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?Why are u studying





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EVIDENCE

EVIDENCE BASED LEARNING


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EVIDENCE
EVIDENCE .
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text book
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text
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examination .
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Taking history history
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history



good history = 60 % of diagnosis

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ENOUGH FOR THE ADVICE
NOW , THE REAL TALK
INTERNAL MEDICINE
The highest score of grades in our college at all = 900 , but luckilyits grades are distributed among 4th , 5th , 6thys in internal
medicine , clinical pathology , tropical , psychology, and final , so
.study hard and collect its grades to get the prize
u should study it real hard as it is too much and with the highest). bulk , so pls dont ever never say: ( too much
:Books
for basic clinical : -u should buy : :- Davidson
drosamamahmoad books :chest , endocrinology , renal ,
-hematology , liver
-Danish
onur pc u should have Harrison and case files in internal medicine
N.B. dont ever buy another Egyptian book there are el fatatry and el
hawary - , pls for good sake most of ur study will be from Davidson and
Danish and good knows, I dont tell u to buy osama Mahmoud except for
that I knew Danish after I finished internal medicine round and I didnt

literally studied from it but it is very good as it show the content of a text
.book by the Egyptian way, butI am taking precautions
there are a lot of text books as kumar and lecture notes and oxford and I have bought them and studied from them and I am begging u
plsnoooooooooooooooooooooooooooooooo , dont buy them as,
.kumar=Davidson but drasem el sherief recommended Davidson
Osama mahmoad is the Egyptian version of lecture notes and again
Davidson + Danish is so good as a text book and an evidence and for
understanding and very helpful for keeping information in mind so pls
. dont buy lecture notes
Oxford internlmedicin is so briefed and it was made in the first place for
post graduated newly working drs who need to remember from a mobile
.and adorable source, so it was made as a pocket book, so pls dont buy it
For clinical examination: u should buy : - macloid
magdyishakFor D.D. : u should buy oxford text book of differential diagnosis
So again u will buy Davidson
DanishosamamahmoadMacLoidmagdyishak. oxford text book of differential diagnosis I want to tell u an advise that is so powerful = ( pls know that
everything u encounter has an explanation , u should seek that
explanation and pls dont let anything pass u without explanation,
thats why I always say why? And then explain)

?How to study
It will be divided to :- history taking , examination , diseases
. , D.D.=differential diagnosis , pathophysiology
I advise u to begin with
History taking
U will read it from examination books and u will take more
information from drs in clinical sessions, apparently they will tell u
about the importance of the item u are taking i.e. why? Why are u
?asking about this item
.Here I will try to explain to u how to take a history
History
PERSONAL HISTORY
-:NAME

u should take the name of the father and grandfather , why ? for
legal causes i.e. someone may commit a crime and give an
absence evidence of being in ur clinic , or the matters of name
. matching
-:AGE
.For age related diseases
-:SEX
For sex related diseases and the sexual conditions like intersex and
. others
:RSIDENCE
Important for knowing the place-related factors affecting the ptn
-=patient- , if the ptn case is critical or he will need an emergency
interference , is his residence is near the hospital or in a remote
. area
-:JOB
For occupational causes and the level of education and the
. economic level
:MARITAL STATUS
.For some issues such as infection control and depression disorders
- :SPECIALHABITS OF MEDICAL IMPORTANCE
smokingeatinghabits: excessive salt consumption, fatty or spicy foods , .etc
drinking habits: excessive tea,coffee , alcohol consumption , etc
.Drug habits: drug abusers, etc
.E.G
Mr. ahmedsayedahmed ,20y male , married , living in Ismailia city ,
. he is a carpenter ,has no special habits of medical importance

:.N.B
try to make personal history one sentence, it may be difficult but u .will get used to it
for the special habits of medical importance u may write it as I did or u may enumerate it , generally it is best to enumerate it in
.surgery not internal medicine
COMPLAINT
From the ptn own words + the duration of the complaint
.e.g.Theptn complains of cough and breathlessness since 2 days
.N.B
the symptoms should be written as the ptn said and not in
medical terms i.e. dyspnea = breathlessness , in complaint it is
written breathlessness as the ptn won't say dyspnea as he dont
know it , but u will use the medical term in present history as u are
. analyzing what the ptn says
try to mention the 2 or 3 major complaints and dont enumerate a lot of complaints, as u will be obligated to analyze all of them so
.plsdont

u should mention the most recent complaint after the ptn was last .well. This is very important
if the ptn wasnt complaining of anything and is seeking medical advise for follow up or getting his monthly medication , u should
. writethe ptn came for follow up instead of a complain
PRESENT HISTORY
.in this topic u should analyze the case its true name is history of present illness, i.e. u should analyze and interpret the complaint , related signs and symptoms and the
present chronic diseases , to be more simple : analyze every single
. morbid condition he has now
:U should first begin with the sentences
, .. The ptn is
means chronic illness he has and the recent
.medications he is receiving
e.g. the ptn is diabetic , on regular insulin and he is hypertensive ,
. on furosemide diuretics
?Why
Because the chronic illness may be complicated, and the complaint
is due to these complications, so this will be easier for the listener
.to reach diagnosis quickly
E.G. if a diabetic ptn complains of repeated coma and burning or
tingling sensation in his feet and u didnt preceded with the
informing the listener that he is a diabetic ptn,he will rush to the
D.D. and think too much and when u reach the end of ur analysis
and start to talk about chronic diseases he will finally find out that
this condition is due to diabetes and when u say that he is on insulin
he will find out that the cause of repeated coma may be bad
compliance to insulin therapy , and believe me this is very irritating
to doctors and they will say to u : why didnt u mentioned that he is
diabetic at the beginning of ur history , it would be so easy to
diagnose this way . This means that the way u presented ur history
was defective, so pls always mention the chronic disease and its
.medication before proceeding to the analysis of complaint
Then
u should begin ur analysis with
theptn was last well .- period of time- ..ago ,
when he started to complain of - the first
..- complaint
?Why
It is very important as this means that every s &s - = symptoms and
signs u are mentioning and analyzing is related to the recent
.condition which is very helpful in diagnosis
U begins with the first complaint because u are telling the story of
.this recent morbid condition
.I.E

u mention the first complain and analyses it, then it was


associated with - s&s- , then u start to analyze
. the associated symptoms
Then u mention the following symptoms appeared after the first ,
especially if it were mentioned in complaint E.G. after ..apriod of time - . , - symptom -
appeared . Then u start to analyze this symptom and its
. associated s&s
And so on, continue to tell the story tell u reach the time he seeked
.u for medical advice
E.g. :the ptn was last well a week ago when he developed cough .
Cough was analyze the symptom- . Cough was associated with
.dyspnea
. -Dyspnea started 2 hours after cough and analyze dyspnea
. - After 2 days the ptn developed wheez analyze weez
And so on
?How to analyze the symptom
Onset , course , duration , releaving and aggravating factors
., special character and associated symptoms
I advise u to study history from oxford text book of clinical
examination on urpc , it really is verygood in explaining
.these items , so I won't explain it here
After u finish ur analysis of the complaint and associated symptoms,
u should ask
About the affected system . E.G.respiratory system in our example
.here
Then u should make
review of other systems
I.E. systematic enquiry about the other systems of the body to
reveal any hidden or forgotten s&s which contribute greatly in
proving diagnosis and finding other morbid condition as the ptn may
be with double pathology and it also help in complete reassurance
. of the ptn
U will got it also from oxford ( one page keep it like ur name )
U will interpret the review by mentioning all the s&s u asked about
or u say NAD = no abnormality detected . and this is better
done in internal medicine but in surgery it is preferred to list and pls
do what u love but I recommend to list to say something good in ur
.exam
After this u should write
history of chronic illness
I.e. mention the story and analysis of the chronic illness from its
.diagnosis tell now
E.G. : 10 years ago the ptn complaint of frequency of micturition
and slight blurring of vision and consulted the dr who diagnosed
him as a diabetic ptn , and gave him oral hypoglycemic drugs . 2
years later the ptn complained of burning or tingling sensation in his

feet and also he developed glaucoma. Thedr gave him insulin and
.he is on insulin till now
Something like this and so on .u should know that present history is
the hardest part of the history , and if u mastered it u properly
mastered history taking . Sopls polish ur skills by repeated
. numerous history taking and discussing it with drs
.N.B
if a ptn has already seeked medical advice and he is following up now or taking his monthly medications u wont write anything in
. present history except history of chronic illness
if the ptn has already seeked medical advice or attended hospital for his current illness and still ill and is now seeking medical advice
. again , u should mention this in ur story in present history
E.G. : the ptnseeked medical advice and he was given
-mention the drugs prescribed- . after 2 days
he wasnt relieved and symptoms increase - whatever
happened , u should mention it and he was hospitalized . in
hospital he was given and investigations were made . he was discharged
from hospital after 4 days and was on .. . after a
week the attack recurred and he as hospitalized again . he
. . is now in hospital receiving
I tried to mention all the possible conditions in this ex. But u would
.get used to it by practice
the following advices is not right to be done in real work but u .should do it in ur exam
If a ptn had double pathology and in ur systematic enquiry u
discovered this and this second pathology is not in ur objectives
or ur curriculum or u didnt study it well, u should immediately
delete it from ur history and dont mention it and try to tell this
to the ptn if the dr requested the ptn attendance in exam and u
found out that the ptn is cooperative because u must know: what
u say u will be asked about , so pls dont say anything u dont
.know
If the case is too much for u or u didnt studied it well u should . do one of the following : - beg the dr for changing ur case
dont answer the exam and obligate the dr to fail u , and u well reexamine with another one on anew case and luckily from
100% . but for honesty some drs now know this trick and in this
case they will give u 60% , which means that u are screwed
really screwed . Sopls for good sake study hard and try to
. impress the examiner - too rare and needs a superman
One q pls , I need a break , are u a super man ? Areu? If u are u
will pass internal medicine and u will get A but if u are not, sorry
. to tell u u will be

.Enough of present history, I am very bored


DRUG HISTORY
Some prefer it after past history and others prefer it after present history. I
advise u to stick to oxford and pls defend uropinion. Whynot? U have an
.evidence, live the moment
Of course u will mention the drugs the ptn are taking and I think it
.doesn't need an explanation

HISTORY OF ALLERGY
Again some prefer it with past history and others dont so pls do as
.above
. U should mention if the ptn has allergy or not

PAST HISTORY
previous traumaprevious hospitalizationPrevious blood transfusion previous operations. -Allergy if u didnt mentioned it before
. Pls revise the ex.book
SOCIOECONOMIC HISTORY
Dont need an explanation

Now history is done and again pls revises the examination book

EXAMINATION
At first u should know that u will study general,abdominal,chest,
.cardiac examinations

.Cardiac is less important but u should study it


U should begin with listening to drnoran el ghandor videos and
.reading its notes
?Why
Because it will be like u have got an idea about examination and its
.titles and subtitles, it is like an introduction for u to the following
After this, u should study drmagdyishak book .pls read it with
. concentration first then finish with macloid
Why? Becausemacloid is better than magdyishak in
.pathophysiology of symptoms and also their D.D
Magdyishak is defective in these 2 points but to some extent it
exhibits other topics good for u to some extent
. But u should read macloid , even once
I advise u to read the examination at once from all sources
with the order mentioned above. This is more convenient and
.more reliable and is better for u
I advise u to begin with general examination then chest then
.abdomen then cardio at last
U should attend the clinical sessions and should be already had
.studied the examination, for ur own sake
U should ask the junior drs for help , I.e. u ask them to come with u
at night in hospital to teach u how to perform examination and tell u
. the most popular tricks and the q that drs ask in exams and so on
Macloidadvantages: - the right D.D. of s & s + some
.pathophysiology + evidence for u to fight using it
.So pls study it
DISEASES OR THE CORRICULUM OR THE OBJECTIVES
First and above all, u will study chest,endocrinology, hematology
and nephrology in 4th year but u will study liver which is part from
GIT curriculum in 6thyear, only for clinical exam. Because most
cases are liver ptns , but u won't be examined on liver in written
. exam , again clinical only
Now, pls concentrate
: Ur curriculum
.Chest:T.B.,pneumonia,COPD, bronchogenic carcinoma
Endocrinology:diabetes,thyroid, adrenal
Hematology:anemia,leukemia, coagulopathies
Renal: acute and chronic renal failure, nephritic and nephrotic
.syndromes
.Chest is the most important
In endocrinology: study diabetes well and read thyroid and
adrenal. Diabetes is very important, followed by thyroid which is not
common in exams , and adrenal should be read only and left at the
. end as it doesnt come in any exam before and not liable to come
Hematology:in anemias : read + aplastic anemia is important

Leukemias : read + AML is important


Coagulopathies: read but ITP is important
The above 3 important topics is the most likely examples of the
three components in hematology curriculum to come in exam and
the only problem had come was a one for D.D. in a hematological
.problem which at last appeared to be AML
Renal: very important in case drasem el sherief is the one who puts
the exam. However, in any case nephrotic and nephritic syndromes
are very important. Acute and chronic renal failure : read and
concentrate on acute . Dont forget diabetic nephropathy very
. - important

?This is internal medicine curriculum, small ha isnt it


Yup, it is really small but the trick is in studying
examination and history taking and pathophysiology with it
. - - only in 5 weeks
However, lucky u from now on u will study internal medicine
in 8 weeks and the exam is in the 9thweek, which is very
.good for u to take a good care of internal medicine
If u follow the instructions, u will finish each examination in
one week if u are playing, not studying and history
taking won't take any time with the explanation above. So if
u attended clinical sessions and worked well u will be
alright in history and examination which will u very relaxed
.in every new round
OK
.Now, for the real work and the heavy canons
?In what order should u study urcurriculum
Begin with chest followed by diabetes then hematology then
nephrotic and nephritic then thyroid then acute and chronic renal
. failures.And read what is left in urorder
Before u know how to study the disease u should know well
about ur exam
?Why
Cause u will need to know how to pass ur exam tricks and
.take care of it when studying
Internal medicine written exam
- :basic questions 3
.D.D PATHOPHYSIOLOGY MANAGEMENT May be some additional questions as asking about investigations
.only
asking about pathology which is very new and only in our exam ( y . 2010-2011) both terms

asking about adverse effects which is also very new and only in our exam ,cause the one who put the exam was the brilliant drasem
. el sherief
Dont bother ur self with these new editions of questions just
.concentrate on the 3 unchangeable questions
One moment
?Why those 3 only
Cause if u encounter a case u should be able to put a differential
diagnosis then use the clinical data to reach the diagnosis and if not
enough ask for the precise investigations that will help u reach the
diagnosis and finally u should reach the provisional diagnosis and
after u diagnose u should be able to manage the disease, and dont
forget that u should be able to interpret the pathophysiology of the
.disease and its symptoms and signs
Now I will talk about how u will answer the internal medicine exam
which is very valuable to be known before u beginsur study of
.diseases
HOW TO ANSWER THE D.D.QUESTION
.U liststhe D.D. First and it should be listed according to priority
I.e. 1- the most probable diagnosis
the second in priority which is more likely to be if 1 is not -2
approved
the 3rd in priority and so on-3
It is very important for u to put them in these order according to
priority cause this will represent ur understanding and if u put them
in a different order this will mean u are (7afez mosh fahem) and this
will leave a bad impression on the examiner as this is the
.1stquestion
After listing u will put the s & s mentioned in the problem only
only, only and only in the vertical column of a table and the D.D.
.should be put in the horizontal line
For each S or S u should write if it with, against, highly or less
.common with or against the disease
After this u should write the +VE criteria for the provisional
diagnosis followed by each other differential and its VE criteria of
.selection
N.B. if the q is mention the provisional diagnosis of this case u will
mention it and its positive criteria i.e. C\P clinical picture - of the
. disease
N.B.

VIP

U should know that every word in ur exam problem has a use and
no single word is unusable or has been put for nothing. Every

sentence closes u to the write diagnosis by proving it and excluding


other diagnosis. however , sometimes there may be a tricky
sentence which would be for the purpose of taking u away from ur
diagnosis or the worst : a double pathology which u should identify
. and differentiate its S & S from the real diagnosis S & S
So u should read the exam paper in a slow very concreting manner
and mark each S & s u encounter to make it easy for u to answer
.the D.D. and the pathophysiology questions
O course u will get the previous exams note from SALA7 EL DIEN
.MEMBERS OR from any one older than u
N.B.
VIP
?Why u use only the S & S mentioned in the exam paper
Because this is an exam and those S& S has been put very carefully
to test ur information and who u would act based on the clinical
.data GIVEN TO U
Besides, if u added 1 more information from ur mind to enhance r
answer u will open the way for all possibilities and as
. drmhamednasersaid:( lwhazehe tasta7der 3amal el shaytan )
N.B.
VIP
Pls for god sake dont write the D.D. of the signs and symptoms , u
are asked about the differential diagnosis of the disease not the S &
? S , do u got it
And for god sake if u wrote the D.D. of a single S OR S, the exam
paper won't be enough. pls use ur mind and dont ever listen to a
.one who says something like this
. And believe me some do

? HOW TO ANSWER THE PATHOPHYSIOLOGY Q


U should write the cause of the S OR S followed by the consequence
.of actions tell the S OR the S appeared
E.g. cough: irritation of the cough receptors in by . ,
. nervous signals = reflex arc , mechanism
The most important is the stimulus and the mechanism. The reflex
arc is not that important to be mentioned in the exam paper BUT if
u needs to get the full mark u should impress the examiner and put
ur touch in the exam paper, so if u are one of those who seek the
.full mark write it all
.N.B
Dont ever write a definition,I amasking u about how the -1
?symptom appeared not what it is
dont write something that it is not related to the symptom or sign -2
.I.E. Another pathway or mechanisms
some of the drs advised us to write a small note about the -3
pathophysiology of the disease itself and explain all the possible S
& S related to it before u begin answering and the signs and
symptoms mentioned in it should be marked and highlighted so the
. examiner would know that those are answered

I didnt use this method because I didnt know it but it is very good
.and I recommended that u use it
pls for god sake for all of u answer what is needed from the -4
question first and then impress the examiner as u want because I
dont want someone to waste his time in something not important
like the rest of the exam and then time is out and he will curse me
so pls be smart not a machine get the information then make the
. best use of it and be creative

?HOW TO ANSWER THE MANAGEMENT QUESTION


U should know that management include the diagnosis of the ptn to
the follow up so u should understand this carefully
Aim of management
.confirm P.V. = provisional diagnosis-1
.exclude D.D. = differential diagnosis -2
. TTT of the case = symptomatic ttt + effective ttt -3
.TTT of complications if present-4
.prevention of complications if possible-5
.follow up-6
N.B.U write the above stamp in the beginning of ur answer as it is )
written cause it means u are understanding and u will answer
(rightly
Steps of management
-:to confirm P.V. and exclude D.D. by-1
history: mention a brief note on the +ve criteria of ur P.D. and if -1
u had answered it in the D.D. question so u should write it was
. .answered in the q n
.exmination: - also brief note or previously mentioned-2
investigations : u should write both the investigations written in -3
the exam problem and that needed which should be written by u
.also , u should write for each investigation why u have asked for it
. + its interpretation and what is the data u expect from it

: TTT of the case (symptomatic & effective ttt) -2


U should write the dose and schedule- if there is- as in insulin + the most
.common adverse effect
N.b. I am not telling u to write all the adverse effects of a drug, but writing
the most common adverse effect and how to avoid will be very good in
uranswer. E.g. one of the ANTI T.B. drugs cause neuropathy as a very

common adverse effect, so to avoid it u give him (..) I dont remember


it now; however it is a b12 compound so it decreases neuropathy. Do u got
?it
Another example
Rifampicin and INH cause some degree of hepatic damage and other anti
T.B. drugs cause renal damage so if course u should mention
assessment of liver and kidney function is recommended in follow
up as the drugs may cause renal or hepatic damage
?Do u got it

:TTT of complication if present -3


Important if there are complications in the exam problem, of course he
didnt put it for fun. If there isnt, I recommend not writing it and
proceeding for the following step is better

:prevention of complications if possible -4


.By proper management and effective follow up
.Of course if u dont know how u will write the above sentence

:health education -5
.If u knows it write it, if u dont so leave it empty

:follow up -6
.for monitoring effectiveness of ttt

-:General tips in answering management question


drs means by management =investigation + ttt , but what I mentioned -1
above is the true meaning of managing a ptn . so if u are answering it
internal medicine or pediatrics written exam write it exactly as mentioned
above. But if u are answering it in surgery exam u should write only
investigations and ttt if u dont have time but if u have pls write it as
mentioned above. Obstetric has some unique management so write it as u
. study it
management is too long to be written correctly so u should be already -2
has kept the steps well and u are writing them so fast. If u dont know the
complications, health education and the follow up just write the sentences
.I have wrote in front of every topic

Now u must now that clinical exam


=
Exam

VS

time

:So u should make the best use of ur exam time as follows


u should be trained on answering management q quickly + u should have kept investigations and ttt perfectly in mind
u should be trained on answering the D.D. q by knowing the D.D. for each disease in yr curriculum and keeping it like and remember them like
ur name + pls good study for clinical picture so u can put the +ve and-ve
criteria quickly just by reading the exam paper once in a deep
. concentration
u should be trained on answering pathophysiology q by a very good study for the pathophysiology of the diseases + the constitutional symptoms +
the common symptoms of every system u are studying in ur curriculum +
.complications
Like this u will be prepared to any shock and believe me every clinical
.exam is a shock
Of course I will mention how u could achieve this when u are studying ur
.curriculum so dont be pessimistic
.at last u should never try to cheat ?Why
Cause when u ask ur friend and he the stupid answers u u both will lose
time and I mentioned before . exam VS time , the exam is put precisely
for its time and for a professional to answer in this time , so will u be able
to answer all the questions correctly or we should say professionally at this
?time ? And if u couldnt, how far will u go
This is the method of evaluation in clinical exams, so u need time and if u
are the one who are asking ur friend for an answer (I totally dont respect
u), I dont care about u , but if u are the one who are answering his friend ,
pls I petty u when u finish ur time without completing the exam answer . U
will lose ur time when u are helping ur friends in exam so again and again
.and again dont cheat in exam for ur own sake

?How to study ur curriculum


Look, the right thing is to study from Davidson and Danish. No one knew
about Danish except last year. so I dont really know about it perfectly but
I saw it and most people says that it is perfect so pls dont use
. osamamahmoad except u are in a hurry
First u should read the subject from Davidson first then Danish and in the
?end osamamahmoad .Why
Davidson is a respected text book and investigations and ttt and D.D. In it
. is near perfect
Danish is a text book that is written like the Egyptian way i.e. notes
.So it is very useful for keeping and revising
U will compare both books, and then u will read from osamamahmoad so
that u will see that it is a disgusting book and it is no match for the
. previous 2
Why am I reading from 3 books? Sorry, are u crazy? It is time consuming
.or more correctly a time waste
.U are write In it being time consuming but it is not time wasting
U will have a notebook with u and for every topic u read u will write in it :D.D. just names- , c\p ( in brief, just s & s names and if u dont want to
write it, it would be very fine as I dont want to waste time in c\p , u will
read it from the book at the exam night and it dont need any briefing ) ,
complications just names - , investigations and ttt ( write them precisely
like what u will answer in exam , cuase u will revise from these notes at
the exam night and u should keep them will in ur mind as u need to be
. quick in exam )
This is a method
Another one is to assemble all information in Danish and studying from it
.only after that
Those 2 methods aims for 2 things:- reading from all available sources and
getting every piece of information and know the weakness and power
points of each + having one last source for the topic to be studied from it
and revised from it which is also a very organized near perfect one that is
. made by u so it would be very easy to remember and recall
By achieving those goals u have achieved both being a good dr who had
read from a lot of sources and made his own and now u have evidence for
ur take + u made an easy to keep and recall source which is very
. necessary in examination to achieve the best grades
This is the aim of every dr

However, the topic will take 2 days from u and I am speaking about 2 days
.including clinical sessions not 2 days of the empty ones
So that means u would end chest in 10 days and diabetes in 3 I give u
time to reassure u and give u confidence and those are the most
.important topics
So if u really studied hard and well u will finish examination by the third
week and chest and diabetes by the 5 th week I am taking about the new
system as internal medicine now is 8 weeks and the exam is in the 9 th
one , u are very lucky I really half an inch from envying u - . however ,
after this u should study those 3 most important topics in hematology ( ITP
, AML , APLASTIC ANEMIA ) those should also be studied by any of the
. above mentioned methods
.After that u should study nephrotic and nephritic also the same way
Now if u followed the steps well by the end of the 6 week u will have
.finished the most important topics in both ur written and oral examination
Now u have only 10 days left u should study the liver for the oral exam
which will be in the 9th week + u should read the rest of ur curriculum from
. osamamahmoad
The rest of ur curriculum is thyroid, adrenal disorders, acute and chronic
.renal failures and the rest of leukemia's and anemia's and coagulopathies
Begin with thyroid then acute and chronic renal failure then anemia then
.leukemia then coagulopathies and finish with adrenal
Dont worry if u didnt studied the rest of ur curriculum that I told u to read
. from osamamahmoad
?Why
Because only thyroid ,acute and chronic renal failure had come before
once. and the rest is not a one to be examined in as they are so advanced
for u and there is chest and diabetes and nephritic and nephrotic and ITP
as an example for coagulopathies, AML as an example for leukemia and
APLASTIC ANEMIA as an example of anemia and all of these 3 examples
are of clinical importance and common and had come in a hematologic
exam problem once before in a case of D.D. and open management. Do u
copy? Once for thyroid and once for blood and twice for renal failure, in
internal medicine u should study according to importance, it is very
.important for ur success in it as it is very long and need a hard work

To prove my point of view I will explain to u the oral and written


exam tricks

Oral examination
However, in oral exam u mostly examined on a chest or liver or diabetic
.case. In the worst scenario u will have a git or cvs or anemic case
To examin on a git or cvs case that will be for the ones who have their
exam in the days of git or cvs outpatient clinic and almost it is not done as
u examine in Sunday and Monday . Sunday is the cvs day and Monday is
the chest day. So the worst case scenario is for the people who will
examine at the outpatient clinic in Sunday. dont worry study the cardiac
examination well and u will have no problems as drs knows that u dont
have cvscurriculum and also u have the right to object if u are examined
. on a case that isnt in ur curriculum
Anemia is very rare for u to be examined on as the case that will be
.hospitalized for sure won't be for anemia
And u should know that u dont examine one a renal or a hematologic case
?in oral examination. Why
Because they are in a separate building and no one has been examined in
.the urology building tell now
So again in an oral exam u examine on a chest case ( outpatient or
hospitalized ) , liver case ( always hospitalized, but may be in outpatient
if u are examined in the git day in outpatient clinic ) , diabetes ( most
, a probably a complication if hospitalized or even in the outpatient clinic )
cvs case in the worst case scenario within normal ( in the outpatient only
. and in Sunday or Wednesday )
The outpatient git clinic is on Saturday and Tuesday. So if u are not
examined in the day of an outpatient clinic feel free not to revise this part
.and concentrate on the cases that will be attending,ok
.This is the tricks I know in the system and the weak point's u should know
.If u have a case that is not in ur curriculum feel free to object
U should go systematically in the oral examination to get the full mark. U
should present ur history then make examination then if u didnt reach a
diagnosis feel free to ask for investigations and put a differential and dont
be afraid if u dont reach a diagnosis , u are examined on ur approach to
diagnosis and management. However u examine the ptn in front of the dr
so dont play smart and examine the ptn before examination and write the
results and tell the dr the results to escape him seeing u doing
examination , simply he will get a bad impression about u and this is bad
for u as he will u , no comment . Also u shouldnt examine the
.ptntwice, imagine he is urfather

.After reaching diagnosis u should manage as we mentioned before


Dr always stops u and ask u in the middle of ur action, why are u doing
).this? If u have ur evidence u pass, if u are not (ob2a 2ablny yaprince
Thats why we are studying internal medicine as separated-connected
pieces (history,examination,investigations, c\p and D.D.,complications,ttt,
)health education and follow up = management
So as to be able to answer with evidence and have ur evidence in dealing
.with the ptn
However, this is the system but there are really an abnormal worst case
scenarios (which is the truth
aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaah , crying ) , sorry
.to tell u but this is the truth and u should be prepared for the worst

:Internal medicine drs I know


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deaf & mute
.
.
For the written exam u are examined in ur curriculum and again
the most important topics are chest , D.M. , nephrotic& nephritic ,
ITP &AML & APLASTIC ANEMIA , may be thyroid or acute renal
. failure or in the worst case chronic renal failure
These are the topics that are repeated in the previous exams ordered
.according to importance

Listen carefully: u should be prepared for everything, again everything.


What I mean is that the common topics in any clinical round should be
finished without any hesitation and never be let to the end of the round
and of course if u are defective in them drs and anyone who knows this
will .. Bad actions - u. Whatdifferentiates
the good student from the bad one is the ability to study every single topic
in the curriculum and be prepared for the worst case scenarios. However,
.u should study in order as we mentioned before

From what is mentioned above in explaining the most important


topics in both exams I think I have explained and proved why I am
.telling u to study in that order

?How yo study pathophysiology


To fully understand this u should know that pathophysiology of a disease
includes: pathophysiology of the disease itself + the S & S (i.e. the
consequence by which the disease caused the S OR S to appear) + the
.complications

:Pathophysiology of the disease itself


From the clinical book or ur previous basic knowledge, however the perfect
book for this is Harrison, but to study diseases from Harrison is very hard,
me myself didnt do it except in some important topics . However, if u are
good in basic ,this will be easy for u and of course if u are not good in
basic ( u are screwed , muha ha hahaha , u deserve it , u will really regret
every single second u have wasted in studying basic ) unlucky for u ,
.. clinical is based on basic so imagine

:Pathophysiology of the complications


From the clinical book also or from the basic so again if u dont know how
to skip this professionally u will suffer and as one of my dearest friends
says:(pathophysiology is a and everybody takes it)

:Pathophysiology of S & S

This is really a hard one to master, it needs high search from u and u will
never find it completely at one textbook but we have a solution for every
.problem
For the general S & S of each system u will find it in Harrison textbook of
internal medicine, Chapter 2. For each S OR S u should study the definition
and the mechanism only, if u need to read more do it in ur spare time
.cause it will be a huge bulk
And pls I dont want anyone to say Harrison is too much, the chapter is
huge, hey! I am telling u to read only the def. and the mechanism and the
.rest is in ur spare time so pls dont say it
U should know that the bigger the prize is, the harder the way to
. get it
However, for the rest u should revise the pathophysiology of the disease
and the complications and if u didnt find it after this use Wikipedia, if not
search the net , if not ask the dr ,if not ask a better dr , if not go kill
. yourself
ways to study pathophysiology 2
U can study pathophysiology from its source and remember it well as it
resembles a story and then u know where it is , so of u needed to
. remember u will back to it
But this method is unreliable cause u will forget with time and most of us
.dont study and revise with the right day, week, month revision
Or
U can do small notes about the mechanism in a pathophysiology-specific
.note book
This is what I done but it took time from me as I also briefed all Harrison
and handbook of S & S so I really wasted time but I didnt revise it since
the day I have briefed it , I really didnt opened the book and didnt revises
.pathophysiology ever for an exam
This method takes time but is very convenient in revision. I ask u
.only to write the mechanism as it is the thing u will write in exam
The pathophysiology q is so important and has 45% of the exam
.mark , a huge bulk worthy of hard work to get
A very important advice and the one who will do it completely by
himself will master the answer of pathophysiology q and he will
.really benefit from it very well
Pls, for good sake, u should study every previous exam and for
each case u should answer the pathophysiology q and write it and

ask the drs if it is right and after u accomplish this u should put it
in a notebook, this pathophysiology note will be very useful to u
and u wont look in it after this as the work u exerted in getting it
wont be in vain. Pls if any one do this notebook pls contact me
and I will take a copy from him\her ,pls

?.How to study D.D


Very easy, after u finish studying the disease u will discover it yourself. It is
.good in Davidson and Danish
Oxford textbook of differential diagnosis of signs and symptoms , is good
to give u information , also read it after u finish the system and I
recommended it in chest only but of course if u have time go on hero
.,study devour the books show yourself , I will be very pleased

I think I am done , but u should know that I am only a student not


, professional dr
U should study well and if I missed something dont blame me,
.blame yourself that u didnt search for it
I will write another file for all the 4th year rounds
But god helps me to do so

If anyone needs any help, pls contact me at


Drfota_theseeker@yahoo.com
Or
At Facebook with the same email

.And pls contact me on face better


I hope u benefit from this writing and I hope u feedback me for
,any note or any part need to be modified
I appreciate criticism and I hope u give this information for
anyone who needs it and pass it down through generations in this
college
Special thanks for drs

Mostfaabd el haliem
Mohamed mamdoh
Ahmed el sehiely

.My dearest friends and my guiders in this college


Sorry for being so talka
tive
Good be with us
DR \ AHMED SAID AHMED