When using a yellow jelco, as soon
as you get flashback remove the needle and then try and advance the jelco. If you try advance
the jelco with the needle you overshoot the vein :') Another very important tup: DO NOT flush
the drip with a 5ml syringe, the pressure causes the vavies veins to burst, always use a 2ml
syringe and flush slowly, ensure the tourniquet is off before doing this. Paeds veins burst very
quickly.
- Whenever taking bloods always use arteries, veins are reserved for drips. Try radial first, then
brachial but never femoral in paeds (can cause avascular necrosis of the femur)
- You might see interns scooping bloods into the tube (when the blood leaks after removing the Clinics:
needle). This messes up U&E results and isn't the best practice. Rather try get blood to drip -You need 5 clinics (including HIV, Teddy Bear clinic and Neurodevelopmental -- these are
from the needle into the tube. Blood can clot very quickly in children which can be frustrating. If DP)--> Teddy bear clinic is on Wednesday mornings and Dr Barnes only wants a few people at
this happens rather opt for a black needle which is more painful for the child but larger and a time (so it's usually the people who are in neonate week that go)
therefore less likely to clot. -Same as above for HIV clinic (also go during neonates week) - HIV clinic often only had 4 or 5
patients, so get there early cos it can be done within an hour sometimes.
BARA: -Endocrine clinic is on Monday morning and also only takes a limited amount of people. There is
You are on call every four days (with your unit.) Some units are less bu a sy than others due to no endocrine tut despite being scheduled for Monday, rather you go for clinic
the number of doctors and registrars. You will be expected to take over and see 2-3 patients -The clinic timetable is completely wrong, clinics usually start early, around 8. It's quite difficult
everyday that you are in your unit. I was handed two babies on day one and asked to see them, getting to clinics since they finish before ward rounds and ward work sometimes. So make sure
present them on the reg round. You should try to formulate a plan for your patients daily so that to prioritise clinics or else you won't get enough
you get into the hang of it. I personally found all the consultants extremely approachable and Tuts:
friendly, and I didnt get any complaints about consultants specifically. Some of the paeds -The Monday cardiology tut is with Dr Motara who is usually happier to do it earlier than it's
registrars are quite hectic about detail, and come across as rude. But nothing out of the ordinary scheduled time (Rotation 2 tuts were with Dr Koch. she was also very flexible)
for doctors egos. You will be expected to integrate with yùour team/ unit, so its worth making - For neonates, EXPECTED to do the questions before the tutorials (orange book)
friends, and getting stuck in early. Also, tuts usually get scheduled well and get stuck to them. Neonates week:
On day one, you will be oriented and they explain everything very well. -In area 177. To get there go down to 277 then walk across and follow the corridor past ICU
Attendance at special clinics is important, and often you learn alot of random but useful ways of (ABG machine is in the ward on the left). The door at the end of the corridor is the entrance to
handling children / asking questions. Calls are theoretically from 8am to 8pm. However, each neonates ICU. There's a code (4179#) introduce yourself to the interns and registrars.
unit works differently, and your unit consultant will dictate more clearly what they expect. Our -Essentially you're expected to clerk patients and present to the consultant. You get a patients
unit we used to be early on post call days to start consultant rounds by 9am, and be done with file, repeat the medical history written and then perform the exam. You then adjust the feeds as
work by 1 pm. (didnt always happen, but we try.). necessary for that day and evaluate the medications and copy what is still needed (always write
Neonates = lots of work! You see maybe 9 different babies every morning (ward 68 is always the day of antibiotics)
packed) on your own and then present them on the round, which usually starts quite late - I recommend reading up on how to work out feeds and fluids for neonates before neonates
considering the whole morning is taken up with seeing ALL the patients. Rewarding because week
they trust your examination so it’s all on you to decide if the baby you see is safe to go home or -NB when taking bloods in neonates you can't scoop it, it deranged the results especially for
not. Both Saturday and Sunday are part of the neonate week but you only stay until 12 pm. You U&Es. If you're struggling rather ask an intern to do it
unfortunately miss tuts in your neonate week because the neonates take preference and you -You will not find APGARS in 177, rather you must got to gynae and fine Ceaser theatre to get
are usually still in rounds when the tuts happen. the APGAR. You might see a neonatal resus in the ward, but more likely in theatre. T/U in 162 is
also a good place to see resusc and/or apgars. Otherwise just ask a registrar if they can
‘simulate’ a scenario and you can demonstrate you know the algorithm and how to calculate
CMJAH: APGARs.
There are 4 units: Unit 1A and 1B, Unit 2A and 2B
Calls
-On intake every 4th day (e.g. Monday, Friday, Tuesday, Saturday etc.) - with your unit. All RMMCH: Overall a very nice block, but it does get busy very quickly. Try to do skills from week
1 and assessments in week 3 and 4.
students there. You’re supposed to clerk admissions and present on the PIWR → must have 6 - The students on day 3 will clerk a patient to present to a consultant for a tut at 2pm every
clerks and presentations for DP. Our rotation struggled to get enough admissions though - some weekday except Fridays. The tuts were on Teams, so elect a rep to make a teams group
and share the link with the doctors. Some doctors did prefer to do the tuts in person but
intakes there were no patients admitted. The note below about bringing work to do is important! we still used teams for those at home or on call. They didn't have a problem with that at
-Weekday calls are until 8pm all.
-Weekend calls are 8a5m-8pm - The first Friday you have an ethics discussion and the following 3 Fridays are for online
- Sometimes it's very quiet so bring work to do. Essentially you clerk a patient from scratch in comm paeds presentations.
264 (paeds casualty - it may move due to and present to the registrars. You are also expected - Minimum 6X calls/intake with your unit, clerk patients to present on PIWR and get skills
to present to the consultant on post-intake done. We left at 8pm but it goes very quick when busy! We didn't do calls the week of
-Post intake starts whenever the consultant on call arrives (usually 7:30-8:00) neonates.
-When in neonates week, do a call the weekend before just to get acclimated. Neonates calls - Minimum 6 Ward Cases clerked
aren't too hectic and you're usually done earlier, no calls on weekdays in neonates
 - For neonates week, go to KMC in the morning to clerk and present patients on the KMC 6. (Procedure) ECG Interpretation: sinus tachy + very big T waves, Right Axis Deviation,
round and then go to the ward rounds in 16B. The interns are great and you learn a lot! right ventricular hypertrophy.
Ask them to show you how to take blood, how to calculate feeds and how to do 7. Explain to parent what is wrong, how it happened, what the treatment will be
Thompson/Apgar/Ballard scores. Also know how to work out photo levels for Neonatal
Jaundice. Rotation 2
- HIV Empilweni clinic on 4th floor is compulsory for 2 or 3 sessions, but they finish super
early most days. It run on Tuesday, Wednesday and Thursday mornings. Ask your unit if Structured oral
you can miss the ward round one morning a week to go to HIV clinic. Also fill in the
logbook task at the clinic. It is not for marks but needs to be signed off by a doctor. Use Scenario of a kid with tachypnea, resp distress signs (Alar flaring, recessions etc.) and fever.
the 2019 PMTCT Guidelines to fill in the last 2 questions in the logbook: HIV-. Is vomiting and has abdominal pain. (Was clear from the scenario that it was Pneumonia).

1) discuss the case. What is going on with the kid? According to IMCI, how would you
assess and classify the kid? → it was severe pneumonia due to the fast breathing,

cyanosis and fever.

2) What Investigations would you do? CXR, ABG, FBC (WCC, CRP, U&E and admit.
Consider blood culture too.
3) The examiner gives you a CXR and an ABG to interpret. (This is the demonstration of a
skill part of the oral assessment) CXR AP and Lat showed a right middle lobe
opacification consistent with lobar pneumonia
4) What is the emergency Mx of his resp distress? Set up IV, NPO2 at 2l.min-1, intubation
is only if unprotected airway (diminished consciousness etc). I said give hypertonic
saline nebs and drops to thin mucus as likely that the infection has blocked the airways.
Can also nebulise antibiotics (this is done for Pseudomonas in CF patients)
5) What are the most likely organisms that cause this ? Strep Pneumoniae is most
common, others are moraxella, chlamydia, staph aureus, klebsiella, TB etc. Viral less
likely but you can also talk about viral causes of pneumonia to demonstrate knowledge.
6) Counsel the mom - How would you prevent the kid from getting this in the future ?
(Immunizations, good nutrition, washing hands with soap, brushing teeth etc.)

MCQ (rotation 1+2) (100 MCQs)

- The structured osce takesf4 place at your base hospital on the last Friday of the (About 25% of the Qs were repeats from previous Tips documents Qs. Go thru previous Tips
- The final MCQ will be at the end of the TERM, unfortunately. documents. There were 22 questions with pictures.) A few questions came from Lissauer's MCQ
textbook (you can find it on PDF drive, it had about 20 questions per chapter and is really useful
OSCE (Structured Oral) Term 1: for studying).
Structured, no SP or patient, just you and the consultant
1. Pic of Intussusception (abdominal sausage mass) Asked about Metabolic abnormalities.
Mom brings in a 4yo boy with recurrent cyanosis and squatting spells Hypochloremic, hyponatremic, hypokalemic, metabolic ALKALOSIS.
2. WhatPic of erythema toxicum → 3 day old neonate develops rash
1. What do you think is wrong? Cyanotic Congenital Cardiac defect, likely TOF
3. Pic of pedigree (AR condition). Choose the condition from the list. (OCA- oculocutaneus
2. What is TOF? 4x 7What is causing the cyanosis? Cardiac defects mixing cyanotic blood,
albinism).
infundibular spasm. They wanted ‘Hypercyanotic Spells’
4. Pic of Bell's palsy. Which is most likely virus? HSV, EBV 8or CMV or VZV
3. Why do they squat?
5. Pic of a graph showing diarrhea decreasing since 2011. What is the reason? Rotavirus
4. OTHER causes of cyanosis in children? Respiratory, 0 itShock, poisoning
vaccine as part of EPI.
5. Management: ATLS, O2, pain management, b blockers, surgery long term
6. Xray showing widened wrist of a 6month old, with history of child living in apartment in
inner city, what is this child lacking? Vitamin D
7. Pic of a CXR. B/L patchy infiltrates and Hx of Resp distress after a cough and poor 25. UTI Defn (10 to power of 4 = in out catheter, 10 to power 5 = midstream, any growth in
feeding. Bronchiolitis (other option was interstitial pneumonia, bronchiectasis) suprapubic is a UTI) Know different requirements for different samples (midstream,
8. Pic of pale and oily stool. The likely diagnosis was Cystic Fibrosis (if it was biliary catheter, clean catch and suprapubic)
atresia they would have given a jaundice hx) 26. 11 year old goes to clinic and asks for HIV test. Nurse says no, the child must bring
9. Pic of cap refill being tested on a dark skinned child. What is the possible limitation of parents along. Is she right to? Age of consent for HIV test is 12 years, however the child
this test? His complexion or the environmental temperature? can get the test if sufficiently mature.
10. Patchy rash shown and asked what immune mediated sensitivity it was (IgG, IgA, IgM, 27. Which feature in a constipated child would NOT suggest that their constipation is a
IgE). functional cause and that it is actually due to pathology. Options were stool on
11. Picture of an abdomen with multiple Cafe au lat spots and a solitary neurofibroma underwear, explosive release of stool, overflow diarrhoea and occurring after a child has
nodule, asks for diagnosis. Neurofibromatosis been toilet trained. Question asked what is not functional constipation.
12. Picture of what looked like Herpes around the mouth (it was impetigo → crusting and 28. Blood results table. Patient had an Hb of 8, platelets of 32 and White cells of 1.5.
Aplastic anemia scenario
yellow), asked about the treatment. → most likely staph infection. 29. Asked what the most likely cause of a male toddler presenting with mild anaemia on
13. Picture of leukocoria (it was a congenital cataract, not leukocoria) and asked which FBC and swelling of the knees following mild trauma. Haemophilia
condition does not cause it (Consanguinity, Galactosaemia, Wilson's disease and 30. Immune thrombocytopenia scenario (blood results given) following an infection
Rubella were the options) 31. Kid who lives on a farm in the Eastern⁷ Cape presents with new onset seizures. Has a
14. Picture of Koplik spots and asked (which other symptom would not have fitted with the focal lesion in brain in frontal lobe on CT. Likely Cause ? Taenia solium or echinoccocus
granulosus.
diagnosis (Measles) → options were coryza, cough, conjunctivitis (the 3 C’s of measles) 32. Kid has foreign body in his airways. Is unstable on vitals. Mx? Intubate and ventilate,
and another one, i think diarrhea? Bronchoscopy
33. kid is HIV+ and has TB. ARVs ? 3TC+ABC+Kaletra+RITONAVIR (need to add extra
15. Picture showing assymetrical tonic neck reflex (ATNR or fencing reflex) and asking at
ritonavir because of the interact
which age this reflex disappeared. (6-8months) other options were 2-3months, 4-6
34. 3 year old comes in and is up to date on immunisations until 18mo. What are you going
months, 9-12 months
to give them? Answer is deworming meds and Vitamin A (road to health booklet page
16. Picture of chest x-ray (not sure what it was showing). History was of a 3 year old who
9)
was running with siblings then choked for a bit then developed an acute cough. Foreign
35. Child comes in with diarrhoea, decreased skin pinch but still occasionally drinks milk.
object aspiration
How do you manage? (IMCI question). Do you admit to tertiary hospital, send home,
17. Pic of a kid with inguinal mass. History of scrotal swelling that is reduceable but pops out
admit to clinic or something else.
when coughing. What must you you do? Surgical consult
36. Pale child comes to clinic, gives the Hb as 8?. How do you manage? (Another imci
18. Picture of molluscum rash and asks for treatment in immunocompetent child. Just leave question)
it as it resolves spontaneously → i think this is incorrect as the one option was to apply 37. Child comes in with inspiratory noise that is worse on lying down. What is wrong?
Laryngomalacia
topical irritants.
38. Mother comes in with exclusively breastfed infant and says since Child was born baby
19. RVD exposed Infant at 6/52 whose mum (diagnosed at delivery) stopped taking ARVs
has always vomited up a little bit of her feeds most of the time. The child feeds well then
after 4/52 because she only had a 1 month supply. He is now 6 weeks old. What should
cries when she vomits (clue to esophageal irritation) The baby is still growing well and
you do now? do a PCR test? Or start co trimoxazole? Stop breastfeeding?
thriving. What is the cause? Gastro oesophageal reflux disease (Lissauer mcq)
20. Preterm Neonate is now day 42. GA 32/40. Was ventilated and is weaned to NPO2. Still
39. Girl has a confirmed UTI that recurs, what is your next investigation? Renal ultrasound,
dependent on O2. Why? Bronchopulmonary dysplasia (straight out of Lissauer)
voiding cystourethrogram…..
21. Q on Mx of asthma. Child with nocturnal symptoms and cough for 3 months. ICS
40. Cardiac history and mentioned blood pressure is weird in the right arm? Which
controller and SABA reliever.
congenital lesion is it
22. Q on cyanotic vs acyanotic heart lesion. Must read the scenario and then decide if is 41. Cardiac question with murmur heard on left sternal edge, which one is it?
acyanotic or not. It was an infant who has had multiple chest infections, failure to thrive 42. Baby has broken bone after rolling off the bed at 5 months old. What is not appropriate.
A full bone scan, involving social worker, admitting baby for further workup, getting s
and who has sats of 93% → acyanotic congenital heart lesion consult
23. Adrenaline dosage - in paeds you take the 1:1000 and dilute 1ml with 9ml saline to make 43. Neural tube defect prevented in SA soon by which action? Giving women of child
1:10000. Dosage is 0.1-0.3 mg/kg IMI. bearing age folate( primary prevention)
24. Red currant jelly stool in a 1 year old with bowel obstruction - Intussusception
44. Which E is not part of the prevention of accidental injuries in children in South Africa? 65. Child comes in with jaundice and fever (looks like hepatitis) what test would you do
The three E’s are Education, Engineering and Enforcement (policy). Comes from decide on admission? ALT/AST, INR, two others
Comm Paeds presentations. 66. Xray of duodenal atresia (dubble bubble) - what is the likely association… trisomy 13?
45. What is an absolute contraindication to breastfeeding in South Africa? Same question as Trisomy 18? Trisomy 21?
last year: galactosaemia, hiv positive, mastitis etc 67. Picture of a retina, history of child being irritable and crying all the time - diagnosis? CMV
46. Infant with history of reduced foetal movements during last pprt of pregnancy. retinitis? Hypertension? Non accident injury ( shaken baby syndrome)
Examination findings consistent with hypotonic conditions. Options were Duchenne 68. Glomerulonephritis presentation - management? Steroids? I think antihypertensives is
Muscular Dystrophy, Spinal Muscular Atrophy, Hyopotonic CP and something else. better option, steroids are for nephrotic syndrome.
47. Cerebral palsy kid comes in with difficulty walking, but able to use his arms. What kind of 69. Hba1c is an indicator of control for at least how long… 1 month, 2 months, 6 months. 3
"plegia" is this? Diplegia months not an option
48. What kind of test do you NOT need to send a Trisomy 21 child for. Audiology, xray 70. DKA type presentation - what is the first test you’d do? glucose
videofluroscopy (don’t need it), hypothyroidism and something else(?) 71. A pic of a child with olive mass on the LUQ metabolic derangement (pyloric stenosis)-
49. Child comes back from preschool with an itchy and crusty eye unilateral, other children metabolic alkalosis, low K, low Cl
had the same at school, what is responsible for this? Pink eye=Adenovirus 72. Rash looking like urticaria- what immune response is it?
50. A child is found unresponsive in the garden with his grandfather who is only partially 73. Crusty yellow lessions around the mouth and the nose looking like impetigo- what
responsive, due to some kind of poison causing a hypoglycaemia, what did he most treatment?
likely ingest? Organophosphate, ethanol, DDT i 74. A child with acute respiratory symptoms, trachea deviated to right, dull on the left and
51. What is the characteristics of a full thickness burn? White and do not feel pain reduced air entry on the left? Pleural effusion on the left
52. Mother is worried about her teenage daughter abusing substances, what changes in 75. Which of these is NOT a cause of earache in children- brain tumors, gum disease,
behavior would you ask the mother to look out for in her child? Correct answer was sinusitis, something else
neglect of personal care and hygiene. 76. Interpretation of SAAG for ascites
53. increased attention to weight and appearance, anxiety about social acceptance and one 77. Acute management of a child with tetralogy of fallot- fluid bolus, oxygen, prostaglandins
more. and something
54. What complications are common in teenage pregnancy? Low birth weight baby 78. Side effects of vancomycin.
55. After prolonged vaginal delivery baby has a non tender bump on his head, what is the 79. Low tone, absent deep tendon reflexes, tongue fasciculations - SMA
most likely cause? Cephalohaematoma I think this was actually Caput Succedaneum. 80. Least associated with childhood obesity- type 1 DM, low self esteem and two others
56. 3-year old Child comes in with left-sided Abdominal mass, gives blood results showing 81. A child in respiratory distress and a cough, not growing well- start antibiotics, start TB
anaemia what is it? Nephroblastoma. Options were lymphoma, splenomegaly and treatment empirically, investigate TB and start broad spectrum antibiotics and another
something else. option
57. Child comes in with a history of grunting while urinating, palpable bladder and bilateral
abdominal masses what caused this? Posterior urethral valve
58. Mother has chickenpox one week after giving birth - how should the baby be managed? Rotation 3
Answer is give Ig to the child.
59. Neonate bleeding from umbilical site, what is most likely deficiency? Vitamin K (past OSCE
papers question) its actaully Factor 13 deficiency.
60. 25 year old mother (first child) -- baby blood comes in Rhesus positive, discover she had 7 yo Sipho
a previous medical termination at 18. Current baby is fine, what do you do? (Mom is RH Leg weakness, hypotonic, no reflexes, now spread to other leg. No loss of bowel or
negative) bladder functioning. RTI 2 weeks earlier
61. Macrosomic neonate born 4.5kg at 37 weeks is found to be Hypoglycaemic, normal Hb
but hematocrit is 0.6 what is most likely cause of hypoglycaemia? Born to diabetic 1. what is your assessment: demyelinating neuropathy with ascending weakness; LMNL; acute
mother flaccid paralysis
62. Xray of croup (steeple sign) 2. what is this called? - answer: acute flaccid paralysis
63. Picture of baby with flaky dermatitis on cheeks - contact dermatitis?allergic 3. Ddx: GBS, Poliomyelitis, spinal cord compression (unlikely to be spinal cord compression
dermatitis?seborrhaic dermatitis? because of the lack of bladder and bowel symptoms as well as the presentation with LMN
64. Ethics question about a girl with intellectual disability, she is 14 but intellectually is the symptoms), etc. (many ddx exist!)
level of 7 year old. She now begins menstruating - what advice as her GP? To take her 4. Why do you think it’s GBS: prev RTI, symmetrical ascending paralysis
to clinic and get injectable contraceptive, remove her from the school and put her in 5. How would you treat this? Polygam (intravenous immunoglobulin), LMWH (prevent clots),
an all girls school, sterilise her, home school her plasma exchange, biopsychosocial (OT, speech therapy, psychologist)
6. How would you investigate (LP, nerve conduction studies) 6. Diarrhoea and weight loss feeding on nan-formula, improved on stopping the formula -
7. Why is it dangerous when it ascends? Respiratory what do you switch to: nan-hypoallergenic, extensively hydrolysed, soy milk formula or
failure (might need intubation and ICU) humanised milk?
7. Picture - clubfoot - talipes equinovarus
Pic of LP equipment - explain 8. GBS scenario
how to do LP and know equipment names: 9. Picture of retinal hemorrhage? Social worker consult.
1. 1st explain to mom what you are going to do. 10. Administration of adrenaline. Dilution etc.
2. She is worried that is gonna be painful. Can you give him something to make the pain better - 11. Pic or Koplik spots- repeat. Incorrect answer was Jaundice.
lignocaine 12. Picture a pale oily stool in a nappy? No hx of jaundice. Options were BA, Cystic Fibrosis,
3. Sterile procedure malabsorption.
4. Draping, swabs, alcohol, sterile gloves, needles, 3 tubes 13. Herpes Zoster Rash
5. How would you position him? Banana shape 14. A graph showing decrease in Diarrhoea, which vaccine? Rotavirus ( Repeat).
6. You will need help to do this - nurse/colleague 15. Downs Baby, which cardiac defect is most likely? AVSD
7. What would you see on CSF - normal glucose, increased protein, some WCs, increased ICP 16. CXR showing military TB or LIP
8. What tool would you use to measure ICP during LP (manometer?) - also papilledema in ICP 17. Chronological age question → starts from birth.

Council mother:
Rotation 5
1. what does he have (AI condition; body attacking own cells because they think it’s the same
“bug” that he had two weeks ago)
Structured oral
2. Will he fully recover: Approximately 80% patients with GBS walk independently at 6 months,
4 y/o Sarah presenting with a nose bleed that lasted 30 minutes. This was the first episode.
and about 60% of patients attain full recovery of motor strength by 1 year. Recovery in
Parents also noticed bruising around the eyes with a petechial rash. Sarah has a history of
approximately 5-10% of patients with GBS is prolonged, with several months of ventilator
previous URTI 2 weeks ago.
dependency and a very delayed, incomplete recovery.
3. Is it infectious - my other son got resp infection one week after him (no, AI mediated)
On examination there was no lymphadenopathy or hepatosplenomegaly.
4. Will he have to stay on medication for the rest of his life: no (polygam only given for 10 days);
might need long term (up to 18 months) of OT or physio
1. Types of bleeding disorders?
5. Will it get worse: peak weakness in 10-14 days (can only really tell prognosis then; depends
2. What on history will be suggestive of a bleeding disorder?
on severity and type of GBS)
3. Name 2 inherited and 2 acquired bleeding disorders?
4. Platelet vs coagulation factor bleeding disorders
Rotation 4
5. Mechanisms that cause platelet related bleeding disorders
OSCE
6. Investigations to do with a suspected bleeding disorder
7 yo Siyabonga from Hillbrow. Presented with seizure, on examination: rachiti rosary
1. What's your assessment
For the skill part had to interpret FBC with diff count as well as INR and PTT (Isolated
2. Clinical signs of the disorder (Rickets)
thrombocytopenia with a normal diff count and normal INR and PTT)
3. What investigations would you do?
4. Interpret X ray of wrist and pelvis
Counsel mother on child's condition (ITP)
5. Interpret Lab results
6. How would you manage Siyabonga, and for how long?
Rotation 6
7. Counsel the mother.
OSCE
MCQs
- HIE
** They repeated a lot of MCQs from the past papers. So go through everything.
- Neonatal resus steps
1. Picture of hydrocephalus (sunset eyes was the answer)
- Like ratio respiration to compression
2. Innocent murmur. Which of the following requires further investigation (answer= thrill)
- Rate of compression
3. Vitamin D deficiency
- Rate of BMV
4. Lead toxicity side effects - learning disability
- Calculating the 1 min APGAR
5. Side effect of medication - child was on aminoglycoside, piperacillin-tazobactam and
- Future complications
vancomycin - nephrotoxic
 - Risk factors a. GE reflux
- It was a 4kg baby 14. WHat does a p value show
- Prolonged 2nd stage a. Study reached a level of significance
- Possibly also to monitor Hgt due to increased weight 15. Kid sitting on own and passing things from hand to hand - what age in months
- Blood gas 16. Kid who can lift head when prone and track parent
- Metabolic acidosis a. ? 3months
17. When should kids get next dose of mebendazole and Vit A if 15mo
MCQ(again study old mcq and also from the Lissuars peads mcq book) 18. Best way to increase iron in kids
1. A picture of a foot with rash, the child had had 2 months of fatigue. I think there was a. Food fortification
hepatosplenomegaly. 19. Kid from a vegan family with hypochromic, microcytic anaemia
a. Options were acute leukaemia a. Advise to introduce meat
b. Some other stuff b. Eat dark leafy green
2. X ray of chest with NG tube curled up c. Increase foods with phytates and oxalates
a. Oesophageal atresia 20. Neonate of vegan mom - what are they likely to be lacking
3. Child comes in with earache and you hear a murmur - which sign shows that it needs a. B6
further investigation b. B12
a. A thrill 21. Kid lives in an inner city flat and has this X ray - rickets. What are they lacking
4. The same question as above but i think they came in with a cough a. Vit D
a. A thrill b. Calcium
5. CXR of boot shaped heart in a neonate - what signs will this child likely have? 22. Kid with rickets - what blood value will likely be low?
a. Hypercyanotic spells a. 25 hydroxy vit D
b. Can’t remember the other options b. Ionised calcium
6. Baby with diarrhea or some illness and then the apex was in the 6th ICS and signs of 23. Rehydrating a kid with dehydration but passing urine
heart failure a. Maintenance
a. Cardiomyopathy b. Rehydrate over 24h then maintenance
b. Myocarditis c. Rehydrate over 48h then maintenance
c. Forgot the rest 24. Boy playing soccer then gets crampy pain on left abdomen. No trauma. They get
7. Small child with rash on chest, they came in with a limp, fever, red throat recurrent UTIs. WHat is it?
a. Rheumatic fever a. Nephrolithiasis
b. Kawasaki b. Pyelonephritis
8. Pic of white pupil 25. Picture of scabies - what is the treatment
a. Leukocoria (whitening of the pupil. Can be due to cataract, retinoblastoma most 26. Kid with pneumonia
commonly) a. Oral amoxocillin
b. Corneal something b. IV co-amoxiclav
9. Picture illustrating gower sign 27. Picture of kid with puss from eye - Rx
a. Muscular dystrophy a. Ceftriaxone IM/IV
b. Polymyositis b. Ampicillin
10. NAC normogram picture - what overdose is it for 28. Importance of seeing if trisomy 21 is from non-dysjunction
a. Organophosphates a. Risk of recurrence
b. Paracetamol 29. Vinette of croup, sats of 70%, sats of 80% on O2
11. Picture of girl with webbed neck a. Intubate in theatre
a. Karyotype 46XO b. Intubate in ICU
12. Kid with folds under their eyes and no eyebrows - then it asked what clinic they are likely c. Nebulise adrenalin
to follow up at - idek what it was. 30. Sick for 3 days, barking cough, now severe stridor. What would increase suspician of
a. Pulmonology epiglotitis
b. Cardiology a. Temp of 38.1
c. Endocrinology b. Not swallowing
13. Kid who had always thrown up some of food. On 95th percentile c. Hoarse voice
 d. Pulsus paradoxus 48. Girl with PCOS, now virtualization signs. What is high cousing this
31. Baby with apnoeic spells and not breathing when feeding - what Ix will help with Dx a. Testosterone
a. Pass catheter into each nostril b. LH
32. Picture of meningomyelocoele - what preventative method may have helped c. FSH
a. Folate 49. Muac 12.4, WLZ < -3, finished RUTF
33. Kid with chicken pox - when can they go back to school a. Uncomplicated SAM
a. Lesions crusted 50. Asthamtic kid who has white painful plaques in mouth
34. Kid with bloody stools, shigella cultured a. Stop using spacer
a. Close school to disinfect b. Stop using corticosteroid
b. Kid must stay home c. Rinse mouth after use
c. Kid can go to school with antibiotics 51. Kid with hypothyroidism - a complication
d. Kid can go to school but must isolate a. Prolonged jaundice
35. Kid drank something from sprike bottle now miosis, bradycardia, salivation 52. Pebble like stools, abdominal pain. You feel hard stools. What do you do?
a. Organophosphates a. CT
36. Kid found crying by teacher, admits to taking 5 unknown pills. At hospital they are b. X ray
completely fine c. Nothing
a. Admit 53. 9 month old with stranger danger
b. r/f to non urgent social worker visit a. Apt for age
c. r/f for non urgent psych consult b. They have this the whole of the first year
37. Nephritic picture, indian male, what do they have 54. What is a kid born at 30 weeks most at risk of
a. FSGS (a cause of nephrotic syndrome, not responsive to steroids) a. RDS
b. Minimal change ( a cause of nephrotic syndrome, responsive to steroids) b. IVH
38. Kid with haematuria, what finding will make you think of nephritic syndrome 55. Baby born, big, green tinged nails, now low sats
a. Hypertension a. Meconium aspiration
39. First presentation of nephroblastoma 56. Picture of impetigo
a. Abdo mass a. Impetigo
b. Hypertension 57. Another picture of skin peeling on face
40. Bloods - Hb 3, Plt 25, WC 1,4 a. Staph aureus
a. ITP 58. If you have HIV what should change with vaccination
b. Apalastic anaemia a. Nothing
c. Myelodysplastic syndrome b. Delay measles
41. Pyloric stenosis 59. Kid with constipation and low tone
a. Hypochloraemic, hypokalaemic met alkalosis a. Gene sequencing
42. Kid has 20000cfu of e coli on culture, What will make you think it is a UTI b. Biopsy
a. It was a suprapubic sample 60. Kid born via vacuum, now has tender swelling crossing suture line
43. Red urine, dipstick shows no blood a. Caput
a. Eaten beatroot is most likely b. Cephalhematoma
44. PDA, mom worried about them being dead c. Sub arachnoid hemorrhage
a. Congenital rubella d. Sub aponeurotic haemorrhage
45. Most likely cause of meningitis in neonates 61. GBS scenario with pins and needles in feet and then weakness. Most useful
a. Strep agalactia investiagteion
b. Strep pneumoniae (or maybe it was pyogenes) a. LP
c. H influenzae b. MRI
46. CSF with low glucose, high leucocytes 62. Limited number of beds - ethics principal
a. TB meningitis a. Distributive justice
47. Girl with morning headache and vomiting. On contraceptive pill 63. Picture of hemiplegia
a. Drug side effect a. Hemiplegia
b. Space occupying lesion 64. Some kid with seizures and low HGT. Normal insulin values. Low T4 and low cortisol.
 a. Adrenal insufficiency (i think its this one)(Why?Cortisol usually increase glucose
and adrenal insufficiency causes increased insulin sensitivity) Surgery
b. Cushings syndrome
c. Insulinoma ____________________________________________________________________________
_
Rotation 7
Oral Osce (Neurodevelopment)
Scenario is on a 5 year old who is an ex-prem. He has not achieved his growth and Rotation 1
development milestones and his parents are concerned about why he is not like the other kids?
He has cerebral palsy. You have to determine what type it is from an exam they tell you about CHBAH
and you comment on the findings. Meet at 2nd floor of friends of Bara building, at the surgery department boardroom
The skill was to mention when milestones are reached in terms of drawings, stacking blocks and opposite the secretary Ethel’s office.
writing etc.- Go to Neurodev clinic! Alot of is saw those diagrams for the first time in the osce (;
Then you counsel the parents on their concerns around CP and he had bad eyesight and you CMJAH:
recommend he get assessed at the optometrist and that they qualify for a grant etc. MiniCEx
Week 5 of the rotation on Monday and Tuesday there will be a mini cex done, one on each day.
It could be a patient from any ward or literally with any condition. They won’t let you know which
doctor is taking you for the mini cex exam either. So prepare thoroughly.
Most common topics done for our rotation is Obstructive jaundice, breast Ca and CLTI for
vascular. A few other ones were appendiceal mass, sarcoma, colorectal etc.

HJH
4 calls (2 weekday until 8pm and 2 weekend)
We were told to shadow registrars so we would do calls on the day your registrar is on call.
They wanted us there until 10pm and even gave us permits but the registrars usually let you
leave earlier. We were allowed to split the weekend call.
Ward 19: hepatobiliary
Ward 18: colorectal
Anna can answer any questions you may have. Her office is on the 6th floor outside Ward 17.
You will get a timetable allocating what to do with your time each day. Also on the wall between
Walls 16 and 17
You have to sign a register everyday
Thursday is breast unit (Tuesday is also breast clinic)
You must do a palliative case report and a surgery case report.
Surgery case report recommended to be submitted on week 3 Friday as the consultants claim to
give corrections.
There are lots of tuts at HJH which are useful. They are at 7:30am on most days and two in the
afternoon. Most consultants expect you to read up on topics in detail the day before. (Also a lot
of tuts tend to be cancelled and rushingly completed in Week 4, giving students inadequate time
to revise topics for OSCE)
If doctors aren't giving tuts, please ask your group rep to report this on a daily basis to either Dr
Bulabula or Dr Mulira
Allegedly it is a Wits law that tuts cannot happen between 9am and 12pm. Be aware of this rule
because the vascular surgeons from CMJAH (who work at HJH due to the fire) may want to
schedule tuts in that time

MiniCEX: on the last week of the block over two days

1. Acute Severe pancreatitis
 2. Liposarcoma of the neck (approach to a neck mass) Your unit is on call one day a week and every 4th weekend. You must do a minimum of 2
3. Anal SCC (but asked questions about colorectal cancer) weekday calls and 2 weekend calls to get DP and be allowed to take exams. Keep track of your
4. Fibroadenoma (approach to breast lump and know about breast cancer) patients in the logbook, but we weren’t asked to hand it in. It’s just your ‘backup’ or proof if you
5. Non benign lateral neck mass need it. Be prepared to do a lot of the ward work and teach the GEMP 3’s - Possibly because
6. GOO they didn’t have clinical methods and did everything online last year, they were really hesitant to
7. OJ do ANYTHING and wanted constant hand-holding and help with basic stuff like drips and taking
8. Colon cancer with bowel obstruction blood. I’m sure we were also not as sharp as we could have been last year but there seems to
9. Post amputation due to skin malignancy/melanoma (Dr Sanders likes to include be a massive gap between gemp 3 and gemp 4s in terms of confidence.
melanomas)
10. Cellulitis Start studying from day 1… honestly, 5 weeks is not enough time to get through all the content.
11. Thyroid cancer (approach to midline neck mass) You need to make sure you read everything and don’t miss the tuts -- the consultants like to
12. Rectal cancer drop hints and golden nuggets for exams and the MiniCEXs later in the block. There were even
13. Colorectal cancer hints in week 4 and 5 tuts that answered questions in the SACS case.
14. Diabetic foot (approach to a patient with foot sepsis)
Asked about differentials for each condition e.g. a neck mass, acute abdomen, breasts lump Go to clinics as much as you can and just clerk patients. It’s consultant driven. You’ll get lots of
etc.. Then asked about investigations and management. questions from the registrars and consultants and some teaching, so definitely learning
They repeat cases from the first day on the second day so check what your friends got. opportunities.
● 15 minutes to clerk
● 5 minutes to write an assessment What counts for Marks: Case reports count 10% of the block. There is also a Palliative Care
● 10 minutes to get grilled
case report due for the end of week 4. It helps if you clerk a case for presenting in the weekly
SACS tutorials because then you get it done and can get feedback from Dr Blanchard before you need
Rotation 1- SACS was on rectal cancer only. Know investigations, management and the order in
which you’d do them. to write, so i highly recommend you volunteer (with your clinical partner or your unit) to present.
Rotation 2 - duodenal ulcer with Forrest, management (acute and longer term), and some Not sure how much palliative care counts for marks. There is a MiniCEX exam on the
questions on Zollinger.
Rotation 3-? Wednesday of week 5 → you get assigned a consultant who will examine you with an
Rotation 4- Breast cancer, all the way from identification, history, exam, investigations, MO/registrar. 15min to clerk the patient and 15min to present and answer questions, but many
management, treatment etc etc. Gave FBC and asked to interpret post chemo.
Rotation 5: ? examiners don’t care about the time and continue well past the 30minute mark - asking
Rotation 6: acute diverticulitis- investigations, interpreting a CT scan, complications,
questions and assessing your knowledge.
colovesicular fistula management
Rotation 7: Melanoma On the Thursday of week 5 you write a 2h30min 100 question MCQ (A-types, 4 options per
question) -- you need to do it pretty fast because there are some tough questions that you need
MCQ to ponder a bit. Then you do SACS (not sure what it stands for) that is all online in Path lab -
There is a google drive with some of the questions from the paper and their answers 1pm to 2.30, but most people finish in 45min. You get a situation of a Case and you answer
somewhere. Try to find someone who has it. Half the questions were on trauma but apparently questions on the case about management, what investigations you’d do, what is the most
they took those out. Apparently they don’t take them out for future groups. important problem to attend to at the time etc. At each step it’s like a ‘choose your own
adventure’ where you need to choose for example, ‘what four blood tests (out of these 10’ do
Rotation 2 you want to do? Then on the next page you get the answer of what tests you should have asked
for and then have to interpret the results. Make sure you WRITE down important information on
each screen as you can’t go back once you answer a section.

Rotation 3 MiniCex: (depends on what is in the wards and which consultants you get assigned)
● Dr Devar/Dr Omoshoro Jones/Dr Khan = HPB
CHBAH
● Dr Mistry/Dr Arain = vascular
GENERAL:
● Dr Saloojee = Upper GIT
● Dr Surridge/Dr Pattinson/Dr V Naidoo = Colorectal
 ● Dr Moore/Dr Miller/Dr N Naidoo/Dr Careira = ACS (literally anything acute) 6. Excision margins in a melanoma 0.75mm wide.
● Dr Puttergill/Dr Bombil = Thyroid
● Prof Cubasch/Dr Ndwambi = Breast 7. Patient with a 4x4cm thyroid nodule. You do an uptake scan and the nodule is ‘cold’. Patient
*these are what they are typically doing, but they can examine anything is euthyroid. What do you do? (bethesda classification -- Tirads 5 = thyroidectomy)
CASES WE HAD (each student gets 2)
1. Breast Ca 8. What lung pathology do mine workers get - pneumoconiosis I thought it was silicosis.
2. Diabetic foot/ALTI TTThanksT
3. Obstructive jaundice (HOP tumour)rrdesssedeees 9. Patient admitted after massive alcoholic binge. They gave you biochemi cal results and you
4. Sarcoma needed to recognise 1) this is a pancreatitis (eliminated the 2 other options 2) you needed to
5. Oes Ca decide Whether it was severe or moderate acute pancreatitis. (atlanta score or Glasgow-Imrie
6. PUD score.)
7. IBD
8. Cellulitis 10. Patient has thyroid storm during thyroidectomy - how do you manage
9. Thyroid - IV propranolol
10. CLTI
11. Diverticulitis 11. Post total thyroidectomy, what investigations would you do for your patient? Answer = 6
12. Rectal CA hourly serum calcium.
13. Anal condylomata
14. Hepatocellular carcinoma 12. 21 year old from Zim. One day vomiting of blood and clots and dark stool. Pale and
distended abdomen and shifting dullness. WCC 13.2 HB 6.4 MCV 64.5 platelet 74 . LFT normal
Rotation 4 CEX Cases: A. Gastric ulcer
1. Upper GI bleed B. Gastric varies
2. Oesophageal cancer C. Duodenal ulcer
3. Breast cancer D. Oesophageal varices
4. Thyroid nodule 7
5. Chronic limb threatening ischaemia (lots of it) 13. Patient has a mobile mass on their thigh 10cm by 5cm. Overlying skin is normal
6. Metastatic melanoma
A. Synovial sarcoma
B. Rhabdosarcoma
Keep in mind during covid they do not do elective procedures, therefore you are unlikely to get
C. Angiosarcoma
someone with an early cancer or a basic inguinal hernia.
D. Lipoma

Also keep in mind they can and do take you to clinic sometimes (Dr Murrigan does. As does
Prof Cubasch). 14. Patient had a coffee at 06h00. How many hours after a cup of coffee with milk can one have
an elective sequence induction?
MCQ exam questions:
● Fasting :
1. A patient with obstructive jaundice, T2 head of Pancreas mass. Management options: Answer - 2 hrs = clear fluids
is a Whipples (they put the proper name: pancreaticoduodenectomy) - 4 hrs = breast milk + other fluids
- 6 hrs = formula milk + light foods + other milk
2. What made a male patient at risk of indirect inguinal hernia. I think the correct answer was - 8hrs =heavy meal with fats
urethral strictures (peeing against resistance = increased abdominal pressure). · Therefore this patient can have elective sequence after 6 hours

3. Classify a breast Ca with peau d’ orange = T4d

15. Anaesthetic question: which induction agent would you use for a patient with a history of
4. Patient with a confirmed thyroid cancer and hyperparathyroidism on blood results (PTH was nausea and vomiting after anaesthetic? Options were midazolam, etomidate, Ketamine and
89, ref range was 0-<5). The thyroid cancer hinted at being medullary carcinoma = MEN-2a Propofol.

5. Classify a stomach ulcer (written description) by forrest classification 16. There were some trauma questions too. What urine output would you be aiming for in a
patient with crush injuries? 2-3ml/kg/hr (approx 200ml/hr)
 34. Man comes in 6 hours after POP was inserted, complaining of severe pain. Compartment
17. Child comes in with burns on eyelids, arms and trunk. What do you treat first syndrome, requires fasciotomy.

18. Granny comes in from a shack fire and is struggling to breathe, what do you do? Establish 35. Picture of baby with omphalocele
airway
26. Baby comes in with different BP in arms and limbs, legs paler than arms. Aortic coarctation
19. Person with parotid tumour infiltrating the facial nerve causing eyelid problems. Which
branch of facial nerve is affected 27. What will cause the worst vascular injury. Dislocation of knee, acetabular fracture etc

20. Really terrible CT scan with some kind of mass in the mediastinum and asked to identify it 28. Lady has a rash on her nipple, what is the most important condition to rule out? Paget’s
disease
21. Lady with previous TB completed treatment, now comes in with parotid tumour, what
management do you do 29. Oesophageal ca with hoarseness. Mass is located to the mid-thoracic region. What is the
mass compressing?
22. Obese lady with pancreatitis and you had to know the criteria in order to grade it moderate
or severe A. Right recurrent laryngeal nerve

23. Obese lady, diabetic, smokes, drinks and family history of digestion disturbances has B. Left recurrent laryngeal nerve
pancreatic cancer. What is the biggest risk factor in her

24. Picture of old granny with a massive tumour on her left breast. What is it? Giant 30. Child comes in the ED after drinking bleach, what do you do? Dilute with water, vomit back
fibrosarcoma, up, endoscopy NG tube
fibroadenoma, carcinoma
31. Patient with large abdoomen and coffee bean on xray, how would you manage them
25. Male patient has lump in breast, characteristics suggestive of malignancy, what is it?

26. Question about a neuroendocrine tumour removed from small intestine. Asked question SACS Exam
about which feature is correct for a NET tumour A patient presentedd with vomiting - initially it was a bowel obstruction type picture. What
investigations would you do? Then it became apparent he was in DKA with a pH of 7.1 and
27. Truck driver has pain on sitting and has a red, tender area leaking pus, what is it? Glucose of 32mmol/L - the blood gas said Glu was 2.3 - clarified with the examiner who said go
with the text not the picture of the gas. Really glad I asked because the follow up questions were
28. Young man has a 6mo history of diarrhoea and crampy abdominal pain, also has an anal about shifting potassium - give calcium gluconate before you give insulin to treat hyperkalemia.
fistula, what is it? Crohn’s
Our patient needed an amputation - needed to know wagner classification. Then admitted to ICU.
29. Parents of baby notice red currant jelly stool. Intussusception Some questions about ventilation - know that males typically use a 7-8.5 Fr tube, vent settings
are usually 6ml/kg ideal weight tidal volume.
30. Picture of a thyroglossal cyst. What is management. Remove sinus, tract and part of hyoid
bone Overall the exams were brutal and rude and even the best students left disgusted with the test….

31. Patient complains of pain and swallowing just before eating what is it? Options were salivary
gland tumour, sialectasis and 2 others

32. Describes a benign lesion of the liver. You need to know haemangioma is the most common
Rotation 4
benign lesion.
Rotation 4 information is integrated above, but I’ll add that our SACS was a really nice and simple
33. Describes cancerous lesion of the liver, you need to know HCC is most common. case about breast ca. They asked the standard things like what other cancers you are at risk for
with BRCA, how to counsel patients, risk factors, treatment etc. It was done in like 15 minutes on
the laptops in the Elab on Education Campus.
Rotation 5 Psychiatry
____________________________________________________________________________
_
Rotation 6

MCQ: some repeats from above, but very random. Mcqs integrated into questions above.
Rotation 1
If you are at Tara, word of advice, Ward 7 is a lot of work. You do not leave early, you get to
SACS: acute diverticulitis- investigations, interpreting a CT scan, interpreting a clerk a lot of patients but your ward mark will be low but you will be taught a lot. The regs and
cystourethrogram (to identify the fistula), complications, colovesicular fistula management everyone will teach you over and above your tuts.

OSCE stations we got at Helen: Update from rotation 3 - the ward 7 doctors want you to be in the ward until 4 (even though the
1. UGIT bleed- peptic ulcer bus leaves at 3!). If you show enthusiasm your ward mark will be good. You learn a lot and the
2. OJ ward 7 patients are really nice to work with.
3. Rectal cancer
4. Sigmoid volvulus MCQ exam
5. Thyroid with obstructive symptoms
● 50 questions. Mix of topics. Very similar to the questions in the self assessment quiz
OSCE/Mini-CEX at CMJAH: doc. I think these were the questions that were asked last year on the Sakai site.
1. Breast Ca (Phakathi) A few questions I recall
2. HOP mass (Bizos) ● Diagnose the difference between a psychiatric illness and a major NCD
3. CLTI (Khan) ● What are the side effects of methylphenidate
● What will you prescribe for ADHD
● Side effects of Lamotrigine
Rotation 7 ● What can you do to assess someone who has moderate intellectual impairment
● Can you treat someone who is having their index episode with ARVS as well
OSCE
● Child abuse, what are the tell tale signs you will see during an assessment
- This youtube channel is great for the OSCE: Universitätsspital Zürich. It seems like a lot
● Diagnose alcohol dependence
but the examiners genuinely expect a lot from you and they often want to know
● Borderline personality disorder
pathophysiology of conditions.

Rotation 2

MCQ
● There were 50 questions
● A lot of the questions came from that “self assessment quiz” document
● • Schizophrenia
● • Bipolar disorder
● • Anxiety disorders (know PTSD criteria)
● • Postpartum psychosis
● • Drugs in pregnancy and lactation
● • ADHD: know three different drug classes and their doses and their side
effects (also know this for the MEQ)
● • Delusional disorder
● • NMS treatment clozapine S/Ej
 ● • What is the first sign of lithium toxicity ? 2. A bipolar woman is 12 weeks pregnant and is poorly controlled on Olanzapine 10mg and
● • Know the medications given in withdrawals Lithium 800mg BD. What is your approach to the pharmacological management in this
● • Eating disorders (it was a question wanting you to know the difference patient? (Teratogenicity, dosage considerations, change agents)
between bulima and binge eating disorders) 3. A patient comes into casualty acutely intoxicated from cannabis. He is aggressive,
delusional, and actively hallucinating. Using the MHCA what is your approach to the
MEQ exam admission of this patient?
4 questions each counting 10 marks with a vignette and then a couple of questions under each 4. What are the psychiatric manifestations of cannabis use? (SUD, Intoxication,
vignette. Withdrawal, Psychosis, Anxiety, Amotivational Syndrome, etc) has
1. Thabo is an 8 year old kid with suspected ADHD (struggles in class, lags behind peers 5. Alternative question to number 4 was:
etc) - differentials for his presentation, physical causes that can lead to his symptoms, 4
features of the inattentive type, similarities between ADHD and bipolar.
2. Depressed 42 year old lady. Define positive diurnal shift, anhedonia, terminal insomnia.
Is it PDD or MDD? treatment approach -biopsychococial, which features suggest
depression.
3. Guy comes in with suicidal attempt but had bad somatic hallucinations - risk factors for Viva questions CMJAH
suicide, why was it most likely a medical condition causing his presentation, psych 1. A 21 year old patient presenting with psychosis, discuss approach to MHCA
symptoms d/t TBI, define malingering, conversion disorder, factitious disorder 2. A 11 year old child comes in with his parents he’s been hitting other children at school
4. Schizophrenic guy: what are the different psychotic disorders and differentiate them, how and destroys property, discuss your approach to this patient
will you increase adherence, approach after 2 failed antipsychotic trials, different S/E of 3. Bipolar female 12 weeks pregnant scenario as above
the atypical and typical antipsychotics. 4. What are the psychiatric manifestations of cannabis use (same as above)
5. Members of MDT and their roles
VIVA QUESTIONS AT BARA (Did my rotation at Tara) 6. Resistant psychosis definition and treatment
1) How do you admit someone who is intellectually impaired? Name the exact MHCA 7. ESPE’s
forms. Make sure to ask them if the individuals family was present for a form 4 8. Enuresis
2) Describe the lifetime duration of schizophrenia and how it continues from the prodromal
phase to the index, the mortality and the good and bad prognostic factors. Viva questions Bara
3) Someone who is HIV positive comes in confused. You have to say you want to rule out 1. Approach to ADHD
delirium and how exactly you would do that 2. Approach to disruptive behavioural disorders
4) Name the criteria for ADHD and how you would assess a 7 year old with his parents at 3. Criteria for substance dependence
your office 4. ADHD comorbidities
5) Alternative to question 2 that some of us got at Bara: A lady who was raped and 5. Pregnant woman on lithium and olanzapine, what is your approach
assaulted 3 months ago. Was irritable and struggling with insomnia since. What is your 6. Schizophrenia in young university male, discuss approach to MHCA
approach? They wanted you to go through the PTSD criteria.
Important extra documents for Psych:
1. Just the tips - psychiatry (has past MEQ and viva questions from many years)
MEQ - Same as first rotation, 4 questions for 10 marks each 2. Basic psychopharmacology
1. 65-year old male with features of progressive NCD and depression - List features 3. Pysch vivas
supporting Medical differentials for NCD, Investigations (2 haem max) to rule out 4. 2020 Psych Past Papers
medical causes, Approach to psychotropic prescribing in the elderly
2. ADHD - List all inattentive criteria, psychosocial management of ADHD, Comorbids of
ADHD,
3. OCD - Define obsessions & compulsions, pharmacological management of OCD, Rotation 3
Comorbidities, Lots of repeated questions from the Sakai Assessments
4. Schizophrenic patient on clozapine - Indications for clozapine, side effects that
negatively impact quality of life, MHCA provisions for admitting a patient against their MEQ:
will. Generalised anxiety disorder vignette
Viva Questions Tara 1. Differentiating between OCD/Adjustment disorder vs Generalised Anxiety disorder (4)
1. What is the pharmacological & non-pharmacological management of a child with ADHD?
 2. 6 substances causing anxiety as a withdrawal symptom (3) 19. 22yo female with history of TBI (Sakai)
3. Management of anxiety (2) 20. What features of depression are the elderly more likely to get. Cognitive disturbances??
4. Neuroanatomy [part of the brain] & Neurotransmitter most affected by Anxiety (1) 21. What features are suggestive of binging in Bulimia nervosa
22. Best treatment for ADHD
ADHD vignette (exact same as on Sakai) 23. Best treatment for Antisocial PD
1. 6 features of Irritability (3) 24. Patient with Psychotic features, need to make a diagnosis based on the timeline (2x
2. 6 features of Hyperactivity (3) questions, different scenario)
3. Exams and Tests required before commencing treatment (3) 25. An eating disorder patient with hypokalaemic alkalosis. What activity has she been doing
4. Neuro disorder worsened by treatment (1) to purge?

Schizophrenia (patient very negative, keeps saying “i don't know” Hi

1. 4 investigations to do for this patient and reasons why (only 2 are allowed to be blood Viva at Tara (same questions were asked at Bara)
tests) (4) 1) Difference between OCD and OC personality disorder. Also definition of obsessions and
2. Table comparing Schizophrenia & MDD (Affect, Cognitive behaviour, ?, ?) (4) compulsions
3. What antipsychotic would you commence and why? (2) 2) 9yr old child suddenly has a decline in school performance. What is your approach to
this child?
Alcoholic who has relapsed and is suicidal 3) Patient comes in aggressive and psychotic. Explain to the family the process of admitting
1. 6 risk factors that make this patient a suicide risk (3) him. Name the MHCA forms and their purpose
2. 4 signs of Delirium Tremens (2) 4) What is the difference between a patient with MDD and a patient who is in the
3. 2 Medications to manage alcohol withdrawal (2) depressive phase of Bipolar (helped to mention specifier, ie. with atypical features)
4. Questions to ask the patient to determine Alcoholic use disorder (3) Other question given to some students at Bara: indications and contraindications for
Benzodiazepines (as well how catatonic patients would respond to benzos) , approach to
MCQ enuresis (know treatment and be specific about type of therapy)
1. Mood stabiliser to use in a pregnant womenO
2. 21 year old female who recently broke up with boyfriend, features of depression since
she was 15, what is the diagnosis? (PDD, Borderline, etc)
3. Features differentiating Hypomania from mania (decreased need for sleep, grandiosity,
irritability, etc)
Rotation 4
4. What features of OCD suggest a poor prognosis Tara was very pleasant. Ward 1+2 is adolescents and eating disorders.
5. Drug withdrawal with features of piloerection and dilated pupils, what drug was it Ward 4+5 is psychotherapy wards for personality disorders
6. Man who sniffs glue brought in, what are features of inhalant intoxication Ward 6-8 are biological wards (schizophrenia, delusional disorders, dementia etc)
7. 67yo Male in a nursing home with a 1 year history of slowly deteriorating functioning. Ward rounds are on Mondays and Thursdays, and typically go from 9-11h30 or 12.
Neurocognitive
8. 80yr old lady who has a 3 day history of acting strange. Delirium Helen Joseph Hospital: you spend 2 weeks in the wards, 1 week in the emergency department
9. 35 yr old female complains of palpitations, dizziness & feelings of going crazy (Sakai and 1 week in consults.
question) Panic disorder
10. Bafana 27yo male (Sakai question) MCQs
11. Amotivation syndrome of Cannabis (Sakai) Very very few Qs came from the Sakai self assessment. Only 1 or 2 Qs.
12. Whole family smokes cannabis, what will you tell them about cannabis? Predisposes A few were from sakai. Some notable ones:
patients to schizophrenia 1. Regarding cognitive domains, which of the following represents impaired cognitive
13. MHCA: Involuntary patient can get review from board, assisted can consent to treatment function? Expressive aphasia, flexible thinking, selective mutism, and one other option.
& care, assisted patient observed for 72hrs 2. Knssźow the mental health care act well including voluntary users.
14. 8 policemen bring in violent patient (Sakai) 3. The different types of psychotic disorders
15. Hypochondriac question (Sakai) 4. 5) An eating disorder patient with hypokalaemic alkalosis. What activity has she been
16. 13 yo Child presents with features of anxiety. What is true. Depression common doing to purge?
comorbidity, child too young to have GAD, ? ? 5. 80yr old lady who has a 3 day history of acting strange. Delirium
17. Patient with symptoms of PTSD, what is the diagnosis? 6. Man who sniffs glue brought in, what are features of inhalant intoxication
18. Female patient with features of personality disorder. Borderline/Histrionic
 7. Enuresis family of stealing all his possessions and trying to poison him. The visit today was precipitated
8. Eating disorders (it was a question wanting you to know the difference between bulima by him not knowing where he was or the day of the week.
and binge eating disorders) On history you learn that he was diagnosed with schizophrenia when he was 18yrs and has had
9. alcohol dependence - pre-contemplation HIV for the last 12yrs. His family is aware that he visits the local clinic to get treatment for both
10. S/Es lamotragine - teratogenic conditions and he takes his medication independently. They also state that he has always used
significant amounts of alcohol and this has increased in the last two years.
1. How would you investigate this patient (25 marks)
MEQ 2. Supply a differential diagnosis for this patient and substantiate your decisions (25 marks)
4 questions, 10 marks each. 3. Discuss your treatment strategy for this patient using a biopsychosocial approach
(exclude investigations) (35 marks)
1) Borderline personality disorder and suicide 4. Discuss his prognosis - include further information that may help you assess this). (15
a. List risk factors for suicide in this case marks)
b. List 6 features of borderline personality disorder
c. What factors of borderline personality disorder would make you admit a patient? Viva - HJH
d. Biopsychosocial management 4 Qs in total chosen from 5.15 minutes total duration of viva.
The
2) Schizophrenic patient with residual hallucinations. 1. Kid has ADHD. What is your management?
a. What are the causes of residual psychotic symptoms in a schizophrenic patient on 2. How would you differentiate between the (negative symptoms of) schizophrenia and
treatment. MDD on Hx and exam?
b. Consider temporal lobe epilepsy in this patient. What are the features of TLE you would 3. What Qs will you ask a woman that you suspect has borderline personality disorder?
enquire about? 4. A woman just gave birth to a premature baby two days ago and is currently acutely
c. Why is an EEG not a reliable diagnostic test for TLE? confused. Discuss your management.
d. What investigations would you do before starting clozapine? 5. What psychiatric conditions can you get from cannabis?
6. 8 policemen bring in violent patient (Sakai)
3) 8 or 9 year old girl that refuses to go to school, worries about her mother, will not sleep 7. MHCA: Involuntary patient can get review from board, assisted can consent to treatment
without her mother, will not go to her best friend's sleepover. Is happy and cheerful at home & care, assisted patient observed for 72hrs
during during the holidays.
a. What is the most likely diagnosis? List 3 differential diagnoses. Viva @ Tara Hospital
b. What are the risk factors for the development of anxiety in a child?
c. What class of drug would you use for an anxious child? Name 3 side effects. 1. Discuss Conduct Disorder in children - asked definition, DSM V criteria, management
2. A 24 year old patient gives birth to a premature baby by C/S. 2 use days later, you are
4) Heroin user called to the ward as the nurses report that she is confused. What is your differential in
a. What are the features of heroin intoxication? this patient? How would you investigate?
b. Name 2 drugs you would use for symptoms of heroin withdrawal 3. What Qs will you ask a woman that you suspect has borderline personality disorder?
c. What are the features of heroin withdrawal? 4. There was a fourth question that I cannot recall right now - this question was similar to
d. Discuss the concept of Harm Reduction in the context of substance use q5 that HJH student got, it asked about the psychiatric manifestations of cannabis use
(acute and long term) - they hinted towards amotivational syndrome, and they wanted
you to explain that.
5.

Paper based Case Scenario

(In the third wave, there was no patient to clerk. We had scenario to discuss with 2 consultants).
Rotation 5
Scenario:
A 54 year old male is brought to casualty by his family with a six month history of a change in Bara Viva:
his behavior which has been getting progressively worse. They describe that he is short 1. Child with aggression
tempered, forgetful, distracted and has word finding difficulties. He loses track of conversations 2. Child with depression
and is sometimes socially inappropriate. Lately, he sleeps very poorly at night and accuses his 3. Borderline vs MDD
 4. MHCA - disease progression and prognosis
5. Pregnant lady with OCD - pt is gaining weight , why ?
6. Prognostic factors of Schizophrenia
3. 54 year old pt with HIV and schizophrenia. Also has a 6 month history of personality changes
Tara Hospital viva: , forgetfulness , speech difficulties and being inappropriate in social settings. Now came to
● dDx of an aggressive child hospital as he was disoriented . Also was exhibiting some persecutory delusions .
● MDD vs Borderline PD in terms of Hx and examination - 3 differential diagnoses and reasons why
● 29yo pregnant lady with OCD - Dx + Mx - biopsychosocial management
● MHCA considerations when admitting a patient with florid psychosis - what forms to fill
out 4. 25 y/o medical intern was found in the doctors quarters singing and dancing and saying that
she was moving to Hollywood to marry John Legend . There was crystal meth paraphernalia
MEQ found in the room . She admitted to using it initially to help stay awake and then having to use it
Cannabis use disorder (including other terms asked to define like medical marijuana, daily . She also had a previous episode of depressive symptoms after her boyfriend left her .
amotivational syndrome), aggressive patient, delirium, approach to school refusal - 3 differential diagnoses and reasons why
- forms used to admit involuntary pt
- risk assessment

Rotation 6 Viva (Bara)

- How would a person with borderline personality disorder present to casualty?
Viva (Bara) - Approach to a 36yr male presenting with a 5 day history of auditory and visual
Approach to HIV delirium vs Psychotic Disorder secondary to HIV hallucinations and irritable. He's hiv positive on treatment.
Approach to child who is disrupting class - ADHD - 21yr male with schizophreniform disorder, approach to choosing an antipsychotic agent
The criteria for alcohol use disorder (impaired control, social and risky use) - Criteria for PTSD
Counsel the family of a schizophrenic patient on course of disease, good vs bad prognostic
factors Viva at Tara
Consel father of bipolar patient who was initially admitted as involuntary then wants to take son 21 male with schizophreniform disorder, approach to choosing an antipsychotic agent
to traditional healer (appeal process etc) 10 year old boy with 3 months history of behaving badly and doing poorly at school. There is a
history of divorce ( similar to HJH)
MEQ 36 year old male with 5 day of auditory and visual hallucinations and irritable. He is on HIV
Adjustment disorder vs MDD treatment, approach
Admitting a psychotic patient who refuses treatment under the MHCA Approach to eating disorder
Dementia vs MDD
A child with ADHD
VIVA at HJH
Almost the same as at Bara , however , we didn't get the schizophreniform question , instead ,
we had a child psych question. It was something like a 10 y/o boy comes in with a 3 month
Rotation 7 history of behaving badly and doing poorly at school . There is a recent history of parents getting
divorced . What is your approach ?
MEQ
1. Enuresis
- 6 questions to ask on history
- 2 different types of drugs and their MOA
- non-pharmacological management + complications

2. Pt with Schizophrenia who was in hospital for 6 weeks and is currently on olanzapine 15mg.
- aetiology of schizophrenia
- risk to other siblings
 Emergency Medicine
____________________________________________________________________________
_

Rotation 1
A really nice rotation that you’ll certainly enjoy. Lots of practical work to do. The OSCE on the
last Friday of the block is really simple, and they’ll usually tell you exactly what is coming in it.
I’m pretty sure it will be the same in for all rotations, our 3 stations were: BLS (adult CPR with
defib), a choking infant, and a Bag-Valve-Mask. The short courses (AIME and BLS, mostly BLS)
cover everything you need for this OSCE, but you’ll also be fine if you haven’t done them yet.
Attached are the rubrics we used for studying purposes which were really helpful. Can’t
guarantee they’ll be exactly what is used to examine though (and they are slightly outdated -
esp. the way in which you get a seal with a BVM). Also know features of high quality CPR, as
well as reversible causes of cardiac arrest (H’s and T’s).
 c. ?
5. Absolute/relative C/I for thrombolysis
a. Stroke within 3months
b. SBP over 180
c. Aortic dissection
6. Choose correct answer regarding PCI
a. Must be done within 60-120 mins
b. Must be done after thrombolysis
c. 2nd line in elderly patients
7. Pt with asthma attack being nebuliser but showing no signs of improvement -
next drug + dosage to be given.
a. Hydrocortisone 200mg
b. MgSO4 1mg
c. Prednisolone
8. Pt went into cardiac arrest in front of you - showed ECG strip. What did the ECG
show? (I think it was vfib)
9. Immediate management of the above
a. Early defib
b. ?
10. Dose of sodium valproate loading dose
a. 20-30mg/kg
11. PAWPER tape - which is false
a. Made in south africa
b. Improvement of Pawper XL
End of term 1 MCQ: c. Goes from 2kg to 47 kg (may have the values wrong but this one was
true)
[PSA - I'm not 100 % sure that these questions are accurate as I could be mixing them 12. Anaphylaxis is least likely to be associated with:
up or remembering wrong] a. asthma
b. eczema
1. Dosage of lorazepam c. SLE
a. 0.2/kg d. Atopy/allergic rhinitis
b. 0.1/kg 13. CPR in an intubated pt
c. ? a. Give breaths every 6 seconds
2. Dose of adrenaline in 6 year old with anaphylaxis b. Rate of 30 compressions to 2 breaths
c. ?
a. 0.5mg IV
b. 0.5mg IM 14. CPR in a teenager
c. 0.3mg IM a. Max of 100 compressions per minute
d. 1:4 nebulised b. Rate of 100-120
3. Child presenting with acute stridor, in tripod posture and drooling - most likely 15. Management of symptomatic brady
a. Adrenaline
cause?
b. Atropine 1mg
a. Forein body
b. Epiglotitis c. Early CPR
c. Croup d. Transcutaneous pacing
d. Tonsillitis 16. Asthma characteristics include i. Increased bronchi lumen diameter/Bronchiolar
4. Best anti-epileptic to use to stop or prevent seizures in eclampsia? oedema ii. Increased thick mucus production, iii. Bronchiole constriction, iv.
Resistance to air flow
a. MgSO4
b. Phenytoin a. Combinations of different options
b. “ “
 c. “ “ In a choking infant the scenario was at a braai so remember to ask someone to phone the
d. All of the above ambulance before you start giving backslaps etc. When they tell you the ambulance arrives then
17. In a cricothyroidotomy you can ask for a laryngoscopes, oxygen, suction, bag mask ventilator, magille forceps.
a. Children over 6 have a well developed membrane Also for a choking infant use two fingers if you’re alone and use the thumb circling technique if
b. Needle cric always done first you’re with someone.
c. Landmark is between cricoid cartilage and thyhroid cartilage
d. Can only be done by an experienced surgeon In the CPR/defib station remember to feel for the pulse if the rhythm changes
18. LECG of brady and you are called to the patient bed, he is pulseless, first e.g. you first assess it to be a V Fib so you shock and do 2 minutes of CPR and attach your
management? leads etc. When you reassess it has changed to an organised rhythm so feel for the pulse
a. CPR before continuing CPR. If it changes to asystole then you don’t have to feel for the pulse
b. Defib because obviously it won’t be there.
c. ? Make sure you feel for at least 7 seconds.
19. Which leads show the lateral heart
a. V5, V6, II Look for a patient with STEMI, asthma, seizure, organophosphate poisoning and DKA and find
b. V1-V4 how they were managed to complete the ED orientation quiz.
c. Other combinations
20. Which industry does not use organophosphates Rotation 4
a. Mining Same stations as before, but we were warned the Hypoglycemia is no longer a part of the Hs
b. Medicine and Ts
c. Farming OSCE is on the last Friday of the block.
d. Chemical warfare
21. Which is not a muscarinic symptoms of organophosphates
a. Myadirasis
b. ?
Rotation 5
22. In RSI
a. Insert laryngeal blade as soon as muscle relaxant is given TMH - With regards to the rotation, it was very pleasant to be at Tambo Memorial. The ED there
b. Wait for the patient to fall asleep before giving the muscle relaxant is new and well-stocked with everything except gloves (HA!). So take some of the uume ones
23. In organophosphates cos otherwise you’re using sterile gloves (expensive to taxpayers). Depending on the hospital,
a. The cholinergic receptors (maybe it was a different one) cause urinary you will need to document everything you do and every patient you see, as some ED’s are
retention busier than others and they set a clear goal of 20 patients minimum and 40 procedures
b. Neuromuscular junction blockade causes paralysis minimum.
c. The last 2 options were about effe ts on nicotinic and one other receptor
24. Showed an ECG The lectures on Ulwazi/Sakai are enough for about half of the questions that come up in the end
a. Mobits type 2 of block exam. Keep in mind your ABCDE’s. Most questions there was a very clear “this is the
b. Wenkenbach phenomenon logical next step because of ABCDEs”. There was a fair amount of AIME and BLS smuggled in
c. 2 other options as well. Principles of airway management and RSI etc.

Organophosphate poisoning (know the Muscarinic effects “Dumbells” and nicotinic

“MTWTF”). Know emergency management (atropine 2-3mg stat, double every 5minutes until
Rotation 2 atropinisation. Then give infusion at 10-20% of the total Atropine)
ACS - asked about the adjuncts and following the algorithm, showed ECGs, and wanted you to
identify when to act on things.
Anaphylaxis Need to know the doses of Adrenaline. Adjuncts to management.
Rotation 3
Asthma → know the criteria of what is considered a mild/moderate/severe attack (HR, FEV1, O2
We had the same 3 stations in rotation 2 as in rotation 1.
Some feedback they gave us post OSCE/some common mistakes: sats) and how to manage at each level
MCQ (10 Sept): (25Qs)
Rotation 7
1.Which of the following is not a nicotinic effect of organophosphate poisoning:
Diarrhoea (this one) Rotation 8
Mydriasis
Tachycardia

2.Which of the following is not part of the ACS classification:

Stable angina (this one)
Unstable angine
NSTEMI
STEMI

3.Which is not an adjunct therapy in STEMI:

Alteplase (this one)
Aspirin
Clexane
Clopidogrel

4.With regards to Anaphylaxis, which of the following is correct:

IgE-mediated (this one)
IgM mediated
Mast cells are not involved
Serotonin is released during anaphylaxis event

5.ECGs: 3 questions with ECGs in them:

1. There was a monomorphic Ventricular tachycardia -- had to identify what it was.
Asked a followup question about the ECG above - What is the next appropriate management?
The answer was to defib. The three other options all had you faffing about setting up infusions.
2. Young man comes in after a “night out” → narrow complex QRS tachy → supraventricular

tachycardia

3. Wenkebach phenomenon (Mobitz) → p-r interval gets longer, longer, then a missing

QRS, then normal. Showed you the ECG and asked you to identify what it was.
6. What is the intermediate syndrome in OPP?
07. In status epilepticus, would you first secure the airway or give drugs to stop the
seizures first?
8. Dose of phenytoin in status epilepticus.
9. If you can’t give dextrose IV, what other routes? IM or buccal or IN or rectally ?
10. When do you use a bougie? When it is courmack lehane ⁵.

Rotation 6
 4. Case on hypertension (what important questions to ask on history, which important
Anaesthetics investigations can be done name 3, management principles)

____________________________________________________________________________
_
Group 3B
1. Oral: RSI vs ESI, also asked alternative drugs that you could give with dosing and CIs
● EXACT same osce as file named “Anaesthesia 2. Local anaesthetics calculations and what you can do make the onset faster
3. Identify LMA and reservoir bag, uses of reservoir bag and advantages and
disadvantages of LMA
Rotation 1 4. Case of elevated HR 30 mins into operation, everything else stays the same. What are
the possible causes (2) what to use to ID the actually cause, management of the causes,
OSCE Group 6E multimodal analgesia three different drugs
1. Local anaesthetic calculations and CNS toxicity
2. Asthma - airway changes, questions to ask on history, medications that are
contraindicated
Group 3C
1. Oral - RSI in a stabbed abdomen with normal pulse, BP, and potassium
3. Questions on sats and CO2 absorber(soda lime) 2. Local anaesthetics calculations & how to 4 methods to prevent toxicity
4. Oral Station - ESI method / 3. Investigations to confirm IHD (ECG), 2 things you would see, 4 other investigations,
Previous group had questions on Capnography and hypertension. features of angina that would increase your concern, 2 important stimuli and how you
would blunt them
Rotation 2 4. 3 IV Induction Agents (Ketamine, Propofol, & Etomidate), Benefit of each over the
OSCE 5A:OJ others, dosages, contraindications
1. Muscle relaxants (rocuronium & atracurium) > doses & which is CI in asthma (why)
2. Oral station: RSI Rotation 1 and 2 Anaesthetics MCQ:
3. Pregnant diabetic patient & complications/concerns with diabetes
4. Local anaesthetics calculation (lignocaine with adrenaline & Bupivacaine) 1. HIV + patient on ritonavir, which drug can you give? Don't remember the case details
OSCE 5&6 C: a. Morphine
1. Local anaesthetic calculations (toxic doses) & 4 ways to prevent reaching toxicity. b. Fentanyl
2. 3 drugs given (propofol, etomidate and ketamine): what class of drugs are these? What c. Midazolam
are their doses for induction? One advantage of each over the other 2? One d. Pethidine
contraindication for each.
3. Patient with ischaemic heart disease. What investigation would you like to do in pre-med 2. A man comes in for an elective surgery to remove lipoma. His BPs are measured to be
to confirm this? (ECG) and what features of IHD would you look for (2)? Other consistently over 180 SBP. For how long should the surgery be delayed to control BP?
investigations to do (4)? What effect would your anaesthetic have on this patient and a. 2 weeks
what would you need to be cautious about? (4) How would you blunt responses to b. 4 weeks
different parts of the anaesthetic? c. 6 weeks
4. Oral station: Emergency laparotomy for stab abdomen. Explain the anaesthetic process d. 8 weeks
you would do. (an RSI)
Rotation 3 OSCE: 3. How can you help prevent post dural puncture headaches?
1. Know when to apply cricoid pressure and when to release in RSI. a. Use a small pencil point (Whitacre) needle
2. Know what adjustments are done to the ventilator machine once you have connected the b. Use cutting end hole (quincke) needle
machine and the tube (e.g lower the O2 levels etc) c. ?
Group 3 A d. Ask the patient to lie in left lateral afterwards
1. Local anaesthetics calculations and cns toxicity
2. Oral station, patient with bowel obstruction going in for a laparotomy (RSI) 4. Which agent reduced PONV
3. Capnography, know all the graphs from the book and all examples a. Propofol
b. Halothane
c. ?
 14. C/I in pt with seizures - ? enflurane
5. Colour of oxygen tube 15. Can be used for analgesia - Nitrous oxide
a. Black 16. Causes diffusional hypoxia - ? nitrous oxide
b. White
c. Blue Regarding muscle relaxants - (options atracurium, suxinylcholine, rocuronium, vecuronium)
d. Yellow 17. Is a depolarising agent - sux
Clearance won't be affected in pt with hepatic or renal dysfunction - atracurium
6. Which of the following is a sign of a difficult Airway 18. Causes myalgia - sux
a. Receding chin 19. C/I in asthma - atracurium
b. Thyromental distance of more than 6.5cm
c. Incisor gap of >3cm 20. Choose incorrect answer about capnograph
a. Can tell you accurately about cardiac output
7. Increasing end tidal CO2 over time indicates b. Accurate information about oxygenation
a. Cardiac output gradually decreasing
b. PE
c. Asystole
Rotation 3
d. Hyperventilation (maybe the option was hypoventilation?)
Rotation 3C
8. Choose pt that can undergo an ESI (it was based on the last meal eaten) for operation HJH: meet in front of the Anaesthesia department at 7:30. You’ll get your logbooks and charts
at 08:00 and orientation from the consultant Dr Georghiou. The first week is at HJH and the second week
a. Diabetic ate at 22:00 is at RMMCH.
b. Child drank orange juice at 05:30
c. Child drank human milk at 06:00 OSCE
d. Renal failure patient ae at 22:00 1. Oral station: 34 year old male, gunshot wound to the abdomen going to emergency
laparotomy, what is your anaesthetic plan? describe RSI
9. Agent used in multimodal analgesia 2. 63 year old male with a family history of ischaemic heart disease. Complains of angina.
a. Dexamethasone What investigations would you do to see if there’s ischaemia? What blood tests? What
would you avoid intra-op? Tachycardia and low blood pressure
10. Side effect of ketamine 3. Etomidate, Ketamine and propofol. Doses, contraindications for each, advantage of each
a. Salivation 4. Calculates of local anaesthetic, ways to avoid CNS toxicity

11. Malignant hyperthermia ( i think they asked which was inappropriate)

a. Deepen the anaesthesia
b. Send to ICU Rotation 4
c. Stop the operation
d. ? MCQ
What would do for pre meds on a man with ischemic heart disease?
12. A patient sustained a 10% burn a week ago, they were given propofol for debridement of Choose a drug which is used as part of mulitmodal analgesia?
wounds. He has bronchospasm. He is then given sux. He goes into cardiac asystole. Which drug predisposes you to seizures?
What is the most likely cause Which drug causes diffusional hypoxia?
a. Hypoxia
b. Anaphylaxis How often do you record vitals on an anaesthetics chart?
c. Hyperkalaemia Which colour pipe is the nitrous oxide?
d. ? What drug is used to treat a high spinal?
How do you know the ETT is in the correct place?
H0ow do you treat hypersalivation in ketamine? (anticholinergic)
Regarding volatile induction agents - Agent to treat PONV?
13. Lowest MAC - ? halothane
Rotation 5 4) Patient for emergency laparotomy, expected to realise it is RSI and interpret potassium level
as being safe for Succs. Describe all the steps and mention the drug doses as well

OSCE:
1. Oral - Explain the RSI sequence Rotation 7
2. Calculate the L/A Toxicity doses in mg and mL. Name two preservatives we add to L/As OSCE Group 8D
and explain their mechanism of action/how they help. 1. RSI- drugs, dosages, contraindications, alternative drugs
3. 53 yr old female, Diabetic ppt on metformin. 2. LA calculations and 2 additives that can be found in LA drugs
a. What difficulties do you anticipate in securing the airway? 3. Given 3 muscle relaxants- which one contraindicated in asthma
b. What advice would you give the ppt in terms of preparing for the op in Light of her 4. Diabetic patient- pre op considerations, airway difficulty to be expected, optimising
being diabetic? patient and management principles
c. How would you manage the ppt the day of the operation in light of her DM
4. They put three bottles of muscle relaxants. Group 8E
a. Name the class of drugs. (Non depolarizing muscle relaxants) 1. LA calculations and Signs of toxcicity
b. How do they get eliminated from the body? 2. Given a spirometry probe and cylinder with the soda lime. Asked questions regarding each
c. Which one do we not use in asthma and why? (identify; what is their purpose) - when will Sats be inaccurate. What is the point of the
soda lime (function etc)
OSCE 3. Asthma patient for electie surgery. Questions asked on what is asthma; airway concerns.
1. ORAL- Describe Esi. What questions to ask on Hx. Then asked in terms of Bronchilator reversibility - would
- Know alternatives for induction agents and muscle relaxants as well as dosages. you delay surgery - why? What drugs are contraindicated in asthmatic patients. Why?
2. Calculate dosages of LA in ml and mg. 4. Active Station. ESI for a patient with controlled hypertension. You were then asked (if not
- What 4 actions can increase the onset of action of LA? stated) his ASA status. Things to avoid (ie Ketamine). What is important with GA and
3. Identify a reservoir bag and an LMA. hypertensives (MAP in the ward etc).
- List functions of reservoir bag.8
- List advantages and disadvantages of LMA.
4. Case- 30 mins into procedure patients heart rate increases.
- List 2 possible causes. Rotation 8
- What machine will help you differentiate between the causes? OSCE
- How will you manage the causes? 1. IV induction drugs (propofol, ketamine, etomidate) - dosage, contraindications and one
- Name 3 agents of different classes that form part of multimodal pain benefit over the other two
management. 2. Local anaesthetic calculations. On local anaesthetic, what 4 precautions can you take to
prevent toxicity? (You can find this in the anaesthetics book)
OSCE Group 2C: 3. Ischaemic heart disease
1) Patient with angina and possible Ishcaemic Heart disease 4. Active station: describe RSI in a healthy patient. We were also asked what other drug
a) What investigation would you use to confirm the IHD can be used instead of Sux and when you apply cricoid pressure
b) What 2 things will you see on this investigation to confirm disease
c) What other 4 investigations would you like to do
d) What can you do in theatre to blunt hypertensive response to intubation?
2) Gave you Propofol, Etomidate and Ketamine
a) What class of drugs are these (Induction agents)
b) What do each of these have an advantage of over the other 2
c) What is one contraindication for each of these besides allergy
d) What are their dosages
3) Calculations:
a) 1% Lignocaine in patient who is 10kg (expected to realise it is a Paediatric patient) Mg
and ML answer
b) 3% Bupivicaine and patient who is 30kg (again it’s a paediatric patient)
c) What 4 things can you do when injecting local anaesthetic to prevent toxicity?
 2. Which of the following scenarios best represents community participation when starting a
Public Health diabetes mellitus screening programme in the community
a. Fund already existing organisations
____________________________________________________________________________ b. Get people in the community to plan and organise
_ c. Have a town hall meeting and tell the community your plans
3. Which of the following is not secondary prevention when a man comes in for an STI
All groups will be told not to bring our BP cuffs or stethoscopes or to touch patients but rather to a. Contract tracing and treating sexual partners
just observe. During the home based visits we realised it would actually have been very useful to b. Treat for HIV using PEP
have our equipment. Many patients want to have their BP measured or for example have a cough 4. Tertiary prevention example ina man with hypertension
and need someone to listen to their chest. You could really be helping the community if you bring a. Send to opthalm for regular checks of his eyes
your equipment and the nurses and CHWs encouraged us to examine and assist patients during b. Start screening all people over 40 for hypertension
home based visits. 5. Which is true
a. The government is working on a plan to have national health care system for
You can take one set of scrubs for the hospital day visit - however the point is not to go with a everyone
‘clinical mindset’ but rather to go with a public health mindset. It’s more about interviewing patients b. Some other options
and hearing their stories than solving a clinical problem. 6. Malaria prevention
a. Training people to use quinines will not be helpful (something like that with one of the
It was a really nice block, but also hard work. It is not a vacation. You have a pp presentation and outdated medications)
long question test at the end of your 2 weeks. 7. Which of the following is least likely to be a social determinant of health
a. Where the boy was born
In terms of the accommodation - you will be staying at Caravilla at the Wits Rural Campus Facility. b. The fact that he is male
There is a massive kitchen (and a separate Halal) kitchen. Two fridges (one wasn’t working) but c. The fact that his mother is unemployed
the other is an industrial sized fridge so it works fine. Bring things you prefer to have there (eg a 8. Which of the following is not a WHO building block for health systems
Nutribullet if you are a health freak) but the rest should be covered. Rooms are equipped with a. Accurate information
desks and bunk-beds - decent bedding and pillows but take your own if you REALLY want to. b. Advocacy
Personally thought it was fine. Big shared bathrooms, cleaned and supplied every day. There is 9. Which forms part of a DCST
also 2x washing machines and a dryer in case you want. a. District specialist paediatrician
b. Paediatric consultant
c. Paediatric nurse
10. Which is false
Rotation 1 a. Health care is free in clinics for the poorest of the poor
b. ?
TEST 25 marks: 11. South Africa has a quadruple burden of disease, not a triple burden of disease like other
Long Questions: countries. This is because
Know PH principles a. Violent crime is very high
Know AIM( PH approach) b. HIV prevalence is high
Know public health system and Ottawa charter 12. In terms of health expenditure
They will ask you about this in combo with your experience in BBR. a. Health expenditure directly correlates to better health outcomes (false)
Not a difficult test but just make sure you don’t get confused. b. Can’t remember the other options
13. Primary health care is
MCQ a. Only delivered by nurses
1. Which of the following is not part of access b. First point of care
a. Affordability c. Referral system for hospitals
b. Availability d. A philosophy of equitable access to health care
c. Acceptability
d. ? In general the questions were not as straightforward as they are written here. They were very
wordy and confusing. A lot of “most likely” and “least likely” so read carefully. In many questions
it would say “Which is true '' and then give 4 fairly long scenarios as the options.
 Individual assessment same as above (but our focus was maternal health instead of respiratory
Rotation 2 diseases)
Rotation 3
Individual assessment same as above (focus on cardiovascular disease)
Test 25 marks
Know PH principles
Know social determinants of health Rotation 5
Know building blocks Rotation 6

Rotation 7
Individual assessment same as above (focus on occupational disease)
Rotation 4
Rotation 8
Trip to bushbuckridge was cancelled due to Covid so we had online lectures instead. Generally Same as above but the focus was on Maternal Health
2 or 3 lectures a day on teams, they can be quite long. We had one outing to the community
clinic/community health care worker visit.

INDIVIDUAL ASSIGNMENT (done online):

1. Give 2 examples of determinants of health for respiratory disease from your site visit and
explain them (4)
2. Say what type of determinants they are(1/2)
3. Explain how the determinants impact the community (4)
4. Give an indicator to measure the burden of disease.
5. For respiratory disease describe an intervention that already exists to improve health for
respiratory disease. How is it intended to improve health?
6. What sort of intervention is it in relation to the three interventions of public health?
7. In what service delivery platform is your intervention provided?
8. Name a building block that makes this intervention more challenging? And explain.
9. What intervention would you suggest adding and how?
10. Is the intervention feasible. If not why?
11. Describe one positive thing about health service quality in the district you visited
12. Describe one negative thing about health care service accessibility in the district
13. One indicator to monitor quality of health services.

Individual assessment same as above (but our focus was maternal health instead of respiratory
diseases)

Individual assessment same as above (focus on cardiovascular disease)

Rotation 5
Rotation 6

Rotation 7
Individual assessment same as above (focus on occupational disease
 Obstetrics Gynaecology
____________________________________________________________________________ ____________________________________________________________________________
_ _
Rotation 1
Rahima Moosa:
● Day 1
Rotation 1

Rotation 2 MCQ

Rotation 3 ● doctor
● Side effects of oral oestrogen
Rotation 4 ● What contraception to give in heart valve and hiv patient no
● TOP laws
Rotation 5 ● Order of puberty m
● SCC cervix most common HPV type
Rotation 6 ● Recessive condition facts eg 1 in 4 chance of child being affected with heterozygous
parents
Rotation 7 ● Nerve innervating medial thigh and causing adduction
● Side effect of injectable progesterone
● What would make vaginal hysterectomy difficult
● Dose of acyclovir in HIV positive
● When to stop HRT before surgery
● When to stop clexane before spinal anesthesia
● What is not cause of discharge in 7 y/o
● What hormone not raised in PCOS: FSH
● Dose and route of administration of mifepristone and mechanism of action: 200mg PO,
followed by misoprostol 24-48/36-48 hours later at less than and greater than 9 weeks
gestation respectively
● Early cervical cancer and fertility sparing treatment: radical trachelectomy
● Previous appendectomy now infertility what investigation
● CA-125 raised in what conditions -endometriosis, PID, liver disease
● Uterus at umbilicus, missed 3 periods, little bit of pain and PV bleeding -differentials
● How often pap smear in HIV positive
● Treatment of precocious puberty: GnRH analogues
● Highest prevalance of FGM
● Treatment of ovarian cancer- do you do pelvic lymphadenectomy?
● Turners syndrome question
● Intimate partner violence
● Do you give antibiotics at time of surgery, and whi
Molar pregnancy
- Ultrasound
- Types
- Follow up
- Management
Female genital mutilation- know WHO types and short and long term complications. Also know Given a U/S picture and told to identify. Is there a foetus? What’s first line mx? What hormonal
the name of the surgery required. assay helps in diagnosing? How would you follow them up and what do you tell them regarding
Galactorrhea pregnancy/contraception? What do you do if it persists?
- drugs that can cause it - PID
- Complications Give a regimen for the outpatient tx for it (name, dose, duration)? I can’t remember the other
- Name of tumour associated with galactorrhea questions for this station
Post menopausal bleeding - Imperforate hymen
- causes What does this condition present with? What other condition presents like it? What would the
HGSIL-investigations and treatment hormone profile for a patient like this be? What would their chromosomes be?
Infertility- 6 things to investigate for - Stress urinary incontinence
Vulval warts- what causes them, prevention, additional tests to doc Define frequency and nocturia? What conservative mx is there? What investigation would you
Surgical site infection- wound care after do prior to surgery?
- HGSIL on cervical smear
What is the next step (colposcopy) and what would you find for this lesion? What treatment
options are there for this patient? (5 is) how would you follow this patient up?
- MEC for contraception
Describe the MEC categories. If a well controlled epileptic patient wanted to go on COCs what
Rotation 2 factors need to be considered with them? (5)u
MCQ

Obturator nerve injury and what action it affects at the hip joint (adduction, abduction)
When to stop HRT prior to surgery (4 weeks, 6 weeks, 12 weeks)
Rotation 3
Complication rate of laparoscopy
- 1 in 100, 1 in 500, 1 in 1000 OSCE
Sequence of events in puberty
- Menarche, pubarche, axillary hair development, I can't remember the stations in their correct order or remember absolutely everything but
Risk of recurrence of an autosomal recessive condition in heterozygous parents (1:4) hoping someone will fill in the gaps :)
Benign conditions that can raise CA125 levels
1.Benign ovarian cyst.
Patient had pleural effusion as well.
OSCE a) What do you call the combination of this? Meig's syndrome?.
This is what stations and questions we got in our OSCE: b) How would you treat this?
- Endometriosis 2. Intrauterine pregnancy
a) What would you see on ultrasound to confirm i) intrauterine pregnancy(2) ii) ectopic
Given symptoms and asked to give a likely diagnosis. Asked to identify a picture of a chocolate pregnancy (2)
cyst and describe the abnormality in the ovary. How different manifestations lead to infertility. b) I can't remember this one
- Abdominal distension (ascites) and an ovarian tumour in a 70 year old. Asked what’s the c) what investigations would you do to confirm intrauterine pregnancy
likely diagnosis if there’s no GIT or renal pathology. What investigations would give you a d) What blood investigations would you do in early pregnancy
diagnosis (6). What you would consent the patient for in a surgery. 3. Female genital mutilation (Type III)
- VVF a) What procedure is being shown in the picture and when do you do it ? Deinfibulation was
Given a picture and asked to identify. What obstetric causes lead to it. What gynae causes lead the procedure.
to it. b) At what point or age in a woman's reproductive life would you do this procedure?
- Post menopausal bleeding c) What further investigations would you do in this patient
8 causes of PMB. List in a stepwise fashion the work up for it. d) How does this impact on a woman's gynaecological health/management?
- Complete mole 4. An ABG that we had to interpret
a) What sinister features are there in the ABG (5)
b) How would you resuscitate this patient (5)
5. Patient comes in complaining of ……… Her doctor told her she has secondary - Causes of cervical incompetence
dysmenorrhea. - What defines need for cerclage
a) Define what secondary dysmenorrhea is - Causes of recurrent pregnancy loss
b) What conditions can cause this (5) - Male causes of infertility (CF)
c) Forgot what the next question was - Teratogens and effects
6. Patient diagnosed Ca Cervix stage 4a I believe - When is a teratogen most likely to affect the baby
a) What is meant by Ca Cervix stage 3b? - Treatment of pcos
b) What is Ca Cervix stage 4b? - What does invasion mean in choriocarcinoma
c) What is the name of the pain management approach used in cancer patients and - What bacteria is not cured in pregnancy
describe it (5)? WHO stepwise approach. There are 4 steps in it. - What std causes pain and grey vaginal discharge
7. A picture of a breast. She presented with 'flu-like' symptoms as well. I have no idea what it - Picture of ovarian mass - is it malignant or benign
was. - Girl comes in with abdo pain - see cyst on ovary. Is it malignant or benign
a) What is your diagnosis? - Treatment of micro invasive HSIL
b) What organism commonly causes this? - When to stop HRT before surgery
c) What management advise would you give? - 1 day post lap scope for ectopic now loin pain and flank pain no fever. What’s the cause
d) It then becomes exudative. What do you think happened/what pathology did it progress - Treatment of endometrial hyperplasia on tamoxifen
to and give 2 features of this pathology? - Benign causes of ulcers (hpv, primary syphilis, herpes,ulcerative colitis)
8. A picture of an organism. Make sure you look up what T. Vaginalis looks like. It's a flagellate - Which isn’t a cause of dysparunia (ibd)
protozoa. - What doesn’t arise from Müllerian duct
a) What is the organism? Trichomonas vaginalis - Benign cysts/growths of vulva/vagina
b) What presenting signs/symptoms are associated with the pathology caused by this - Order of puberty
organism? - Blood supply of uterine artery
c) What bedside investigation can you do to confirm diagnosis? - Nerve injured in surgery - parasthesia on lateral thigh and Mons pubis
d) What other organisms can give a similar presentation? - Treatment of endometrioma
9. A patient presents with hyperemesis gravidarim - MOA of mifepristone and misoprostol
A. 4 causes - Qualifying for medical management of ectopic
B. 4 investigations - Common organism for PID
C. 4 complications - Classify miscarriage according to type
10. Pic of vaginal warts (I think hpv) - Mrkh
A. What is this - What doesn’t cause galactorrhoea
B. What organism is responsible
C. What primary preventions are there to stop it 1. A girl is pregnant after taking emergency progesterone contraception. Is it
D. Where else in the body can it go? teratogenic, what will your management be? Second trimester sonar vs reassure vs
first trimester tests vs terminate?
, MCQ 2.
32 What type of vaccine is the HPV vaccine? Live attenuated vs
- Hormones in PCOS inactivated whole virus, vs L1 protein. (I think it’s L1 protein)
- Frequency of Papsmears in HIV + 3.
- Which isn’t true in turners syndrome (xx karyotpe) Type of ovarian cancer if you have a BRCA mutation. -papillary
- Androgen insensitivity which is false (xx karyotpe) serous adenocarcinoma ?
- Causes of childhood PV bleeding 4.
- Treatment of childhood PV bleeding Azoospermia, what will ensure pregnancy? Donor sperm vs steroid
- Lichen sclerosis which is true (I think that it’s premalignant) treatment vs exercise.
- Causes of a vulval itch in an incontinent patient 5.
- Rectocoele risk factors Increased BMI is a risk factor for which cancer? Endometrial vs
- Laws of abortion ovarian vs cervical vs vaginal.
- What do you need for consent (voluntary, capacity, understanding etc) 6.
- If something is 1/500 risk is this common, uncommon, rare By how much will GnRH agonists reduce the size of fibroids by how
much at the time of drug administration? (this question didn’t really make 6. Dysmenorrhoea - difference in symptoms between primary and secondary, treatment
sense) 7. Pap smear results indicating HGSIL - treatment options
7. 8. Prolactinoma - signs and symptoms, management
Ectopic, unruptured, 3cm, no fetal heart, stable, hcg 16000. 9. Hirsutism - 15 questions to ask, management
What’s your management? Methotrexate vs laparoscopic salpingectomy/salpingostomy
8.
Hyperemesis gravidarum. 4 causes. 4 investigations. 4
complications.
Rotation 7
9. OSCE
Type of ovarian cyst in molar pregnancy. 1. Picture of mass on a cervix. Describe the mass. Give four differentials. When is
10. conisation indicated?
Which type of ovarian cyst is most likely to undergo torsion 2. MRI showing mass in pituitary, girl stopped menstruating for 13 months. Diagnosis (2).
during pregnancy. Further investigations. Management (2). Causes of secondary amenorrhoea.
11. 3. Picture of a female condom. What is it. How do you insert it. How do you remove it. 4
Which emergency contraception to use. advantages. 4 disadvantages.
12. 4. Case scenario of HGSIL referred for colposcopy. What do you stain with? What features
Mifepristone mechanism of action. would you see if CIN 3. Management options if she desires fertility.
13. 5. Case scenario of a postpartum woman, gave birth 8 months ago, second degree tears,
Indications for cervical cerclage post LLETZ breastfeeding on POP, kid has colic. She is now having superficial and deep
14. HSV genital ulcers dyspareunia. Most likely cause of superficial dyspareunia. Three questions to ask to
15. investigate the cause of deep dyspareunia. How to definitively diagnose the cause of
Malignant ultrasound features of ovarian mass deep dyspareunia.
16. 6. Para 0, virgin, getting married in 3 months comes in for premarital counselling. How will
Lichen sclerosis which is true you manage this patient (10 marks). 201
17. 7. ABG, lactic acidosis, Hb 4, sats 89%. Incomplete miscarriage. What are the sinister
Erythema and scaling of vulva in 60 year old who has had features on the blood gas. How will you resuscitate this patient.
incontinence for 2 years. 8. Picture of unruptured ectopic in the ampulla. Diagnosis. What are the requirements for
18. medical management.
Early pregnancy loss - criteria 9. PID? - gram negative diplococci. What is the organism. What is the antibiotic. What
19. other blood tests will you offer the patient.
19 year old. Primary amenorrhoea. Cyclical pain for 5-7 days. 10. I forgot the last one.
Bulging mass at introitus. What is most likely?

Rotation 4

OSCE

1. Anatomy of the fallopian tube - gross anatomy, blood supply and innervation.
2. Hyperemesis gravidarum - causes, investigations, complications.
3. Multifibroid uterus - what type of bleeding does it cause
4. Inevitable miscarriage - management
5. IUD - how does it work, gave an ultrasound picture to identify what was wrong
 The logbook is HECTIC- so start early :)
IPC
Lillian Ngoyi CHC
____________________________________________________________________________ Meet at Dr Malaza’s room, B2, at 08:30 on the first day.
_

Sites Rotation 1
Alex :
Meet in the boardroom of the admin block at 8am. You park in doctors parking. MCQ:
Similar to family med- questions are random and include all rotations- basically an integrated
Klerksdorp : paper :(
You’ll get to the site on the Monday of your block and in the morning on Tuesday you’ll meet the LOTS of psych questions
supervisors on the second floor of the FMC clinic which is between the hospital entrance and 1. Which of the following present with psychotic features- GAD, MDD, dementia, bipolar
the wits accommodation. 2. 7 year old with generalised anxiety disorder?
3. Treatment options for depression
Chiawelo: Meet in the boardroom at 7:30 - 8am. The supervisors are Dr Kabir and Shivani. It’s 4. Patient with a murmur
the most extreme left (right depending on how you look at it) building, close to dentist’s area. 5. Immunisations questions (know EPI schedule)
Tips for Chiawelo: 6. Child development question- at what age to kids crawl
You’ll get an orientation on the first day. 7. Known types of dementias
Do the facility audit early (by week 2). 8. Murmurs
Shivani, the clinical associate, will give you your topic for QIP.
For health promotion you’ll teach the CHWs a topic that Shivani gives you. They’re very keen to 1. Person broke their 2nd toe, what is the mx- Splint? Bed rest? Analgesia?
be taught and very responsive to questions you ask. 2. Trichomoniasis STI treatment? Metronidazole?
Make sure that some students are in CCP everyday (you’ll see chronic and undifferentiated 3. ANC card with increased SFH compared to dates- reason?
patients here) 4. Block of WHO health building blocks
Casualty is very very busy. I once saw 8 patients in 2 to 3 hours so you can fill up the log book 5. Ottawa charter
quickly. You learn a lot on call! 6. Pic of type of obstetrics forceps- when is it used?
You make your own timetable to rotate through clinics 7. 26 year old with body ache, headache, unable to do work- diagnosis? GAD?
Clinics to attend:
1. Family planning (everyday) & Pap smears (Monday & Wednesday) are done in the same 8. Class of drugs used to treat the above patient?
room 9. 7 year old with psych condition- ADHD? GAD? MDD?
2. EPI & anthropometry (same building, measure the patients you vaccinate) 10. Female with left flank pain, on COCc- diagnosis- acute pyelonephritis?
3. IMCI (Monday) (sister is not very happy to have students sadly :( ) 11. ECG- man had viral flu last week, now has acute chest pain and high BP- acute
4. TB (starts early) pericarditis?
5. HIV 12. BCG, OPV, Rotavirus- which is not injected?
6. Labour ward (you can go to Bara if it’s too quiet) 13. 25 year old male with 2 month history of 5cm mobile mass on upper neck, under SCM-
7. ANC branchial cyst etc?
8. IPE 14. S/E of TB drugs- INH liver damage? Ethambutol ototoxic? HIV- adjust nucleoside
inhibitors?
Klerksdorp site : accommodation is basic but with a bit of determination you can make it work for 15. Man with chronic disease, now depressed- MDD dt another medical condition??
you. There is WiFi available but it doesn’t have a very good/strong connection. The doctors and 16. Benign vulvar ulcers- chancroid, tertiary syphilis, HPV?
nurses are all super helpful and friendly. You do one weekend call of a Friday and Saturday, 2 17. Man with an autosomal dominant condition is with a normal female- what is the risk of
labour calls (at Klerksdorp hospital) and 2 casualty calls (within Tshepong hospital). There are son being affected?
two clinics that are a 5 and 20 minute drive away. All the rotation requirements will be explained 18. Acne in girl- treatment? High oestrogen pill?
during the orientation online on the Monday of the block. 19. Contraindications to HRT? PE? Colon ca?
There is a fridge, stove, oven and kettle available. Bring bedding and utensils/ cutlery. 20. X-ray of a lung of a man with 1 month cough- what is most UNLIKELY??
 21. Diagnostic factor of rheumatic fever? Prolonged PR interval? Targetoid rash on hands?
22. Unwell, had pneumonia a week ago, has oedema, proteinuria, no hx of kidney disease,
what is dx?
23. Features of mixed mitral valve disease with regurg predominating stenosis
Rotation 2
24. Cause of normal anion gap metabolic acidosis? MCQ:
25. Your shift at hospital is ending, but rape victim comes in- what do you do? NB Look at past papers as a lot of questions were repeated.
26. Hypothyroidism and infiltration of lymph follicles?or something into gland, what would
blood results be like? 1. What is least likely to be part of the 3As of healthcare? (Approachability)
27. IMCI- 30 month with night symptoms and a wheeze- what is management? 2. Pregnant woman at 18 weeks with peripartum cardiomyopathy in last pregnancy, now on
28. Child who is wasted?, stunted? and underweight? parameters Enalapril. What is most correct about the use of enalapril in pregnancy? Can be used,
29. Development of a child at 10 months- crawling, standing, cruising, walking? not effective, causes oliguria and fetal death, d
30. Signs of uterine rupture- shock, no contractions, pain? 3. 28 year old woman at 37 weeks gestation. Presenting with thrombocytopenia. What is
31. Man with progressive dysphagia and weight loss? the likely cause?
32. Mother who is unwell and losing weight with a 15 month old who has a cough? 4. Picture of 7year old with a rash, mild fever. What kind of rash is it? Measles, chicken
33. How to check 15 month old for the disease? pox, c, d
34. Young adult with diabetes, blood glucose is 15mmol/L. How to check long term control? 5. Primigravid patient in labour. Given oxytocin. What can be done for pain relief? Back
35. Alcoholic with 2 kids. Does not think he has a problem, not aggressive, no liver disease massage, b, d, pethidine
otherwise fine- what do you do? 6. According to the mental health act, what is true about voluntary mental health treatment?
36. 23 year old girl wants to commit suicide and wants to leave to talk to her boyfriend- what Voluntary admission of a patient to a psychiatric hospital or other inpatient
do you do? MHCA of 2003?? unit at his or her own request, without coercion. Such hospitalization can
37. Something about NHI end whenever the patient sees fit, unlike involuntary hospitalization, the
38. 7cm mass in lady complaining of pain- mx? Expectant, laparotomy?
length of which is determined by a court or the hospital.
39. Guy who smokes has toe pain but pulses are present- dx?
7. Woman saw ECT as treatment in a movie and asked if husband could undergo this.
40. Old man who is a smoker and has HT- now has memory loss etc- what is diagnosis?
What is the indication for ECT? ECT is used mainly to treat severe depression,
41. Mother who is breastfeeding wants to reduce breastfeeding to 6 times? How to advise/
counsel? but is also indicated for patients with other conditions, including bipolar disorder,
42. Patient has covid-19. Advice- isolate from family? schizophrenia, schizoaffective disorder, catatonia, and neuroleptic malignant
43. Chronic lung disease- what is NOT a contributing factor? syndrome
44. Hematemesis- which vein is involved? 8. Infant with chest indrawing. What is the IMCI classification?
45. Social determinants of health 9. What is not part of community action to improve health promotion?
10. 80 year old patient brought in by daughter. For the last 8 months forgets his way home,
OSCE: struggles to use cutlery and change TV channels, but most importantly he’s not
6 active interested in doing previous hobbies. What is the diagnosis?
4 written 11. Child brought in with ear pain, tender mass behind ear (mastoiditis) and ear discharge.
Each station is 7 minutes long What is the next step in management?
12. ECG: patient described as one with obtundation, alcoholic. Options: U-waves present,
1. Approach to unconscious patient hyperthermia, complete heart block, J-waves present
2. Abdo exam -bleeding peptic ulcer? 13. Patient with alcohol cirrhosis presenting with confusion, sleep disturbance and asterixis.
3. Pap smear -and speculum as well as counselling Cause?
4. history 14. Woman on OCP and a smoker - which is the most correct option regarding this scenario.
5. IMCI station - diarrhoea? You have access to a copy of the IMCI book so know where to 15. Woman presenting with a 3 hour history of shortness of breath, R costal pain, had hip
find stuff. surgery a few days ago. What is the likely diagnosis?
6. J88 form- written -work very fast, there isn’t enough time. 16. A patient was brought in due to a suicide attempt. Took 12 x 500mg paracetamol pills.
7. Counseling - intimate partner violence Options to due with parasuicide vs failed suicide attempt. Options: this is a parasuicide
8. Referral letter- written -for abnormal pap smear patient because it was a failed suicide attempt, this is a parasuicide because he only took 12
9. X- ray interpretation- written -TB? tablets etc.
10. Public health station- written - road traffic accident fund and alcohol blood and breath 17. Formula-fed baby who has been vomiting milk since birth. Grandmother thinks he is sick,
limits but mother thinks he is well. O/E baby gaining weight and growing well. What do you do?
 18. How do you differentiate thrombotic vs haemorrhagic stroke? 4. Levels of prevention
19. Manage a stab chest, with trachea deviated to the left. 5. Criteria for vacuum delivery: maternal/cardiac disease,prolonges 2nd stage or fetal
20. Humerus fracture? Which nerve damaged if the patient has imparied dorsiflexion distress, vertex presentation, does not have to be occiput-anterior, >2kg, head not more
21. Female patient with a genital ulcer: chancroid, molluscum, than ⅕ above brim, fully dilated, ruptured membranes, strong contractions
22. Female patient with a breast lump, dimpling: refer or do ultrasound, refer to surgery, fine 6. Types of Dementia and their presentation
needle aspirate 7. Medication classes in Major Depressive Disorder
23. Features of a migraine Types of SSRIs
24. Management of alcohol withdrawal, Class of drug used: Anticonvulsant, antihistamine, ● citalopram (Cipramil)
benzodiazepine ● dapoxetine (Priligy)
25. Chest X-ray of a man: TB or PJP or sarcoidosis ● escitalopram (Cipralex)
26. Old patient who is anemic, previously had oesophagogastroduodenoscopy that showed
● fluoxetine (Prozac or Oxactin)
oesophagitis, no gastro/abdominal symptoms, no history of blood loss. What are you
● fluvoxamine (Faverin)
doing next: ultrasound, refer for c-scope,
27. Young woman presents, hypotensive, pv bleeding, RIF pain. What condition must you ● paroxetine (Seroxat)
exclude: ectopic pregnancy ● sertraline (Lustral)
28. Aggressive patient brought into casualty by SAPS, features of psychosis. Which ● vortioxetine (Brintellix)
sedation would you like to use: Haloperidol, diazepam, diazepam (SNRIs) include desvenlafaxine (Pristiq), duloxetine (Cymbalta), venlafaxine (Effexor),
29. Notifiable disease in South Africa: which one is not notifiable: venlafaxine XR (Effexor XR), milnacipran (Savella), and levomilnacipran (Fetzima).
30. Which condition, that is part of EPI is considered eradicated:
8.
31. Hypertensive urgency
9. ECG electrical alternans (Know that this is pericardial effusion), management in
32. Which immunisations are intramuscular: rota virus, polio, BCG, measles
emergency?
33. When to do appendectomy on appendicitis? Do you send home if it is uncomplicated?
10. CXR: Gastric bubble seen behind cardiac shadow (haital hernia??). Whom to refer to:
Cardio. Pulmonology, Gastro, vascular.
Osce:
11. What are cohort studies? Tests rare disease, dynamic study?
12. CTG: What do the three decelerations mean
1. IMCI diarrhea
13. IMCI management of oral candidiasis
2. History PV bleeding, tiredness
14. Which vaccine is administered intradermally(BCG, Rotavirus, Measles, Polio)
3. FBC interpretation of iron def anemia?
15. Management of appendicitis with a CT scan showing inflammation but no faecoliths and
4. Cord prolapse
full relief of pain after IV antibiotics. 24 hours
5. Ankle exam
16. Wrist examinations: Phallen negative, Finkelstein positive: What is the likely diagnosis
6. Ankle fracture, weber A1
17. Vagina breech delivery manouvres: lovset maneuvre?
7. Breaking bad news- cancer
18. Milky discharge from breast: what test to do?
8. Public health 4 burden of disease and primary prevention
19. CTG. What does it show?
9. ECG STEMI
20. Drugs are the most teratogenic at how many weeks of pregnancy??
10. CVS exam
21. How many months can a baby start walking independently?
22. 25 y/o female stressed at work. p/w body aches and headache. On further history taking
patient says that the are tired, missing deadlines at work and stressed. Generalized
anxiety or somatic symptom disorder??
23. Melanoma picture
Rotation 3 24. Cause of hyponatremia, high urine osmolality.
25. Side effect of HCTZ: erectile dysfunction
MCQ 26. Man with leg claudication management: physio exercise therapy/ refer to vascular/
1. Anaemia with low MCV and normal MCHC, what would you check next: Ferritin, diabetes diagnosis and treatment
Transferrin, Serum iron or Total Iron binding capacity 27. Genital ulcer causative agent
2. How to de-escalate a psychotic patient pharmacologically: 28. Alcoholic denies addiction: refer to social worker for more counselling
Lorazepam/Diazepam/Haloperidol (Know correct dosages) 29. Patient with alzheimers and bipolar, now with cloudy urine ?fever ? Cause: delirium due
3. Ottawa charter in relation to Health Promotion to UTI
 30. Patient with memory loss, now with cogwheel rigidity: Lewy-Body dementia/ a. Delirium due to UTI
alzheimer's/ vascular dementia 7. Person in an accident. They are cyanotic. Very low BP and a tachy. Obviously fractured
31. Patients (child) dad passed away 2 weeks ago, crying, talking to pictures of father: femur which is bleeding. Dull lung sounds on right.
Grief/bereavement due to time frame a. Put up 2 IV line
32. Prevalence: will decrease if people with disease X leave area. b. Intubate
33. Pt uncontrolled HPT. How to change the prescription. c. Anterior and posterior nasal packing
34. Pt with headache and pain around the eyes, which question to ask first (any changes in d. Intercostal drain
vision, ) 8. Outbreak of diarrhoea streaked with blood in the community. Best step.
35. Treatment for oral thrush (nystatin suspension a. Educate staff on IMCI
36. Emergency contraceptive for pts on antibiotics and after 4 days ( iucd) b. Check you have supplies of rehydrate
37. Which benzodiazepines that can not be giving IM: Diazepam c. Educate community
d. Notify government
OSCE: 9. With regard to decreasing health inequality
1. Prescription for uncontrolled hypertension a. Governemnt should work to achieve it
2. Acute seizure management. b. Government can’t play a role
3. IMCI diarrhea with some dehydration c. Gets worse with time
4. Written station on maternal health: osmoe d. Only in developing countries
5. Written station on cervix with discharge. Describe the picture. Possible complications if 10. What type of notifiable disease is Covid 19. Category one
untreated. Management. 11. Lady who has LOC at home. Brought in by family and they think she is suffering from
6. ENT exam pharyngitis dementia because her father had it. You think she has delirium - what is true:
7. Counselling on adherence to antihypertensive a. Delirium only happens after 65
8. Breast exam, give examples of breast masses b. Dementia only happens after 65
9. Shingles written station. Describe the lesions. Management. When to refer up c. Delirium presents with LOC
10. History on patient with right sided chest pain. Later revealed to be shingles. d. Dementia presents with LOC
12. Karyotype of a woman who is amenorrhoeic. They only showed us up to chromosome
12 and no sex chromosomes. The chromosomes looked balanced.
a. Turners
b. Kleinfelters
Rotation 4 c. Trisomy 21
d. Bechets
1. Picture of HSG - I think just one tube was occluded. - i thought bicornuate uterus? 13. Patient feels tired and has epigastric pain. See the blood results: low Hb, microcytic
a. Bicornuate uterus ok anaemia. WCC and plaelets normal
b. Bilateral tubal occlusion a. Iron deficiency anaemia
c. Bilateral tube patency b. Anemia of chronic disease
d. Cervical incompetance c. Pancytopenia
2. Picture of shingles over breast 14. What is not first line treatment of depression
3. a. MOA
a. Cancer of lunch b. SSRI
b. CN palsy c. SNRI
4. Patient with 4 days of diplopia. You see strabismus. They don’t have blurred vision. d. Antipsychotic
a. CVA 15. What is first line treatment of GAD
b. CN VI palsy a. SSRI
5. Patient gets shooting pain when walking for a long time. Helps if she leans forward or b. SNRI
sits. Negative straight leg test. c. Beta blocker
a. Sciatica 16. Treatment of aggressive patient
b. Spinal stenosis a. 4mg lorazepam IM
6. Old man with dementia gets confused. Cloudy urine. b. 10mg diazepam IM
c. Haloperidol IM
17. What vaccine will a child get at 6 months b. Fibromyalgia
a. PCV right thigh IM c. MDD
b. Measles right thigh IM d. Somatising syndrome
c. Measles orally 29. Primigravida presents with oliguria
d. PCV left thigh IM a. Renal agenesis
18. Patient with high smoking pack year history (35 years or so) who has cough for 10 years. b. Maternal diabetes
Wheezes all over lungs. Coughs up sputum often, sometimes with yellow. 30. Person swims every day and they have pain of ear - pain of tragus.
a. Chronic bronchitis a. Otitis externa
b. Acute bronchitis b. Otitis media
19. Person has anaphylaxis to bee sting. Best course of action 31. Lady who is known epileptic comes in confused. Find out she has GAD.
a. Nasal prong oxygen and salbutemol a. Delirium
b. IM adrenaline b. GAD
c. Start voluven infusion 32. Man with burning micturation since yesterday
20. Woman has abdominal pain. You palpate right upper quadrant and she stops breathing a. Gonorrhoea
a. Acute hepatitis b. I think E coli or klebsiella was an option
b. Cholecytitis 33. Most likely to succeed with VBAC
21. Man comes back from mozam with scleral icterus and feeling ill. RUP pain. Can’t a. Previous caesar at mothers request
remember other symptoms. Most likely b. CPD previously
a. Hep A c. No cervical dilation
b. Hep B 34. Woman with 5 days of bleeding. Missed 2 periods. Positive preg test 3 weeks before.
c. Hep C Previously regular periods SFH at umbilicus. What isn’t a cause.
d. Atypical mononucleosis a. Misc in multifibroid uterus
22. Alcoholic comes in with abdominal pain, epigastric mass, pain radiates to pack b. Misc at 20 weeks
a. Pancreatic pseudocyst c. Ectopic
23. CXR d. One more
a. Bronchial wall carcinoma 35. Lady with weight loss and not feeling well for past few months. Husband died last year.
b. Bronchial cyst a. Trial antidepressants
c. Can’t remember - I think PJP or aspergilloma? b. Some other diagnostic tests - I think colonoscopy or something
24. Patient has BP of 180 over 90 or something like that. Severe headache and epigastric 36. Reason for decreased childhood mortality between 2008 and 2011
pain. a. HIV treatment improved
a. Amlodipine 10mg and refer to charlotte 37. What isn’t a role of WBOTs
b. Amlodipine and enalapril a. CPR
c. High dose of niffedipine b. Check immunisation
d. Something else c. Teenager struggling to take TB meds - how to help
25. Someone who has been vomiting for 4 days. Which blood gas is theirs d. Deliver baby of multiparous woman for increased comfort
a. pH 7.3 38. Hypertensive patient - what is tertiary prevention
b. pH 7.3 a. Early diagnosis
c. pH 7.4 PCO2 40 HCO3 lowish b. Change individual behaviour
d. pH7.45 HCO3 high PCO2 high c. Modify risk factors
26. Picture of a kid with CP who had all limbs straight and head back. d. Treat and prevent complications
a. Spastic paraplegic 39. Fit young man has palpitations and dizziness after running. His examination is normal
b. Spastic quadreplegic other than rapid pulse. Which ECG is his. Then showed ECG of A flutter, V fib, sinus
c. Mixed tachy and I think the last was a AV block.
27. What grant does a child with CP qualify for 40. Gastroenteritis is a big issue in gauteng in winter. Which is an important consideration
a. Disability when studying the population size of gauteng
b. Child dependancy grant a. Migration into the province.
28. Girl with body aches and headaches, inability to perform at work, irritable. b. Pregnancies in that period
a. GAD c. People sick with gastritis
 d. Something else random oral contraceptive pill, iron supplementation and or transfusion depending on the
Hb results. Pregnancy test.
2. Written station - based on station 1 (heavy menstrual bleeding in teenager) ,
Rotation 5 given FBC results to interpret ( it was iron deficiency anaemia) ,asked for
management - Hb was low hence Blood transfusion , iron supplementation ,
Biopsychosocial approach (counselling etc. speak about when to come back etc.
1. health promotion
)
2. governance Public health function
3. DRE - patient history of dysuria, urgency etc possible prostate enlargement .
3. Factor that contribute to increased prevalence Covid-19 in SA
asked for management- spoke about PSA test +ultrasonography . Possible
4. Palmar erythema, spider naevi, I think upper Gi bleeding
Biopsy of prostate depending on U/S findings.
5. Smoker – ischemic foot, what's the cause
4. Written - Referral letter format for patient to go to CHBAH urology department (
6. tiredness worsening over 6 months and burning epigastric pain ↓Hb, ↓MCV, ↑MCHC ensure you look at the format online ,they ref geeky medics, i found it useful as
7. Hypertensive on HCTZ doesn’t follow-up now headache and chest pain, BP:180/175 referral letters at certain sites don’t always have all the info the examiners may
HR:90 require)
8. herpes zoster picture 5. Breaking bad news - IUFD
9. SOB, Diastolic dysfunction, X-Ray trachea pushed to Right 6. Approach to Hypertensive emergency /urgency :( . speak about morphine to calm
10. Gout – what effect on kidneys? the patient , know all of your drug doses and which to use in order to stabilize the
11. labour vertex left occiput anterior, what is the presenting part patient before transfer.
12.Cerebral palsy, ↑muscle tone, pushes back into extension →what type of CP 7. IMCI - approach to cough. They will ask you to count breaths. Classify cough etc
then explain to father the management . Would help if you briefly read through
13. ecg hyperkalemia the IMCI management for Diarrhea /cough etc so that when you get in there it
14. ectopic pregnancy rupture management flows nicer lol. Mention that you’d like to check immunisations, growth , screen for
15. IPV and delivery with forceps or something? TB etc to sound more wholesome lol. Expect Saloojie to be your examiner.
17. In a 16 year old female, painful breast mass differentials: fibroadenoma, fibrocystic 8. Public health station - Blood alcohol limit . Asked to define DALY and say why it
disease, phylldes tumour, another option is useful. There’s a document on Yashka’s drive that has possible PH stations .
18. it’s like a PDF document and has different rotations theer and possible Qs .
9. Explain and demonstrate to an asthmatic patient how to use their inhaler . Cute
Rotation 5 Date : 06 august 2021 station. Simple,nice and easy.
Osce stations : 10. SCABIES . There’s a dermatology lecture online (sakai). Very helpful. And the
Random . You could get tested on just about anything. They don’t seem to be repeating
word doc practice examples that Dr Ruch will send out is also very helpful. I’m
osce stations. There will always be a history station , an IMCI station (this is often pretty sure the Qs come only from these two documents so make sure you read
repeated ) , there will also likely be a maternal health Q ,pap smears /STI the lecture and complete the activity.
counseling/mx, (know your OBS emergencies ESMOE videos) , there will also always
be an emergency station of some sort (unconscious patient, epilepsy,acute asthma ,
ACS ,Hypertensive emergency etc) . We were told that the written station should follow
up on what happened in the active station(oftentimes as you will see below) . Goodluck.
I really enjoyed the organisation of the block, it’s a great opportunity to revise what
you’ve learned so far and gain more experience. Begin the online work early, it’s tedious
Rotation 6
to get through but quite enjoyable. (most questions are from past papers)
1. History taking station -15 year old patient presenting with irregular menstrual 1. Acute tubular necrosis what would you find- muddy urine, oedema of legs, high osmolality of
bleeding, low blood pressure,pale. Asked to take a full history,make an urine etc… The presence of "muddy brown casts" of epithelial cells found in the urine
assessment , discuss management of the patient. Most likely- hormonal cause. during urinalysis is pathognomonic for ATN.
Management discussed : Ultrasonography of uterus, possible implementation of 2. Vasectomy - do you check post sperm count, it’s reversible, or Do they have general
anaesthesia(the have local A)
3. IMCI baby 16 weeks diarrhoea with skin pinch slow, no sunken eyes is it severe persistent or 38) HIV +, dry cough and distressed SATs <90 - PCP
persistent diarrhoea 39) 45 year old female on haart. Who stage 3 previous tb x2 presents with hearing loss- options
4. Kid with fall on outstretched hand, can move arm and wrist but painful when above head- drug ototoxicity, acoustic neuroma, age related hearing loss etc
green stick fracture, Colles, scaphoid fracture or sternoclavicular joint dislocation… 40) elderly man, right handed, presents with inability to talk- left frontal lobe affected
5. Pt with three previous C/S, smokes cigarettes, next day has SOB, fever ??, tachycardia etc- 41) type of anaemia, patient lising blood, low MCV
is it PE, sepsis, amniotic fluid embolism 42) Mx asthmatic with symptoms exacerbated by a flu - Prednisone
6) h Pylori max-specific appropriate antibiotic regimen and PPI 43) 65 y/o male with symptoms of bph
7)bipolar type 1 mx-in a newly diagnosed pt 44) primary prevention - obese children/early tb mx for kids with contacts
8) management of aggressive and psychotic patient- give which drug ? Know dosage (Options 45) heart pathology which doesn’t show much abnormalities (don’t remember how they worded
were haloperidol(dose was 15mg and should be avoided anyway in the neuroleptic naive) , this) on the angiogram ? aortic stenosis,pulmonary stenosis, aortic insufficiency, tricuspid
lorazepam… but lorazepam dosage was correct-4mg) stenosis
9) how to assess if there's enough doctors- Look at amount of docs for /1000 46) know the extrapyramidal side effects of antipsychotics especially the psychiatric
10) xray looks like free air, pt had distended abdo but no tenderness on palpation, was acute emergencies
sudden onset with obstipation - do you set up IV line, flexible sigmoidoscopy with flatus tube, 47) lady previously used alcohol to calm her anxiety now shes in therapy and asking for different
laparotomy or NG tube…. ways to cope, which medication is indicated as a first line for her generalised anxiety disorder ?
11) old lady with confusion and incontinence (both urinary and bowel) following a fall "a few 48) first line treatment of lichen planus
weeks ago", where a doc was not consulted- options were: lo wer lobe pneumonia, SAH, 49) RUQ pain and when pressed the lady holds her breath in pain.
dementia… 50) I think another heart murmur question
12) age child says mama and dada
13) kiwi vacuum pic and when to use- DM with 7cm dilated, fetal distress…. Rotation 6 OSCE
14)hiv man, dry cough - pcp, pneumonia extra Written
15) post menopause lady , 5 day pv bleeding, no papsmears dne- what to do- papsmears and 1. Malaria-non-pharmacological and pharmacological management. Investigation.
endometrial sampling , pap and TUS and endometrial biopsy, cervical biopsy and some other 2. Shoulder x-ray: dislocation, acute and chronic complications. Management (non-
options pharmacological advise)
16) mental healthcare act 17 (2002) 3. Sick note
17) old guy - lost his wife a month ago- sad and loa and trouble sleeping, also sees her face in 4. Partogram- assessment, management, obstetric risk factors that would alert possible
crowd - mdd, adjustment d/o with depressed mood, neurocog? complication(? CPD)
18) p value - high p value shows little correlation, low proves hypoth /H0, significant at 0.05
19) picture of burns - partial thickness Active
20) what to do in bby with burns - fluid resus 1. History: AUB
21) obstipation vomitting X-ray with distended bowel what do you do to solve - laparotomy 2. Postpartum depression: Assess Risk
22) right sided pain, 2cm mass in endometrium - next step beta hcg in 48 hours, ultra sound in 7 3. Shoulder exam
days, methotrexate 4. Breast Exam
23) HIV CD4 dropping and VL rising - no need to test resistance, treatment failure 5. IMCI- diarrhoea
24) SAM by MUAC 6. Counselling a patient over the phone with epistaxis. What would you ask, what must they
25) antifreeze poisoning - casts in urine do… etc
26) herpes zoster ophthalmicus by fluoroscein and symptoms
27) post-herpetic neuralgia
28) EBV causing flu like symptoms and mild jaundice
29) community involvement - asking them to help plan and implement
Rotation 7
30) GDOH governance - holding hospital accountable for patient outcomes Most questions were from past papers
31) LOA vertex widest part- biparietal
32) poor social circumstances, confused etc - give thiamine 1)Green meconium after the baby is born- what causes the green? Listeria, Strep A or B, CMV
33) seizure post joll - check glucose 2)Patient with 2mo history of delusions and negative symptoms-Schizophreniform, brief
34) past question about lobar pneumonia causing acute confusion psychotic, delusional disorder or schizophrenia
35) elderly man known NCD and BPD aggressive, temp, in 24 hours - delirium from infection 3)Molluscum contagiosum picture and treatment-topical irritant
36) tx manic BP1D - lithium
37) depression, suicidal ideation- admit and social work
4) incidence of participants in a study-calculation. Answer had to be per 1000, question was 6) Approach to unconscious patient- Patient was just sitting there unconscious. Had to talk
over 2 years but had to divide by through approach with examiner. They would throw in random comments. E.g. assess
5)Young lady with erythema modulus and chest xray- Sarcoidosis, TB patient according to ACLS principles-they would say what would you do if there’s no
5) Lady came after hip replacement came in with cyanosis, acute respiratory distress-Acute pulse, e.g. check blood sugar, they would say it’s 2 what is your treatment etc etc.
pulmonary embolism 7) Written: Road Accident Fund, same as past paper question. Know both your levels and
6)PCOS hormone levels false- increased prolactin,increased LH/FSH ratio the units
7) SLE, ECG with ST elevations. Chest pain on long down-pericarditis 8) History station-29 year old male with chest pain. Remember ICE and Biopsychosocial
8) Young male comes in with dysuria and frequency ç=8 , treated by GP and not resolving- approach
9) treatment for gonorrhea- Ceftriaxone 9) Written-ECG of previous patient: asked about rythm, rate & axis, asked about P wave,
10) 68 man with chest pain also Hb of 9.8-Blood transfusion, PR interval and QRS complexes. Asked about complications and differentials
11) increased PSA,8 Check PSA in 3 months (10 months). Trus & Ultrasound 10) Paeds (: Had Saloojee, was a dissaaaaaaaaasssttteeer (for me personally, he totally
12) lady can't extend middle finger without holding trigger finger prolapse threw me off, also it was phrased weirdly). So they said station would assess: child
13) cataracts in diabetic development, immunisation and growth charts and you would spend a certain amount of
14) leiomyoma time on each. You went in and they had your logbook. They would pick one of your
15) anorexia patients and ask developmentally what you would tell the mom to encourage the next
16) parathyroid adenoma stage of development??? Then for the immunisation they point out another patient you
17) HIV when to do Lumbar Puncture had for immunisations and layout all the vaccines and ask you which one you would give
18) dizziness for 4 hrs, vomiting, sensorineural hearing loss- labyrinthine, Menezes, Acoustic (so know that, theres no road to health book there). Then after you pick one they tell you
neuroma if you’re right or wrong. Then they ask you to draw it up and show where on the baby you
19) breastfeeding feed less-8 times a day would give it. Then you had to show on the naartjie your technique (remember to wipe
20) wheezing child IMCI management first). Then for child development they ask you to plot and interpret (they expect decimal
21) crabs treatment- permethrin answers (: but don’t give you a ruler (:) Anyways, so try fill in the paeds section with as
22) swimmer-Otitis external much detail as possible to help your future self out.
23)OCD -ssri, cbt
24) ptsd- hallucinations
23) qualitative-not numerical
24) endemic
Rotation 8
25) ulcerative colitis-question asked about diarrhea and large joint pain
26) government and leadership - building blocks WHO, asked which one was one Osce
27) Site for Hep B vaccination (IM) 1. EPI, growth chart , development
28) 10 month old crawling - asked about what developmental milestones needed to be reached 2. Hx - LAP. Differential Diagnosis and management (UTI, STI, PID etc)
29) angina pectoris- S3 gallop, jaw claudication, bradycardia, increased jvp 3. Script - uncomplicated UTI
30) pleural effusion 4. Breech delivery - demonstrated
31)threatened abortion-Gave scenario of pregnant female who was bleeding and needed to 5. Diabetic foot exam
decide if it was threatened etc etc 6. Picture of diabetic foot with ulcer - questions on management
7. Patient with seizure - run through ablation and causes for seizure/unconsciousness
OSCE Stations (Eww) 8. Counsel patient being abused by husband - NB advise of right to press charges
9. Fill out J88
1) Phone call with Nurse at PHC- Lady with cord prolapse. Had to talk through 10. PH - prevention questions
management and help nurse decide on following steps etc etc
2) Abdo exam- Acute abdomen. Literally just a straightforward abdo exam MCQ
3) Written: Referral letter for previous patient Pretty much all from the past papers and previous rotations.
4) Had to counsel a patient on adherence to her Hpt medicines. She is unable to come to Some new ones:
the clinic so had to know of alternative method for collection of chronic medication. 1. Picture of painless red eye - conjunctivitis, subconjunctival haemorrhage, uveitis
Explore lifestyle factors. Patient cannot afford healthy food etc etc 2. Rinne and Weber test - sensorineural hearing loss
5) Written: Showed fundoscopy and asked about what was seen, what further 3. Which drug is best to prevent onset of alcohol withdrawal symptoms - benzo?
investigations need to be done, further management for hpt etc etc. Same picture as 4. Best option for emergency contraception 5 days post unprotected sex
fundoscopy on Yashkas drive
5. Man who ate only hot dogs and cool drinks for 2 years, now with bleeding gums - Scurvy