FSP in BAYER 2023 (1) Translated

Machine Translated by Google
Shamil Gurbanov
Contents
Example - Case................................................................................................................................................8
PAOD......................................................................................................................................................10
TVT .......................................................................................................................................................16
Leg ulcers.................................................................................................................................................21
ACS .......................................................................................................................................................28
Heart Failure .....................................................................................................................................33
Pneumonia / angina tonsillaris........................................................................................................40

Bronchial asthma.................................................................................................................................45
Esophageal Carcinoma .....................................................................................................................................53

Gastric ulcer .......................................................................................................................................................58
Cholecystolithiasis .....................................................................................................................................63
IBD........................................................................................................................................................68
Colon carcinoma.................................................................................................................................74
Hypothyroidism .....................................................................................................................................79
Hyperthyroidism........................................................................................................................................84
Hypoglycemia.........................................................................................................................................89
Hodgkin Lymphoma ................................................................................................................................95

Acute Leukemia.................................................................................................................................101
Migraines................................................................................................................................................105
Epilepsy .....................................................................................................................................................110
Angina tonsillaris / pneumonia ............................................................................................................118

Infectious mononucleosis .....................................................................................................................124
Wrist Fracture + Rib Fracture ......................................................................................................130 Wrist

Fracture + Hip Distortion ........................................................................................134
Patella fracture + hip joint distortion.................................................................................................140
Ankle Distortion ........................................................................................................................144
Polytrauma ............................................................................................................................................149
Ruptured Spleen (My Case) ..........................................................................................................................153
Cervical Disc Prolapse................................................................................................................................159

Lumbar disc herniation ................................................................................................................................163
Urolithiasis........................................................................................................................................169
Pyelonephritis.....................................................................................................................................175
Physical Examination ........................................................................................................................225

Neurological Examination.................................................................................................................228
foreword
"FSP in Bayern 2023" is the first book for targeted preparation for the technical
language test.
My goal in writing this book was to show people how to properly prepare for the exam.
From my personal experience, preparing for the exam was quite complicated because
I didn't know what to study. Also, I had to look at a lot of different materials, as well as the
protocols, which unfortunately were mostly written in a difficult and unstructured way.
Because of all these factors, my preparation for the exam took almost 8 months.
It's time to change all that!
It took me almost 10 months to write the book "FSP in Bavaria 2023". In writing this book, I
analyzed many logs, books, and other PDF files.
I would now like to go into them briefly.

The most important thing is the logs. Although they were quite well written by colleague
Dimitri Rudy, they lacked many important little things. An improved version of ZAY's logs
contains a lot of unnecessary information. The other log files were full of structural
and grammatical errors. Based on the new 2021-2023 protocols, I have changed each protocol
by 80% and added current protocols.
This book consists not only of all current protocols, but also of PDF materials for
"technical terms", explanations and reactions and empathy".
I am happy to share this book with all colleagues. The book is only part of the success, the
rest is up to you.
I wish everyone good luck!
1 FSP IN BAVARIA 2023 | Shamil Gurbanov

Important!
- Incorrect diagnosis plays no role in the technical language test!
- It is false, without an ECG, even without a troponin determination, from a myocardial infarction
or unstable angina pectoris. Acute Coronary Syndrome (ACS)
is the clinically correct diagnosis, which should be given without ECG and troponin determination.
- The "Pneumonia" protocol is the same as the "Tonsillary Angina" protocol . If you give pneumonia as a
suspected diagnosis in Part 3, you will be asked questions about pneumonia. However , based on the clinical
picture in this protocol, angina tonsillaris is more suitable.
- Enterocolitis means inflammation of the small and large intestine (colon). It covers a very broad spectrum of
gastrointestinal diseases, so it is not correct to name this as a suspected diagnosis. As a diagnosis, it is more
correct to say either IBD or colon cancer .
- It is not entirely clear if there is a “colon carcinoma” protocol as it does not

differs significantly from IBD .
- The “Acute Leukemia” protocol was only identified once in the exam. There was also a case in 2022 where
this diagnosis was accepted.
o Tip: You can read the case once, but the simulation is not here
necessary.
- There is no "Diabetes mellitus" protocol. The protocol you have seen so far,
was not spelled correctly.

technical language test

The specialist language test for doctors is relevant for all foreign doctors who have not studied in Germany.
The technical language test lasts 60 minutes and takes the form of an individual test. The examiners are
experienced doctors. Content of the technical language test is a case study of a typical situation in the hospital. A
discussion and documentation situation is simulated. The test focuses on listening comprehension as well as oral
and written expression. In this context, medical expertise is not evaluated.
Before the start of the exam, you will be introduced to the members of the judging panel. The members of the
evaluation committee would be pleased if you introduced yourself and briefly told us about your studies or your degree.
would report on your previous professional career.
Part 1: Doctor patient conversation

The first part of the test includes a simulated doctor-patient conversation. The test candidate conducts an
anamnesis interview with a simulated patient. In the conversation, the patient is played by a doctor on the
examination board. The task of the test candidate is to explain and formulate the suspected diagnoses, to submit
suggestions for further diagnostics and therapy and to explain the intended measures to the patient. The candidate
must respond appropriately to the patient's questions. In this respect, listening comprehension is a central part of
the test. Furthermore, the extent to which the candidate can respond to the patient and ask appropriate questions
is evaluated.
Use terms that are easy for the patient to understand and avoid technical terms where possible. You may keep
written records. (Notes do not have to be presented to the judging panel, but must be handed in at the end of the
exam).
Part 2: Documentation
The second part of the technical language test includes the documentation and builds on the previous doctor-
patient conversation. The examinee receives a medical history form for this purpose. On this anamnesis form, the
candidate should summarize the medically relevant information obtained in the anamnesis interview in writing in a
doctor's report. You may use your notes from Part 1 for this.
You are welcome to use the laptop provided for this purpose or to make your entries by hand.
Part 3: Doctor-doctor communication

This involves a patient presentation within a handover discussion with a medical colleague. Use medical terms.
The examiner then asks further questions.
Below is a short list of questions and tips for writing documentation!

Part 1: "Doctor patient conversation"

General questions
Surname
What's your name? Could you please spell your first and last name slowly? Did I spell that correctly?
Age/Birthday How old are Size Weight
you? When were you born? How tall are you? how heavy are you
Current complaints Associated Complaints

Mr./Mrs.., What complaints do you have? What Sir/Madam…, is there anything you would like to
leads you to us? add regarding your current complaints?
Questions depending on the case (See cases) Questions depending on the case (See cases)
Vegetative anamnesis If necessary, women's medical history
Fever
Do you have fever? Did you measure your body temperature? Age:
45 > Are your periods regular?

Do you have chills or sweats? 45-50 < Still having your periods?
noticed? When was your last period?

Appetite
How's your appetite? Has he changed lately -Do you visit your gynecologist regularly?
changes?
Weight
Have you gained or lost weight lately?

how many kilos In which period? Was that
accidental or desired?
Sleep
Do you have trouble sleeping? Do you have trouble

falling asleep or staying asleep? Is there a specific reason for this?
Bowel movements/urination
Do you have problems with bowel movements and/or urination?
Pre-existing illness medication
Mr./Ms. ... , Do you have previous illnesses, from You should ask about the medication immediately
that I should know? E.g. high blood pressure or after a confirmed previous illness:
diabetes and etc. - What do you take for that? (tablets)
- Since when have you...? - What do you use against it? (ointment,
- Do you take anything against it? suppository, etc.)
- For fracture and some diseases – - How strong?
Which side was/is affected?
- How many times a day?
- How was this disease treated?
- Do not take medication other than those mentioned
! Depending on the clinical picture, there are different questions
you what else? Do you have yours?
(see cases)
medication list?

Operations
Mr. Mrs ..., Have you ever had an operation? Why and when? Was this surgery uncomplicated?
- In the case of fractures: which side? How did this happen?
allergies/intolerances
Mr/Ms … Are you allergic to / certain Vaccination Are you vaccinated against all childhood
medication or food? diseases and Covid-19?
- How does this allergy manifest itself? Against Covid-19 how many times? Are you already
-
What part of the body does it occur in? (possibly.) boosted?
-
Are you aware of any other allergies or intolerances?
- In case of drug allergies (NSAIDs/antibiotics…):

How was this determined?
noxae
Nicotine consumption: Mr./Ms. … Do you smoke or have you smoked? What? Since when? How much daily?
Alcohol consumption: Do you drink alcohol? What? How often?
Drug use: Sir/Madam, do I have ..., please don't take my next question personally but routinely
to ask you whether you have had any contact with drugs before?
social history family history

What is your marital status? Mr./ Mrs. ..., Are your parents still alive?
What do you do / what did you do for a living? Are there any important illnesses in your close relatives?
Do you have children? is everyone healthy

Where and with whom do you live?
Part 2: “Documentation”
This book contains all the current protocols, which are written in a letter form.
The meaning of the medical terms is given in red letters .

Additional information provided by the patient is written in blue .
You can safely write the letter as in the protocols, except for the words that are written in red
and blue letters.

Part 3: “Doctor-doctor communication”

Senior physician: Sir/ ..., I heard you admitted a patient today. Can
Madam, would you please introduce the patient?
Introduction
Yes gladly.
- I would like to introduce Mr./Ms. Mustermann today.
- Mr./Mrs. Mustermann is an XY year old patient
- It is about an XY-year-old patient, Mr. / Mrs. Mustermann, born on ...
- It concerns an XY-year-old patient, Mr./Ms. Mustermann, born on ...
Anamnesis (current complaints)

main symptoms
He/she came to us because of pain in the right lower leg that had suddenly appeared for 5 days
and was radiating pain to the right foot.
Or
He/she came to us because of pain in the right lower leg that had occurred 5 days ago .
- The pain would radiate to the right foot .
- He/she also reported that the pain was stabbing and aching - According to the patient, the pain came
on suddenly/slowly and got better/worse over time.
Pain intensity was rated X out of 10 on the pain scale.
Accompanying
symptoms - He/she also complained about ...
- He/she also reported on...
Vegetative anamnesis if necessary, women's

The vegetative anamnesis was unremarkable except for .... medical history - At women's medical history, she said that
her periods are regular.
- She also visits her gynecologist
regularly.
Pre-existing illness medication
- He suffers from previous illnesses ... - Regarding the medication he/she takes
- Pre-existing conditions are (...) known ... (tablets) a.
previous operations - He/she takes medicines ...
- He/She had an operation for bursitis 2 years ago . (tablets) a.
- In addition, he/she uses ... (spray, ointment,
- He/she had a bursectomy 2 years ago Suppository)
Have been carried out.

allergies/intolerances vaccinations
- He/She has an allergy to ... which is related to ... He/she was vaccinated against all childhood
expresses. diseases and against Covid-19 (three times) .
- She/he is also allergic to …
- The allergy manifests itself with …
- He/she is also known to have lactose intolerance,
which manifests itself as ...
noxae
- He/she is a non-smoker. Before that , he/she smoked 10 cigarettes a day for 14 years .
- He/she drinks a glass of wine on weekends - He/
she used joints occasionally when young .
- Alcohol/drug use was denied
social history
He/she is widowed, a teacher by profession, has two children, lives in a house with his family.
family history
The following illnesses were found in the family: - The father

died at the age of 65 from a colon carcinoma .
- The mother suffers from diabetes mellitus type 2.
- Brother/sister suffered from obesity .
presumptive diagnosis differential diagnosis

- Because of the information mentioned , I assume Differential diagnostic come ... in
a suspicion of ... out. consideration.
- The anamnestic information indicates on

most likely towards .
Proceed further therapy

For further clarification , the following measures The following therapeutic measures can be
such as (...) should be carried out considered: …
Example - case "PAD"

It is a 58-year-old patient, Mr. Böhm, born on July 5th, 1965 . He came to us because of pain in his right lower leg that
had been going on for 3 months . The pain would radiate to the right foot . He also reported that the pain was stabbing
and stress-dependent. According to the patient, the pain started after walking about 150 m and got worse over time.
Pain intensity was rated at 8-9 out of 10 when walking and at 4-5 out of 10 at rest on the pain scale
rated.
He also complained of feeling cold, shiny dry skin, pallor and effluvium of the affected lower leg.
Questions about fever, edema, paresthesia, hypoesthesia and restriction of movement were answered in the negative.

The vegetative anamnesis was unremarkable except for constipation and stress-related insomnia in the form of disturbances in
sleeping through the night.
He has suffered from previous illnesses from type 2 diabetes mellitus for 8 years, hypercholesterolemia for 8 years, eczema on the
head for 2 years, prostatic hyperplasia for 6 years, and bronchial asthma at the age of 49.
He had had PTCA 8 years ago and had pilonidal sinus surgery 10 years ago .
In terms of medication, he is taking Icandra 50/1000mg 1-0-1, Fluvastatin 20mg 0-0-1, ASA 100mg 1-0-0, Tamsulosin 0.4mg 1-0-0 .
He also uses Symbicort Spray 1-0-1.
He is allergic to pollen . The allergy manifests itself with rhinoconjunctivitis.
He is also known to have a latex allergy, which manifests itself with exanthema and pruritus .
He was vaccinated against all childhood diseases and against Covid-19 .
He is a non-smoker, drinks half a bottle of red wine and a glass of cognac in the evening.
He used hashish in his youth .
He is an early retiree, has worked as a chef, is married, has 2 children and 4 grandchildren and lives with her
his family.
The following illnesses ran in the family :

- The father is dementia, lives in a nursing home
- The mother died of a hemorrhagic stroke at the age of 55
The anamnestic information most likely points to PAD .
DVT and diabetic polyneuropathy can be considered in the differential diagnosis .
For further clarification, I would physically examine the patient, take blood and arrange for laboratory diagnostics and perform color
duplex sonography.
The following therapeutic measures can be considered: Conservative measures such as lifestyle changes (abstaining from
smoking, diet, maintaining normal blood sugar and blood pressure, maintaining healthy cholesterol levels). Drug therapy with statins,
ASA / clopidogrel, pain therapy (metamizol, paracetamol), anticoagulation (heparin). Interventional and operative revascularization
and, if necessary, amputation are further options.
8th FSP IN BAVARIA 2023 | Shamil Gurbanov

1. Pain history
! Where? Can you pinpoint the exact location of the pain, please? Is the right or left side affected?
! When? How long have you had this pain? Is the pain sudden or gradual?
began?
! pain scale? How bad is the pain on a pain scale of 1 to 10, with 1 being mild and
10 is unbearable? Did you take anything for pain?
! What? Could you please describe the pain more precisely, is the pain rather dull,
stinging, burning or pulling?
! radiate? Does the pain radiate to other parts of the body?
! Course? Has the pain gotten better or worse over time? Is the pain stress related? Have you had pain like this before? That's why
you went to the other person
Physician?
! Trigger? Are there specific triggers for the pain? Is there pain relief at the high
or deep storage?
! for PAVK: Should you stop running and take a break? How far can you
walk without the pain appearing?
2. Swelling
- Are your legs swollen? Since when? Did the swelling start slowly or suddenly?
Has the swelling gotten better or worse over time?
3. Trophic changes
! Temperature? Are your legs overheated or do you feel cold in your legs?
! skin changes? Has the skin changed in this area? Do you have hair loss
Have you noticed skin discoloration, flaky skin or brittle nails?
4. Additional Questions
- TVT - Are you short of breath? (to exclude a pulmonary embolism)
- Ulcus cruris - Is the ulcer weeping or moist? Does the ulcer get bigger over time?
become?
- Have you had an accident? (DD with fracture)

- Have you noticed tingling, numbness, paralysis or pain in your back? (around LBWS
excluded) (DD with disc prolapse)

PAD
patient
First name, last name: Alfons Böhm, age: 58 years, height: 178 cm, weight: 90 kg
allergies, intolerances
- Pollen allergy with allergic rhinoconjunctivitis hay fever

- Latex allergy with exanthema skin rash and pruritus itching
stimulants
ÿ Nicotine consumption: non-smokers
ÿ Alcohol consumption: 1/2 bottle of red wine and 1 glass of cognac in the evening (for a good night's sleep)
ÿ Drug use: Hashish in his youth
social history
He is an early pensioner (because he has to take care of his wife), has worked as a chef, is married (his wife
had apoplexy a year ago and suffers from hemiparesis), has 2 children and 4 grandchildren, lives with his family.
family history
§ Father: be dementia, live in nursing home

§ Mother: died at the age of 55 from a hemorrhagic stroke (a brain vessel burst).
Anamnesis (current complaints, vegetative anamnesis, previous illnesses and

previous operation)
Mr. Böhm is a 58-year-old patient who presented to us because of increasing, stabbing, stress-related pain in
the right lower leg that had been present for 3 months and was radiating to the right foot.
Pain intensity was rated at 8-9 out of 10 when walking and at 4-5 out of 10 at rest
rated on a pain scale.
According to the patient, the pain comes after walking about 150 m.
developed and got worse over time. (After that he had to take a break of about 1 minute to be able to continue)
He also noticed the following accompanying symptoms: feeling cold, shiny skin
dry skin, pallor and effluvium hair loss of the affected lower leg.
Questions about fever, edema, swelling, paresthesia, tingling, hypesthesia , numbness and
restriction of movement were answered in the negative.
The vegetative anamnesis is normal except for constipation and insomnia . (because of his wife).

The following illnesses are known to him:

• Type 2 diabetes mellitus for 8 years,
• hypercholesterolaemia increased blood lipid levels for 8 years,
• eczema on the head for 2 years,
• prostatic hyperplasia enlargement of the prostate gland for 6 years,
• Bronchial asthma at the age of 49 (he had asthma three days before his 50th birthday
bronchial been diagnosed).
He underwent a PTCA cardiac catheterization with stent implantation 8 years ago and had an operation
for pilonidal sinus coccyx fistula 10 years ago .
medication
- Icandra 50/1000mg 1-0-1

- Fluvastatin 20 mg 0-0-1
- ASA 100 mg 1-0-0
- Tamsulosin 0.4 mg 1-0-0
- Symbicort Spray 1-0-1
Suspect and differential diagnosis

The anamnestic information most likely points to PAD.
DVT and diabetic polyneuropathy can be considered in the differential diagnosis.
Proceed further:
1. CU
- Inspection: skin color, trophic disorders

- Palpation: lateral comparison of the extremities (temperature, sensitivity, pulse status)
- Auscultation: systolic noises over affected extremities 2. Ratschow positioning
test - The patient performs foot movements in a supine position with the legs raised vertically. In
the case of PAD, the foot fades prematurely, possibly with calf pain (claudication).
3. ABI (Ankle-brachial index) – Ratio of systolic leg artery pressure to

Arm artery pressure (normal value 0.9 -1.2)
4. Laboratory: small BB, CRP, ESR, D-dimer, glucose, Hba1C 5.
FDS (color duplex sonography)
6. If necessary, angiography (-CT/ -MRI)

Therapy:
1. Conservative - Lifestyle changes: quit smoking, diet, normal blood sugar

and maintain blood pressure, maintain healthy cholesterol levels.
2. Medicinal: depending on the stage

- from stage I - statins
- from stage II - ASA / clopidogrel
- from stage IV - systemic antibiotics
3. Pain therapy (Metamizol, Paracetamol)
4. Anticoagulation (heparin)
5. Interventional and operative revascularization (from stage III-IV)

- PTA with balloon dilatation
- Bypass surgery
6. Possibly amputation
questions during the exam

From the patient:
1. What about me? Do I have to stay in the KH? My husband is home alone.
o Mr. Böhm, we only did an admission interview and therefore I cannot say the exact diagnosis without further important
measures. I only have suspicions at the moment
window sickness. Can Your Husband Cope On His Own? Because currently we can
can't say for sure if this is life threatening or not. Would be better if you stay with us.
2. What investigations are you continuing?

o I do further physical examination, then I take blood to check important parameters. Then we do an imaging test.
ultrasound examination.
3. What is an ultrasound scan?
o Please see “Clarifications”
From the examiners:

1. Why does the patient take simvastatin in the evening?
o This is very important because of better metabolism. The body's cholesterol production is slightly higher at night than
during the day. For this reason, the statins lower cholesterol slightly better when taken in the evening.
2. What is Pilonidal Sinus?
o Pilonidal sinus is an inflammation of the subcutaneous fat tissue, usually

the sacral region, which is often caused by ingrown hairs.

3. How does ASA work?
o ASA inhibits cyclooxygenase enzymes and thereby blocks the production of prostoglandins, which stops inflammatory
processes and reduces pain perception. In addition, ASA inhibits platelet aggregation by blocking thromboxane A2
synthesis in the platelets.
4. Why does she have a stent? How does a stent work?
o It is a small tube that is inserted into a vessel to keep it open.

Stent implantation is used to treat narrowing of the coronary arteries.
5. How do you do physical exam?
o First, I will do a physical exam.
ÿ When inspecting the leg, I expect it to be pale, dry and possibly

cyanotic skin, and trophic disorders (ie, hair loss, necrosis, gangrene, or ulceration).
ÿ When palpating , I expect cold skin and weak or

Scan non-existent pulses.
ÿ When auscultating the leg, I expect a systolic stenosis murmur

Listen to affected vessel in side comparison.
6. Which pulses do you mean?
o I will check the peripheral pulse, especially the dorsal pedis artery, artery
tibialis posterior and popliteal artery
7. Your VD and DD?
o My suspected diagnosis is PAD and the differential diagnosis includes DVT and diabetic polyneuropathy.
8. What further investigation will you do?

o I will use laboratory chemistry to determine small BB, CRP, ESR, D-dimer, glucose and HbA1C. As
the gold standard for pVAK diagnosis, I will do color duplex sonography and, if necessary,
angiography (CT/MRI).
9. What should we watch out for when using contrast media in the examinations?
o Patient is taking metformin. In addition, prior to the examination, kidney and
Thyroid levels checked.
10. What stage of PAD is the patient in?

o Patient expresses pain after walking distance of 150 m, that's why I follow up about stage 2b
fountain.
11. If your suspected diagnosis has been confirmed, treatment to a hospital or

be able to find state on an outpatient basis?
o Pat. showed an advanced stage of PAD, therefore further treatment in the

be carried out in hospital.
12. PCTA –
Reconnaissance o Please see “Reconnaissance”
13. Is the patient at risk of an allergic reaction?
o Yes, she is already allergic to pollen and rubber gloves, so we have to
be careful.

14. What is the clinical difference between PAD and DVT?
PAD DVT
1. Intermittent claudication 1. Acute pulling pains - swelling of an extremity 2.

-chronic, stress-related pain, SZ improve when lying in an
-Improvement after the break, -no elevated position
swelling 3. Pulse palpable
2. SZ improve when deep storage 4. Hyperthermia

3. Pulse not palpable
4. Hypothermia
5. Trophic disorders: skin suppuration, hair loss,
nail dystrophy
Comment!
When I arrived and sat down they offered me water and told me. I found the atmosphere very relaxed, everyone was smiling.
Completely different from the first time. First they introduced themselves and me.
They asked me what I had done to improve since the first exam and I told them. I told them that I had taken a phonetics course
and this caught their attention, so they asked me about it.
Then I created my spreadsheet for the notes and we started. The patient spoke quickly and gave a lot of dates, almost none of
the numbers were whole numbers, all with decimals. While
when he told me about his current complaints, he told me about previous illnesses and medication and allergies. Caution! I had
about 10 minutes and wasn't sure if I was on time or not because I had jotted down a bit of each section of my notes but not all
and I had to try to catch everything so I tried to moderate the conversation more. The patient asked me in the middle of the
conversation if I could tell him the diagnosis and I told him that we would finish the questions and do some tests
would have to do before we could talk about an accurate diagnosis.

In the 3rd part the performance began. He interrupted me a couple of times, mainly to ask me for details and numbers
(sometimes it was difficult to understand him because he didn't speak loudly and clearly, and with the glass and the FPP2 it's
not easy).
I finally waited in the waiting room for about 10 minutes. And other colleagues came by and said they failed the exam. When I
came back to the examiner I thought I failed the exam because of my pronunciation because I spoke without paying attention to
how I say the sentences even though I tried to speak slowly. And when I sat down, they told me that I did very well. That the
written part was good too. What I need to improve is my pronunciation and they know I know that because I've already taken a
course. And then we talked about the medical specialty I wanted to do...

INFO!
Ø Hay fever (pollen allergy, allergic rhinoconjunctivitis) is a hypersensitivity of the immune system to
different plant pollen.
regards
Hay fever the conjunctiva of the eye and the nasal mucosa.
before Typical symptoms of hay fever are: Itching
everything
(pruritus), redness (erythema), "runny nose" (rhinorrhea) and swelling of the nasal mucosa.
Ø Cognac is a brandy from the French city of Cognac and the surrounding area
Wine-growing region obtained from white wines.
Ø Chef - male person trained in cooking, food preparation and cooking for a living.
Ø Angioplasty (PTA = percutaneous transluminal angioplasty) is a treatment method to widen blocked or

narrowed blood vessels. To do this, the doctor uses a special catheter that he inserts into the vascular
system under radiological control. Catheter is a tube from
Plastic.
Ø Hemiparesis is slight and incomplete occurring on one half of the body

Paralysis of a muscle, muscle group, or limb.
Ø In the event of a cerebral hemorrhage (“hemorrhagic insult”), blood comes out of a ruptured
vessel into the cerebral space. The bleeding can occur directly into the brain (intracerebral) or close to
the brain between the meninges (subarachnoid).
Ø The pilonidal sinus (coccyx fistula) is an inflammation of the subcutaneous fat tissue, which usually occurs
in the sacral region and often through
ingrown hair occurs.
Ø Icandra - 50 mg vildagliptin + 1000 mg metformin.
Ø Fluvastatin is used to treat hypercholesterolaemia.
Ø Symbicort is an inhaler used to treat bronchial asthma and COPD. He

contains two different active ingredients: budesonide and formoterol.

Ø Tamsulosin is used exclusively in men to treat lower urinary tract symptoms associated with a benign
enlargement of the prostate, known as benign prostatic hyperplasia (BPH).
Ø PAD - stages according to Fontaine:

- Stage 1- symptom free (no pain)
- Stage 2- Intermittent claudication
• 2a Complaint-free walking distance 200 <
• 2b Complaint-free walking distance 200 >
- Stage 3 - Rest pain
- Stage 4 - Trophic disorders (necrosis, ulcers, gangrene)
DVT
patient
First name, last name: Rio Neumann, age: 53 years, height: 172 cm, weight: 82 kg.
- Penicillin with exanthema skin rash (found after therapy of erysipelas)
- Lactose intolerance Lactose intolerance with gastralgia stomach pain and diarrhea diarrhea
stimulants
ÿ Nicotine consumption: 1 pack of cigarettes for 20 years, PY-20.
ÿ Alcohol consumption: 1 bottle of beer and 1 glass of wine

occasionally ÿ Drug consumption was denied
social history
He is self-employed, salesman at a costume shop, married twice in 2 years, lives with his family, has a son who
suffers from ADHD Attention Deficit Hyperactivity Disorder
suffers (after death of pet – guinea pig).

family history
§ Father: (80 years) died 3 years ago of mesenteric infarction intestinal infarction .
§ Mother: suffering from coxarthrosis right. Hip joint wear, was treated with hip TEP and
suffer from varicose veins
Section brother: obesity obesity, was treated with bariatric gastric surgery
cared for (weight before surgery was 152 kg, after surgery 80 kg)

previous operation)
Mr. Neumann is a 53-year-old patient who came to see us because of stabbing pain in the right lower
leg that had suddenly appeared for 2 days and was radiating to the hollow of the knee, calf and right foot.
Pain intensity was rated 5 out of 10 on a pain scale.
According to the patient, the pain was relieved with elevation.
The patient noticed the following accompanying symptoms: edema, shiny and red skin, Swelling,
hyperthermia, overheating, and a feeling of tension in the affected lower leg.
The vegetative anamnesis is unremarkable except for insomnia , sleep disturbance in the form of
disturbances in sleeping through the night (without reasons) and constipation .
The following are known to be pre-existing conditions:

• Arterial hypertension high blood pressure for 10 years,
• Varicose veins on both sides for 5 years,
• Recurrent tendovaginitis tendonitis on the right wrist for 8 years,
• Eczema on the supercilium eyebrow on both sides,
• Distal radius fracture wrist fracture left. 14 years ago, was treated with an orthosis.
He was operated 7 years ago for the fracture of the Os carpi carpal bone fracture . (treated with plate
removed after 6 months)
medication
- Vote plus 20/12.5mg 1-0-0

- diclofenac ointment b. B.
- Cortisone ointment (Decoderm) bB

- Movicol sachet bB

The anamnestic information is most indicative of DVT.
Thrombophlebitis, erysipelas and PAD can be considered in the differential diagnosis.
Proceed further:
1. KU (inspection, palpation, auscultation)

- Inspection: skin color (cyanosis)
- Palpation: leg circumference (oedema), temperature (hyperthermia) , pulse status
(palpable) , - signs of thrombosis:
• Payer's sign: tenderness on the medial sole of the foot.
• Meyer's sign: Calf compression pain

• Homan's sign: calf pain with dorsiflexion of the foot
2. Laboratory: small BB, CRP, ESR, coagulation, D-dimer, electrolytes

3. Color duplex compression sonography
4. Possibly phlebography
Therapy:
1. If necessary, pain therapy bB
2. Compression therapy with compression bandage or stocking.
3. Anticoagulation therapy with low molecular weight heparin 4. OAK
therapy with vitamin K antagonists (Marcumar) or direct OAK (apixaban,
rivaroxaban)
5. Surgical therapy - open or balloon catheter thromboectomy
Questions during the exam:

1. Detailed about anamnesis.
2. What is the patient taking for constipation?

o He is taking Movicol sachets
3. What does he take for aHT? o He

is taking Votum Plus for arterial hypertension – (Votum Plus- Olmesartan + HCT)
4. Were the varicose veins operated on? And why?
Oh no. The surgical indication of varicose veins is pronounced trunk varicose veins 5. How
did the patient describe the fracture of the os carpi? What was used? And when was
it removed?
o He said carpal fracture and that was treated with a plate. The plate
was removed after 6 months.
6. What is Technical Terms of Tendonitis?

o tendovaginitis

7. In which eyebrow does the patient have eczema? o

Eczema is bilateral 8. How
did the patient get the os carpi fracture?
o He sustained the fracture in the long jump.
9. What's up with the mother?
o His mother has right coxarthrosis, which was treated surgically with hip TEP and she suffers from it
varicose veins
10. What is his occupation? What does costume shop mean?
o He is self-employed, a seller at a costume shop. o Trachten shop is

a place where clothes, jewelry and accessories are sold
11. What is wrong with the son? And how does this disorder manifest itself?
o The son has ADHD and he said that your son's guinea pig passed away. Children with ADHD are hyperactive, chaotic,
bursting with impulsiveness and easily distracted. You often have problems with your homework.
12. What is your VD?
o Based on the information mentioned, I suspect DVT.

13. How can you prove DVT?
o TVT's gold standard is color duplex compression sonography.

14. Can you please briefly describe the principle of color duplex compression sonography? o Please see
“Clarifications”
15. Why is it called compression sonography?
o Basically, the examination method is based on the question of whether the vessel lumen can be compressed by
pressure with the transducer (compression sonography). The lumen of a normal vein is fully compressible. If there
is a thrombosis, the lumen can only be compressed partially or not at all.
16. What risk factors of DVT do you know?

o As with all thromboses, phlebothrombosis is also a combination of
theclotting disorder (so-called Virchow triad).
Decrease in flow rate, blood wall changes and
o Immobilization of the patient or traumatization of the vein lead to stasis.

Damage to the vessel wall is due to injury, surgery or inflammation.
Hematological and neoplastic diseases are possible causes of the coagulation disorder
17. Which coagulation disorder is most common in young men?

o Willebrand disease
18. What is Willebrand disease?
o Willebrand factor is a blood protein and influences the function of the thrombocytes. In this disease there is a
significant deficiency of the blood protein von Willebrand factor.
19. Which coagulation factor in vWF disease is reduced
o Factor 8.
Comment!
Hello everyone. Yesterday I took the FSP and thank God I passed. My case was TVT, the commission were very nice and helpful.

INFO!
Ø Erysipelas is an infection mostly caused by Streptococcus pyogenes
of the skin.
Ø Lactose intolerance is an intolerance to milk sugar (lactose) due to an enzyme deficiency.
Ø Attention Deficit Hyperactivity Disorder (ADHD) is a behavioral disorder that occurs primarily in children
and is associated with difficulty concentrating, motor hyperactivity and increased excitability.
Ø Mesenteric infarction is called the complete closure of a

mesenteric vessel with subsequent infarction and necrosis of the supplied one
intestinal section.
Ø A total endoprosthesis (TEP) is an artificial joint replacement (joint endoprosthesis) in which the entire
joint, ie the joint head and the joint socket, are replaced.
Ø Bariatric surgery or obesity surgery is a branch of surgery that deals with surgical interventions that are
intended to lead to a reduction in body weight.
Ø Tendovaginitis is an inflammation of the muscle tendons and

their sheaths.
Ø Thrombophlebitis is an inflammation of superficial (epifascial)

Veins with secondary formation of thrombosis.
Ø Superficial vein thrombosis (OVT) is also called thrombophlebitis and

deep vein thrombosis (DVT) is called phlebothrombosis.
Ø Signs of thrombosis:
- Payr sign The examiner presses the sole of the foot with his fingers. Meyer's sign is positive when
tenderness occurs on the inside of the foot
- Meyer's sign The examiner presses the calf with fingers. Mayer's sign is positive when pressure
causes pain on the medial side of the
lower leg occur
- Homan's sign Calf pain when toe is lifted

Ø Heparin is a group of endogenous glycosaminoglycans

which have an inhibitory effect on the coagulation cascade.
Ø Marcumar contains the active ingredient phenoprocoumon, which has a “blood-thinning” effect.
The drug Marcumar is a so-called antagonist of vitamin K, which is important for blood clotting
and is needed by the body to stop bleeding. With Marcumar therapy, the effect of vitamin K is
reduced, it takes longer for the blood to clot.
Ø Direct oral anticoagulants, DOAC for short, is the generic term for a group of anticoagulant
the and can be taken orally.
drugs that act directly against certain coagulation factors
Ø The mode of action of classic anticoagulants is indirect: Heparin works by increasing the affinity
of antithrombin for thrombin and factor Xa. vitamin
K antagonists (Marcumar) inhibit the production of coagulation factors in the liver. Therefore,
the DOAK represent a new principle of action.
Leg Ulcer
patient
First name, last name: Sissi Wagner, age: 63 years, height: 174 cm, weight: 83 kg
! Seafood with diarrhea diarrhea and pruritus itching
! Ointment for wounds with erythema redness and pruritus itching, (she has the ointment in the pharmacy
bought and used on wound)
stimulants
ÿ Nicotine consumption: non-smoker for 13 years. Before – 25 cigarettes daily, 35 years, 43.75
PY
ÿ Alcohol consumption: 1 bottle of beer occasionally.
ÿ Drug use was denied.

social history
She is a pastry chef by profession, will retire in 2 years, is married, lives with her husband, who is wheelchair
bound after a Zn Apoplex cerebri stroke , has 2 adult children and a grandchild who is currently suffering from
Scarlatina scarlet fever .
family history
§ Father: 10 years ago from cholangiocarcinoma biliary tract malignancy (She said biliary tract malignancy
and she didn't know if it was cancer but it's definitely cholangiocarcinoma, OA agreed.)
§ Mother: Zn intestinal perforation , intestinal breakthrough, Z. n. surgical treatment 5 years ago
with the installation of Anus praeter artificial bowel outlet

previous operation)
Mr. Wagner is a 68-year-old patient who came to us for painful, weeping

Ulceration Ulcer at malleolus medialis medial malleolus radiating to the right
presented right lower leg.
Pain intensity was rated 5 out of 10 at rest and 7 out of 10 at dressing changes
rated on a pain scale.
The patient added that he had been suffering from leg ulcers for 9 months .
According to the patient, for the past 3-4 days, the pain had increased and the ulceration had become deeper
and wider with brownish excretion and discharge .
(According to the patient, she used an ointment for wounds, but without improvement and with a contact
allergy.)
In addition, the patient noticed the following accompanying symptoms: increasing edema
Increase in circumference and hyperpigmentation brown skin discoloration of the right lower leg
and exertional dyspnoea, exertional shortness of breath.
The questions about accident and hair loss were answered in the negative.
The vegetative anamnesis is unremarkable except for pain-related insomnia sleep disturbance in the form of
difficulty sleeping through the night and constipation .
He is aware of the following pre-existing conditions:
• Arterial hypertension high blood pressure for 10 years,
• chronic otitis media otitis media for 4 years, wear hearing aid, last
exacerbation relapse 3 weeks ago,
• phlebothrombosis TVT 5 years ago,
• Varicosis varicose veins bds. since a young age.

He underwent an endoscopic polypectomy 6 months ago and an appendectomy when he was 27 .
medication
- Benazepril 5 mg 1-0-1
- HCT 25mg 1-0-0
- ASA 100 mg 0-1-0
- Marcumar 3 mg (according to INR/plan)
- Drops against constipation (name not remembered) bB

The anamnestic information most likely indicates venous leg ulcers.
Differential diagnosis includes ulcus cruris arteriosum and diabetic foot syndrome,
under consideration.
Proceed further:
1. CU
! Inspection of the ulcer: photographic documentation and precise description of ulcers (irregularly
limited and weeping ulceration on the lower leg)
! Palpation (depending on the type of ulcer venosum or arteriosum)

2. Laboratory: small BB, CRP, ESR, glucose, coagulation, D-dimers, electrolytes 3. CCDS
and, if necessary, pflebography (in the case of venosum)
4. Dopler sonography and, if necessary, angiography (arteriosum)
therapy
1. Local wound therapy with regular dressing changes:
- Flushing and removal of slips
- Alginate (formation of secretion) foam insert for filling defects
- Therapy of the skin/the edge of the wound: panthenol, zinc ointment (every 3 days)
2. Compression therapy 3.
Treatment of the underlying disease: venous surgery therapy and therapy of
PAD
4. If necessary, antibiotic therapy
5. If necessary, plastic procedures to cover the defect (skin transplant or
flap plastic)


1. How much does the patient
weigh? o Patient weighs 83 kg.
2. What does the pastry chef do for a living?
o Confectioner is a person who professionally produces pastries and sweets.

3. Who takes care of the man?
o Unfortunately, I didn't ask about that.

4. Why does she have exertional dyspnoea? What can be underlying?
o This may be a complication of DVT or pulmonary embolism, which manifests as dyspnea on exertion.
5. What is Scarlatina?
o Scarlet fever (Scarlatina) is an acute streptococcal infection of the tonsils (tonsils) and throat with a characteristic skin
rash caused by group A beta-hemolytic streptococci that produce erythrotoxins.
6. What previous illnesses does the patient have?

o Arterial hypertension for 10 years,
o Chronic otitis media for 4 years,
o DVT 5 years ago, o
Varicosis on both sides since a young age.
7. Why does she suffer from chronic otitis media?
o Because of the hearing aid

8. Why does a hearing aid cause inflammation?
o The ear canal can be squeezed by hearing aid and this leads to ear canal eczema
9. What kind of hearing aids do you know?
o Basically, you can differentiate between analogue and digital hearing aids. The
Most new hearing aids are digital.
10. How are the new hearing aids built
o The new devices are mobile and you can put them down to prevent the pressure point
(decubitus)
11. What is the technical term for inflammation of the auditory meatus?
o Diffuse external otitis
12. What is the patient's risk factor for U. cruris?
o She has DVT as a risk factor for venous leg ulcers.
13. What clinical signs of DVT can you tell?

o Hyperthermia, palpable peripheral pulses, cyanosis, sudden swelling and
drawing pains in the affected extremity.
14. Why do you need HbA1C in laboratory?
o This could also be a diabetic foot.

15. How can you know in 10 seconds what type of leg ulcer is it?
o We can quickly feel peripheral pulses. Palpable pulse speaks for Uc Venosum

16. What therapeutic measures would you take?

o Local wound therapy with regular dressing changes:
o Compression therapy o
Treatment of the underlying disease: Here therapy of DVT
o If necessary, antibiotic therapy
o If necessary, plastic procedures to cover the defect (skin transplantation or flap plastic)
17. What does local wound care mean?
o Cooling, irrigation and removal of slips with sterile compresses and regular
Change bandage
18. How to suspect an infection? And how do you decide which antibiotic?
o Excretion from the wound suggests infection, antibiotics should be administered as therapy.
An antibiotic antibiogram is crucial for antibiotic therapy.
19. What does antibiogram mean?
o The antibiogram is a microbiological examination method in which the effectiveness of different antibiotics against
bacteria is tested. In this way, antibiotic resistance of bacteria can be detected. For that we take
Swab from wound.
Comment!
The exam is a bit stressful but doable. You have to understand well and speak fluently. The examiners are nice and have no
negative bias. I studied every day for 3 months. I've been in DE for 3.5 months and I've done 3 individual training sessions with
Ms. Beate Pabst. She is really very helpful. I worked with the protocols, DocChek Flexikon, "For the technical language exam -
Bahaa Mahmoud" Good luck!
INFO!
Ø Apoplex cerebri (stroke) is the result of a circulatory disorder in the brain that usually
occurs "suddenly", which leads to a regional lack of oxygen (O2) and nutrients (glucose)
and thus to the death of brain tissue.
Ø A bile duct carcinoma or cholangiocarcinoma means one

malignant tumor in the area of the efferent bile ducts.
Ø Intestinal perforation is a locally limited breakthrough of

intestinal contents through the intestinal wall into the abdominal cavity.

Ø Anus praeter (enterostoma) is an artificially created intestinal outlet, in which the

intestine is discharged through the abdominal wall. The stoma is red and wet and is standing
on the abdominal wall.
Ø Otitis is the medical term for an inflammation of the ears.

- Otitis interna (labyrinthitis) is the inflammation of the labyrinth
in the inner ear.
- Otitis media is an inflammation of the middle ear (auris media).

- Otitis externa is an inflammation of the skin and subcutis in the area of the external
auditory canal (meatus acusticus externus).
Ø Benazepril is an antihypertensive drug from the group of ACE inhibitors, which

is used to treat arterial hypertension and heart failure.
Ø The diabetic foot syndrome, DFS for short, is a frequent complication of diabetes
mellitus. Clinically, the diabetic foot syndrome is characterized by poorly healing
erosions, weak or absent foot pulses and pain sensation:

1. Chest pain history
! Where? Can you pinpoint the exact location of the pain, please?
! When? How long have you had this pain? Is the pain sudden or gradual?
began?
! pain scale? How bad is the pain on a pain scale of 1 to 10, with 1 being very
easy and 10 is unbearable? Did you take anything for pain?
! What? Could you please describe the pain in more detail, is the pain rather dull, pressing, stabbing, burning or pulling?
! Course? Has the pain gotten better or worse over time? When do they kick?
Pain on, during exertion or at rest? Have you had pain like this before? Is that why you went to the other doctor?
! Trigger? Are there specific triggers for the pain?
2. Dyspnea
Are you short of breath?
- When? Since when? Did the shortness of breath start suddenly or slowly?
- History? When does the shortness of breath occur, during exertion or at rest? How did the shortness of breath with the
time changed? How many floors can you climb without getting short of breath?
- orthopnea? How many pillows do you need to sleep or do you sleep with elevated
Upper body?
- Paroxysmal nocturnal dyspnea? Do you have to wake up at night because of shortness of breath?
3. Cough / phlegm
- Do you have a cough and have you noticed sputum? Since when?
4. Swelling
! Are your legs swollen? Since when? Did the swelling start slowly or suddenly?
Does the swelling get better or worse over time?
! Have you also noticed swelling in your abdomen?
5. Cardiac arrhythmias
- Does your heart beat unusually slower or faster
6. Nocturnal urination
! Do you need to go to the toilet frequently at night?

ACS
patient
First name, last name: Edith Voigt, age: 76 years, height: 178 cm., weight: 85 kg.
allergies/intolerances
- Chicken protein allergy with abdominal pain Abdominal pain and erythema redness
(since youth)
stimulants
ÿ Nicotine consumption: occasional pipe for 5 years. Before that 25 PY (50 years half
box daily)
ÿ Alcohol consumption: 1-2 beers a day.
social history
She is retired, worked as a caretaker in a school, is married, lives separately from his husband (he has lived in
a nursing home for 3.5 years because of dementia), has 2 children (both are healthy) and 3 grandchildren, lives
with the eldest who broke his leg.
family history
§ Mother: died at the age of 60 from pulmonary artery embolism , occlusion of a pulmonary blood vessel
§ Father: died at 53 from colon cancer

previous operation)
Ms. Voigt is a 76-year-old patient who came to us because of 1.5 hours of stress-related, pressing, dull,
retrosternal pain radiating to the mandible, the neck and the left arm.
He shared that the pain came on after exertion and got worse over time.
(She had to walk home from the supermarket with 2 bags after shopping because his grandchild broke
his leg. Then she suddenly expressed chest pains, which got worse over time. Then she called his
daughter-in-law, who drove her to the hospital.)
The patient noticed the following accompanying symptoms: Vertigo, dizziness, nausea , dyspnea , shortness of
breath and anxiety.

The vegetative medical history is unremarkable except for nocturia, nocturnal urination, chronic
constipation , and insomnia.
The patient was aware of the following pre-existing conditions:

• Arterial hypertension high blood pressure for 12.5 years,
• Type 2 diabetes mellitus since 11 years,
• Zn TVT in the left lower leg 4 years ago, was treated conservatively,
• Pediculosis capitis Head lice infestation for 5 days, treated with a solution.
She had been operated on 20 years ago for the fracture of the acetabulum. (She fell off a ladder)
medication
- Lisinopril 10 mg 1-0-0
- Metformin 1000mg 1-0-1
- ASS 100mg 0-1-0 (prophylactic after TVT)
- Ketozolin Shampoo bB (against pediculosis capitis)
- Dulcolax Sup. bB (against constipation)
The anamnestic information most likely points to acute coronary syndrome.
Pulmonary embolism and stable angina pectoris should be considered in the differential diagnosis.
Proceed further:
1. Physical examination: check vital parameters (pulse, SpO2, RR) and
cardiac auscultation.
2. Laboratory: BB, CRP, electrolytes, lipid status, kidney values, TSH, cardiac enzymes (CK,
LDH, troponin I/T, myoglobin)
3. ECG <10 min after initial contact.
4. Coronary angiography - gold standard for diagnosis and severity assessment
of coronary heart disease.
5. If necessary, echocardiography: location/size of hypokinesia.
Therapy:
1. General acute measures - “MONA”

o M-morphine – for nitrorefractory pain (STEMI)
o O-O2 administration – at SpO2 <90%
o N-nitrates – not used in STEMI, option for angina control in
NSTEMI
o A- ASS

! Oxygen (O2) and nitrates should only be given when indicated
2. Revascularizing therapy:
o PTCA at STEMI (within 120 min.) and NSTEMI (2 h-72 h)
3. Other acute measures
o Dual antiplatelet therapy (ASA+clopidogrel or ticagrelor)
o Anticoagulation IV with heparin
4. Supportive therapy (reinfarction prophylaxis)
o B2 blockers (metoprolol) o
ACE inhibitors (ramipril)
o Statin (atorvastatin – depending on lipid status)
5. If necessary, iv thrombolysis – only for STEMI if PTCA does not occur within 120 minutes
available
6. Bypass surgery if necessary

1. Anamnesis - detailed
2. What is your VD?
o According to the patient's complaints, I suspect ACS (Acute Coronary Syndrome)

out of.
3. What should you do next with the patient?
o Check vital parameters: pulse, oxygen, blood pressure, etc., KU, laboratory,
4. Which KU would you do?
o The most important here is cardiac auscultation to assess heart sounds and
heartbeats
5. What is ACS?
o The term acute coronary syndrome (ACS) is used in medicine to describe a spectrum of cardiovascular diseases
that are caused by the occlusion or severe narrowing of a coronary artery. It ranges from unstable angina pectoris
(UA) to the two main forms of heart attack (NSTEMI) and (STEMI).
6. If it was a myocardial infarction, what do you see on the EKG?

o A recent infarction can manifest itself with two ECG changes:
• Excessive T: An exaggerated T wave may be the earliest sign.
• ST elevation: The ST elevation as a classic early sign of a heart attack presents itself as
ST segments immediately following the R wave.
7. How do you deal with the heart attack?
o We should quickly assess vital parameters and carry out an ECG.
8. And what are the first therapeutic measures you take?
o Sedation o
Morphine: 5-10 mg IV to relieve pain.

o O2 - oxygen delivery (2-3L/M).

o Nitrate : To improve myocardial blood flow.
o ASA: 500 mg IV to inhibit platelet aggregation.
o Heparin: 5000 IU for anticoagulation; anticoagulant.
9. What speaks in the anamnesis for and against a pulmonary embolism?
o This suggests anxiety and dyspnoea. For DD one must determine D-dimers and perform CT angiography. The
character and type of pain and pain radiation speak against this.
10. Coronarography - Enlightenment

11. What risk factors for MI do you know?
o The following risk factors can be considered: arterial hypertension,

Hyperlipidemia, family history, DM, nicotine abuse, age.
12. How to distinguish angina pectoris and MI?
Stable AP MI
• Occurs through stress. • Occurs for the first time or at rest.

• lasts < 5 min. • lasts >10 min.
• responds to antianginal drugs • Does not respond after typing
such as nitrate. nitrate
13. How to distinguish unstable AP from non-ST elevation myocardial infarction?

o We can determine heart enzymes in a laboratory. NSTEMI leads to increased
cardiac enzyme levels.
14. What are cardiac enzymes?
o Heart enzymes are laboratory values that indicate possible heart disease or impaired heart function. These are
primarily so-called cardiac enzymes such as: CK (creatine kinase), LDH (lactate dehydrogenase), troponin T.
15. Why did you ask about fever? If there was a fever, what could it be?
o Fever in this can speak for the pneumonia, that's why I asked about it.
Comment!
1st chapter
The examiners were very nice. The patient talked a lot and quickly. I once had to offer her to speak more slowly because I had to
write everything down.
In the beginning she told the whole story about shopping because that's where her ailments arose. She was in severe pain, so I
offer painkillers. I've also
interrupted the conversation because it was an emergency. The examiners were happy with that.
It is very important to actively listen to her because she said several things that were necessary in the anamnesis.
If I didn't understand something, I asked and she helped me. For example, I didn't know the name of a drug, so I asked if she
could spell it.

Part 2
Time is really tight, but I organized everything well. I wrote allergies, stimulants and medication at the
beginning, then the current anamnesis and VD, DD and further procedures and at the end FA, SA. I saved a
minute at the end so I took a quick quick look at everything with my eyes.
3rd part
In the last part I didn't have to do the introduction. The OA made a start himself by hearing about our new
patient. He asked about the medical history in detail. I presented everything.
Sometimes he interrupted me and asked something or he wanted further clarification. When I finished the
performance, the OA asked about my VD.
I think the most important thing is to speak slowly and clearly. It's not very easy in the masks. Another
important thing is to ask. It doesn't matter whether it's through anamnesis or a doctor-doctor conversation.
It's a big help if they use slightly different words.
INFO!
Ø A pipe consists of a cavity into which tobacco is placed and lit, and a mouthpiece
through which the smoke of the burned tobacco is drawn.
Ø A pulmonary embolism refers to the displacement or narrowing of a

pulmonary artery or a bronchial artery by an embolus
Ø Caretakers relieve real estate owners of a large number of activities that arise during
the operation of a real estate. For example, the caretaker can take care of the garden,
organize the winter service and minor repairs
take care of.
Ø The head louse is an insect from the human lice family (Pediculidae), which lives as
an ectoparasite in the human hair and feeds on blood.
The occurrence of head lice in a person is medically referred to as pediculosis

capitis or head lice infestation.
Ø The acetabulum fracture is a bone fracture in the area of the

acetabulum

heart failure
patient
First name, last name: Konstanze Mayer, age: 62 years, height: 168 cm, weight: 83 kg
- Amoxicillin with exanthem skin rash and dyspnea shortness of breath

- Dust mites with dry cough
stimulants
ÿ Nicotine consumption: only 3 cigs for 2 years. per day. Before that – 30 PY. (I currently smoke
less because of my son, he suffers from full body paralysis)
ÿ Alcohol consumption: 2-3 glasses of beer daily. ÿ
Drug use was denied.
social history
She retired early, worked as a caretaker at a vocational school, was widowed (her husband died of apoplexy 1.5
years ago), lived alone on the 4th floor, had 3 children, one of whom suffered from tetraplegia, complete
paralysis of all extremities after a motorcycle accident.
family history
§ Father: died at 80 from osteosarcoma bone cancer .
§ Mother: had an operation for abdominal cancer 3 months ago
Anamnesis (current complaints, vegetative anamnesis, previous illnesses and previous surgery)
Ms. Mayer is a 62-year-old patient who came to us because of increasing, exercise-related dyspnea, shortness
of breath and chest tightness that had been present for 5-7 weeks.
According to the patient, these symptoms would occur when climbing stairs on the 1st floor.
She also shared that the symptoms had gotten worse over time and that she was now lying on her back with an
elevated upper body because of the orthopnea, shortness of breath
have to sleep. (Pat. needs 2 pillows to sleep due to shortness of breath lying on his back).
In addition, she noticed the following accompanying symptoms: edema, swelling on both lower legs, dry cough,
vertigo, fatigue and nocturia, urinating at night .
Questions about pain and fever were answered in the negative.

The vegetative anamnesis is unremarkable except for insomnia sleep disturbance in the form of
Trouble sleeping through the night (due to nocturia and orthopnea), weight gain of 2-3 kg within
from 6 weeks.
The following illnesses are known to her:
• Atrial fibrillation for 2 years,
• Arterial hypertension High blood pressure for 5 years

• Hypercholesterolemia Elevated blood lipids for 5 years
• Inpatient treatment of pancreatitis Pancreatitis at the age of 55.
She underwent right knee replacement 2 years ago.
medication
- Marcumar 0-0-1 (under regular INR controls)
- Bisoprolol 5mg 1-0-0

- Ramipril 5 mg 1-0-0
- Atorvastatin 10 mg 1-0-0 (here the patient asked me -Is that right that I
take atorvastatin in the morning?)
- HCT 12.5 mg 1-0-0
The anamnestic information most likely points to cardiac insufficiency.
COPD and angina pectoris can be considered in the differential diagnosis.
Proceed further:
1. CU:
- Inspection: signs of jugular vein congestion (increased jugular vein pressure and positive hepatojugular
reflux).
- Palpation: tachycardia (HR >90-100/min), irregular pulse, tachypnea
(> 20/min) Peripheral edema.
- Auscultation:
• Cardiac auscultation - Dislocated (and widened) apex impulse,

presence of 3rd heart sound
• Pulmonary Auscultation - Pulmonary rales, also after coughing

persist
2. Laboratory:
• proBNP (for progress control and risk class determination)

• Small BB and possibly ferritin and transferrin saturation (anemia can cause heart failure
trigger or aggravate)
• Kidney values: urea and creatinine

• Liver values: y-GT and, if necessary, GOT, GPT

• TSH (hyper- or hypothyroidism can trigger or worsen heart failure)
• Electrolytes: (hypokalemia may occur as a result of diuretic use and hyponatraemia
may occur as a result of prolonged diuresis and end-stage heart failure)
3. Apparative and invasive diagnostics

1. ECG (cardiac arrhythmia)
2. Echocardiography: gold standard for diagnosing heart failure (heart muscle and
valve condition, size of EF (ejection fraction)
3. X-ray chest: widened heart shadow, increased vascular markings,
interstitial pulmonary edema
4. Cardio MRI if necessary
5. If necessary, coronary angiography heart catheter examination with the possibility of

dilating any vascular narrowing that may be visible (PTCA, balloon dilatation and, if
necessary, stenting)
Therapy:
- Non-drug basic therapy
• Weight reduction and physical activity
• Salt reduction
• Limiting fluid intake
• Limitation or restriction of alcohol and tobacco consumption
- Drug therapy
1. ACE Inhibitors (Ramipril)

In case of intolerance, alternatively - AT1 receptor antagonists (Sartane) or ARNI
(Enteresto).
2. Aldosterone antagonists (spironolactone or eplerenone) 3. ß-
blockers (bisprolol, metoprolol).
4. Diuretics (loop diuretics) (torasemide, furosemide)
5. If necessary, cardiac glycosides (digoxin or digitoxin)
6. SGLT-2 Inhibitors (Dapagliflozin and Empagliflozin)
- Other options • Implantable

cardioverter defibrillator (ICD)
• Cardiac resynchronization (CRT) •
Heart transplantation


1. Detailed questions about medical history.
2. Where does the patient live?
o She lives alone on the 4th floor
3. Is there an elevator?
o Unfortunately I didn't ask about it
4. Why is patient taking Marcumar?
o She is taking Marcumar for atrial fibrillation.

5. Are there any other options besides Marcumar?
o Yes, for example at the moment there is an even better option with NOAK, the little risk and the
have side effects.
6. Why is she smoking less these days?
o He smokes less because of your son who is quadriplegic.
7. What can we do for the son if the patient stays in hospital?
o We can provide home care for the patient's son for this period
organize support.
8. Is weight gain of about 3 kg within the last 6 weeks normal?
o This is not normal because the patient has a normal appetite and that was what the patient wanted. In my opinion
weight gain is due to water retention
in the legs.
9. What is your suspected diagnosis? What are the pros and cons?
o My VD is heart failure. Almost all the complaints mentioned speak for this.
10. Could you say differential diagnosis? o COPD and
angina pectoris can be considered as differential diagnostics.
11. What is COPD? How will you rule out COPD? What investigations are required
be performed?
o COPD is a collective term for chronic diseases of the airways that are associated with an increasing restriction of lung
ventilation. COPD has a different clinical picture with chronic cough and main symptoms such as dyspnoea.
Spirometry and pulse oximetry should be performed to rule out COPD.
12. What is pulse oximetry?

o This is a non-invasive measurement of arterial blood oxygen saturation and
pulse rate.
13. What forms of heart failure do you know?
o One subdivides heart failure as right, left and global heart failure as well as
compensated and decompensated heart failure.
14. What shape does the patient have?
o Pat has global congestive heart failure.

15. What procedures are you initiating for this patient?
o Please see “Further procedure”

16. What do you expect on physical examination for right heart failure?
o Here we could see signs of right heart failure such as edema, jugular vein congestion,
Hepatosplenomegaly and ascites.

17. What ECG changes can we find in this patient?

o Here you can see atrial fibrillation on EKG.
o The ECG shows a typical picture: no P waves and irregular RR intervals

18. How can you diagnose heart failure?
o I would carry out an echocardiography as a basic diagnosis of heart failure. Here you can assess left ventricular
ejection fraction (LVEF), heart valve condition, wall movements, right heart stress and rule out myocardial
hypertrophy.
19th NYHA classification
o NYHA Stage I: No symptoms present. o NYHA stage II: slight

limitation of physical performance.
o NYHA stage III: Complaints already appear during low exertion.
o NYHA Stage IV: Severe symptoms present. At rest and at all
physical activities, shortness of breath and rapid exhaustion occur.
20. Therapeutic measures?
o Please see “Therapy”
Comment!
I have been learning German for 1.5 years and have a B2 certificate. I prepared for the exam for 2 months (did 5 simulations with
Ms. Pabst, which were very helpful) and did not sit in. My tips are - in the 1st part, always show empathy, don't just ask questions.
INFO!
Ø Dust mites- Mites prefer to live in mattresses, carpets and
upholstered furniture
Ø Janitors keep buildings and grounds in good condition. They take on small ones
Repairs, winter and summer services, maintain heating and ventilation systems and maintain the
outside area.
Ø A tetraparesis is a paralysis (paresis) of all four extremities.

Complete paralysis without any residual voluntary activity is called quadriplegia.
Ø An osteosarcoma is a malignant bone tumor that consists of

Cells are formed that produce the bone matrix.

Ø Lower abdomen (hypogastrium) is a medical term for the pelvic organs and their surroundings, which is
sometimes also used to describe the sexual organs (especially the uterus).
Ø Various types of cancer of the female reproductive organs are summarized under the term abdominal
cancer : uterine body cancer, ovarian and fallopian tube Cervix- and
cancer, vaginal cancer and labia cancer.
Ø Orthopnea is severe dyspnea that occurs when lying down, which requires an upright posture and frequent
use of the auxiliary respiratory muscles
might.
Ø Pancreatitis is an inflammation of the pancreas (pancreas). Man

distinguish between acute and chronic pancreatitis.
Ø A total endoprosthesis (TEP) is an artificial joint replacement (joint endoprosthesis) in which the entire joint,
ie the joint head and the joint socket, are replaced.
Ø Neck vein congestion, or JVD for short, is a congestion in the jugular veins. Congestion in the jugular vein
corresponds to increased jugular venous pressure (JVP) and is a sign of upper inflow congestion.
Ø Hepatojugular reflux is a congestion of the neck veins, which is called

Phenomenon in the context of right heart failure as a clinical sign in
Examination of the patient can be determined.
Ø NT-pro-BNP is a prohormone fragment from the group of natriuretic peptides.

This protein belongs to the group of hormones produced in the heart, which stimulate the kidneys to excrete
fluid.
Ø SGLT2 inhibitors are primarily prescribed by physicians for diabetes mellitus
Type 2 diseases. The active ingredient group leads to increased excretion

of glucose and can also be used in heart failure.

1. Cough / phlegm
Do you have a cough?
- When? How long have you had the cough? Did the cough start suddenly or slowly?
- History? Does the cough only occur during the day or also at night? Is the cough
Does it depend on the load or does it also occur at rest?
- sputum? Is the cough dry or have you also noticed sputum?
- color? What is the color of sputum? Is it yellowish, greenish or transparent?
- Consistency? What is the consistency of sputum? Is it rather thin, viscous (tough), slimy
or purulent?
2. Dyspnea
Are you short of breath?
- When? Since when? Did the shortness of breath start suddenly or slowly?
- History? When does the shortness of breath occur, during exertion or at rest? How has shortness of breath changed over time?
Where is the shortness of breath: when breathing in? / Exhale?
- Trigger? Was there a specific trigger?
- orthopnea? How many pillows do you need to sleep or do you sleep with elevated
Upper body? (DD heart failure)
- Paroxysmal nocturnal dyspnea? Do you have to wake up at night because of shortness of breath?
(DD heart failure)
3. Pain / tightness
- Do you have chest pain or tightness? Since when?
- Is the pain dependent on breathing (in the case of chest pain)

- Do you have any other pains? Head, stomach or body aches?
4. Fever
- Do you have a fever? did you measure it?

- Have you noticed chills and sweating?
- Have you had a respiratory infection recently?
- Covid-19? Have you recently been in contact with someone who has contracted Covid-19?

Pneumonia / tonsillar angina

Patient first
name, last name: Rudolph Pohl, age: 56 years, height: 169 cm, weight: 65 kg.
- amoxicillin with exanthema skin rash,

- Indication of lactose intolerance Lactose intolerance with meteorism flatulence
stimulants
• Nicotine consumption: smoker since 20 years. 20 cig. per day, 20PY

• Alcohol consumption: 1 beer daily
• Drug use was denied.
social history
He is a florist, married, lives with his family, has 3 children, one of whom is suffering
of Down syndrome.
family history
§ Father: suffer from pneumoconiosis pneumoconiosis

§ Mother: status after strangulation ileus surgery bowel obstruction 4 weeks ago due to adhesions
Adhesions (the mother had a hysterectomy for uterine myoma 10 years ago and the
adhesions arose a few years ago as a result of a previous hysterectomy
been.)

previous operation)
Mr. Pohl is a 56-year-old patient who presented to us because of a five-day productive cough with yellowish-
greenish sputum.
In addition, the patient noticed the following accompanying symptoms: fever up to 39.1°C, dyspnea , shortness
of breath, tachypnea rapid breathing, rhinorrhea , runny nose, nocturnal hyperhidrosis , night sweats, cephalgia ,
headache, chest pain, chest pain, 1-time epistaxis , nosebleeds, fatigue .
The vegetative anamnesis is unremarkable except for meteorism, flatulence, insomnia , sleep disturbance
and inappetence loss of appetite.

• Lentigo solaris Age spots in the temporal region of the temples
• Burn-out syndrome, emotional exhaustion 8 years ago •
Arthritis urica gout for 5 years, podagra gout attack 5 weeks ago • Chronic low
back pain Lumbar pain for 14 years

He was operated on 13 years ago for carpal tunnel syndrome on the right side of the thumb and 3 years ago for
a cut on the thenar on the left side of the thumb .
medication
- Zyloric 300mg 1-0-0,

- lactrase b. B.
- Solaraze gel in summer 1-1-0
The anamnestic information most likely points to pneumonia.
Angina tonsillaris and acute bronchitis should be considered in the differential diagnosis.
Proceed further:
1. CU:
- Palpation: increased bronchophony and vocal fremitus

- Percussion: Head noise reduction -
Auscultation: Moist rales and crepitation (in pleurisy)
2. Laboratory: small BB, CRP, ESR, PCT, BGA, electrolytes.
3. X-ray thorax - gold standard
4. Microbiology - culture, PCR and serology. material (sputum,

bronchial secretion, blood cultures)
5. If necessary, CT thorax in the case of unclear X-ray findings and complications
6. If necessary, pleural sonography for pleural effusion
Therapy:
1. Assess Severity (CURB-65)

2. Bed rest, respiratory therapy, infusion therapy with adequate fluid administration.
3. Antibiotic therapy - early calculated antibiotic therapy.
§ Light: penicillin (amoxicillin)-in case of penicillin allergy-> macrolide (clarithromycin)
§ Moderate: amoxicillin or clarithromycin + clavulanic acid
§ Severity: piperacillin/tazobactam
4. Antipyretic for fever > 38.5 C – (Paracetamol)
5. Antitussive for Cough - (Codeine Drops)
6. Mucolytic Expectorant - (ACC, Ambroxol)
7. If necessary, oxygen administration in severe respiratory distress (SpO2 <93%)

1. What is your suspected diagnosis?

o The anamnestic information most likely points to pneumonia.
2. Which diagnosis is still relevant?
o Angina tonsillaris and acute bronchitis can be considered as differential diagnosis.
3. What are the pros and cons? o This is
supported by the main complaints such as productive cough, fever, dyspnea, tachypnea, chest pain, hyperhidrosis,
cephalgia. On the other hand speaks here epistaxis, the unusual
is with pneumonia.
4. Which KU would you perform?

5. Which apparatus-based examination is the most important?
o Here x-ray thorax is the most important examination method.
6. X-ray thorax reconnaissance.
7. What would you see in Rö recording?
o Typically – alveolar congestion with infiltration and possibly accompanying pleural effusion (as a complication). In viral
pneumonia - interstitial interconnection.
8. What do you expect in BB?
o I am expecting either leukocytosis or leukopenia.

9. What is the inflammation parameters?
o The term inflammation parameters includes all laboratory values that indicate inflammation
can indicate. This includes:
§ blood sedimentation rate (ESR)
§ C-reactive protein (CRP)
§ Leukocytosis (Small BB)
§ Procalcitonin (PCT)
§ Left Shift (Diff.-BB)
10. Do you also need a differential BB here?
o Yes, if necessary, bacterial and viral pneumonia can be differentiated with a differential image.
11. What is ESR?
o The blood cell sedimentation rate (ESR) is used to determine the rate at which the red blood cells (erythrocytes) sink in
the blood that has been made uncoagulable. The test is a search test when an inflammatory disease is suspected.
12. What is CRP and PCT?
o The C-reactive protein, short CRP, is a plasma protein that is formed in the liver and to
the so-called acute phase proteins and the inflammatory parameters
o Procalcitonin, PCT for short, is the prohormone of calcitonin. It is used, among other things, as a marker for bacterial
infectious diseases (eg in the case of sepsis).
13. What is solar lentigo?
o Lentigo senilis (or solaris) is defined as that resulting from chronic UV exposure
hyperpigmented spots on sun-exposed skin areas.

14. What is burn-out syndrome?

o A burn-out syndrome is a condition in which the patient is so burdened by ongoing professional and/or private stress
that a state of physical and emotional exhaustion sets in with significantly reduced performance.
15. How is viral pneumonia different from bacterial?
Alveolar (bacterial) pneumonia Interstitial (viral) pneumonia
Acute onset Subacute onset
previously healthy Influenza infection as a pre-existing condition
fever > 38.5°C, Fever < 38.5°C (subfebrile)

chills
Left-shift leukocytosis, CRP lymphocytosis

and ESR increased
Productive cough Dry cough
Lobular infiltrates in the X-ray chest preferably Interstitial and/or lobular infiltrates, flat shadowing
basal
severe malaise, tachypnea, Less feeling of being sick

tachycardia
16. In the case of angina tonsilaris in particular, what other tests would you carry out?
o Bacterial culture from throat swab and antibody detection
Comment!
Hello dear colleagues, Yesterday I took and passed the FSP in Munich. The patient spoke in great detail and unclearly. That's
why I wasn't able to finish the anamnesis interview. I don't have the family history and social history within 20 minutes
done, but that helped me with the second part, so I wrote the whole doctor's letter (except for the families - social anamnesis, of
course). My letter wasn't perfect.
INFO!
Ø Lactose intolerance is an intolerance to milk sugar (lactose) due to an enzyme
deficiency.
Ø Florist is a flower expert who finds an endless number of different ways of arranging
flowers and making bouquets, flower arrangements or table decorations from them.
Ø Down syndrome is a genetic disease that is triggered by a chromosomal aberration.

The chromosome 21 is not present twice, but three times (trisomy) in the genome.

Ø Pneumoconiosis means the reactive behavior of the lung tissue

on inhaled and deposited inorganic dusts.
Ø Strangulation ileus is constriction of a section of intestine with simultaneous

circulatory disorder of the intestinal wall
Ø Adhesions (adhesions) - are connective tissue strands between organs in the

Abdomen or between an organ and the abdominal wall that are not normally connected
Ø Arthritis urica (gout) is the clinical manifestation of hyperuricemia with urate precipitation
in the joints and other tissues.
Ø Podagra is an acute attack of gout at the metatarsophalangeal joint or at the end joint of
the big toe. Pain attacks triggered by an acute attack of gout in other joints are also
referred to as Podagra in a broader sense.
Ø Lumbago or lumbalgia , commonly referred to as "lumbago", is understood to mean severe

acute back pain in the loins. She
are among the most common back pains.
Ø The carpal tunnel syndrome is a bottleneck syndrome (nerve compression syndrome) of the
Median nerve in the wrist area.
Ø Zyloric (Allopurinol) - including in all forms of hyperuricemia
Ø Solaraze Gel (Diclofenac) is a non-steroidal, anti-inflammatory

dermatological gel
Ø Rattling noises (RS) are perceptible noise phenomena in the auscultation of the lungs,
which are caused by the movement of liquids or secretions in the
Ø Airways develop during inspiration and expiration

bronchial asthma
patient
First name, last name: Ferdinand Düsterhof, age: 32 years, height: 177 cm, weight: 87 kg
- Grass pollen with allergic rhinoconjunctivitis hay fever (he always has a runny nose, watery eyes and his
nose is blocked), was treated with allergen immunotherapy 6 years ago
hyposensitization treated. (and since then the seizures have been shorter and less frequent)
- Nuts with meteorism flatulence
stimulants
ÿ Nicotine consumption: non-smoker for 5 years. Before that he had been 18 years old
(especially during training) Smoked 1 pack a day, PY - 9
ÿ Alcohol and drug consumption were denied. (I don't drink alcohol because my father
is addicted to alcohol)
social history
He is self-employed, communication trainer by profession (he travels a lot and also works a lot on the computer),
single (planning to get married in 3/4 of a year), have a partner who had a spontaneous miscarriage 8 months
ago.
family history
§ Vatter: known alcohol abuser, 5 years ago received a rehab treatment for addictions , but without
improvement. (The patient no longer has any contact with him)
§ Mother: suffer from nephrolithiasis kidney stones with frequent recurrences (my mother has
recurring problems with kidney stones) and loss of visual field due to scotoma

previous operation)
Mr. Düsterhof is a 32-year-old patient who came to us because of a sudden onset of chest tightness that has
been present since last night
and productive cough with mucous and viscous sputum .
(According to the patient yesterday afternoon he was stuck in traffic for hours in a tunnel and it was very difficult to get air)
The patient also added that he had a dry cough for 2 weeks.
He also noticed the following accompanying symptoms: whistling expiration

Exhale, Scratchy throat and scared of suffocation (like an air mattress and I'm scared
because of this)

The vegetative anamnesis is unremarkable except for insomnia in the form of trouble sleeping through the
night (since the spontaneous abortion of his partner) and meteorism (that’s why he’s been on a special diet
with intervals of fasting from 4 p.m. to 8 a.m. for 4 months. He feels much better now)
ÿ Influenza infection cold 2.5 weeks ago with fever up to 39.0 degrees,
ÿ Cervical neck pain for 5 years (because he works a lot on the computer)
ÿ Panaritium nail ulcer of the right ring finger 3 years ago, was treated with drainage, (He
had inflammation of the tip of the right ring finger. His GP made a small cut and then pus
leaked out. Then he just had a bandage.)
ÿ Bronchial hyperreactivity since childhood, (I have had very sensitive bronchi since
Childhood)
ÿ Rhagade Cracks on the fingers (especially in winter he has a very dry and scaly
Skin. There is even cracking and redness on fingers)
ÿ Os zygomaticum fracture, cheekbone fracture while playing handball (heads hitting an
opponent), was treated conservatively. (but my face was still swollen).
He was operated on arthroscopically 5 years ago for corpus liberum / arthrolith free joint bodies .
(also during a handball game, he fell on the ground and injured his left ankle.
After two MRIs, a loose body was found. surgeons removed it arthroscopically)
Medicines:
- Diclofenac ointment bB
- Ibuprofen 400 mg 1-0-0
- Cortisone ointment bB
- Lefax chewing tablets bB (against meteorism)

The anamnestic information most likely points to bronchial asthma.
COPD and pneumonia should be considered in the differential diagnosis.
Proceed further:
1. CU:
ÿ Inspection: barrel chest and cyanosis
ÿ Percussion: Hypersonic knocking sound
ÿ Auscultation: Wheezing/ whistling and bronchial breathing sounds
2. Laboratory: differential blood count (eosinophils), CRP, ESR, BGA
3. Allergy diagnostics – allergy history, IgE determination and Pick skin test.
4. Roe thorax

5. Lung function diagnostics - gold standard:

ÿ Spirometry basis for assessing lung function. ÿ Whole-body
plethysmography – examination that provides a graphical representation
measured changes in circumference of the body.
ÿ Pulse oximetry - oxygen saturation + HR
ÿ PFM (Peak Flow Meter) – Determination of the maximum respiratory flow during expiration. It
can be carried out by the patient himself.
Therapy (graded scheme)
- Stage 1: short-acting B2 agonists as needed (SABA)

- Stage 2: Inhaled glucocorticoids (ICS) + short-acting B2 agonists bB (SABA)
- Stage 3: low-dose ICS + long-acting B2 agonists (LABA) as a fixed combination
or medium dose ICS + SABA bB
- Level 4: ICS (medium to high dosage) + LABA + SABA bB

- Stage 5: ICS (high dose) + LABA + long-acting muscarinic antagonists (LAMA)
+ Antibody therapy if necessary.

1. What makes a communication trainer professional?
o The "Communication Trainer" course teaches the participants the methodical core
competencies for the analysis of communication processes. You learn to interpret the
verbal and non-verbal communication of interlocutors, to point out problems and to find
solutions.
2. Why doesn't he drink alcohol?
o Because the father is addicted to alcohol.

3. Term for nose and eye involvement in allergies?
o Allergic rhinoconjunctivitis
4. Term for inhaling and exhaling?
o inspiration and expiration
5. Which is affected in bronchial asthma?
o In bronchial asthma, expiration is usually impaired.
6. Do we absolutely need an MRI to detect arthrolith?
o A calcified arthrolith can also be visualized on conventional radiographs.
Other forms are better visualized on an MRI or directly on an arthroscopy.
7. Do you know any other term for loose body? o Corpus liberum 8. How
does an arthrolith
manifest itself clinically?
o Arthrolith may be asymptomatic but, depending on its size and location, will interfere with
normal joint function. This typically leads to joint blockages or pinching, which is
accompanied by restricted movement. with pain and

9. Which vital parameters are important to you in relation to the traffic jam-in-the-tunnel story?
o Oxygen saturation (SpO2)
10. Which laboratory test would you carry out?
o I would like to have a differential blood count with determination of the number of eosinophils, CRP,
Determine BSG and BGA.
11. What are such deep cracks and redness on fingers called?
o That's called Rhagade.
12. In the case of a non-displaced zygomaticus fracture, what signs can you see in the
detect facial inspection? o Upon inspection,
the following signs may be detected: swelling in the eyes, bruising around the eye, nosebleeds, bleeding from the
maxillary sinus, facial sores, and blurred vision (double vision)
13. What other differential diagnosis do you have and what prompts you to base your suspicion on
confirm?
o COPD and pneumonia are possible differential diagnoses. Pneumonia can be ruled out with x-ray. In contrast to
asthma, COPD has a different clinical picture.
COPD bronchial asthma
Caused smoking/pollutants allergy
shortness of breath under pressure paroxysmal

(allergy/pollutants/external
charms)
Cough mucous cough, often in the dry, often at night, patient
morning, patient "coughs coughs himself into a fit
yourself free" in
lung function Narrowing of the airways only Narrowing of the airways can
partially resolve completely
recoverable
symptoms, course a lot of sputum, Little, tough expectoration,
constant or evenly paroxysmal character
increasing complaints over
the long term
Airway hypersensitivity hardly any hypersensitivity severe hypersensitivity
Age at first manifestation older than 40 years younger than 40 years

Comment!
I share with you my experience today.
My case was bronchial asthma and it was just as in logs. I have already documented the small changes in
detail. I only got the letter as far as DD and in part 3 I didn't get any questions about the therapy. They just
want to check that we have understood everything correctly about the anamnesis and the focus is exactly
on that. I didn't do any explanations either.
The doctor asked ALL the anamnestic information!
I wish you much success!
INFO!
Ø A grass pollen allergy is understood as an overreaction of the immune system to very

specific grasses, such as cocksfoot, ryegrass, ryegrass, etc.
Ø Certain allergies can be treated with allergen immunotherapy (AIT) (hyposensitization) .

The specific immunotherapy causes the immune system to gradually get used to the
allergy trigger. This reduces the discomfort after contact.
With the classic method, the doctor injects an extract of the allergy-triggering substance
- the allergen - into the fatty tissue on the upper arm. Initially, the allergen dose is
increased weekly (lead-in phase). This is followed by monthly injections with the so-
called maintenance dose. Therapy can last up to three years
last.
Ø Marriage – including marriage, marriage and wedding ceremony – includes a variety

of social and private contracts, religious and secular rites, ceremonies and wedding
customs, as well as accompanying celebrations at the beginning of a marriage,
depending on the respective religious, legal and cultural framework of a society.
Ø A spontaneous abortion is the non-induced embryonic or fetal death or loss

of the pregnancy product before the 20th week.
Ø Alcohol abuse is defined as the harmful use of alcohol, in the narrower sense ethanol,
which causes physical, psychological and social damage.
Ø Withdrawal is a term for withdrawal treatments for addictions. The treatment is usually
carried out under medical supervision
Supervision in a specialist clinic.

Ø Nephrolithiasis means the occurrence of concrements (stones) in the kidneys.

Nephrolithiasis is a form of urolithiasis.
Ø A recurrence is the recurrence of a physical or mental illness after its temporary

healing. The corresponding verb is to recur.
Ø A scotoma is the loss or weakening (damping) of part of the visual field. In the area of
a scotoma there is reduced sensitivity to visual perception (seeing)
Ø Fear of suffocation occurs mainly in panic disorders and hyperventilation.

Difficulty breathing in bronchial asthma and chronic obstructive pulmonary disease
must be clarified in the differential diagnosis.
Ø Influenza infection and cold are medically not clearly defined everyday terms for
uncomplicated respiratory tract infections, which are usually caused by viruses (especially
rhinoviruses) are triggered. A common cold is not the same as having the flu.
Ø Panaritium is a non-specific purulent inflammation of the toes and fingers. Panaritium

is most often caused by infection with staphylococci and streptococci, less often by
infection with other bacteria. Affected patients complain of pulsating pain in the area of
the finger or toe.
Ø In medicine, hyperreactivity is the excessive responsiveness of the organism to an

exogenous stimulus. The term "hyperreactivity" is mainly used in connection with the
airways.
This is referred to as "bronchial hyperreactivity"
Ø A rhagade is a narrow, fissure-like tear in the skin that extends through all layers of the
epidermis. A rhagade is caused by overstretching of the skin with reduced elasticity,
eg as a result of physical stress (dehydration, cold). Rhagades tend to appear on
mechanically stressed skin regions, eg in the area of the hands and feet as well as the
joints.

Ø A lateral midface fracture is a bone fracture (fracture) that essentially occurs in the area
of the zygomatic bone (lat. Os zygomaticum)
is localized.
Ø Corpus liberum (arthrolith) is a freely movable structure in the joint cavity, the main
symptom of which is incarceration. Loose bodies can result from a broken piece of
cartilage or bone tissue.
Ø Wheezing is an audible breath noise that can be heard during auscultation of the lungs,
which is especially audible in obstructive lung diseases such as bronchial asthma.
Ø Immunoglobulin E (IgE) is a subclass of antibodies synthesized by plasma cells. In

laboratory medicine, for example, it can be determined as part of allergy diagnostics.
The total IgE in the serum is only of minor importance for the diagnosis of a type I
allergy, since the value is only roughly associated with allergies.
Ø The prick test is a diagnostic method for detecting immediate allergic reactions (type I
allergic reaction). In the prick test, standardized allergen solutions are applied to the
skin in the form of drops - usually on the inside of the forearm. Redness, itching and
wheal formation within 5 to 60 minutes indicate a possible allergy to the allergen
contained in the test solution.

1. Dysphagia (in esophageal carcinoma)

- When? How long have you had trouble swallowing? Are the symptoms sudden or gradual?
began?
- What? Do you have trouble swallowing solid food or also liquid food?
- History? Is it episodic or continuous? Have the symptoms gotten better or worse over time?
- Trigger? Are there specific triggers for this? Eg food intake?

- odynophagia? Have you also noticed pain when swallowing?
2. Pain history
- Where? Can you pinpoint the exact location of the pain, please?
- When? How long have you had this pain? Is the pain sudden or gradual?
began?
- pain scale? How bad is the pain on a pain scale of 1 to 10, with 1 being mild and
- What? Could you please describe the pain more precisely, is the pain rather dull,
- Radiate? Does the pain radiate to other parts of the body?

- History? Has the pain gotten better or worse over time? Do you have such
had pain before? Is that why you went to the other doctor?
- Trigger? Are there specific triggers for the pain? Eg food intake?
3. Nausea/vomiting
- Have you noticed nausea or have you already vomited?
- When and how often did you vomit?
- Could you describe the vomit in more detail? Was the vomit more of food leftovers (like
Stomach contents) or also slimy? Did you also notice traces of blood?
4. Diarrhea
- Do you have diarrhea?
- When did your diarrhea start?

- How often do you need to go to the toilet?
- Has the consistency of your excreta changed? (Hard, firm, soft or slimy)
- Has the color of your stool changed? bloody, black, tar black, white?
- What's the bleeding like? dark or light blood?
- Pyrosis/ Regurgitation - Do you have heartburn? Do you often have sour belching?
- Globus feeling - Do you feel like you have a lump in your throat - Have you eaten anything
unusual?

esophageal carcinoma
patient
First name, last name: Ludwig Schreiner, age: 56 years, height: 180 cm, weight: 86 kg.
- Cross allergy: grass pollen and flour allergy with rhinorrhea and runny nose
Epiphora watery eyes
- Voltaren ointment with exanthem skin rash
stimulants
ÿ Nicotine consumption: 12-15 cigs. /day since LY 20, PY – 27

ÿ Alcohol consumption: 1-2 bottles. Beer daily, 2-3 glasses of liquor on weekends.
social history
He is a porter, widowed for 2.5 years, lives alone, has 2 children, one of whom is a foster child.
family history
§ Father: suffering from gastric ulcer , was treated surgically § Mother: died of colon
carcinoma and colon cancer

previous operation)
Mr. Schreiner is a 56-year-old patient who presented to us because of dysphagia, swallowing disorders with
solid and liquid food, and odynophagia, painful swallowing disorders that had existed for 2-3 weeks .
Pain intensity was rated at 5-6 out of 10 when swallowing on a pain scale
rated
According to the patient, the dysphagia had gotten worse over time and now occurs even with drinking water.
In addition, the patient noticed the following accompanying symptoms: hypersalivation/sialorrhea , increased
salivation, regurgitation , backflow of the contents of hollow organs, globus hystericus lump in the throat,
melena , tarry stool for 3 days, dry cough (especially at night when lying down), fatigue , fatigue, gag reflex.
The vegetative anamnesis is unremarkable except for loss of appetite of about 3 kg weight loss
within 3 weeks, constipation , cough-related insomnia, sleep disturbance

in the form of insomnia.


• Type 2 diabetes mellitus for 15 years, status after hyperglycaemic derailment 2 weeks ago •
Auricular dysplasia, auricular
malformation on the right, wears a hearing aid on the right. •
Extrasystole cardiac arrhythmia in the form of palpitations 4 years ago
• Rib contusion Rib bruise after a handball accident 12 years ago
treated as an inpatient.
He was operated on laparoscopically 5 years ago for an inguinal hernia and 2 years ago for bursitis
of the right elbow .
medication
- Icandra 50mg/1000mg 1-0-1
- Eliquis 5 mg 1-0-1

The anamnestic information most likely points to an esophageal carcinoma.
Zenker's diverticula and GERD can be considered in the differential diagnosis .
Proceed further:
1. CU
2. Laboratory: Small BB, CRP, liver parameters + tumor markers (SCC, CEA, CA 19-9) 3.
EGD with biopsy (gold standard)
4. X-ray contrast medium examination (esophageal barrage swallow)
5. CT chest and abdomen for metastases
6. Abdominal sono
7. Possibly PET-CT
therapy
1. Surgical therapy §
Endoscopic mucosal resection- for superficial and non-invasive
carcinomas
§ Esophagectomy with lymphadenectomy and gastric pull-up with
esophagogastric anastomosis
2. Radiation and chemotherapy - mostly like preoperative measures 3. Palliative
therapy - dilatation, stenting, laser photocoagulation


From the patient:
1 What do I have, Doctor?

o Please see “Reactions”
2 Can it be cancer? My mother had cancer and I'm scared because of it?
o Please see reactions
3 What does cross allergy mean? Why am I allergic to pollen and flour?
o In the case of a cross-allergy, the immune system reacts hypersensitively to the same or similar allergy-causing
substances (allergens) from different allergen sources: First, the affected person develops an initial allergy, for
example to birch pollen. An apple or hazelnut allergy, for example, can occur later as a cross-reaction.
These foods contain proteins similar to those found in birch pollen.
From the examiner:

o In this case I am assuming esophageal carcinoma . This is supported by the
main complaints such as dysphagia and odynophagia and accompanying symptoms.
2. What DD can you tell? o Zenker's
diverticula and GERD can be considered as DD.
3. What is Zenker's diverticula?
o Zenker's diverticulum is a diverticula of the pharynx located between the hypopharynx and the spine. It belongs to
the so-called false diverticula (pseudodiverticula).
Clinically manifests itself with dysphagia, regurgitation and globus sensation in the throat. Sometimes an intense
bad breath (halitosis) can also occur.
4. How can Zenker diverticula be treated?
o This can only be surgically removed.

5. What is GERD?
o Reflux disease, GERD for short, is an inflammatory disease of the esophagus (esophagus) caused by pathological
reflux of gastric contents.
6. Why does the patient have melena?
o Because of the OGI bleeding.

7. What do you expect from the blood count then?
o Laboratory chemistry I expect anemia (low Hb and erythrocytes)

8. What further investigations do you initiate?
o I arrange for the following examinations such as ÖGD, abdominal sonography, Rö
Contrast medium examination, CT thorax and CT abdomen.
9. What do we have to consider before the ÖGD?
o Pat takes Eliquis. That has to be removed first.

10. Enlightenment ÖGD.
11. What other cancers do you know of in the neck area?
o Malignant goiter, laryngeal and pharyngeal carcinoma and bronchial carcinoma can also occur
be.

12. Why is the patient coughing? And why mostly lying down?
o This can be due to regular microaspiration due to increased saliva production. When lying down, some amount
of saliva flows back because of dysphagia.
13. Why does aspiration develop in humans and what role does age play?
o Causes for aspiration in awake patients are neurological diseases or severe physical deterioration (mostly in
elderly patients). From time to time foreign bodies can be inadvertently aspirated.
14. Does the patient have true hypersalivation or salivary obstruction in the esophagus
and this just flows back?
o This is more likely to be saliva that remains in the mouth due to pronounced dysphagia, so-called
pseudohypersalivation.
15. What other causes of hypersalivation do you know? o
Hypersalivation can have a variety of causes. In addition to diseases of the salivary glands and the oral cavity,
poisoning, neurodegenerative diseases (e.g. Parkinson's disease, amyotrophic lateral sclerosis) and
psychological causes can also trigger increased saliva production.
Comment!
Good day, dear colleagues.

I passed FSP on 01/30/2023 and would like to share my case with you. There were no patient presentations, only
questions about the name, age and main complaints and other questions.
INFO!
Ø Schnaps is another word for spirit and stands for alcoholic beverages with
at least 15% vol. Alcohol.
Ø A porter- monitors the incoming and outgoing people or the movement of goods in
a building or demarcated area. His other duties include opening and closing the
doors and keeping keys safe and handing them out if necessary.
Ø Foster child means a child who is temporarily or permanently taken in and cared
for by another adult and lives with the foster family instead of with his or her parents
of origin.
Ø Regurgitation is the pathological backflow of the contents of hollow organs, for

example the backflow of chyme from the esophagus into the mouth.

Ø Hypersalivation is the secretion of excessive amounts of saliva.
Ø One speaks of a globus hystericus when the patient complains of a foreign body
sensation in the pharynx or throat, which is independent of food intake, i.e. occurs
primarily when swallowing empty.
Ø A stool that is abnormally black in color due to the presence of blood is called melena .
Around 100 to 200 ml of blood are required for a melena to form.
Ø The gag reflex is a foreign reflex of the human body that is caused by contraction
of the back of the throat triggers gagging.
Ø Auricular dysplasia involves several types of malformations

of the ear.
Ø The rib bruise (rib contusion) is a bruise (contusion) in the area of the
bony ribs resulting from blunt trauma.
Ø Hernia inguinalis An inguinal hernia means the passage of

Abdominal viscera (hernia) through the inguinal canal above the inguinal ligament
Ø Bursitis is the inflammation of a bursa (bursa

synovium).

Gastric ulcer
patient
First name, last name: Jacob Bauer, age: 57 years, height: 168 cm, weight: 75 kg.
- Brown patch with exanthema skin rash and pruritus itching
- Preservatives with angioedema facial swelling

stimulants
ÿ Nicotine consumption: 30 years, 30 cigs. per day, PY-45

ÿ Alcohol consumption: 1-2 bottles of beer
daily ÿ Drug consumption: Marijuana such as joints and amphetamines occasionally at parties in
young age
social history
He is a medical technician in a company in Stuttgart (he installs various medical devices, such as ultrasound
and CT in Bavaria and suffers from chronic low back pain because of a lot of physical work), married, lives alone
in Stuttgart for weeks, (his wife lives in Munich all the time and they only meet at weekends) (“I have a second
place to live and I’m stressed about it”) have 2 stepchildren (25 and 27 years old) .
family history
§ Father died in a car accident when he was 37 years old, while he was alive
been healthy
§ Mother is about 80 years old, lives in a nursing home, suffers from PAD
Shop window disease with Ulcus Cruris left leg ulcer
§ Sister is in her 50th year because of a colon resection removal of a part of the large intestine
following colostomy Creation of an artificial bowel outlet due to a colon carcinoma
undergone colon cancer .

previous operation)
Mr. Bauer is a 57-year-old patient who has been with us for 3 weeks,
presented progressive, spasmodic, postprandial after eating, epigastric pain.
In addition, he added that the pain had gotten worse for 2 days and was more likely to be food-independent.

In addition, the patient noticed the following accompanying symptoms: repeated hematemesis, bloody vomiting
(like coffee grounds) since yesterday, melena tarry stool twice since yesterday, pyrosis heartburn , fatigue .
The vegetative anamnesis is unremarkable except for pain-related insomnia sleep disturbance in the form of
difficulty falling asleep, loss of appetite and weight loss of about 1.5 kg within 3 weeks.
ÿ arterial hypertension high blood pressure for 5 years,
ÿ Hypercholesterolemia, increased blood lipids for 5 years (found together with aHT during inpatient treatment
for kidney surgery)
ÿ Psoriasis vulgaris psoriasis on the inside of the elbow from children,
ÿ Chronic lumbago Lumbar pain for 15 years (because of work)
ÿ Acceleration trauma in a Zn car accident 6 years ago (another driver has from
bumped my car in the back) , was treated conservatively with a Schanz tie.
ÿ Phlebothrombosis DVT of the lower leg left 6 months ago.
He had undergone thyroidectomy 15 years ago for thyroidectomy 5 years ago for ureteral stent urinary stone and before
insertion for urolithiasis .
medication
- Candesartan 16mg 1-0-0
- Simvastatin 20 mg 0-0-1.5 -
Topisolone ointment bB
- Ibuprofen 600 mg bB
- L-thyroxine 150 mcg 1-0-0
The anamnestic information most likely indicates gastric ulcer.
Cholecystolithiasis and pancreatitis should be considered in the differential diagnosis.
Proceed further:
1. KU: abdominal palpation - pressure pain in the epigastrium + vital parameters
2nd laboratory: small BB, CRP, D-dimer, electrolytes, 3rd
EGD with biopsy (gold standard)
4. Hp detection: rapid urease test, 13C breath test

5. Abdominal sono as DD
6. If necessary, determination of gastrin (va gastrinoma) and Ca + parathyroid hormone (va

hyperparathyroidism)

therapy
1. Hp eradication therapy for Hp-positive U. Ventriculi:
- PPI in double standard (pantoprazole, omeprazole) + 2 antibiotics
(clarithromycin, amoxicillin, or metronidazole)
2. General measures:
- Alcohol and nicotine abstinence
- Stress reduction
- Avoid NSAIDs and glucocorticoids
3. Surgical therapy for complications.

- In case of bleeding – endoscopic suturing
- Gastric resection if carcinoma is suspected
questions during exam

1. Please tell us about the patient. (name, age, etc.)
2. What previous illnesses does the patient have?
o Please see "VE"
3. What dose of L-thyroxine is the patient taking?
o He takes 150 mcg .
4. To which pharmacological group candesartan belongs? o
Candesartan belongs to the AT1 receptor antagonists.
5. How many children does the patient have?
o He has 2 children.
6. Are the children his own?
o No, they were stepchildren
7. What does stepchildren mean?
o These are his wife's children from a previous marriage.

8. What does the patient do for a living?
o He is a medical technician by trade. He works in a company in Stuttgart and installs

various medical devices such as ultrasound and CT in Bavaria.
9. Does the patient live separately with his wife?
o Yes, he has his second place of residence in Stuttgart. Marriage lives in Bavaria. You can only sign up at
meet weekend.
10. What diseases does his mother have?
o His mother suffers from PAD with Ulcus cruris.
11. Can leg ulcers only be due to PAD?
o No, there are various etiologies for it. Leg ulcers can be arterial and venous, because
PAD and DVT.
12. How was the car accident (acceleration trauma) described by the patient?
o Like a push from behind.
13. What diagnosis do you suspect?

o Because of the information mentioned, I suspect gastric ulcer.

14. What risk factors does the patient have with regard to u.ventriculi?
o Ibuprofen, nicotine and alcohol abuse and stress.
15. Does the patient still have complications?
o Yes, I suspect OGI (Upper Gastrointestinal Hemorrhage).
16. Why Upper GI Bleeding? o The
patient had had hematemesis and melena. He described stool as black, at
lower GI bleeding but you can see real blood in the stool (hematochezia)
17. How did the patient describe hematemesis?
o Like coffee grounds
18. What diagnostics do you continue to do when the patient comes to you as an outpatient?
o If the patient is stable (if no shock symptoms such as drop in blood pressure, pale skin,
vertigo, weakness, dyspnoea), then further KU and abdominal sono and laboratory)
19. What do you clearly check at KU?
o We can detect tenderness over the epigastrium on abdominal palpation.
20. What could you find in abdomen?
o As DD, we can have cholecystitis (thickening and three-layering of the GB wall, free
fluid) or pancreatitis (enlargement and compression of the head of the pancreas, free
liquid) to exclude
21. If the patient has Hb of about 7.5 in the laboratory, then what will you do?
o I will perform blood transfusion.
22. Which therapy do you continue?

Comment!
Everyone was very nice and helpful. I wrote my letter briefly and it is enough (only VD, DD, diagnostics and therapy with full
sentences). In any case, you should use simple words during the admission interview and as many technical terms as possible
with the doctor-doctor. (That's important!) There is no marked part for previous illnesses in the letter sheet, you should write
everything (previous illnesses and previous operations) in the current anamnesis (that was a bit surprising for me).
I wish everyone good luck!
INFO!
Ø are preservatives antimicrobial biocides to kill or
Growth inhibition of microorganisms.
Ø The synthetic drug amphetamine belongs to the group of stimulants, which also includes
methamphetamine.
Ø Mediyintechnician is engaged in the development, planning and manufacture of new ones

medical devices and systems involved.

Ø Hypercholesterolemia is a fat metabolism disorder

(dyslipidemia), characterized by increased blood cholesterol levels
is.
Ø A colostomy is the surgical installation of an artificial bowel outlet of the colon (colostoma).
Ø Hematemesis is the vomiting of blood or blood components. The
Vomit has a black-brown coffee grounds-like appearance—so speak

one also vomits coffee grounds.
Ø Psoriasis vulgaris or plaque psoriasis is the most common clinical form of psoriasis (psoriasis). It becomes
noticeable through raised, sharply and irregularly demarcated, reddish plaques on the skin with silvery scales.
Ø A whiplash injury (acceleration trauma) is a traumatic soft tissue injury in the area of the cervical spine.
Traffic accidents are one of the most common causes of whiplash. Usually this is about
rear-end collisions.
Ø Schanz tie is a bandage made of cotton wool and foam in the form of a
“Neck tie”, which is used to immobilize and relieve the cervical spine, e.g. B. is used after whiplash.
Ø Topisolone ointment contains the active ingredient desoximetasone, a modified adrenal cortex hormone
with, among other things, anti-inflammatory and allergy-inhibiting properties (glucocorticoid).
Ø The rapid urease test is a bedside test used in gastroscopy to detect Helicobacter pylori in antral biopsies of
the gastric mucosa.
Ø The 13C breath test is a laboratory chemical, non-invasive test for the detection of Helicobacter pylori.

cholecystolithiasis
patient
First name, last name: Maik Keller, age: 57 years, height: 158 cm, weight: 72 kg.
- Grass pollen with allergic rhinoconjunctivitis hay fever
- Fructose intolerance with meteorism bloating
stimulants
ÿ Nicotine consumption: A pack of Zig for 15 years. daily, 15 PY.

ÿ Alcohol consumption: 1-2 glasses of wine on weekends.
social history
He is a tax officer, divorced, lives alone, has 2 children.
family history
§ Father: 85 years old, Zn colon cancer colon cancer, was operated on with a
Colon resection , removal of parts of the bowel .

§ Mother: 89 years old, suffering from leg edema leg swelling

previous operation)
Mr. Keller is a 57-year-old patient who presented to us with a 3-hour history of sudden, colicky postprandial pain
in the right upper abdomen after eating .
According to the patient, the pain started right after breakfast (croissant with jam and milk) and got worse over
time.
He also noticed the following accompanying symptoms: Nausea and nausea

Pyrosis heartburn.
The vegetative history is unremarkable except for constipation .
The patient is known to have the following pre-existing conditions:
• Arterial hypertension High blood pressure for 5

years • Hypercholesterolemia Elevated blood lipids for
5 years • Lumbar spine disc prolapse Herniated disc for 20 years, was treated conservatively
• Unguis incarnatus Ingrown toenail of the left big toe since 10 days.
He was operated on for perforated appendicitis 35 years ago .

medication
- enalapril 10 mg 1-0-0,
- Simvastatin 40 mg 0-0-1, -
Movicol b. B., -
Ibuprofen 400 mg b. B.

The anamnestic information most likely points to cholecystolithiasis.
Differential diagnosis includes gastric ulcer and pancreatitis.
Proceed further:
1. KU: Palpation
- pressure pain over the epigastrium or right upper abdomen
- Murphy's sign - pain-related reflex cessation of inspiration
while palpating the right upper abdomen.
2. Laboratory: small BB, creatinine, electrolytes, liver values (ALT, AST, GGT, bilirubin),
Pancreatic enzymes, CRP
3. Abdominal sono (gold standard) - thickening and three-layering of the gallbladder wall, free
fluid, the acoustic shadow of the stone at least 3 mm long.
4. Possibly endosonography – exclusion of microlithiasis of the bile ducts (DD)

5. Possibly ERCP - stones in the gallbladder can be detected and possibly immediately during the
be removed.
6. If necessary, ÖGDS – exclusion of U. ventriculi (DD)
therapy
1. General measures:
- Fasting, diet
- antispasmodics (butylscopolamine)
- analgesics (metamizole)
2. Surgical method - Early cholecystectomy laparoscopic or open
3. In the case of additional choledocholithiasis- ERCP + endoscopic papillotomy + if necessary
Stone extraction using a Dormia basket.
4. Alternative method for stones <2cm:
- Medicinal litholysis using ursodeoxycholic acid

- ESWT (extracorporeal shock wave lithotrpsy)


From the patient:
1. What do you want to do with me now?

o Mr. Keller, now I would like to tell you about further measures. First, I'm going to examine you physically. Then I
would do an important imaging test, like an ultrasound. At the end I will discuss your case with the senior physician.
2. How long do I have to stay here?

o Unfortunately I can't say exactly how long you should stay here at the moment. First have to
we all do important research what is a "
3. What is Ultrasound?

4. Do I have colon cancer like my father? Now how can you find out?
o Herr Keller, please touch yourself. At the moment I can't say exactly what the underlying disease is for your
symptoms. But you shouldn't think the worst
think. Cancer is not always 100% hereditary.
5. Should I have surgery? o At this

time we cannot rule out a surgical procedure. I can only look exactly
investigations tell you
From the examiner:
1. What did the patient eat?

o He ate a croissant with jam and milk
2. What is the patient taking for constipation?
o He is taking Movicol Btl.
3. How often does he drink alcohol? o

He drinks 1-2 glasses of wine on weekends.
4. Is he married?
o No, he is divorced 5. What is

the highest dosage of ibuprofen?
o The maximum single dose should not exceed 800 mg and the maximum daily dose
must be no more than 2400 mg.
6. Is there a problem if the patient takes a lot of ibuprofen? What can happen?
o Ibuprofen is an NSAID and has a different side effect profile. Depending on the dosage and individual tolerability,
ibuprofen very often leads to side effects in the gastrointestinal tract such as heartburn, abdominal pain, nausea,
vomiting, flatulence, diarrhea, constipation, gastroduodenal ulcer disease and bleeding in the stomach and
intestines.
7. What vital signs would you check? o I will check temperature,

respiration rate, heart rate, blood pressure, SpO2%
8. How do you say oxygen in blood in Latin?
o saturation
9. How can this be measured?
o Oxygen saturation can be measured with pulse oximetry.
FSP IN BAVARIA 2023 | Shamil Gurbanov

65
10. What do you want to palpate and examine in the abdomen?

o Pressure pain over the epigastrium or right upper abdomen
o Murphy's sign – pain-related reflex cessation of inspiration during
right upper abdomen is palpated.
o Based on the information mentioned, I assume cholecystolithiasis.
12. Which diagnoses do you still want to rule out?
o I would rule out pancreatitis and u.ventriculi as DD here.
13. Which diagnostic measures would you carry out? o Please see "Further
procedure"
14. Why blood count, CRP and ESR?
o Elevated levels of inflammation may indicate cholecystitis as a complication.
15. What can an abdominal sono find?
o Thickening and tripartition of the gallbladder wall, free fluid, size of the stones.
16. Bilirubin is not specific, what can also cause increased bilirubin?
o Hemolysis or liver disease 17. What speaks
for and against gastric ulcer?
o Pyrosis, nausea, upper abdominal pain speak for this, but the localization of upper abdominal pain, which is more to
the right, speaks against it.
18. What speaks against pancreatitis?

o The patient does not drink as much alcohol. Pain is not belt shaped.
19. What is the worst pancreatic disease?
o Pancreatic head carcinoma 20.

What is the prognosis?
o Very bad
21. How do you treat pancreatitis?
o Fluid intake, fasting, analgesics and, importantly, pancreatic enzymes (Kreon)

22. Can it be kidney disease?
o Yes, as an atypical localization of urolithiasis 23. Important

laboratory values for kidneys? o Kidney
retention parameters: creatinine and GFR
24. The kidneys are intra or retroperitoneal? o Retroperitoneal.
Comment!
Hello fellow colleagues! Today I took the FSP and PASSED! This wasn't my first time. I really learned a lot. My case was
cholecystolithiasis (very similar to the protocol). This group (Approbation for foreign doctors - Facebook) helped me a lot.
The OA spoke very calmly and slowly. I was nervous but I put a lot of time and effort into this
Invested in projects, that's why I didn't forget to ask.
I wish you good luck and study hard!!!

INFO!
Ø Tax officials ensure in different ways that the state gets the taxes. He processes tax
returns in the office or checks their correctness on site in the companies.
Ø Colic pain is the most violent, cramping and wavy (labor-like) pain caused by the
muscle contraction of a hollow organ. The most common forms are biliary and renal
colic. Colic pain often radiates to typical regions and is often accompanied by
vegetative symptoms.
Ø Heartburn (pyrosis) describes a burning and painful sensation behind the breastbone
rising from the upper abdomen, which may radiate to the neck and throat, often
accompanied by sour or bitter belching.
Ø An unguis incarnatus is a nail that has grown into the surrounding tissue.
The main symptom is the local pain.
Ø Perforated appendicitis If the appendicitis is more advanced and there is already a

hole in the appendix. Inflammation of the abdomen and peritoneum occurs. The
appendix is then usually also removed by surgery.
Ø Murphy's sign – pain-related reflex cessation of inspiration while palpating the right
upper abdomen.

IBD
patient
First name, last name: Maximilian Ziegler Age: 43 years, height: 180 cm, weight: 92 kg
- Contrast agent with anaphylactic shock (he had strong allergic reaction with
Dyspnea and exanthem after CT scan with contrast media in septum fracture)
- Nuts with paresthesia tingling on the tongue
stimulants
ÿ Nicotine and alcohol consumption were denied.
ÿ Drug use: Joints twice a month, on weekends
social history
He is a sewer worker, married (for the second time), lives with his family and has a son
(from the 1st marriage) , who suffers from hypacusis and has a hearing implant.
family history
§ Father: suffered from alcohol abuse and from esophageal varicose veins
deceased (he therefore does not drink alcohol)
§ Mother: 67 years old, Zn cholelithiasis with ileus bowel obstruction 3 years ago.
Mr. Ziegler is a 43-year-old patient who presented to us with a 2.5-week history of sudden onset, spasmodic,
undulating, periumbilical abdominal pain.
He also noticed the following accompanying symptoms: 5 emesis vomiting

of stomach contents, watery diarrhea, diarrhea (5 times a day), hematochezia, blood in the stool, fatigue , pallor
(his wife told him this).
According to the patient, the pain started 2.5 weeks ago during a trip to Austria and got worse over time.
He reported taking Imodium and MCP (metoclopramide) but with no improvement in symptoms.
The questions about hematemesis, melena, hematochezia and vertigo were answered in the negative.
The vegetative anamnesis is unremarkable except for insomnia , sleep disturbance, constipation, lack of
appetite, weight loss of about 3.5 kg within 2.5 weeks.


• arrhythmia cardiac arrhythmia in the form of extrasystoles heart palpitations since
2018, • dermatitis on the spaces between the toes 2 years ago (because of the rubber boots,
because he works as a sewer worker), was treated with the cortisone ointment for 5 days,
(dermatologist gave him cortisone for 5 days and it helped him) •
psoriasis psoriasis for 8 years,
• Broken septum of the nose 33 years ago, was treated conservatively, (he had a CT with
contrast agent and was found to be allergic to contrast agent, so he was treated in the trauma
room).
• Condition after herpes zoster shingles in the area of the left thorax 3 years ago,
• Status post meningitis Meningitis at the age of 15, was treated conservatively
The patient had been operated on for the fracture of the mandible 5 years ago.
medication
- Beloc-Zok Metoprolol 95 mg 1-0-0 -

sleeping pills (can't remember the name) bB
- Daivonex solution bB
- Metoclopramide 10 mg bB
- Imodium bB
The anamnestic information most likely points to chronic inflammatory bowel disease (IBD).
Colon carcinoma and infectious enterocolitis should be considered in the differential diagnosis.
Proceed further:
1. CU:
- pressure pain, defensive tension during palpation,
- Inspection of the oral cavity - anus
- Digital rectal examination (DRE)
2. Laboratory: small BB, CRP, ESR, electrolytes, CEA, CA19-9, antibodies (goblet cell)
3. Stool examination- hemoccult, stool culture, calprotectin
4. Abdomen sono - thickening of the colon wall for Crohn's disease, if necessary CT abdomen
5. Rö and MRT after Sellink (enteroclysis) with KM
6. Colonoscopy with step biopsy:
- Discontinuous, elongated ulcerations, strictures and histological
Granulomas in Crohn's disease
- Continuous, superficial ulcerations, contact bleeding, histological
Crypt abscesses – ulcerative colitis

therapy
1. General Measures
- Nicotine and alcohol abstinence
- Diet, vitamins, Zn, Ca
2. Drug therapy
- Long-term therapy - in remission - mesalazine (tbl. or suppositories)
- Immunosuppressants – glucocorticoids (prednisolone)
- Acute relapse - inpatient admission, parenteral fluid, thrombosis prophylaxis and systemic steroid
therapy (alternative therapy - infliximab, ciclosporin A)
- Antibiotic therapy – in case of infectious complications (metronidazole with

ceftriaxone)
3. Surgical therapy in the case of medication that cannot be controlled or in the case of
complications
- strictureplasty
- Proctocolectomy

1. Why does the patient need the rubber boots?
o He needs this because of his work. He is a sewer worker by trade

2. What does sewer worker do?
o Sewer workers check the water channels for leaks. With the help of
Special cameras and remote-controlled robots seal damaged areas.

They also carry out routine checks in the public sewer network. They check pools, pipes and gutters for
leaks and repair them if necessary.
3. Is the water in these canals fresh, right?
o This depends on the water channel, but mostly unfresh.
4. Where was anaphylactic shock treated?
o It was treated in the trauma room
5. What is the difference between an implant and a hearing aid?

o A hearing aid is a non-invasive hearing aid that does not require surgery. It is inserted and removed as needed.
An implant is an electronic hearing prosthesis that is surgically inserted.

o I am currently suspected of having IBD
7. What is IBD?
o Chronic inflammatory bowel disease, IBD for short, is a group of clinical pictures that are characterized by
relapsing or continuously occurring inflammatory changes in the bowel. The most important chronic inflammatory
bowel diseases are: Crohn's disease and ulcerative colitis

8. Could this be food poisoning?

o This is unlikely because the patient did not complain of postprandial discomfort
and his wife and son have no complaints
9. How do we differentiate clinically?
Ulcerative colitis Crohn's disease

affected ÿ ÿ
only the large intestine (colon) is entire digestive tract can be affected
section of intestine affected
ÿ Inflammation spreads ÿ Inflammation occurs unevenly, healthy and

starting from the rectum evenly inflamed
in the large intestine Sections alternate
ÿ
only the innermost layer of the ÿ all wall layers can
intestinal wall affected be inflamed
typical ÿ mucoid-bloody diarrhea ÿ chronic diarrhea (rarely bloody)

symptoms
ÿ more often more painful ÿ abdominal cramps
urge to defecate ÿ Weight loss
ÿ abdominal cramps ÿ Fever
Course
ÿ often acute onset ÿ often insidious onset
ÿ Course in bursts with ÿ Course in episodes with often
complete remission incomplete remission
complications ÿ heavy bleeding ÿ Narrowing of the intestine (stenoses)
ÿ toxic megacolon ÿ Fistulas
ÿ Colon carcinoma ÿ Abscesses
10. What is the DD?
o As a DD, I assume colon carcinoma and infectious enterocolitis.

11. What are the pros and cons of infectious enterocolitis?
o The patient does not have a fever and the symptoms have been present for 2.5 weeks, so an intestinal infection is
less likely.
12. Is this acute or chronic diarrhea?
o Diarrhea present for 2.5 weeks. Chronic diarrhea is when a person has soft/liquid stools more than 3 times a day
for more than 4 weeks.
13. Which pathogens are most common in infectious eneterocolitis? o Clostridia -

after prolonged treatment with antibiotics, the clostridia can multiply because the antibiotic agents also kill off parts of
the beneficial intestinal flora.
o Yersinia, Escherichia coli, Shigella and Salmonella can be considered as further bacterial triggers for enterocolitis.
But viruses can also cause enterocolitis.
These primarily include adenoviruses and enteroviruses. The same applies to yeasts such as Candida species
and parasites such as Entamoeba histolytica and Giardia lamblia.

14. What are your next steps?

15. What do you do at KU?
o First one has to assess vital signs whether there is a shock situation. Abdomen, examination with palpation to
exclude, defensive tension, tenderness and with auscultation in the case of pathological bowel sounds as well as
digital rectal examination come into consideration.
16. What investigation do you start with?

o We start with a stool sample and stool examination – pathogenic germs, clostridia,
calprotectin.
17. Colonoscopy Education
o Please see “clarifications”
18. Is colonoscopy dangerous in this case?
o Although colonoscopy is the gold standard in the case of IBD, colonoscopy can also be dangerous because the
bowel wall is reasonably thin and can become perforated.
19. Why do you need laboratory tests?
o Evaluate inflammation parameters (leucocytosis, increased CRP and ESR) as an indication of infections, blood
count (anaemia), kidney and liver values, electrolytes.
20. What do you expect from electrolytes? o
Hypokalemia due to volume depletion. That's why we also need adequate fluids
respectively.
commentary!
I am of the opinion that you have to prepare very well for this exam, the observations are of great importance. My patient
was quite nice and friendly, as was the commission. I asked 3-4 times and he happily repeated it. It's really all about the
language. I wrote the letter on the computer and it was very convenient and quick. I prepared for this exam intensively
for 2.5 months and did about 40-50 simulations. In addition, I did an internship for 3 months in winter and that was very
helpful. I also did 6 simulations with Petr and they were super helpful for me and I can only recommend them. He pays
attention to the little things that I haven't paid attention to and corrects them. The simulations with my colleagues were
also of great importance to me. I also read through the cases of the anvil to get the full picture.
The materials: protocols, Petr e-learning, anvil and Doccheck Flexikon.

INFO!
Ø Esophageal varices are varices in the submucosal veins of the esophagus caused by
portal hypertension. Bleeding from esophageal varices is a life-threatening complication
and a medical emergency. ileus
Ø A nasal bone fracture is a closed or open fracture

of the nasal bone.
Ø Herpes zoster (shingles) is the second manifestation of an infection with varicella-

zoster viruses (VZV), which persist for life after the initial infection (chickenpox) in the
neurons and glial cells of the spinal ganglia.
Ø Meningitis is an inflammation of the pia mater and the arachnoid mater. It is triggered
by bacteria, viruses, fungi or parasites. The historical term for meningitis is stretch flow.
Ø Daivonex solution contains the active ingredient calcipotriol. Calcipotriol is used

externally for mild to moderate psoriasis with large scales (plaques).
Ø Metoclopramide is an active ingredient belonging to the dopamine antagonists. He will

used as an antiemetic (against vomiting) and gastrokinetic.
Ø The digital-rectal examination, DRE for short, is an examination of the rectum and
the adjacent organs by palpation carried out with the finger (digitus). It is part of the full
physical examination.
Ø Goblet cell antibodies, BAK for short, are autoantibodies that are chronic in the context
inflammatory bowel disease (IBD).
Ø Calprotectin is a biomarker that can be detected in the stool when there is intestinal
inflammation. The marker is not specific to a specific disease, but can be increased
both in acute infections and in chronic inflammatory bowel diseases such as ulcerative
colitis or Crohn's disease. An elevated calprotectin level can help distinguish between
an organic
cause of abdominal discomfort and a functional cause like that
distinguish irritable bowel syndrome.

colon carcinoma
patient
First name, last name: Melinda Krüger, age: 58 years, height: 167 cm, weight: 89 kg
- Novalgin with dyspnea shortness of breath, paresthesia tingling in the tongue
- Fructose intolerance with diarrhea
stimulants
• Nicotine consumption: 5-6 cigarettes a day for 8 years. Before- 27 PY •

Alcohol consumption: 1-2 beers in the evening.
• Drug use was denied
social history
She has been unemployed for 3ÿ4 years, before that she worked in a drugstore, married (divorced), have a
daughter (born 2 months ago) and a son who suffered from a testicular tumor 8 years ago.
family history
§ Father: 85 years old, Zn colonoscopy colonoscopy with removal of the colon polyps.
§ Mother: suffering from diabetes mellitus diabetes, Zn amputation of the left foot
3 years ago

previous operation)
Ms. Krüger is a 58-year-old patient who came to us for 4-5 weeks of slowly increasing, spasmodic, severe lower
abdominal pain and
paradoxical diarrhea alternating between diarrhea and constipation .
Pain intensity was 5 out of 10 at rest and 9 out of 10 during defecation

rated.
In addition, the patient noticed the following accompanying symptoms: pallor, pyrosis heartburn, reflux acid
regurgitation (she has had reflux for 10 years because of GERD), exercise-related dyspnea, shortness of breath
and hematochezia, blood in the stool after constipation.
Questions about nausea, vomiting, fever, chills and vertigo were answered in the negative.
The vegetative anamnesis is unremarkable except for stress-related insomnia sleep disorder in form
difficulty falling asleep (because of divorce, unemployment, pain) and cravings for sweets increased appetite for
sweets.


• Arterial hypertension High blood pressure for 5 years
• Hemorrhoids for 3 years, • GERD
reflux disease for 10 years, Zn ÖGD 2.5 years ago
• Sinusitis frontalis frontal sinusitis 3ÿ4 years ago, was treated conservatively
(since she has had occasional headaches)
• Fracture of the Articulatio humeri shoulder joint fracture in Zn bicycle accident before 10
years, was treated as an inpatient. (2 days)
• (Inpatient admission 2 months ago when his daughter was born)
She underwent THA 2 years ago.
medication
- Valsartan 80mg 1-0-0
- Ibuprofen 800mg bB
- Omeprazole 20mg 0-0-1
- Valerian dragees bB

The anamnestic information most likely points to colon carcinoma.
IBD and tumors of the small intestine come into consideration in the differential diagnosis.
Proceed further:
1. CU:
- pressure pain, defensive tension during palpation,
- Abdominal auscultation - pathological bowel sounds
- Digital rectal examination (DRE)
2. Laboratory: small BB, CRP, ESR, electrolytes, CEA, CA19-9, antibodies (goblet cell)
3. Stool examination- hemoccult, stool culture
4. Colonoscopy with biopsy samples - the gold standard
5. Abdominal sono - to look for liver metastases
6. Chest x-ray – to look for lung metastases
7. If necessary, CT thorax and abdomen
therapy
1. Surgical therapy – hemicolectomy or transverse resection with lymphadenectomy and, if
necessary, colostomy
2. Adjuvant and neoadjuvant chemotherapy
3. Radiotherapy - with radio frequency ablation
4. Palliative therapy – for unresectable carcinoma, stage IV


1. Why is she having trouble
sleeping? o Because of divorce, unemployment and recently also because of pain
2. Is she taking anything for insomnia?
o Yes, she takes Valerian-Drg. a.
3. What is the technical term for herbal medicines?
o This is called phytotherapy.
4. What is valsartan?
o Valsartan is used to treat aHT. Valsartan belongs to drug group
the AT1 receptor antagonists, the so-called sartans.
5. Where is the shoulder joint?
o The shoulder joint (AC joint) connects the arm to the sternum and thus to the chest. Due to the
large range of motion of the arm, a lot of force is transmitted to the chest via the shoulder joint.
6. What is drugstore?
o Drugstore is a shop for the sale of medicines, chemicals and cosmetics
articles
7. What would you tick for marital status?
o She is married but in divorce

8. Is the patient obese? o
Yes, the weight of 89 kg and a height of 167 cm speaks for obesity, but I can check it exactly
tell the assessment of the BMI.
9. What is BMI?
o Body mass index) is used to classify a person's body weight. BMI is calculated from height in
relation to body weight. Obesity is BMI over 30 and can negatively impact health and life
expectancy.
10. Why does she have a bloody coating from the
constipation? o This may actually be due to hemorrhoids.
11. What would you do as a first action at the moment?
o I will first examine the patient physically and take blood samples.
12. What is CEA?
o CEA (cardio-embryonic-antigen) – tumor marker, used for follow-up and for
used to detect recurrences
13. What are you doing next?
Comment!
I definitely didn't get all the questions right (some didn't answer them at all), but I still passed, so stay
positive! Somehow my examiner was enthusiastic about the abbreviations.

INFO!
Ø The formal legal dissolution of a marriage is referred to as “divorce” or “divorce” . When
the divorce occurs, the ex-spouses acquire the marital status “divorced”.
Ø A testicular tumor can be benign or malignant. Testicular cancer (testicular carcinoma) is unfortunately
not uncommon and can affect younger and older men.
Ø The term amputation describes the separation of a body part from the rest
Body.
Ø In a paradoxical diarrhea is the alternation between solid and liquid stools

possible if the stenosis does not fill the lumen.
Ø Reflux disease, GERD for short , is caused by pathological reflux of gastric contents
triggered inflammatory disease of the esophagus (esophagus).
Ø Frontal sinusitis is an acute or chronic inflammation of one or both frontal sinuses (frontal
sinus). Since the nasal cavity is usually also affected, it is also referred to as rhinosinusitis.

1. Head and Neck

-
Have you noticed the enlargement of the thyroid?
- Have you noticed any difficulty swallowing or heartburn?

- Do you have hoarseness or rough voice?
- Do you have any changes in your eyes, such as drooping, receding or protruding
eyeballs noticed?
2. Skin and hair

- Have you noticed any intolerance to heat or cold?
- Have you noticed dry or warm skin, brittle nails or hair loss?
- Have you been sweating a lot lately?
- Have you noticed any tremors?

- Have you noticed any swelling anywhere in her body?
3. Neuropsychiatry
- Have you been particularly restless or nervous lately?
- Have you noticed trouble concentrating or depressed mood?
- Do you feel tired or exhausted?
- Do you have trouble sleeping?
4. Heart and Lungs -

Do you feel your heart beating unusually fast or slow?
- Have you noticed heart palpitations?
- Do you have shortness of breath?
5. Gastrointestinal and Metabolic

- Do you suffer from diarrhea or constipation?
-
Has your appetite changed lately?
- Have you noticeably lost or gained weight lately?
6. Additional questions (for hypoglycemia)

Do you suffer from diabetes?
- When? - How long have you had diabetes?
- guy? - Is this type 1 or type 2?
- Derailment? - Have you noticed any derailments from diabetes?
- training? - Did you get diabetes training?
- Insulin- Do you inject insulin? How many units and how often per day?

hypothyroidism
patient
First name, last name: Valentin Peters, age: 46 years, height: 181 cm, weight: 82 kg
! Horse hair with exanthem skin rash, pruritus itching in the nose
! Diclofenac with swelling of the eyes, lips and tongue and dyspepsia
stimulants
• Nicotine consumption: non-smoker for 10 years. Before – 20 PY, for 20 years
• Alcohol consumption: 1-2 beers daily in the evening
social history
He works for the Bavarian forest administration (only part-time 75% because of his son), is married (for the
second time), lives with his family, has a son who suffers from lissencephaly and a brain malformation and has
a tracheostomy.
family history
§ Father: suffer from Addison's disease adrenal insufficiency
§ Mother: died of asystole 6 months ago (sudden cardiac arrest, presumably

due to long-term use of antidepressants)
Mr. Peters is a 46-year-old patient who presented to us because he had been listless for 3 months and had no
ability for purposeful activity, fatigue , tiredness/exhaustion and sleepiness.
According to the patient, these symptoms started slowly and got worse over the last 3 weeks.
He noted the following accompanying symptoms: cold and dry palms, facial edema, facial swelling, cold
intolerance, cold intolerance, bradycardia , slow heart rate, difficulty concentrating, depressed mood, low spirits,
dysphonia , hoarse voice, alopecia, hair loss on the head , and onychorrhexis , brittle nails.
The vegetative medical history is unremarkable except for weight gain of about 4 kg within 3 weeks and
constipation .

• Sleep apnea syndrome (SAS) for a long time (probably due to nasal polyps), has been associated with
treated with CPAP therapy.
• Tension headaches for a year,
• Cervical pain, neck pain for a long time, •

Head eczema for 4 years.
He was operated on in 2012 because of the scaphoid fracture, scaphoid fracture on the right side in a bicycle
accident and 2 years ago on tear sacs on both sides.
medication
- Lactulose syrup 1-0-0 (2-3 measuring spoons against constipation)
- ASA 500 mg bB
- ketozoline shampoo bB
- Lavender oil capsule bB
The anamnestic information most likely points to hypothyroidism.
Anemia and depression should be considered in the differential diagnosis.
Further procedure: 1.
KU: pretibial myxedema, bradycardia, hyporeflexia 2. laboratory:

small BB, electrolytes 3. free T3, T4
and TSH
4. Thyroid AK:
- TRAK => Morbus Basedow
- Tg-AK, TPO-AK => Thyroiditis Hashimoto

5. ECG
6. If necessary, thyroid sonography (in the case of goiter)
7. If necessary, fine-needle biopsy
Therapy:
Hormone replacement with L-thyroxine

1. What about the son?
o He suffers from lissencephaly

2. Is this Pat's first marriage?
o No, that's the second one

3. Where does the patient work?
o He works for the Bavarian Forestry Administration, but only part-time – because of his son
4. What is the father suffering from?
o He suffers from Addison's disease (adrenal insufficiency

5. In which part of the adrenal gland is there adrenal insufficiency?
o In the cortex (in German - in the bark part)

6. Which surgeries and why?
o He underwent surgery on both sides of the tear sacs because of the scaphoid fracture on the right side in the Zn bicycle accident
been
7. What is SAS, how would you prove it?

o Sleep apnea syndrome (SAS) is a symptom in which breathing regulation disorders with hypopnea and/or apnea (short-
term cessation of breathing) occur repeatedly during sleep.
o Proof of SAS is required by ENT (ear, nose and throat) doctor and requires several steps. At the beginning, anamnesis
should be questioned and KU performed. The ENT doctor looks for anatomical abnormalities in the oral cavity and in
the nasopharynx area o Sometimes the clarification of sleep disorders and sleep-related breathing disorders also
requires a polysomnography - an examination and measurement of various parameters during sleep. Patients usually
have to spend one to two nights in a sleep laboratory
8. What is CPAP therapy? o

CPAP (English: "Continuous Positive Airway Pressure") is a ventilation method that supports the spontaneously breathing
patient by exerting positive pressure in the inspiration phase. A slightly increased pressure is generated in the airways,
which makes it easier
patient inhalation.
9. What is Lactulose Syrup?

o It is used as a laxative.
10. What is ASA?
o Acetylsalicylic acid, ASA for short, is a cyclooxygenase inhibitor belonging to the non-steroidal
Anti-rheumatic drugs (NSAIDs) count.
11. Technical term for hair loss?

o State of hairlessness on body parts or on the head is called alopecia o The process of hair loss is
called effluvium in Latin.
10. How do you examine the thyroid?
o For this purpose, the patient's neck - usually while sitting - is stretched from the front or from behind with both
hands palpated. The patient is then asked to swallow a few times.

Normally the thyroid cannot be felt.
11. What is the enlargement of the thyroid called?

o This is called goiter
12. How will you rule out hypothyroidism? o To rule out

hypothyroidism, a laboratory test is performed to determine fT3/T4 and TSH
necessary
13. What causes hypothyroidism?

o Autoimmune thyroid disease (Hashimoto's thyroiditis) is usually the cause of a primary
hypothyroidism. About it hypothyroidism also occurs also after
operations or radioiodine therapy.

14. What is Hashimoto's Thyroiditis?

o Hashimoto's thyroiditis is an autoimmune thyroid disease. The body produces antibodies against the
thyroid for unknown reasons. This can destroy thyroid tissue and lead to hypothyroidism.
15. How will you confirm Hashimoto's Thyroiditis? o Antibody

detection - The following autoantibodies are typically found: thyroid peroxidase antibodies (TPO-Ab) and
thyroglobulin antibodies (Tg-Ab)
o Sonography shows a hypoechoic thyroid gland with an inhomogeneous structure and
Overall, the thyroid gland is usually reduced.
o A biopsy or fine-needle aspiration (FNA) and subsequent pathological examination can usually be used
to detect HT.
16. What is TSH?
o TSH -thyroid stimulating hormone produced by the adenohypophysis and
stimulates the thyroid gland to produce thyroid hormones.
17. What are T3, T4? Which forms do you know and what are the most important for diagnostics?
o Triiodothyronine (T3) and thyroxine (T4) are thyroid hormones that are produced directly in the thyroid
gland and stimulate certain metabolic processes. o There are 2 forms of T3
and T4. A large part of T3 and T4 is bound to plasma proteins in the blood, which serve as a means of
transport to the corresponding organs. A small part is free and unbound.
o The most important for diagnosis are free T3 and T4 18. Why
did you order the BB?
o This is necessary to rule out anemia.
19. What further investigations will you order?
o ECG and thyroid ultrasonography
20. How will you explain "sonography" to the patient? o
Please see “Clarifications”
21. Next?
o Fine-needle biopsy for suspected thyroiditis Hashimoto
22. How do you do a fine needle biopsy and why is it important to disinfect the puncture site? o Please
see “Reconnaissance”
o For every invasive examination, the puncture site should be well disinfected. Otherwise
Bacteria can get into the blood and lead to an infection.
23. When can L-thyroxine be administered?
o This depends on the clinical picture and TSH values. With clear clinical signs of
Hypothyroidism and/or if TSH >10 (with subclinical course)
24. In which federal state does goiter occur most frequently?
o In Bavaria, because there is a lack of iodine in the water.

Comment!
Hello dear colleagues
I took the FSP for the first time on June 28, 2021 in Munich and thank God I passed. It wasn't as stressful
as I thought. The examiners are very understanding (I was a bit nervous) and very professional, of course
also nice and friendly.
In the first part, the patient told a lot himself and spoke fairly quickly. That was good because I had enough
time for questions. I often asked (which I didn't understand).
In the second part there is no time to think, only to write
Time passes the slowest in the third part. I wish
you every success!
INFO!
Ø The Bavarian forest administration is responsible for the problems of the forest and forestry in
Bavaria.
Ø Lissencephaly is a brain malformation in which the brain surface takes place

is actually sinuous smooth.
Ø Tracheostoma is the surgical opening of the trachea, which becomes necessary when breathing
in and out naturally is no longer possible.
Ø The adrenal glands are located at the top of the kidneys. It is an endocrine gland that
divided into two areas - adrenal medulla and adrenal cortex.
Ø Addison's disease (primary adrenal insufficiency, “bronze disease”) is a disease with a complete
loss of function of the adrenal cortex. Typical
Sign:
• Browning of the skin (due to cortisol deficiency)

• Hunger for salt (due to aldosterone deficiency)
• Low blood pressure (due to aldosterone deficiency)
Ø The lacrimal sac operation on the eye is a small correction that is performed on an outpatient basis
is performed and tightens the lower eyelid.
Ø An eczema (pruritus or synonymous with the term "dermatitis") is a non

infectious inflammation of the skin, which is accompanied by itching.
Ø Lavender oil has anxiolytic, calming and antidepressant properties.

hyperthyroidism
patient
First name, last name: Daniel Stein, age: 56 years, height: 172 cm, weight: 68 kg.
! Cross-allergy to birch pollen and almonds with rhinoconjunctivitis hay fever
stimulants
ÿ Nicotine consumption: 2-3 cigarillos (short, narrow cigar) daily for 2 years. Before -
12.5 PY for 25 years. ÿ
Alcohol consumption: 2 glasses of wine a day (to sleep)
social history
He is a retail salesman (sells men's outerwear), is widowed (his wife died 2 years ago of pancreatic carcinoma),
has 3 children, the youngest daughter suffering from anorexia nervosa , he lives with his partner.
family history
§ Father: suffer from renal insufficiency requiring dialysis.
§ Mother: died of peritonitis peritonitis 2 years ago.

previous operation)
Mr. Stein is a 56-year-old patient who presented to us because of nervousness and inner restlessness that had
existed for 3-4 months.
The patient noticed the following accompanying symptoms: Tremor, trembling of the hands, mushy stool 2-3
times a day, tachycardia , tachycardia, moist and warm hands, difficulty concentrating, alopecia hairlessness
and myopia nearsightedness.
The vegetative anamnesis is unremarkable except for hyperhidrosis, weight loss of about 4 kg
within the 4 months, polyphagia, abnormally increased food intake, polydipsia , increased thirst,
insomnia , sleep disturbance.
He is known to have the following pre-existing conditions:
• Hypercholesterolaemia Elevated blood lipids for 5 years, •

Lumbar pain Low back / lumbar pain for 12.5 years, • Cholelithiasis
Gallstone disease for 5.5 years. (This was an incidental finding and was not
operated).

He was 7 because of phimosis foreskin narrowing, 2 years ago because of glaucoma Glaucoma / elevated
Intraocular pressure in both eyes, a year ago on thenar thenar thenar (as of post-hedge trimming injury) (was
sutured) and operated at the age of 55 for the distal radius fracture on the right.
Medicines:
- Simvastatin 40mg 0-0-1

- Diclofenac 75 mg b. B.
- Diclofenac - eye drops 1-0-1
- Pantoprazole 20 mg (as stomach protection)
The anamnestic information most likely points to hyperthyroidism.
Graves' disease, goiter maligna, and psychoses can be considered in the differential diagnosis.
Proceed further:
1. CU:
• With palpation - thyroid gland - goiter, pretibial myxedema connective tissue proliferation
(proliferation of connective and fatty tissue in the legs), exophthalmos
eye prolapse / googly eye, tachycardia,
• Tingling on thyroid auscultation
2. Lab: small BB, CRP, ESR, Electrolytes and

• free T3, T4 • TSH
(thyrotropin / thyroid stimulating hormone) • thyroid antibodies: TRAK
(thyrotropin receptor autoantibodies), TPO-AK (thyroid peroxidase antibodies), Tg-AK (thyroglobulin-
AK).
3. Thyroid sonography: size, homogeneity, uniformity, presence of nodules. as well as blood circulation,
nodular changes in the thyroid gland (position and size), swelling of the lymph nodes.
4. ECG
5. Possibly scintigraphy (hot / cold nodes)
6. If necessary, fine-needle biopsy
Therapy:
1. Thyrostatic therapy (antithyroid drugs): with thiamazole or propylthiouracil
2. ß-blockers (propranolol)
3. Subtotal or total thyroidectomy: again in the event of recurrence, in the event of complications such as
compression disorders and in the event of a suspicion of malignancy

–
4. L-thyroxine (after hormone more complete thyroidectomy situation
replacement therapy)
5. Radioiodine therapy: (can be considered as an alternative to surgery)

1. What is cross allergy?
o A cross-allergy is an allergic reaction of human antibodies to others
Antigens that are very similar to the actual allergy-triggering antigen.
2. What is the prognosis of anorexia nervosa?
o The overall prognosis for anorexia nervosa is rather unfavorable. Only about half
of those affected can be cured in the long run.
3. What is glaucoma? The symptoms and treatment? complications? o Glaucoma (green
star) is a collective term for diseases of the eye, which is characterized by severe eyes and headaches, vomiting,
nausea and visual impairment due to increased intraocular pressure.
o Glaucoma is treated with medication (e.g. acetazolamide or local miotics (pilocarpine drops)), surgical therapy and,
if necessary, laser therapy
o Complications: ischemia and atrophy of the optic nerve
4. Regarding the 6 kg, could this case be a thyroid carcinoma? o Yes, this is about 10% of
the patient's weight and in this case we need to do further tests to rule out the suspicion of malignancy.
5. What disease did the patient's mother die of?

o Peritonitis
6. What is the most common cause of peritonitis at this age?

o Diverticulitis
7. What is the opposite of retail salesman?

o wholesale merchant
8. What kind of medicine is simvastatin?
o Cholesterol reducer (main function is lowering of blood cholesterol level)

9. Both forms of goiter?
o Diffusa and Nodosa
10. What is TRAK?
o TRAK (Thyrotropin Receptor Antibodies) - autoantibodies that are directed against the TSH
have receptor-directed action
! Is it elevated or low? What do you expect in this case?

o TRAK in this case is increased
11. How do you proceed with the patients?

o I will examine the patient physically.
12. What do you expect from auscultation of the thyroid gland?
o Snoring, typical clinical signs of Graves' disease

13. Causes of Hyperthyroidism?

o Thyroid autonomy and Graves' disease are often the underlying causes. Rarely can
could also be thyroiditis or thyroid carcinoma.
14. Thyroid sonography – clarification o Please
see “clarifications”
15. What can you evaluate in the ultrasound?
o Enlarged thyroids, homogeneity, hypoechoic tissue, increased vascularization,

presence of the knots.
! Can we differentiate between cold and hot nodes with ultrasound?
Oh no. Can we at scintigraphy.

16. Scintigraphy - Enlightenment
17. What is peritonitis? Most common cause?
o Peritonitis - (peritonitis) - is an inflammation of the peritoneum
Cause:
- appendicitis
- Diverticulitis
- Inflamed gallbladder (cholecystitis).

- gastritis
- Pancreatitis
18. When will a patient no longer be on dialysis, then what other options will they have
She?
o Our last option here is a kidney transplant.

19. Fine needle biopsy - education.
Comment!
Hello folks. I passed FSP yesterday. My case was hyperthyroidism. All examiners were so nice.
This group (approval for foreign doctors in Bavaria) helped me a lot.
Good luck everyone!!!
INFO!
Ø Allergic rhinoconjunctivitis (allergic rhinitis) is an allergic disease of the nasal mucosa (rhinitis) and the
eyes (conjunctivitis), which is caused by an IgE-mediated inflammatory reaction.
Ø Retail merchant- is a merchant who works professionally in a company of

Retail goods of all kinds sold.

Ø Anorexia nervosa is a behavioral disorder or eating disorder in which intentional

weight loss occurs through reduced food intake, induced vomiting and hyperactivity.
Ø Pancreatic carcinoma (pancreatic cancer) is a malignant tissue change

the pancreas
Ø In medicine, dialysis is the term used in the narrower sense to designate therapy
methods that serve to remove substances and toxins from the blood that have to
be excreted in the urine (kidney replacement procedures).
Ø Myopia is a form of defective vision (ametropia) in which distant objects are perceived
as blurry.
Ø Goiter is an independent enlargement of the thyroid tissue

from the etiology.
Ø Iodine ablation- is a therapy method in nuclear medicine, in which maligna

and benign (non-cancerous) are treated with the help of radioactive isotopes.
Thyroid disease can be treated.
Ø A scintigraphy is a nuclear medical procedure for displaying body tissue. This involves
using weakly radioactive substances that accumulate in various organs. There are
cold knots and hot knots. Cold nodules are areas of the thyroid that produce little or
no hormones. Hot lumps, on the other hand, are areas that are more active than other
areas of the thyroid and produce more hormones. The terms "hot" and "cold" have
nothing to do with temperature changes. Rather, it is about how the nodes behave in
the so-called scintigraphy .
Ø A resection is the partial removal of an organ or tissue section through an operation.
Ø Subtotal -The term is often used in surgery to express that although most of an organ
or other body structure has been removed, a small part remains.

hypoglycemia
patient
First name, last name: Ruppert Vögel, age: 61 years, height: 175 cm, weight: 80 kg
- Penicillin with anaphylactic shock (was taken for phlebitis)
- Seafood with dyspnea shortness of breath and diarrhea diarrhea
stimulants
• Nicotine consumption: Only 5-6 cigs/day for 3 years. Before that PY=20
• Alcohol consumption and drug consumption were denied.
social history
He has been an early pensioner since January 2022 and is a civil servant by profession , widowed (his wife died 6 years ago)
months died in a car accident), obsessive-have 3 children,
compulsive one (she
disorder daughter suffers from OCD
got worse because of Covid-19 infection).
family history
§
Father: died at 80 from paranasal sinus carcinoma cancer of the paranasal sinuses
§
Mother: dementia, live in a nursing home (but at the moment in KH because of an accident)

previous operation)
Mr. Vögel is a 61-year-old patient who came to see us because of a sudden and increasing tremor that has
existed since this afternoon ,
nervousness, hyperhidrosis, sweating and palpitations , palpitations
(According to the patient, he has had DM for 6 years and needs daily insulin injections. He overslept today
and therefore missed breakfast (drank only one cup of coffee), but still injected insulin. After that, he went
on a bike ride with friends and after 2 hours the symptoms suddenly came on. He took a break, drank a
little water and he felt better. But after an hour the symptoms came back and got worse over time.)
In addition, the patient noticed the following accompanying symptoms: restlessness, blurred vision, amnesia (he
could not remember his friend's name), weakness in his legs and blackness in his eyes.
The vegetative anamnesis is unremarkable except for insomnia in the form of difficulty falling asleep, nocturia,
nocturnal urination, constipation , weight loss of about 4-5 kg within 2 months

The patient is aware of the following pre-existing conditions:

• DM for 6 years (first 3 years was treated with diet and exercise, then with metformin insulin)
• Osteoarthritis of the ankle wear and tear for 28 years with Zn ankle fracture
treated conservatively (no surgery)
• Tinea axillaris fungal infection in the armpit for 8 days
• Statement of arrhythmia Cardiac arrhythmia for 5 years (probably due to stress and death
his wife)
• Phlebitis phlebitis left leg after insect bite (treated with penicillin
and he got anaphylactic shock).
He has never had an operation before.
medication
- Metformin 500mg 1-0-1

- Insulin 1-0-0
- Diclofenac bB (3-4 times/month)

- Canesten ointment bB
- Valerian drops bB
The anamnestic information most likely points to hypoglycaemia.
Hyperthyroidism and apoplexy come into consideration in the differential diagnosis.
Proceed further:
1. Inpatient admission and KU: check vital parameters

2. Laboratory: BB, CRP, ESR, ESR, Electrolytes, Blood Glucose Measurement, HbA1c
3. ECG
4. If necessary, fasting
test 5. If necessary, CT skull
Therapy:
1. Glucose administration po (20–100 g) - while consciousness is
maintained 2. Secure vein access and addition of glucose to a running infusion (8–
24g glucose) with continuous blood sugar measurements - in case of loss of consciousness.
- Target blood sugar: 200 mg/dL (11.1 mmol/L)

1. What did the patient eat for breakfast?
o He only drank a cup of coffee
2. Did he inject insulin?
O yes

3. How much insulin does the patient inject daily?

o I didn't ask
4. What dose is an insulin bolus?
o 4 IU.
5. What is metformin? When does metformin need to be stopped?

o Metformin is a drug from the group of biguanides and by inhibiting the
Glucose formation (gluconeogenesis) in the liver lowers the glucose levels in the blood. In the
Metformin is usually used in type 2 diabetes mellitus and obesity
(obesity) used.
o Metformin must usually be stopped 48 hours before surgery and administration of contrast media. There is risk of
lactic acidosis. However, emergency surgery is possible with metformin.
§
Normal dosage for metformin?
o A standard dosage is 1000 mg in the morning and in the evening.
6. What is the combination therapy with insulin and metformin together called?
o This is called dual therapy.
7. How did the osteoarthritis of the ankle happen?
o The patient had an accident and broke his ankle
§
How was it treated?
o This was treated conservatively
§
Why no surgery?
o He decided not to have surgery himself?
§
Would be better with OP?
o This depends on indications. If there is no clear dislocation, then you can

also carry out conservative treatment
8. How long has he had arrhythmia?
o Arrhythmia has been reported for 5 years
9. How do you treat an arrhythmia?
o This patient suspects a stress-related cause. We can can patients who
Recommend psychological therapy to help patient reduce stress
10. Has the patient been hospitalized for anaphylactic shock?
o Yes, the patient was admitted and treated in the intensive care unit
11. Why did he lose weight? Has the patient changed their diet?
o Pat has changed her diet because of DM and he also exercises.
12. What do civil servants do for a living?
o Civil servants are people employed by the state. They perform important tasks for the state. This is what teachers
and police officers do, for example.
13. How do we see hemorrhage on CT of the skull? o
Like increased optical density
14. What is HbA1c?
o HbA1c is hemoglobin to which a molecule of sugar (glucose) attaches itself. HbA1c values are used to calculate the
average level of sugar in the human body
To determine blood from diabetics in the last eight to twelve weeks.

§ Limits of HbA1c?
o HbA1c 5.7%-6.4% is threshold. If HbA1c is more than 6.5%, that counts as DM.
15. Why is there also an EKG here?
o Pat. has palpitations and reports of arrhythmia.

16. Difference between DM type 1/2
Type 1 diabetes Type 2 diabetes
entry in children and adolescents, more usually in adulthood, in recent years

rarely in adults increasingly im
adolescence
beginning mostly suddenly mostly insidious
causes Autoimmune Response: Cells Hereditary Disorders

of endogenous Insulin action (insulin resistance)
Immune system attack the insulin- and insulin secretion,
producing beta risk factors for the outbreak
cells and destroy them of the disease: obesity,
wrong Nourishment,
lack of exercise
Symptoms § intense thirst § no complaints for a long time
§ Fatigue § frequent urination

§ Weight loss § feeling weak
§ Cravings § intense thirst
§ frequent urination § dry skin
§ Acetone odor of breath § Fatigue
§ increased susceptibility to infection § increased susceptibility to infection
Little or no insulin resistance often pronounced
Treatment lifelong insulin therapy § adapted nutrition
§ Movement
§ if necessary, oral antidiabetics
§ if necessary insulin therapy
17. Technical terms for armpit fungus?

o Axillary tinea
18. What should DM patients know?
o It is advisable for every patient with type 2 diabetes to attend appropriate training at the beginning of therapy. People
with diabetes who have had training, have better blood sugar levels, have a better quality of life and are less likely
to suffer from depression.
took part
19. Your VD and DD?
o In this case, the medical history indicates hypoglycaemia. DD come

Hyperthyroidism and apoplexy in question.

20. Is it an emergency? And should the patient be treated as an inpatient?
o Yes, the patient has to be treated as an inpatient
Comment!
Hello folks.
I passed the FSP in Munich yesterday. My case was hypoglycemia. It was harder than I thought. The patient had a strong
accent and talked very quickly and a lot.
I always had to interrupt him and ask.
Here is the log.
I wish you much success:)
INFO!
Ø Seafood is generally used to describe all edible marine animals that are not
vertebrates. Typical seafood includes mussels and aquatic snails, squid and squid,
prawns, crabs, langoustines and lobsters.
Ø Early retirement is when an employee retires early although he has not yet reached
the statutory retirement age.
Ø OCD (obsessive compulsive disorder) or obsessive-compulsive disorder (obsessive-

compulsive disorder) serious mental disorder. Those affected have to follow certain
actions or trains of thought over and over again, although these are usually perceived
as nonsensical or stressful.
Ø Dementia is a neurological clinical picture that is characterized by the progressive

loss of cognitive abilities.
Ø Palpitations are cardiac actions that are perceived by the patient as unusually fast,
strained, strong or irregular.
Ø Phlebitis is the inflammation of a venous vessel
Ø The fasting test is an endocrinological function test to clarify hypoglycemia. The

patient is fasted on the day of the fasting test, but drinking water is allowed. Blood
sugar is measured at regular intervals. If the value falls below a critical value, blood
is taken for further diagnostics and the test is terminated. Insulin and C-peptide levels
above the reference range indicate endogenous insulin overproduction.

hematology
1. Lymphadenopathy
- Have you noticed enlargement of the lymph nodes?
- localization? In which area?
- pain? Are these painful or painless?
- When? How long have you had the magnification? Does the enlargement suddenly or slowly
began?
- In the case of mediastinal manifestations – do you have a feeling of pressure on your chest? Are you dry cough
and/or shortness of breath noticed?
- In case of abdominal manifestations- Do you have upper abdominal pain?
2. B symptoms
- Fever- Do you have a fever? What is the temperature and how long has it been?
- Night sweats- Do you sweat more at night?
- Weight Loss- Have you lost weight unintentionally? How many kilos and in what period?
Was that intentional or unintentional?
3. General symptoms
- Skin changes- Have you noticed any skin changes? Do you have itching? Throughout
body or in specific area?
- Anemia- Have you noticed changes such as fatigue, paleness?
- Leukopenia- Do you often get infections?
- Thrombocytopenia- Have you noticed an increased tendency to bleed?
- How long have these symptoms been present?
- Do you have a swallowing disorder? (DD - Thyroid Carcinoma)

Hodgkin lymphoma
patient
First name, last name: Hermann Lorenz Age: 78 years, height: 189 cm, weight: 89 kg
- Strawberry allergy with generalized exanthema whole body skin rash and
abdominal pain abdominal pain
stimulants
ÿ Nicotine consumption: non-smoker for 15 years. Before that PY-10 (I have because of my
cough stopped)
ÿ Alcohol consumption: a glass of sparkling wine 1-2 a month (but only very high quality sparkling wine and only
if there is something funny in the evening in the retirement home)
ÿ Drug use was denied
social history
He was a pensioner, formerly a tailor, single (single, he had neither a wife nor a girlfriend), had no children, lived
in a retirement home and had a nephew who looked after him.
family history
§ Father: died at the age of 73 from laryngeal carcinoma Laryngeal carcinoma . (he was afraid that
it can also be cancer)
§ Mother: died suddenly at the age of 78 from myocardial infarction (his father died at the age of 73 and his
mother survived him by 5 years. She had a heart attack and died suddenly)
§ Sister: I am 63 years old, had a hemorrhagic stroke, cerebral hemorrhage , hence

wheelchair bound and live in a nursing home

previous operation)
Mr. Lorenz is a 78-year-old patient who presented to us because of cervical, indolent, painless lymphadenopathy
and enlarged lymph nodes that had been present for 1.5 weeks .
According to the patient, the knots had grown so large that he could not close his shirt collar.
He also noticed the following accompanying symptoms: fever up to 39.4 for a few days, nocturnal hyperhidrosis
at night, lack of drive, asthenia, lack of strength
Questions about dysphagia and pain were answered in the negative.

The vegetative anamnesis is unremarkable except for insomnia, sleep disturbance in the form of
difficulty falling asleep (due to night sweats), constipation, constipation for 8-9 years (he has been
taking Movicol sachets and the doctor told him that he must drink a lot of water), loss of appetite
and weight loss of about 3 kg within 1.5 weeks.

• Hyperlipidemia High blood lipid levels for 20 years,
• Low back pain Lumbar pain for 8 years (he worked as a tailor for many years
and always sat wrong)
• Chronic recurrent conjunctivitis conjunctivitis on both sides for 10 years (he repeatedly suffers
from conjunctivitis, which manifests itself with dry eyes and a foreign body sensation in the
eyes.),
• Furuncle purulent skin inflammation on the back for 3 weeks (he went to the family doctor about
it and got a surgical referral. After that he went to surgeons and now he is waiting for an
appointment to have the boil removed) ,
• Commotio cerebri concussion 3 years ago, was hospitalized for 2 days (he fell down the stairs
and suffered a fracture of the lower leg and commotio cerebri.),
• Pyelonephritis pyelonephritis 5 years ago, hospitalized with IV antibiotics

treated.
He was operated on 3 years ago for a lower leg fracture on the left after a fall from stairs. (He got a
nail)
medication
- Movicol sachet. bB
- Simvastatin 40mg 0-0-1.
- Ibuprofen 600mg bB
- Pantoprazole 40 mg 0-0-1. (as stomach protection)
- Eye drops (can't remember the name) bB

The anamnestic information most likely points to Hodgkin's lymphoma.
Esophageal carcinoma, angina tonsillaris and acute leukemia can also be considered in the
differential diagnosis.
Proceed further:
1. CU:
- Palpation of the lymph nodes - painless swelling of the lymph nodes
- Palpation of the abdomen- hepatomegaly
2nd laboratory: dif. BB, CRP, ESR, Electrolytes, LDH
3. Bone marrow biopsy with histological examination

4. Abdominal sono - assessment of enlarged organs

5. X-ray thorax in 2 levels - exclusion of a mediastinal tumor
6. CT with contrast agent: neck, thorax and abdomen - lymph node conglomerate 7. If
necessary, MRI and PET
therapy
1. Chemotherapy according to the scheme:
- A- Adriamycin
- B- Bleomycin
- V- Vinblastine
- D-dacarbazine
2. Radiation therapy 3.
Palliative therapy 4.
Autologous stem cell transplantation (SCT) – as recurrence therapy

1. Does the patient have 2 names?
o No, Hermann is a first name.

2. Does he have indolent lymphadenopathy? What did he say exactly?
o He said: painless enlargement of the lymph nodes.
3. Why did he lose weight? Because of difficulty swallowing or because he has no appetite?
o This is more due to inappetence.
4. What allergies does he have?
o Strawberry allergy, which manifests itself with a generalized rash and abdominal pain.
5. Why is he coughing?
o According to the patient because of nicotine abuse

6. What was his occupation?
o He used to be a tailor by trade 7. Why does he have

lumbago?
o He worked as a tailor for many years and was always wrong.
8. What is the social history? is he alone
o He is retired, single, (he said single, has no children, lives in a retirement home and has a nephew who takes care of
patients.
9. Do you think he's scared because his father died of laryngeal cancer? o Yes, he had expressed fear
about this during the anamnesis interview.
10. How old was the mother? And the sister?
o The mother was 78, he said the mother survived his father by 5 years. sister is
63 years old
11. What is he taking with ibuprofen? o He also takes

pantoprazole to protect his stomach.

12. What did he tell about the constipation?

o He has been suffering from constipation for 8-9 years. He is taking Movicol sachets and the doctor has told him to drink
plenty of water.
13. What did he say about the eyes?
o He repeatedly suffers from conjunctivitis, which is associated with dry eyes and
foreign body sensation in eyes.
14. What does pyelonephritis mean? How was the treatment?
o Pyelonephritis is an inflammation of the renal pelvis involving the renal parenchyma, usually caused by a bacterial
infection. It was with
treated with antibiotics.
15. What did he tell about the boil?
o He went to his family doctor about it and got a surgical referral. After that he went to surgeons and is now waiting for an
appointment to have the boil removed)
16. What did he tell about the treatment in the hospital?
o He was hospitalized for traumatic brain injury for 2 days. He fell down the stairs
and have undergone a fracture of the lower leg and commotio cerebri.
17. How was the treatment of the fracture?
o Surgical – osteosynthesis with a nail
18. How do you say Commotio cerebri in German?
o concussion
19. What is your VD?
o History is most indicative of Hodgkin lymphoma.

20. What speaks for a lymphoma?
o Lymphadenopathy with B symptoms –> fever, nocturnal hyperhidrosis speaks for this
and weight loss, and listlessness and asthenia.
21. What do you do during the physical examination?
o Inspection and palpation of the lymph nodes.
22. What do you look for when examining the abdomen? o I am
looking for hepatosplenomegaly.
23. How would you describe normal abdominal examination findings?
o Abdomen soft, no pressure pain, no defensive tension, regular bowel noises.
24. Do you only palpate the lymph nodes in the neck?
o No, except for cervical nodules I still would
25. What do you think the skin looks like?
o Anemic signs such as pallor etc…
26. Are you looking for hematomas or petechiae?
o Yes, this can also be due to thrombocytopenia

27. Is it possible that he has an infection?
o Yes, infectious mononucleosis and angina tonsillaris are possible DDs.
28. What is typical in differential BB in infectious mononucleosis?
o The blood count often shows a conspicuous leukocytosis with mononuclear cells (lymphoid or Pfeiffer cells). In the blood
smear, the mononuclear cells usually present themselves with an irregularly shaped cell nucleus.
29. Can you please say more pathogens?

o Epstein-Barr virus (EBV)

30. Why is your diagnosis not acute leukemia? Can we rule that out immediately?
o Lymphadenopathy speaks more for lymphoma, but without further laboratory and equipment
Investigations cannot rule out acute leukemia.
31. What is bone marrow puncture?
o A bone marrow puncture is used to diagnose diseases and their spread in the bone marrow and the blood-forming system.
After local anesthesia, a special cannula is used to puncture the marrow cavity of flat bones (e.g. sternum, iliac crest).
This serves to remove tissue as part of a biopsy of the bone or
of the bone marrow.
32. What do you expect in histology?

o It is characterized by mononuclear Hodgkin cells and multinucleated Sternberg-Reed cells, collectively referred to as
Hodgkin-Reed-Sternberg cells (HRS cells).
33. What stage of Hodgkin's lymphoma do you suspect? o I think this is
Stage IA
stage Description
Stage I Local infestation:
• Involvement of a lymph node region

• or a localized extranodal focus
stage II One side of the diaphragm affected:
• at least two lymph node regions

• or a localized extranodal focus and lymph node involvement
stage II Both sides of the diaphragm affected:
• at least two lymph node regions

• or a localized extranodal focus and lymph node involvement
Stage IV Disseminated infestation
• Disseminated involvement of at least one extralymphatic organ (eg liver, bone marrow),
independent of the lymph node status
Addition A no B symptoms
Addition B at least one B symptom

Comment!
In preparation I sat in for 3 months, at a practice, practiced with colleagues and had private lessons. It is
very important to read all logs, they are always the same, only small things change.
At first they were all very serious, but during the anamnesis the patient made a few jokes and I had no
trouble understanding him. If I didn't fully understand something, I asked if he could repeat it and he
repeated everything. Part 3 was a lot easier than I thought (and than my first attempts!). It was really just
a conversation between two colleagues.
The examiner was very nice.
In the end they told me that I just have trouble saying the technical terms in German (I think in technical
terms immediately and it is sometimes difficult to say the word in "normal" German).
The commission was serious and professional without wasting time. You just asked me what I did to
improve my German and off you go! I wish everyone every success.
INFO!
Ø Sparkling wine is a carbonated alcoholic beverage whose alcohol content is at least
is ten percent by volume;
Ø Schneider (from Middle High German snÿden "to cut") is a craft apprenticeship in
textile processing. The task of the tailor is to process textiles into clothing.
Ø An old people's home, also, retirement home, is a residential facility for old people
in which they can receive care and attention. The word "old people's home" is
increasingly used as a synonym for nursing home .
Ø Nephew is son of one's brother, sister, brother-in-law or sister-in-law
Ø The larynx carcinoma is a malignant tumor of the voice box (larynx).
Ø Sudden cardiac death (PHT) is an unexpected cardiovascular failure and results

to a natural death from cardiac causes.
Ø The hemorrhagic infarction is an infarction caused by a vascular occlusion and

characterized by an influx of blood into the necrotic area.
Ø A boil is a purulent inflammation of a hair follicle and the surrounding area

subcutaneous tissue - usually caused by infection with Staphylococcus aureus. A boil
is a form of abscess that can appear on any hairy part of the skin.

acute leukemia
patient
First name, last name: Cornelia Jäger, age: 31 years, height: 159 cm, weight: 59 kg.
- Pollen allergy with rhinoconjunctivitis hay fever
stimulants
ÿ Nicotine consumption: smoker
ÿ Alcohol consumption: occasionally

social history
She is a teacher, single, has no children, lives alone.
family history
§ Father: died of thyroid carcinoma thyroid cancer . § Mother: suffer from diabetes
mellitus diabetes
Ms. Jäger is a 32-year-old patient who presented with fatigue that had been going on for 3 weeks .
In addition, the patient noticed the following accompanying symptoms: Pallor, stress-related dyspnoea, shortness
of breath, gingival bleeding , bleeding gums and hematomas
bruises.
She added that she suffered from pneumonia 3 months ago.
The vegetative anamnesis is unremarkable except for insomnia, sleep disturbance, meteorism , flatulence,
weight loss of about 3 kg. Within 3 weeks.
• Pneumonia pneumonia 3 months ago • Atopic

dermatitis Atopic dermatitis for 5 years
• Tendinitis tendinitis for 2 years
• Intoxication intoxication 4 weeks ago
• migraines
She has never had an operation before

medication
- Cortisone 5 mg 1-0-0
- Paracetamol 500 mg 1-1-1
The anamnestic information most likely points to acute leukemia.
Hodgkin's lymphoma and angina tonsillaris are also included in the differential diagnosis
consideration.
Proceed further:
1. CU
2nd laboratory: dif. BB, CRP, ESR, Electrolytes, LDH, Uric Acid
3. Bone marrow puncture with histological examination 4. Abdomen
sono - assessment of enlarged organs
5. X-ray thorax in 2 levels - exclusion of a mediastinal tumor
6. Lumbar puncture
therapy
1. Induction therapy - high-dose chemotherapy (cytarabine, daunorubicin)

2. Consolidation therapy- subsequent cytostatic therapy and, if necessary, allogeneic stem cell transplantation
3. Maintenance therapy - low dose chemotherapy
No comment!

migraine
1. Pain history
- Where? Can you pinpoint the exact location of the pain, please? Do you get headaches?
one side of the head or both sides?
began?
- History? How long does the headache last? Has the pain gotten better or worse over time? Have you had
pain like this before? Is that why you went to the other doctor?
- Trigger? Are there specific triggers for the pain? (body strain, consumption of stimulants,
fear, stress?)
2. Aura
- Visual disturbances -Apart from the headache, do you have accompanying visual disturbances, such as loss
of visual field, flashes of light, flickering or abstract color and shape perceptions?
- Neurological disorder - Do neurological disorders such as paralysis, numbness or tingling occur during the
headache?
- Speech disorder - Do you have speech disorders?
3. Nausea/vomiting
- Have you also noticed nausea, vomiting or noise aversion with the headache?

epilepsy
1. Seizure history
Seizure Event - Could you describe the seizure in more detail? Can you remember everything?
- Seizure onset - When did the seizure occur?
- Seizure localization - Have you noticed cramps or muscle twitching? Only at
extremities or the whole body?
- Seizure duration - How long did the seizure last? Was anyone with you? Does anyone know how long
the seizure lasted?
- Have you lost consciousness or felt dizzy?
- Do you have hallucinations, numbness or something similar?
- Do you have speech, cognitive or affective disorders at the same time?
- Did you bit your tongue?
- Did you hurt your head?
- Do you have involuntary leakage of urine and stool
2. Before the attack
- Before the seizure, do you have vision problems, hearing problems, headaches, signs of paralysis
or had sensory disturbances?
- Triggers- Are there specific triggers for seizures? Have you been stressed lately?
Have you had a fever, lack of sleep, injury?
- Has a similar seizure happened before?
3. After the seizure
- Did you notice headaches, exhaustion, restlessness, nervousness after the attack?

migraine
patient
First name, last name: Lothar Schwarz, age: 53 years, height: 175 cm, weight: 80 kg
- Nickel allergy with erythema skin rash and pruritus itching,

- Fructose intolerance with meteorism flatulence and diarrhea diarrhea
stimulants
• Nicotine use: 1.25 PY for 5 years. Before – about 23 PY. • Alcohol

consumption: a glass of wine in the evening (to relax after work)
social history
He is an editor (in the local newspaper) , married (currently divorcing and living separately) and has a daughter
from his wife ) who has anorexia nervosa
suffer.
family history
§ Father: died of brain tumor 2.5 years ago § Mother: suffer
from scoliosis curvature of the spine
Mr. Schwarz is a 53-year-old patient who came to see us because of a pulsating, left-sided cephalgia headache
that had existed since the day before yesterday and suddenly appeared after physical exertion .
Pain intensity was rated 7-8 out of 10 on a pain scale
According to the patient, the pain started after gardening and got worse over time. He took paracetamol three
times with no improvement.
In addition, the patient noticed the following accompanying symptoms: nausea , vomiting twice , photophobia,
photophobia /photosensitivity , photopsia(flickering in front of the eyes) , vertigo , dizziness, paresthesia, tingling
on the fingertips.
He also added that he had had similar headaches multiple times over the past 9 months
have.
The questions about loss of consciousness, stiff neck, phonophobia and seizures
were denied.

The vegetative anamnesis is unremarkable except for meteorism, flatulence and insomnia, sleep
disturbance in the form of difficulty falling asleep.
The following illnesses are known to him: • COPD for 5 years,
• Cervical pain, neck pain for 2 years (because he mostly works at the table) ,
• Unguis incarnatus ingrown nail of the big toe on the left for 4 weeks (he had
used an ointment against it, but didn't help him) ,
• Herpes labialis cold sores on the upper lip for 3 days (after the stress and the beer
drink at Oktoberfest)
• Rib contusion Rib contusion in the time after a car accident 5 years ago.
He was operated on at the age of 24 for perforated appendicitis . (before the operation he was in intensive care)
medication
- Salbutamol with beclometasone in the spray bB, -

Paracetamol 500 mg bB
- Acic cream bB
- Lefax chewable tablets (administered by the general practitioner) bB
The anamnestic information most likely points to the migraine.
Meningitis, cerebrovascular accident and brain tumor should be considered in the differential diagnosis.
Proceed further:
1. CU:
- Neurological examination - meningeal signs (DD).

2. Laboratory: small BB, CRP, ESR, electrolytes, coagulation.
3. MRI brain: to exclude organic diseases
therapy
1. General measures: stay in the dark room and bed rest

2. Acute therapy
- For mild to moderate attacks -NSAIDs (ASA, paracetamol, ibuprofen)
- For severe attacks - triptans (sumatriptan)
- In the case of status migraenosus - iv cortisone 250 mg)
3. Symptomatic - Antiemetics (MCP)
4. Seizure prevention
- Non-drug: Stress reduction, endurance sports, nicotine alcohol
abstinence, neural therapy, regulation of sleeping habits - Medicinal: ß-Bl.

(metoprolol), flunarizine, antiepileptics (valproic acid)


1. All the little things from anamnesis.
2. When and why does the patient get herpes labialis?
o Stress and drinking beer at the Oktoberfest
3. What is the connection between herpes and Oktoberfest?

o The main reason for this is the Oktoberfest. The musty, warm and humid air in the beer tents on the Theresienwiese
offers an ideal habitat for germs.
The large crowds make it particularly easy for them to jump from one host to the next.
4. Where was the patient before surgery for perforated appendicitis.

o He was in intensive care
5. Do you admit all patients to intensive care for this reason?
o Yes, because there is a high risk of septic shock.

6. What are the symptoms of fructose intolerance?
o The most common symptoms of fructose intolerance are meteorism and diarrhea. The other symptoms are abdominal
pain, abdominal cramps, nausea, bloating, abnormal bowel sounds.
7. What is your VD and DD?
o The anamnestic information most likely points to the migraine. o Meningitis, apoplexy and
brain tumors can be considered in the differential diagnosis.
8. What signs of meningitis do you know?
o Meningitis is manifested by headache, stiff neck, nausea, vomiting, photophobia, fever, confusion, impaired
consciousness and occasionally epileptic seizures. The clinical course of bacterial meningitis is often more
dramatic and faster than the viral form. o The neurological examination should look for the typical meningeal signs:
a positive Kernig, Lasègue and
Brudzinski sign. The patient often adopts a relieving posture. The absence of meningeal signs does not rule out
meningitis.
9. MRI - reconnaissance
o Please see "Clarifications"
10. How do you proceed? o Please
see "Further procedure"
11. How do you conduct neurological examination? o Please see
“Neurological examination”
12. Which nerve in the arm is responsible for the tingling in the tips of the hands?
o Tingling and numbness in the hand suggests median nerve damage. This so-called median nerve runs through the
carpal tunnel in the wrist. It provides feeling for the thumb, index and middle finger and one side of the ring finger.
If the tunnel narrows, there is pressure on the nerve. Causes are mostly idiopathic, overexertion, trauma, arthritis,
diabetes mellitus, pregnancy, obesity, etc.
o Those affected often experience tingling as if they were touching a nettle or as if ants were crawling over the skin.

13. What types of migraines are there?

o Migraine without aura - simple migraine caused by accompanying vegetative symptoms such as
nausea, vomiting, audiovisual abnormal sensations (photophobia, phonophobia), palpitations
and diarrhea.
o Migraine with aura - the headaches are also accompanied by mostly short-lasting neurological
deficits that subside after the end of the attack. For example, visual field defects in the form of
so-called ciliated scotomas are typical of ophthalmic migraines, which are often followed by
flashes of light.
o Status migraenosus - a migraine attack that lasts longer than 3 days is considered a status
referred to as migraenosus.
o Isolated aura
o Retinal migraine - obligatory unilateral, aura-like visual phenomena such as scotomas, fibrillation
or blindness that are limited to the time of the migraine attack.
o Vestibular migraine - episodic disease with symptoms of dizziness (rotation
or swaying, dizziness, unsteady gait, drowsiness)
o Basilar migraine- brainstem symptoms such as dizziness, tinnitus, bilateral sensory and
motor disorders as well as dysarthria, dysphagia and diplopia.
14. How do you treat migraines?
comment
I'm sure I've forgotten a few little things, but overall, that's what my case looked like. I didn't have enough
time to take family history.
Time was short for the written part and I wasn't able to finish everything.
In the third part, the atmosphere was actually pleasant, examiners were very nice, they spoke clearly, were
helpful and patient. Not too many questions were asked, but in the course of the conversation, CT
reconnaissance, diagnostic measures, therapy, and differential diagnoses were discussed.
The most important thing is to be able to express your opinion and simply argue using medical terms.
INFO!
Ø In the case of a nickel allergy , the body's own defense system (immune system) reacts
Nickel – after contact with objects containing nickel.
Ø Editors - plan and organize the content of media of all kinds.

The editor manages and edits the work of journalists and external authors, determines
topics and their priority.

Ø Anorexia nervosa is a behavioral disorder or eating disorder in which intentional weight

loss occurs through reduced food intake, induced vomiting, laxative abuse and
hyperactivity.
Ø Herpes labialis is a herpes simplex virus infection that manifests itself in the lip area. In
the case of herpes labialis, the virus persists in the ganglia after the initial infection.
Ø Acic Crème - The preparation is a drug used to treat viral infections. It is used to relieve
pain and itching in frequently recurring herpes infections with blistering in the genital
and lip area (recurrent genital and labial herpes).
Ø Oktoberfest is known throughout Germany and is even the largest folk festival in the world.
Specialties such as beer and pretzels are part of a visit. In addition, many visitors wear
Bavarian costumes - even if many do not come from Bavaria.
Ø An intensive care unit is a ward in a hospital where patients with serious to life-
threatening illnesses or injuries are treated in intensive care
become.
Ø Meningitis (inflammation of the meninges) is an inflammation of the lining of the brain

and spinal cord, i.e. the covering of the central nervous system (CNS). It can be caused
by viruses, bacteria or other microorganisms, but it can also occur due to non-infectious
stimuli. Since bacterial meningitis is basically life-threatening due to the immediate
proximity of the inflammation to the brain and spinal cord, meningitis always represents
a medical emergency until a bacterial cause has been ruled out with certainty.
Ø Meningeal signs
- Kernig sign - when lying down - with the hip joint flexed - the passive extension of the
knee joint leads to severe pain in the lumbar area.
- Brudzinski's sign - if, when the head is passively bent forward, the
Legs are bent at the knee joints.
- Lasègue sign - Triggering of a stretching pain in the area of the spinal nerve roots of
the spinal cord segments L4-S2 and the sciatic nerve.

epilepsy
patient
First name, last name: Fridolin Sauer, age: 37 years, height: 182 cm, weight: 87 kg
- Dust mite with rhinoconjunctivitis hay fever and exanthema rash

- Seafood with eyelid edema swollen eyes
stimulants
• Nicotine consumption: 10 cigs for 5 years. per day. Before 20 PY (20 cigs / for 10 years) • Alcohol
consumption: occasional beer and liquor, (he sometimes drinks too much at parties)
• Drug use: one joint per month
social history
He is self-employed, has his own copy shop (he occasionally gets help from employees who are hired more as
temporary workers, because the shop is near a university he is overworked and has a lot of stress), is married,
lives with his family, has a son who is
cardiac septal defect cardiac septal defect . (His 8-year-old son has a hole in the cardiac septum. He is stressed
about it, but his son was examined by a cardiologist and conservative treatment was carried out. According to
the cardiologist, surgical therapy may be necessary in the future).
family history
§ Father: corneal keratitis, condition after corneal transplant/keratoplasty

Corneal transplant 4 months ago
§ Mother: Sudeck's disease/CRPS, wrist fracture in the case of status after a distal radius fracture
(she still has problems with severe pain after wrist fracture)

previous operation)
Mr. Sauer is a 37-year-old patient who, accompanied by his wife (with an ambulance), came to us 3 hours ago
because of a sudden, generalized whole-body
presented myoclonus muscle twitching .
(The patient tells that he was having breakfast with his wife this morning as usual when he suddenly felt
a strange feeling in his whole body. Strange because he said that his wife tried to talk to him but he was
no longer responsive. Then generalized convulsions appeared for about 1-2 minutes)
The patient reported that he was in the toilet before breakfast when he
restlessness, photopsia , flashes of light, and cephalgia headaches were noticed.

According to the wife, he froze before the seizure and the myoclonus muscle twitches lasted
about 1-2 minutes.
The patient also added that he had been particularly nervous and restless for 4 days prior to the
seizure. As a possible trigger, he said that he was at his company's 10th anniversary party last
night and drank a lot of alcohol.
The patient noticed the following accompanying symptoms after the seizure:
Fatigue and severe myalgia muscle pain
The answers to the questions were negative: head laceration, tongue bite, stool and urine
leakage were answered in the negative. (He did not fall because his wife held her) (He had never
had such complaints before)
The vegetative anamnesis is unremarkable except for stress-related insomnia sleep disturbance in the form of
disturbances in sleeping through the night as well as constipation and diarrhea alternating diarrhea ( because of
irritable colon)

• Colon irritable bowel syndrome since 5 years,
• Retroauricular dermatitis behind the ear since childhood (dry and scaly skin behind
the ears especially in winter),
• Dysphonia , hoarseness for 2 years,
• Acetabulum fracture of the acetabulum 5 years ago in a Zn climbing accident
treated conservatively with immobilization and support bandage,
• Fever-related seizure in the 5th year, was medicated with paracetamol
suppository suppositories treated,
• Alcohol intoxication Alcohol intoxication at 17, was hospitalized.
She has never had an operation before.

medication
- Imodium 75 mg. bB
- Cortisone ointment bB (especially in winter)
- Neoangin-Plus - lozenges bB
- Ibuprofen gel bB

The anamnestic information most likely points to an epileptic seizure.
Migraine, meningitis, apoplexy and TIA can be considered in the differential diagnosis.

Proceed further
1. KU: neurological examination - no findings in the seizure-free period.

2. Laboratory: small BB, CRP, ESR, kidney, liver parameters, electrolytes, coagulation 3. EEG -
peaks typical of epilepsy; none can during the seizure-free period
be changes
4. MRT- CNS - to exclude organic diseases 5. If necessary CT- CNS
therapy
1. Acute care - storage

with keeping the airways open.
- Protect patient from injury
- Observation of heart action and respiration -
Administration of anticonvulsants (e.g. diazepam) - only if not self-limiting
Course (in status epilepticus, duration >5 min.)
2. Seizure prevention
- Elimination of the cause
- Avoidance of trigger factors - Drug therapy
- in the case of 2 or more seizures within 6 months or in the event of abnormal EEG findings
• administration of anticonvulsants (lamotrigine, valproate, gabapentin)

End of therapy – individually after 2-5 years of freedom from seizures + with, among other things, EEG
3. Surgical intervention
- Resection of pathological changes
- Non-resective procedures (callosotomy)
- stimulation procedures
• Vagus nerve stimulation

• Deep brain stimulation of the anterior thalamus

1. How long did the twitches last? o About
1-2 minutes, the patient said.
2. Did he fall on the floor?
o He didn't fall because his wife held her
3. Did the patient bit his tongue? o no, he
did not bite tongue

4. Was it a grand mal seizure?
o Yes, I believe it was a tonic-clonic (grand mal) seizure. Tonic-clonic seizures follow a characteristic course and are
associated with loss of consciousness.
- Optional pre-seizure symptoms are an aura.
- The first phase of the seizure is characterized by strong tonic contractions with stiffening of the muscles. Those
affected do not respond when spoken to. The extremities are stretched, the eyes are open when the gaze
deviates upwards and the mouth is closed with a firm jaw closure.
- The tonic phase is followed by the clonic phase with involuntary rhythmic muscle twitching, lateral tongue biting
and/or reflex voiding.
Involuntary defecation is less common.
- The duration of the clonic phase is usually three to five minutes, but can vary
however differ individually.
- After the clonic phase has stopped, the affected person usually regains consciousness and falls
Shortly thereafter from exhaustion into a night's sleep.
5. How long did the anniversary celebration last? o
Unfortunately I didn't ask about that.
6. What does anniversary celebration mean?
o An anniversary is a commemoration of the return of a

special date.
7. Why is the patient taking Neoangin Plus? o Because

of dysphonia 8. Is the
shop his own or does he only work as an employee? o The shop
belongs to him. He is self-employed.
9. What does occasional drug use mean?
o This means that he sometimes uses drugs (only once a month)
10. What is a joint?
o A joint is a paper filled with cannabis products (usually hashish or marijuana),

twisted together to be smoked.
11. What are the causes of seizures?
o The most common cause of seizures is epilepsy. However, not every seizure is due to an epileptic disorder (idiopathic).
In some cases, however, there is a disease or situation that explains increased epileptogenicity. For example: Acute
brain diseases (brain tumor, trauma, intracerebral hemorrhage), structural changes in hippocampal sclerosis,
perinatal damage, metabolic-toxic causes (uremia, hypoglycemia, ketoacidosis, hyponatremia, alcohol abuse,
alcohol withdrawal )
o Acute symptomatic seizures (ASA) - Epileptic seizure as an acute symptom of a disorder of the
brain without prior evidence of a generally increased readiness for seizures
o Febrile convulsions are considered a special form.
12. What does febrile seizures mean?

o Febrile seizures are convulsions (seizures) that occur with a high fever in childhood.

13. How are febrile seizures treated? o First

steps in acute therapy - Try administering diazepam as a rectiole (only if the seizure lasts 3 minutes) to break
the spasm. Furthermore, the fever should be reduced by the administration of antipyretics (e.g. paracetamol).
o The second measure to consider is recurrence prophylaxis with low-dose diazepam.

Overall, the diazepam administration should not exceed 72 hours
14. What does Sudeck's disease mean?
o Sudeck's disease or CRPS (Complex Regional Pain Syndrome) is a chronic neurological disease associated
with pain, sensory disorders and trophic disorders, among other things. It occurs after soft tissue or nerve
injury to an extremity, often associated with a fracture or contusion.

o Because of the information mentioned, I suspect an epileptic seizure. But that's only
Suspicion and without appropriate measures cannot be confirmed.
16. What would you then do as a diagnostic measure?
o Please see "Further procedure"
17. Which and how are the neurological examinations carried out?
o Please see “Neurological Examination”
18. EEG - clarification
o Please see “clarifications”
19. What can we see in the EEG?
o Ongoing seizures show specific patterns in the EEG.
- "Sharp waves" are characteristic of a focal seizure. These show

on the lead of the area in which the seizure disorder occurs.
- Generalized seizures showing "spikes and waves" complexes. These occur on all leads with a significantly higher
frequency. They are usually (highly) synchronous
expiring.
20. If the EEG is abnormal, what would you do?

o I would then immediately start drug therapy with administration of anticonvulsants (lamotrigine, valproate,
gabapentin).
21. And differential diagnosis? o
Migraine, meningitis, apoplexy and TIA can be considered in the differential diagnosis.
22. What would you recommend to the patient?
o Regular check-ups by neurologists, careful handling of the medication, avoidance of stress, abstinence from
driving, abstinence from alcohol, nicotine and drugs, no sports such as climbing.
23. How long is he not allowed to drive a
car? o At least for 6 months if he remains seizure free.
24. How long does he need treatment?
o Duration of therapy is individual, from 2 - 5 years with no seizures and normal EEG.
25. Has the patient ever had such symptoms?
o No, he has never had before.
26. Can we talk about epilepsy yet?
o No, because this was just an isolated episode. A seizure is an isolated clinical event. Epilepsy is a condition
characterized by recurrent spontaneous seizures. It is present when at least two unprovoked, individual
seizure events have occurred.
27. What is elevated enzymes in an epileptic seizure
o The level of prolactin in the blood

Comment!
The exam wasn't that easy. During the first part I had difficulties at first because the patient was confused
and he talked a lot. Lots of information, make important and some unimportant.
The most important thing is: always ASK: You must always be 100% sure that you can understand every
detail. I barely finished the anamnesis, all I knew about the parents was their age, but that can NOT be a
PROBLEM if the right questions are asked. For example, if you haven't asked about a trip abroad or other
small things, but always think "did I really understand what the patient said to me? "Would I be able to
answer a question about that detail?" If yes, no problem. If not, ASK.
Doctor's letter: Try to have a scheme in mind. Time is running fast. Avoid long sentences, preferably short
but clear sentences. The examiners must understand exactly what is going on.
Of course, use as many Latin words (technical terms) as possible.
Third part: Case presentation: Concrete, direct, simple. What does the patient have? Why did he come
here? When did that happen? So, concretely, no philosophy. Speak fluently and clearly, speed is not
important. I would also like to thank Ms Pabst warmly. Your teaching and recommendations have been a
tremendous help to me! Good luck with your FSP!!!
The exam wasn't that easy. During the first part I had difficulties at first because the patient was confused
and he talked a lot. A lot of information, make important and some unimportant.
INFO!
Ø A copy shop is a service provider who offers the duplication of documents and often
also digital data by photocopying or printing for a fee.
Ø A septal defect is an incomplete closure of the cardiac septa that separate the left and
right halves of the heart. According to localization one subdivides:
- Atrial septal defect (ASD) - a congenital malformation of the heart in which the
cardiac septum between the atria (interatrial septum) is not completely closed.
- Ventricular septal defect (VSD) - a congenital malformation of the heart in which

the septum between the ventricles (interventricular septum) is not completely
closed.
- Atrioventricular septal defect (AVSD) The atrioventricular septal defect is a
congenital malformation of the heart. The so-called AV channel is formed by the
combination.

Ø A keratoplasty is the replacement (corneal transplant) or remodeling of the cornea of

the eye.
Ø The irritable bowel syndrome is a common, but relatively poorly defined,

gastroenterological clinical picture, which is characterized by diffuse abdominal
complaints. It is often assigned to psychosomatic illnesses. The diagnosis "irritable
bowel syndrome" is strictly a diagnosis of exclusion.
Ø An apoplexy is understood as the sudden circulatory disturbance of an organ, in the

narrower sense of the brain. The circulatory disorder leads to an undersupply of
oxygen with subsequent tissue destruction.
Ø The transient ischemic attack (TIA) is one of theirs

Symptoms Stroke-like transient neurological disorder due to focal CNS ischemia without
imaging detectable infarction
is due.
Ø An anticonvulsant is a drug used to treat epileptic

Diseases or seizure disorders is used.

1. Neck area
- Do you suffer from a sore throat?
ÿ Radiate? Does the pain radiate to other parts of the body?
- Odynophagia - Have you also noticed pain when swallowing?
- Dysphagia- Have you noticed any difficulty swallowing?
- “Clunky Speech” -Notice chunky speech?
- Tonsil swelling - Are your tonsils swollen?
- Halitosis- Do you have bad breath?
2. Fever
- Do you have a fever? Did you measure that? how high it
- Have you noticed chills and sweating?
3. Cough / phlegm
Do you have a cough?
- sputum? Is the cough dry or have you also noticed sputum?
- color? What is the color of sputum? Is it yellowish, greenish or transparent?
- Consistency? What is the consistency of sputum? Is it rather thin, viscous (tough), slimy
or purulent?
4. Lymphadenopathy
- Have you noticed enlargement of the lymph nodes?
- localization? Where exactly? (Neck, armpit, groin?), Is one side or both affected?
- pain? Are these painful or painless?
5. General and additional questions

- Do you have general complaints such as exhaustion, headaches or body aches?
- Epistaxis- Have you had a nosebleed?
- Covid-19? Have you recently been in contact with someone who has contracted Covid-19?
- Splenomegaly (in infectious mononucleosis) - Do you have abdominal pain? Where exactly are these
Pains? (In the upper or lower abdomen) (left / right?)
6. Conclusion
When? How long have you had these symptoms? How did these complaints
began?
Trigger? Are there specific triggers for your symptoms? Do you have someone close to you who has the same
symptoms?

Angina tonsillaris / pneumonia

Patient first
name, last name: Rudolph Pohl, age: 53 years, height: 169 cm, weight: 71 kg.
- Amoxicillin with exanthema rash

- Indication of lactose intolerance Lactose intolerance with meteorism flatulence
stimulants
• Nicotine consumption: non-smoker

• Alcohol consumption: 1-2 bottles of beer on weekends
social history
He is a florist (he is the boss, suffers from physical and mental stress at work, works with his wife and 2
additional employees), is married, lives with his family, has 3 children, one of whom suffers from Down syndrome.
family history
§ Father: suffer from scoliosis pulmonary artery (miner, retired early at 50)
§ Mother: Status after surgically treated strangulation ileus Intestinal obstruction with circulatory disorders
4 weeks ago due to adhesions adhesions (the mother had a hysterectomy because of uterine myoma
10 years ago and the adhesions developed a few years ago as a result of a previous hysterectomy.)

previous operation)
Mr. Pohl is a 53-year-old patient who presented to us because of odynophagia that had existed for 4-5 days,
painful swallowing and a fever of up to 39.5 C.
(The patient reported that he had been to the weekly market on Saturday. He had caught a cold because
of the temperature difference between the market (cold) and outside (hot))
In addition, the patient noticed the following accompanying symptoms: stuffy nose (my nose is closed), yellow
nasal secretion , yellowish discharge from the nose, productive cough with yellowish sputum , nocturnal
hyperhidrosis , night sweats (due to fever), pain in the extremities , joint pain, cephalgia , headache, epistaxis
twice , nosebleeds , and fatigue .
The vegetative anamnesis is unremarkable except for meteorism , flatulence, cough-related insomnia , sleep
disturbance in the form of difficulty falling asleep and loss of appetite.


• Lentigo Solaris age spots in the temporal region ,
• Burn-out syndrome emotional exhaustion 8 years ago, was treated with medication
psychiatrist treated,
• Arthritis urica gout for 5 years, podagra gout attack 5 weeks ago,
• Nephrolithiasis Kidney stones at the age of 35 (as a complication of uricopathy), became conservative
treated,
• Chronic low back pain Lumbar pain for 14 years.
He was operated on 13 years ago for carpal tunnel syndrome on the right and 3 years ago for a cut on the
thenar on the left ball of the thumb (as a result of the accident at work) .
medication
- Lefax chewable tablets bB
- Nose drops (name not remembered) bB - Cortisone

ointment bB
- Zyloric 300mg 1-0-0

- Ibuprofen 600 mg 1-0-1
The anamnestic information most likely points to angina tonsillaris.
Infectious mononucleosis and pneumonia should be considered in the differential diagnosis.
Proceed further
1. CU:
- Inspection: reddening and swelling of the tonsils and possibly yellow-white deposits or Stipples on
tonsils.
- Palpation: painful cervical lymphadenopathy
2. Laboratory: small BB, CRP, ESR, electrolytes and ASLO titers
3. Throat swab: rapid streptococcal test and bacterial culture 4. If necessary, chest
x-ray (DD pneumonia)
therapy
1. Bed rest and adequate hydration

2. Analgesics and antipyretics (ibuprofen and paracetamol)
3. Mucolytic (ACC, Ambroxol)
4. Antibiotic therapy: only with suspected streptococcal infection with penicillin and
1st generation cephalosporin
5. Surgical therapy – for recurrences, massive tonsillar hypertrophy and
complications
- Tonsillectomy or tonsillotomy


1. What is silicosis? Is this an occupational disease?
o Silicosis is pneumoconiosis caused by long-term inhalation of quartz dust particles. She is one of those who are
liable for compensation
occupational diseases
2. What are diagnostic criteria?

o Acute silicosis is typically manifested by rapidly progressive dyspnea.
Respiratory failure requiring ventilation may occur.
o Chronic silicosis usually does not cause any symptoms for a long time. Unspecific symptoms such as coughing
and dyspnea on exertion appear later.
o The diagnosis of silicosis is made using a chest X-ray and HR-CT.
3. What laboratory test do we need to confirm gout?
o uric acid
4. Why do you think that the patient suffered from burn-out syndrome? o Because he has
a lot of stress at work. The burnout syndrome describes a condition in which the patient is so burdened by constant
professional stress that a state of physical and emotional exhaustion sets in with significantly reduced
performance.
5. What are adhesions? o Adhesions

form between organs or tissues that are not normally connected. 6. How do adhesions occur and what causes
them?
o Abdominal adhesions often occur after injury, inflammation or surgery. Capillary bleeding and increased vascular
permeability with subsequent fibrinogen exudation occur as a result of injuries to the peritoneum. After the
fibrinogen has been broken down into fibrin and its connection with fibronectin, the defect is closed and a
temporary wound base is formed.
Within the next 72 hours, endogenous fibrinolytic activity of the mesothelial cells breaks down these fibrin
deposits and thus completely restores them.
7. What is keratosis?
o Keratoses are abnormal changes in the stratum corneum, the uppermost layer of the skin made up of keratinized
cells (keratinization disorder). Painful skin tears can develop, which can become bloody.
8. Why is it dangerous? What cancer can develop after keratosis?

o Actinic keratosis is a precursor to skin cancer that does not heal on its own. If the lesions are not treated, they will
almost certainly continue to grow –
and often degenerate into malignancy. Possible consequences are life-threatening cancers such as black skin
cancer (malignant melanoma) or squamous cell carcinoma. Therefore, actinic keratosis should be treated as
early as possible.
9. How did the patient describe his symptoms?
o Patient said, “My nose is blocked, I have runny nose, cough with yellowish
Mucus".

10. Did he talk about expectoration?

o Yes, the expectoration = the sputum = the sputum 11. What is
your VD?
o My suspicion is angina tonsillaris.

12. How do you proceed?
13. How do you do physical examination and what information can you get right away?
o Inspection: reddening and swelling of the tonsils and possibly yellow-white coatings or
Stipples on tonsils. o
Palpation: painful cervical lymphadenopathy
14. Detailed examination of the lungs? o Please
see investigations
15. What other diagnoses can you tell?
o Infectious mononucleosis and pneumonia can be considered in the differential diagnosis.
16. What do you expect from auscultation in pneumonia?
o Wet rales and possible bronchial breathing.

17. And what about the chest X-ray?
o Alveolar or interstitial connections and infiltrations in the affected area.
18. When a patient comes with the same complaint and with pain in the left
Upper abdomen, what would you think of?
o I would think of infectious mononucleosis.
19. Why infectious mononucleosis?
o Because of splenomegaly, as clinical signs of infectious mononucleosis.

20. What complications of splenomegaly can you name?
o As a complication of splenomegaly, hypersplenism can occur (enlargement of the spleen increases its functional
capacity beyond what is necessary.)
Spontaneous rupture of the spleen can also occur due to overstretching of the splenic capsule.
21. How to diagnose infectious mononucleosis?
o KU and laboratory with diff. BB (lymphocytosis, monocytosis, mononuclear lymphocytes (Pfeiffer cells), leukemic
cleft) CRP, ESR, electrolytes, LDH, GPT and GOT
o Rapid EBV test – detection of IgM against EBV in the blood,
o Serology (gold standard),
o Abdominal sono.
22. Which serology?

o Anti-VCA antibodies to virus capsid antigen o Anti-EBNA-1
antibodies to Epstein-Barr virus nuclear antigen o EA antibodies to early antigen
23. If the tonsillitis is caused by bacteria, what do you expect in the laboratory?
o Increased inflammation values: leukocytosis, CRPÿ and ESRÿ
24. What therapy do you recommend for this patient with acute angina tonsillaris?
o If the primary diagnosis is confirmed, I recommend conservative therapy: plenty of liquids, administration of
analgesics (e.g. paracetamol or ibuprofen), physical rest, nasal spray or nose drops if necessary, glucocorticoids
(e.g
Prednisone systemic or inhaled for obstruction of the upper airway by the inflamed tonsils)

25. And what if bacterial genesis is suspected?
o Antibiotic therapy 26.

Which antibiotic do you specifically administer to this patient?
o The choice here is 1st generation cephalosporin (cefazolin) because the patient is allergic
against amoxicillin.
Comment!
The patient spoke in a chaotically untidy manner, one must say not quite clearly. At the beginning he said
all the complaints at once, then I was asked to repeat everything. After that he "dribbled" the information,
I had to ask about every little thing, I didn't understand many things and asked the patient to say it in other
words.
I couldn't finish the anamnesis because he talked a lot, couldn't concentrate fully and I had to ask some
questions several times to get an answer. Well, I was just writing cues from family and social history while
he was recounting the minutiae of his life.
Part III: The examiner was super nice, but he just wanted to make sure I understood 100% of what the
patient was saying. The exam is about the language, you have to try to understand everything and make
an effort to ask questions if you don't understand something. They just want to see that you can work
fluently in the hospital and understand the patients. And as other colleagues have said, this is not a
knowledge test. The point is that you speak German fluently and, as the examiners said, have a good C1
level.
PREPARATION
I have a Goethe C1 certificate
I did 2 internships, one in internal medicine, which was very helpful to me
Sources: previous experiences of colleagues, anvil, anamnesis and clinical examination checklist
(neurological examination), internal medicine and surgery in question and answer (only the topics that
come up frequently in the exam. Teach with Mrs. Beate Pabst (big up) and practice with some friends .
INFO!
Ø Lactose intolerance is an intolerance to milk sugar (lactose) due to an enzyme
deficiency.
Ø Florist is a flower expert who finds an endless number of different ways of arranging
flowers and making bouquets, flower arrangements or table decorations from them.
Ø A weekly market is a weekly regular market event where mainly fresh food such as
fruit, vegetables, herbs, dairy products, fish, meat, spices and eggs are offered.

Ø Down syndrome is a genetic disease that is triggered by a chromosomal aberration. The

chromosome 21 is not present twice, but three times (trisomy) in the genome.
Ø Strangulation ileus is constriction of a section of intestine with simultaneous

circulatory disorder of the intestinal wall
Ø Arthritis urica (gout) is the clinical manifestation of hyperuricemia with urate precipitation
in the joints and other tissues.
Ø Podagra is an acute attack of gout at the metatarsophalangeal joint or at the end joint of
the big toe. Pain attacks triggered by an acute attack of gout in other joints are also referred
to as Podagra in a broader sense.
Ø Under a lumbago or lumbalgia, popularly known as "lumbago" , one understands severe

acute back pain in the loins. They are among the most common back pains.
Ø The carpal tunnel syndrome is a bottleneck syndrome (nerve compression syndrome) of the
Median nerve in the wrist area.
Ø Zyloric (Allopurinol) - including in all forms of hyperuricemia
Ø Lentigo solaris is the name given to changes in the skin, which often occur with us, in
various parts of the body, especially in the areas exposed to the sun. In and of themselves,
these changes are harmless. If they are present, however, it must be considered whether
it could also be black skin cancer (melanoma).
Ø Lefax chewable tablets - against flatulence. These are caused by gas build-up in the
gastrointestinal tract, which is in the form of a fine foam. The active ingredient promotes
the escape of gases by destroying this foam.
Ø A tonsillectomy is the complete surgical removal of the tonsils (tonsilla palatina) by peeling
them out of their capsule. The partial (subtotal) removal of the tonsils is called a
tonsillotomy. If enlarged tonsils are removed at the same time, this is referred to as an
adenotonsillectomy.

Infectious mononucleosis
patient
First name, last name Hannes Brandt, age: 18 years, height: 173 cm, weight: 62 kg.
! Hazelnut pollen with rhinoconjunctivitis hay fever (use nasal spray)
! Polymorphic light eruption sun allergy with vesicular vesicles and pruritus itching
stimulants
• Nicotine consumption: 1-2 cigs. occasionally at celebrations (do not buy their own box)
• Alcohol consumption: 1-2 bottles of beer, weekends at parties • Drug
consumption was denied.
social history
He is training to be a technical draftsman, single, has no children, lives with his girlfriend (who has similar
complaints)
family history
§ Father: died of goiter maligna thyroid cancer at 60 (in 2019)

§ Mother: unfortunately suffering from type 2 diabetes mellitus with diabetic retinopathy
Retinal disease, status post retinal detachment Retinal detachment.

previous operation)
Mr. Jagger is an 18-year-old patient who came to us because of an increasing sore throat, fatigue and fever up
to 38.9 C
introduced.
He also noticed the following accompanying symptoms: odynophagia, pain when swallowing, cephalgia
headache (since 2 years because of sitting at the PC for a long time) , lymphadenopathy , enlarged cervical
lymph nodes in the neck, foetor ex ore/halitosis bad breath and upper abdominal pain on the left (like tension) .
The vegetative anamnesis is unremarkable except for meteorism, flatulence for 2 years and pain-related
insomnia sleep disturbance in the form of difficulty falling asleep.
• Pneumonia pneumonia at 3, was treated with antibiotics,

• Nasal septum fracture Nasal septum fracture 2 years ago (he had been treated conservatively with
beaten and broken nasal septum) , classmates ,

• Achillodynia pain syndrome in the Achilles tendon for 5 weeks after a sports injury
at the volleyball game, was treated conservatively with a bandage,
• Atopic dermatitis Atopic dermatitis with manifestations on the elbow since childhood (She
mentioned that the atopic dermatitis was stress-related. The symptoms of the atopic
dermatitis had improved when she had been on a vegetarian
diet for 2 months). • Alcohol intoxication Alcohol poisoning a year ago, was hospitalized on the
Treated in intensive care for 1 night.
The patient had never been operated on.
medication
- Nasal spray containing cortisone bB

- Cortisone ointment bB (1-2 times a week)
- Paracetamol 500mg bB (1-2 per month)
- St. John's wort capsules for 5 months (because of her father's death)

The anamnestic information most likely points to infectious mononucleosis glandular fever .
Differential diagnosis include angina tonsillaris, Hodgkin's lymphoma and acute

Consider leukemia.
Proceed further:
1. CU:
- palpation of the lymph nodes - the lymph nodes are elastic, soft,
pushable, separate, smooth, painful.
- Abdominal palpation: hepatomegaly and/or splenomegaly 2nd
laboratory: diff. BB (lymphocytosis, monocytosis, mononuclear lymphocytes (Pfeiffer cells) ,
leukemic column) CRP, ESR, electrolytes, LDH, GPT and GOT
3. Rapid EBV test – detection of IgM against EBV in the blood
4. Serology (gold standard)
- Anti-VCA antibodies to virus capsid antigen - Anti-
EBNA-1 antibodies to Epstein-Barr virus nuclear antigen - EA antibodies to
early antigen 5. Abdominal sono
(splenomegaly)
6. If necessary, lymph node biopsy – as DD
Therapy
1. Physical rest and sufficient fluid intake 2. Symptomatic therapy
with analgesics and antipyretics (e.g. ibuprofen)
! No administration of ASA or paracetamol - risk of Reye's syndrome


in front of the patient
1. What do I have?
o Mr. Brandt, I understand that you want to know the reason for your complaint as quickly as possible, but in order to
confirm a diagnosis we must first carry out all the important tests. At the moment I only have a suspicion of
glandular fever. But that's just a suspicion and we still need to prove it
to conduct investigations.
2. Could it be cancer?
o Mr. Brandt, without further examinations, I unfortunately cannot say exactly what your diagnosis is, but based on
your current symptoms, cancer is rather unlikely.
I advise you to think positively as much as possible. Cancer is not always 100% an option.
In front of the examiner
1. All the little things about patient.

o My suspected diagnosis is infectious mononucleosis (glandular fever), but a serological test must be carried out
to prove it.
3. Why is this called the kissing disease?
o Mononucleosis is also called kissing disease because the virus responsible - the Epstein-Barr virus from the family
of herpes viruses - can be transmitted through saliva when kissing and young people are often affected.
4. Why is infectious mononucleosis called glandular fever?
o It received the name "Pfeiffer's glandular fever" from its discoverer, the pediatrician Emil Pfeiffer (1846-1921), who
named it after its two main symptoms: glandular swelling and fever.
5. What is the causative agent of infectious mononucleosis?

o Infectious mononucleosis is caused by Epstein-Barr virus (EBV, human
herpes virus type 4).
6. What can be considered as a differential diagnosis?
o Differential diagnosis include angina tonsillaris, Hodgkin's lymphoma and acute
Consider leukemia.
7. What else is coming as a DD?
o Covid-19 infection
8. How can you rule out Covid-19 infection?
o With Covid-19 PCR test
9. How do you do the PCR test? How do you tell history to the patient?
o To take the test, tilt your head back and open your mouth wide. I use the test stick to go deep into your throat first
and then into your nose. It's a little awkward, but we need to sample from the right place. Then test sticks should
be sterile packed and sent to the laboratory.

10. What is the complete loss of taste in Covid-19 infection?

o This is called ageusia – “complete loss of the sense of taste”.
o First I will examine patients physically. The other and the most important is
Blood sampling with laboratory chemical and serological tests.
12. What do you see blood in infectious mononucleosis and what in leukemia?
o In the case of infectious mononucleosis, we have a lympho-monocytosis in the laboratory

Leukemia at least 20% increased proportion of lymphoid blast cells.
13. What do we look for in abdominal examination?
o We look for splenomegaly, hepatomegaly,
14. What will you do next at KU?
o I will palpate the lymph nodes (throat, nape of the neck, armpit, groin, over the clavicle, using
circular movements). Normal physiological findings are: usually not palpable, at most due to
scarring after an illness, not
tender
o Pathological findings:
- Soft, easily movable and tender lymph node enlargement ÿ often with
Inflammation (e.g. in infectious mononucleosis)
- Hard, painless lymph nodes "fused" to the surrounding tissue ÿ
Malignant (malignant) changes (e.g. metastases)
15. Could the thyroid cancer be because his father had it?
o Although there is a family disposition, there are hardly any clinically relevant complaints.
As a DD, we can perform thyroid sono.
16. What do you recommend to patients with clinically relevant enlargement of the spleen?
o In the case of clinically relevant splenomegaly, no competitive sport should be practiced for a
period of 3-4 weeks to clarify the symptoms. He should avoid contact sports such as judo,
boxing, karate.
17. Fine needle aspiration reconnaissance
Comment!
Dear colleagues,
I passed the FSP in Munich. This group (Facebook) has helped me tremendously. Thank you very much and
in this post I would like to share my experiences. My case was Infectious Mononucleosis almost identical to
the protocol
Good luck on the exam!

INFO!
Ø Blisters (vesicles) are fluid accumulations that can occur, for example, under the so-called dermis or
under the cornea. The fluid contained in the blisters can be bloody-watery or clear.
Ø Thyroid carcinoma refers to malignant neoplasms of the thyroid epithelium. Thyroid tumors become
conspicuous due to their suppressive growth. Symptoms of a thyroid carcinoma can therefore be:
dysphagia, dyspnea, hoarseness and cough (recurrent laryngeal nerve), enlarged lymph nodes in the
neck area.
Ø We understand diabetic retinopathy to mean changes in the retina that have developed as a result of
diabetes. Long-standing or poorly controlled diabetes leads to vascular changes and circulatory
disorders in the retina.
Ø Retinal detachment (retinal detachment) describes a degenerative retinal disease in which the
neurosensory retina detaches from the retinal pigment epithelium.
Ø Achillodynia is summarized the painful processes of the Achilles tendon.

Those affected feel a more or less severe pain in the tendon and are restricted in the mobility of the
affected leg.
Ø Manifestation is the process of "becoming recognizable" one to
therefore or in the meantime clinically imperceptible (latent) disease.
Ø St. John's wort contains the traditionally proven medicinal plant and is used to improve well-being
during nervous stress and to stabilize emotional stress.
Ø The rapid mononucleosis test can provide a first indication of the presence of an acute Epstein-Barr
virus (EBV) infection. In the rapid mononucleosis test, so-called heterophylly antibodies
(heteroagglutinins) of the IgM type against EBV are detected in the blood.

1. Accident Event
- Could you please describe the course of the accident in more detail? (When, where and how did this happen?)
- Did you fall on your right or left side?
- In the case of a bicycle/motorcycle accident - Were you wearing a helmet at the time?
- In the car accident - were you wearing a seat belt?
- Have you had dizziness or lost consciousness?
2. Pain history
- Where? Can you please tell where exactly the pain is?
10 are unbearable? Did you take anything for pain?
- History? Has the pain gotten better or worse over time?
3. Injuries/disability
- Have you noticed any injuries in your body?
- Do you have abrasions or lacerations?
- Tetanus protection (if wound) - do you have tetanus protection? (If yes , have you had your tetanus shot boosted in the last 10
years?)
-
Is the affected area swollen, discolored, or warm?
- Have you noticed the restricted movement of the affected extremity? Could you move your arm normally in all directions?
- Do you feel numb or tingling?
- How did you get to the hospital?
- Were you on your way to work?
- For craniocerebral trauma - did you injure your head? Do you feel dizzy or do you have
already vomited?
- In case of chest trauma - do you have chest pain? Do you have shortness of breath, cough or tachycardia
noticed?
- In case of abdominal trauma - Do you have abdominal pain? Do you have traces of blood in your bowel movements or
Noticed urination?

Wrist fracture + rib fracture

patient
First name, last name: Fritz Herrmann, age: 53 years, height: 175 cm, weight: 80 kg
- Wasp sting with anaphylactic shock
stimulants
ÿ Nicotine consumption: 3-5 cigs. for 4 years. Before that – 20 PY. ÿ

Alcohol consumption: a bottle of beer daily. ÿ Drug use
was denied.
social history
He is an animal keeper (he works at the zoo in Munich and suffers from a lot of stress because one of
fell ill with his elephants), married, have 3 children, one of whom suffers from dyslexia , lives with the family.
family history
§ Father: died a long time ago in a fatal accident § Mother: surgically

treated basalioma white skin cancer in the region temporalis im
temple area
§ Twin sister: suffer from bulimia nervosa binge eating

previous operation)
Mr. Herrmann is a 53-year-old patient who presented to us as an emergency because of wrist pain that had
existed for 2 hours on the right side after a fall from a motorcycle on the right side.
(He reports that he went to lunch on his motorcycle during working hours today. He missed a sheet of ice,
which is why he slipped and fell on the right side of his body. He was wearing a helmet.)
The patient added that he had injured his right wrist and chest.
Pain intensity was rated 7-8 out of 10 on the pain scale.
In addition, the patient noticed the following accompanying symptoms: chest pain right chest pain when inhaling
inspiration , excoriations skin abrasions / abrasions and hematomas bruises / bruises on the affected side of the
body as well as edema swelling and restricted movement on the right wrist.

The vegetative anamnesis is unremarkable except for stress-related insomnia in the form of difficulty
sleeping through the night.
ÿ Herniated cervical disc Herniated disc for 5 years with pain in the right
Shoulder,
ÿ Arterial hypotension low blood pressure for 10 years,

ÿ Atopic dermatitis Atopic dermatitis on the right ear for 1 week (he had severe itching, dry skin and
eczema on the cheeks and the extensor sides of the extremities as a child.
From the age of 3 he had neurodermatitis on the flexor sides of the extremities),
ÿ Onychomycosis nail fungus on the feet for 10 days.
He had surgery for hidradenitis sweat gland abscess 1 week ago, ruptured Achilles tendon 25 years ago
and underwent sterilization 5 years ago, a medical procedure that renders a human or animal infertile .
medication
- Drops that increase blood pressure (can't remember the name) bB

- Tincture alcoholic solution of herbal extract / against onychomycosis (can't remember the name)
- Ibuprofen bB

The anamnestic information most likely indicates a distal radius fracture on the right and blunt chest
trauma.
Rib fracture and wrist distortion on the right come into the differential diagnosis
consideration.
Proceed further:
1. KU: pDMS, certain and uncertain signs of fracture 2.
Laboratory: small BB, CRP, ESR, BGA, coagulation, electrolytes, blood group 3.
Roe-thorax
4. Right Rö wrist and elbow. in 2 levels

ÿ Colles fracture (extension fracture): Zn fall onto the outstretched hand
ÿ Smith's fracture (flexion fracture): Status after falling onto the flexed hand
5. If necessary, abdominal sono
therapy
1. Protection, cooling and elevation of the affected wrist 2. Vital parameters (heart -
respiratory rate, blood pressure, body temperature and saturation) control

3. Venous access, fluid intake 4. Pain-adapted

analgesia 5. Thrombosis prophylaxis
with low molecular weight heparin
6. If necessary, conservative treatment with an orthosis or plaster cast.
7. If necessary, operation – osteosynthesis

1. What is the first action?
o The first measure here is close monitoring of vital parameters.
2. Diagnostic procedure?
o Please see “Further procedure”.
3. What else can we give the patient if a contrast agent allergy is known?
o Examination with iodinated X-ray contrast media (CM) requires special caution in all patients
with a known allergy to contrast media. If an examination with a contrast agent is nevertheless
medically necessary, we can offer another examination without a contrast agent or carry out
an examination without an iodinated contrast agent such as gadolinium . Gadolinium can be
used in medicine as
Contrast media used in MRI or CT.
4. What is your suspected diagnosis? Which DD are eligible?
o Distal radius fracture and blunt chest trauma. Distal radius bruises, rib fractures, ulna + radius
fractures, and pneumothorax can be considered in the differential diagnosis.
5. For pneumothorax, what further action would you take? o Best is a pleura
puncture and thoracic drainage according to Bülau.
6. All life threatening signs stabilized, what do you do next? o Patient must
be admitted as an inpatient.
7. What is bulimia?
o Bulimia (bulimia) is a mental illness that belongs to the eating disorders. Those affected have
recurring food cravings in which they cannot control themselves
eat.
8. Why does he suffer from insomnia?
o He is an animal keeper by profession and one of his elephants has become ill. Because of this,
he is stressed and cannot sleep well.
Comment!
Good evening! Luckily I passed the FSP last Friday! My case was “Motorcycle accident with distal radius
fracture and rib contusion/fracture”. The examiners were all very nice. The "patient" told a lot spontaneously
and quickly during the anamnesis, so that I was able to round off the anamnesis within 20 minutes.
In Part 2 I didn't have enough time to write about the medication and previous illnesses.

INFO!
Ø Onychomycosis or tinea unguium (nail fungus) is a fungal disease of the fingers
and toenails
Ø Contrast media are drugs that improve the representation of structures and organs in
imaging procedures such as X-ray diagnostics, magnetic resonance imaging (MRT) and
sonography (ultrasound).
Ø Animal keeper looks after animals in zoos, nature parks, veterinary clinics, and animal shelters
farms.
Ø Dyslexia is a reading disorder. Those affected find it difficult to understand words and texts
read and understand, although they hear and see normally.
Ø A basal cell carcinoma or basal cell carcinoma is understood to be a skin tumor caused
by too long and intensive exposure to UV radiation such as sun or
Solarium light is created.
Ø Hematoma- is bleeding into tissue or into a body cavity as a result of a

bleeding from injured vessels
Ø Atopic dermatitis (neurodermatitis) is a chronic inflammatory skin disease that occurs in

episodes. It often affects the scalp, face and hands and is accompanied by excruciating
itching, dry skin and weeping eczema.
Ø Hidradenitis suppurativa is a recurrent and mostly chronic skin disease that is

accompanied by the formation of inflammation, abscesses and fistula formation.
Ø Sterilization is a medical procedure that renders a human or animal infertile,

ie makes further reproduction impossible.
Ø In the event of a dislocation (dislocation), a bone jumps out of the joint with a jerk.
The trigger is usually a fall or extreme force.
Ø A sprain is an injury to the ligaments or joint capsule that is associated with severe pain
and restricted mobility of the joint. Most often, a distortion occurs in the context of sports
accidents.

Wrist fracture + hip joint distortion

patient
First name, last name: Reingard Sommer, age: 69 years, height: 178 cm, weight: 82 kg
- Penicillin with anaphylactic shock (10 years ago he was given penicillin and he had dyspnea, rash and
wheezing, hence anaphylactic shock. That is why he always carries his allergy card with him)
stimulants
ÿ Nicotine consumption: non-smoker for 10 years. Before that PY 15

ÿ Alcohol consumption: a glass of wine in the evening.
social history
He was a pensioner, worked as a travel agent (in a travel agency) , was widowed, had 2 daughters, the younger
one suffered from tinnitus in the ears (was treated with infusions) and a grandson who was currently suffering
from pediculosis capitis with head lice . He lives alone, one of his daughters lives nearby.
family history
§ Father: died at the age of 90 from brain metastases from melanoma black skin cancer
§ Mother: suffer from chronic hepatitis chronic liver disease and live in one
Old people's home

previous operation)
Mr. Sommer is a 69-year-old patient who presented to us as an emergency because of severe pain in his left
wrist that occurred 2.5 hours ago after a fall from a bicycle on his left side.
He also mentioned that he had injured his left wrist and left hip joint.
(He rode his bike to the bakery to buy a pretzel. Then a motorcyclist from an underground car park
crossed his path from the right. That's why he was frightened and fell on the left side. After the accident,
the patient went home to his daughter and she took him to the hospital by car. She was wearing a helmet
at the accident)
Pain intensity was rated 8 out of 10 at the wrist and 3-4 out of 10 am
Hip joint rated on the pain scale.

He also added that hip joint pain in the left groin as well as in the left
thighs would radiate.
In addition, the patient noticed the following accompanying symptoms: excoriations skin
abrasions / abrasions and hematomas bruises / bruises on the affected side of the body as
well as edema swelling and restricted movement of the left wrist.
Loss of consciousness, head injury, hypoaesthesia, and paraesthesia were answered in the
negative
The vegetative anamnesis is unremarkable except for constipation for 3 years and stress-
related insomnia sleep disorder for a year (after the death of his wife).

• Pediculosis capitis infestation with head lice for 6 days,
• chronic sinusitis seasonal sinusitis for 3 years,
• Diabetes mellitus type 2 diabetes for 10 years,
• Hospitalized food poisoning Food poisoning 3 years ago.
He underwent a cholecystectomy gallbladder removal 18 years ago .

medication
- metformin 850 mg 1-1-1, -
lactulose syrup bB
- Dimethicone Oil bB
- Cefalosporine bB (1 time/year for sinusitis)

The anamnestic information most likely indicates a distal radius fracture on the left and a
distortion of the hip joint on the left.
Differential diagnosis includes left wrist distortion and left proximal femur fracture.
Proceed further:
1. KU: pDMS, certain and uncertain signs of fracture
2. Laboratory: small BB, coagulation, electrolytes, blood group, blood sugar,
HbA1c 3. Rö wrist left, hip joint left. in 2 levels. 4.
CT/MRI if necessary
5. Orthopedic Council

Therapy:
1. Protection, cooling and elevation of the affected side of the body
2. Vital parameters (heart - respiratory rate, blood pressure, body temperature and
saturation) check 3.
Venous access, fluid intake 4. Pain-
adapted analgesia 5. Thrombosis
prophylaxis with low molecular weight heparin
6. If necessary, conservative treatment with an orthosis or plaster cast.

1. What would you do next?
o see above “Further procedure”

2. Why do you order CT and MRI
o CT and MRI in this case count as optional examinations. This means that depending on the findings, we can perform
CT (to rule out the multi-fragment fracture) and MRI (to rule out the soft tissue injury or tendon and ligament
rupture).
3. How do you explain the surgical treatment to the patient?
o We have to explain to him why we have to perform the operation on him.
“Yes, right about the indications. What complications? "
o Bleeding, infection, inflammation of the bone, which needs close treatment.
"And what can happen during the operation?"
o Soft tissue injury (nerves, vessels),
"What does this lead to?"
o This can lead to paralysis, bleeding, compartment syndrome after surgery.

4. What must the anesthesiologist pay attention to during the operation?
o He is taking metformin. In general, metformin 48 must be discontinued before surgeries and contrast agent
examinations. In these cases, the risk of lactic acidosis increases . The administration of contrast medium and
preoperative anesthesia can limit renal function, so that metformin accumulates and further administration of
metformin can be rare, but
induce lactic acidosis.
5. When should we start metformin again after surgery?
o Basically can be used after a few days, but in any case I have to
need to talk to an endocrinologist first.
6. What if we have hyperglycemia after the operation?
o Can we start insulin therapy immediately?
7.Cause of food poisoning? o Food poisoning
results from eating food that has been spoiled by toxins or pathogens (such as bacteria). Important infections are
salmonellosis, listeriosis, botulism and clostridium

8. When we do CT with contrast media, what do we need to check first?

o 1) allergy to KM, 2) administration of metformin 3) renal function and thyroid function.
9.Fracture classification
o The AO classification is a system for describing the location and nature of fractures. In the AO
classification, fractures are described using a five-digit code that provides information about
the location.
10.What is the cause of the patient's constipation? o I
didn't ask this, but I will ask this question during the KU.
11. Technical terms for liver values (transaminases) and kidney values?
o Aspartate aminotransferase (AST, also GOT -glutamic-oxaloacetic transaminase)
Alanine aminotransferase (ALT, also GPT-glutamic pyruvic transaminase)
o Kidney values creatinine, urea urea, uric acidum urica
Comment!
I took the FSP yesterday for the first time and thank God I passed.
My case was wrist fracture + hip joint distortion, almost identical to the protocols (super small differences, in
terms of names, age, etc.) The main thing for this case is to understand very, very well how exactly the
patient fell (how did it happen, which direction did he fall, did he have contact with the motorcycle...)
For part 2, I wrote everything up to therapy (it's crazy how fast time flies), but you'll be asking about it in part
3 anyway.
What I noticed what is most important for the FSP is to have German C1 level. The examiners
want to see that you can speak diligently and react and understand spontaneously.
I did German courses up to C1.2. In my opinion it is very important to invest time in German courses.
My preparation:
Simply learn German (the most important!). Medical preparation course for the FSP.
Materials: German for doctors; internal medicine 80 cases; doccheck; It's doable!
Don't lose hope! Good luck to all!
INFO!
Ø The baker is a person who earns his living by baking bread, rolls, biscuits and pastries.
Ø Bakery is a business that produces and sells all kinds of baked goods
Ø Backshop is a shop where you can buy baked goods
Ø Lactic acidosis (lactic acidosis) is a form of metabolic acidosis in which a drop in

blood pH is caused by the accumulation of lactic acid or the acid anion lactate.

Ø An anaphylactic shock is the hypersensitive reaction of the immune system

to a specific substance and acutely life-threatening.
Ø Travel agents organize and mediate trips. They advise and

inform their customers about travel destinations and connections
Ø Tinnitus (ringing or ringing in the ears) Patients with tinnitus hear noises in their ears
such as whistling, hissing or buzzing. They are only for him
perceptible to those affected. Tinnitus can be persistent or keep coming back.
Ø Hepatitis is an inflammation of the liver. This can be caused by viruses,

Poisons, drugs or autoimmune diseases
Ø Constipation- In medical terminology, one speaks of constipation when there are fewer
than three bowel movements per week. Chronic constipation is when there is a regular
absence of bowel movements for four days over a period of more than three months.
Ø ÿnsomnie- mean insomnia or insufficient sleep.

- Difficulty falling asleep is when people spend a long time after
bedtime take more than 30 minutes to fall asleep.
- A sleep disorder is when people sleep at night for a long time

wake up and then lie awake for a long time
Ø The occurrence of head lice in a person is referred to medically as pediculosis capitis

or head lice infestation. The head louse is an insect from the family of human lice
(Pediculidae), which lives as an ectoparasite in the human hair and feeds on blood .
Ø Sinusitis is an inflammation of the paranasal sinuses. It leads to difficult nasal breathing

and pain. One speaks of chronic q when the symptoms last longer than three months .
Ø Diabetes mellitus (diabetes) is a pathological disorder of the sugar metabolism. The

blood sugar level of those affected is permanently elevated. Over time, this damages
the blood vessels and various organs.

Ø Food poisoning is caused by eating food that has been spoiled by poisons or pathogens.
Typical symptoms are stomach pain, diarrhea and vomiting. Important infections
(pathogens) are salmonellosis, listeriosis and botulism.
Ø Lactulose is a synthetically produced double sugar (disaccharide) and is called

Laxatives used.
Ø Dimethicone is a drug used to treat gas buildup in the stomach

intestinal tract and for head lice infestation.
Ø The coagulation of the blood serves to stop bleeding. Blood clotting is a complicated
process that takes place in several phases: If a blood vessel is injured, the blood
platelets (thrombocytes) first settle on the injured part of the vessel wall. The plates
cling together tightly. This is called
aggregation Later, certain proteins from the liver, the so-called coagulation factors,
reach the injured vessel. Through a complicated chain of reactions, the coagulation
factors bring about further aggregation of the blood platelets and repair of the wound.
Ø Electrolytes are substances that can conduct electricity in aqueous solution. They occur
as both positively and negatively charged particles. Important representatives are, for
example, potassium, sodium, calcium and magnesium
Ø The surface of red blood cells (erythrocytes) consists of various structures such as
proteins (proteins) and lipid compounds. They are called blood group antigens. Everyone
has a certain type of such antigens and therefore a certain blood group
Ø The strain gage check is an examination method that enables the quick check of the
conduction pathways after trauma to the extremities. The abbreviation DMS stands for
blood circulation, motor function and sensitivity.
- Blood circulation - takes place with nail bed test, skin color and skin temperature.
- Motor skills:- The patient is asked to move their fingers or toes.
- Sensitivity -The patient is asked if they feel the light stroking of the fingers, toes,
hand and foot.

Patella fracture + hip joint distortion

patient
First name, last name: Jutta Winter, age: 38 years, height: 175 cm, weight: 78 kg
- Hazelnut pollen with rhinoconjunctivitis hay fever

- House dust with stuffy nose
- Egg intolerance with dyspepsia meteorism and abdominal pain
stimulants
ÿ Nicotine consumption: non-smoker for 4 years. Before – 5 PY (He had 10 years then
½ Sch. /day smoked)
ÿ Alcohol consumption: 1 glass of wine occasionally
social history
She is an electricity tariff (at the public utility company / advises customers on how to save electricity), single, has one
Daughter, who suffered from epiglottitis 2 weeks ago , lives with us
her partner and daughter
family history
§ Father: right-sided hypacusis hearing loss due to parotitis mumps / goat peter from child
on.
§ Mother: colon cancer treated surgically 14 years ago

previous operation)
Ms. Winter is a 38-year-old patient who came to us as an emergency (accompanied by a friend) because of
increasing, severe pain in her right knee that had been present for 2 hours after a car accident.
In addition, she reported dull pain in the left hip joint radiating to the left thigh.
(She said that she was in the car on the way to the supermarket with her boyfriend as a passenger. When
an elderly lady crossed her path and fell off the e-bike, his boyfriend had to brake hard and suddenly.
That's why the patient hit the dashboard with her right knee. She wasn't wearing a seat belt and therefore
injured her left hip joint.)
Pain intensity was rated 7 out of 10 on the right knee and 4 out of 10 on the left
Hip joint rated on a pain scale.

In addition, the patient noticed the following accompanying symptoms: edema, swelling, excoriations ,
skin abrasions / abrasions, hematomas , bruising / bruises, restricted movement of the affected side of
the body as well as crepitation, crunching / crackling noises and a feeling of fluid in the right knee.
The vegetative anamnesis is unremarkable except for insomnia in the form of disturbances in sleeping through the night
(since a few months due to stress at work).

• Bronchial asthma in childhood, treated with allergen immunotherapy
(Hyposensitization) treated (she currently has no attacks) ,

• Atopic dermatitis Atopic dermatitis on hands and feet from childhood
• Fractured clavicle left collarbone 4 years ago after a fall from a horse
conservative, treated on an outpatient basis. Since then she has suffered from chronic left
shoulder pain,
• Angina tonsillaris tonsillitis 3.5 weeks ago, was antibiotic (with
amoxicillin) .
10 years ago she was due to corpus liberum free joint bodies on the right ankle at Zn
Sports accident underwent arthroscopic surgery.
The patient was vaccinated against Covid-19, childhood diseases and tetanus (last booster vaccination
4 years ago) .
medication
- Pantoprazole 40 mg bB (as stomach protection because of ibuprofen)
- Xysal 5 mg bB (if you suffer from house dust allergy)

The anamnestic information most likely points to a patella fracture or kneecap fracture
right and hip joint distortion hip joint sprain left.
A cruciate ligament rupture on the right and a hip fracture on the left come into the differential diagnosis
consideration.
Further procedure: 1.
KU: pDMS, certain/uncertain signs of fracture 2.
Laboratory: small BB, CRP, ESR, coagulation, electrolytes, blood group 3.
Rö-knee on the right in 2 levels
4. If necessary, MRI knee right.
5. Orthopedic Council

therapy
1. Protection, cooling and elevation of the affected side of the body

2. Checking vital parameters (heart, respiratory rate, blood pressure, body temperature and saturation) 3.
Venous access, fluid intake 4.
Pain-adapted analgesia 5. Thrombosis

prophylaxis with low molecular weight
heparin

From the patient:
1. What would you do to me?
o I would do a physical exam, specifically I will check mobility, sensitivity and motor function of the right leg. After that I
have to draw blood to check important laboratory parameters as well as some imaging tests like
perform x-ray and MRI.
2. What do you think happened to me?
o Ms. Winter, I can understand that you may want to know the cause of your symptoms quickly. At the moment I only
have a suspicion of a broken kneecap on the right side because of the information mentioned. But, as I said, we
have to carry out a few important tests first.
3. Could you give me some painkillers? I can't take any more pain.
o Of course you will get one immediately.
From the examiner:
1. Who was the driver?

oh his friend
2. Did you bump into the old woman?

Oh no
3. Was he wearing a seat belt?

Oh no
4. Who brought him to the hospital?

o His friend with the car.
5. Is MRI necessary to confirm fracture?

o It is not necessary, but to rule out soft tissue injuries, we should also do an MRI. To confirm the
fracture, X-ray is enough.
6. What would you prescribe in the laboratory?
o Small BB, CRP, ESR, Coagulation, Electrolytes, Blood Type.

7. What does electricity tariff mean?
o Stromtariferin is a professional consultant for electricity tariffs and their calculation.

8. What is tariff anyway?
o This is certain monthly sum depending on consumption for electricity and gas.
9. The patient said he suffered from tonsillitis. What do you think of as the first differential diagnosis?
or Covid-19
11. Which conservative treatment method do you know for clavicle fracture?
o backpack bandage
10. Where were you going before the accident?
o supermarket
11. What is her mother suffering from? And what does she look out for in her mother because of this illness?
o She suffers from colon cancer and has to watch her diet
12. Which symptom tells you that the patella is broken?
o Crepitation as a sure sign of a fracture
13. What would you tell the patient about the prognosis of such a fracture?
o Prognosis here is complicated. In the case of a patella fracture after the operation, there is still a possibility of restricting
movement. Therefore, other important therapeutic measures such as physiotherapy and physiotherapy must be
carried out immediately after the operation.
14. What is epiglottis?
o Epiglottitis -Is it
dangerous? o The
condition is acutely life-threatening. Epiglottitis is swelling of the mucous membranes on and around the epiglottis. This
narrows the trachea, which can lead to shortness of breath.
-How will you handle this?
o First with corticosteroids, but if that is not enough then we have to do intubation and if intubation has not taken place,
the last option is tracheostomy.
Comment!
You asked a lot of questions about the medical history. It is very important to ask good questions like him
accident happened. The senior doctor also asked many details about previous illnesses.
As for the medical part, he only asked about my suspected diagnosis and differential diagnoses, then the
time was up. All in all, the examiners were very nice and the atmosphere relaxed. Just stay calm and stay focused.
INFO!
Ø House dust - dust occurring in the household.
Ø Epiglottitis is an inflammation of the epiglottis caused by the bacterium Haemophilus influenzae type B.

Ø The parotitis epidemica (the mumps or billybill) is a contagious, with

Fever associated infectious disease, especially the salivary glands of the ears
infested.
Ø Parotitis is an inflammation of the parotid gland (Glandula parotis), which is triggered by

mumps viruses and is typically characterized by fever and sore throat.
Ø Colon carcinoma refers to malignant tumors of the large intestine.
Ø An enterostomy (anus praeter, artificial bowel outlet) is an artificially created bowel

outlet in which the bowel is discharged through the abdominal wall.
Ø Dyspepsia is a symptom complex of different causes, which includes nausea, retrosternal

vomiting, bloating, belching, Heartburn, pain,
meteorism and premature satiety.
Ø Corpus liberum (arthrolith) is a freely movable joint body. Loose bodies can result from
a broken piece of cartilage or bone tissue.
ankle sprain
patient
First name, last name: Florian Krone, age: 45 years, height: 187 cm, weight: 57 kg.
- Latex allergy with erythema redness
- Early bloomer allergy to hazelnut pollen with allergic rhinoconjunctivitis
Hay fever and pruritus itching
stimulants
ÿ Nicotine consumption: non-smoker for 5 years. Before that PY -15.
ÿ Alcohol consumption: 0.5l beer at the weekend
ÿ Drug use: at 16-17 he tried hashish and methamphetamine

social history
He is a lawyer, divorced (for 3 years) , has 3 children, one of whom suffers from hypacusis hearing loss and
wears a hearing aid, lives with his partner
(partner).
family history
§ Father: suffer from arterial hypertension high blood pressure and cataract cataract / lens opacity,
Zn lens transplant transplantation. § Mother:
was operated on for breast cancer 2.5 months ago, is currently receiving radiotherapy.
§ Brother: obesity obesity / obesity, Zn bariatric surgery gastric reduction Op

previous operation)
Mr. Krone is a 45-year-old patient who came to us (accompanied by his partner)

presented as an emergency because of severe pain in the left ankle that has existed since yesterday afternoon
when the left foot twisted inwards.
(He says that he was walking the dog in the forest and suddenly had to run after her dog. He missed a
loose stone. That's why he tripped and twisted his left foot inwards)
In addition, the patient noticed the following accompanying symptoms: increasing edema
Swelling, cyanosis Blueness / blue skin discoloration, numbness and hypoesthesia
Restricted movement in the left ankle and left foot.
The questions about excoriations, loss of consciousness, nausea, vertigo were answered in the negative
The vegetative anamnesis is unremarkable except for diarrhea , meteorism , flatulence and
insomnia, sleep disturbance.
• Uricopathy gout for 3 years with Podagra gout attack 3 weeks ago,
• Lumbar disc prolapse Herniated disc in a Zn motorcycle accident 5 years ago (since he's still in pain), was
treated conservatively (with physiotherapy and
Physiotherapy),
• Colon irritable bowel syndrome for 5 years, (so he has diarrhea and meteorism)
• Vocal cord nodules Singer/screaming nodules with dysphonic hoarseness for 15 years (hence receiving
speech therapy and taking Neoangin-Plus lozenges every 3-4 hours).
He had an operation on his right knee 5 years ago for bursitis .

medication
- Allopurinol 300 mg 1-0-0 -
Neoangin lozenges bB
- Imodium bB
Suspect and differential diagnosis:

The anamnestic information most likely points to a sprained ankle on the left.
A fracture of the ankle joint and a proximal fracture of the fibula can be considered in the differential
diagnosis.
Further procedure:
1. KU: pDMS, certain / uncertain signs of fracture,
2. laboratory: small BB, coagulation, electrolytes, blood
group 3. Rö-ankle left. and knee left in 2 levels
4. if necessary CT
Therapy:
1. Protection, cooling, elevation of the affected leg
2. Pain-adapted analgesia 3. If
necessary, conservative treatment with an orthosis or plaster cast +
crutches.
4. For fracture:
- Establishment of the venous access, liquid supply -
thrombosis prophylaxis with low-molecular heparin
- Possibly surgery – osteosynthesis.

o (See above) This depends on the findings of the Roe examination. If a fracture is proven, then the patient must be
admitted to the hospital and treated surgically with osteosynthesis. If there is no fracture, the patient can be treated
conservatively with an orthosis or plaster cast.
2. What are the initial actions before the results of the Rö recording?
o Cooling, protection, elevation of the affected extremity, analgesics, application of the
venous access and thrombosis prophylaxis with low molecular weight heparin.
3. What will you do at the KU?
o First we need to inspect the affected area to determine certain and uncertain fracture signs. After that we can check
pDMS. In addition, there is palpation, in which pressure pain over the affected body area is noticeable.
In addition, we can perform some functional tests to check mobility in the joints.

4. What is the location of the injury?

o Inner malleolus (technical term - medial malleolus)
5. How is the ankle fracture divided?
o According to Weber:
- Type A fracture below the syndesmosis (ligament structure) / syndesmosis always intact
- Type B fracture at the level of the syndesmosis / syndesmosis often injured
- Type C fracture above the syndesmosis / syndesmosis always injured

6. Where can you feel the pulse on your foot?
o There are 2 foot pulses:
- Arteria dorsalis pedis- on the back of the foot lateral to the tendon of the extensor hallucis longus muscle
- Posterior tibial artery- on the medial side of the foot behind the inner malleolus
7. What causes a gout attack?
o Due to increased uric acid levels (e.g. due to stress, high-meat diet, increased alcohol consumption) in the blood, urate
crystals are deposited in articular cartilage
8. What is the technical term for a gout attack on the big toe?
Oh Podagra
9. What is cataract and how can it be treated?
o A cataract is an age-related clouding of the lens of the eye. Cataract is an indication for Op - lens transplantation
10. How do you say early bloomer allergy differently?

o hay fever
Comment!
Hello everyone, I
passed my specialist language exam in Munich. My case was ankle sprain.
In each part there was a digital clock counting down from 20 minutes.
The examiners were very nice and sometimes helped in the third part. But you have to write down all the numbers that appear
in the anamnesis correctly, because here the examiners pay attention to listening and checking whether we have correctly
understood everything the patient said.
The patient said important information in quick succession, so I couldn't keep up with the notes. So I asked him to say the
information again. Some information he gave himself but some you had to ask. The patient spoke very clearly.
In the second part I wrote on the computer. The anamnesis format was slightly different than what I found on the internet.
That's why I'm a bit confused while writing
arrived and there wasn't quite enough time. The other two colleagues wrote it by hand, but each had the choice of computer
or hand documenting.
In the third part, the atmosphere was very pleasant. I was interrupted when the patient was presented after the current medical
history and received questions from the senior physician.

INFO!
Ø In the case of an early bloomer allergy, those affected react allergically to the so-
called early blooming trees, whose flowering period begins very early in the year.
Birch, alder and hazel are among the so-called early bloomers. In case of an allergy
Alder or hazel, the first symptoms often appear in winter.
Ø In a latex allergy, the immune system overreacts to the juice of the

rubber tree or products made from it.
Ø Lawyer- professionally represents other people in court.
Ø Deafness (hypacusia) refers to the reduction in hearing ability
Ø One speaks of adiposity (obesity/obesity) when severely overweight

health (BMI of 30 and more).
Ø The body mass index, BMI for short - body weight (in kg) divided by height (in m)
squared.
Ø Edema is an accumulation of fluid in the extremities .
Ø Gout is a metabolic disorder that mainly causes painful inflammation in the joints. It is
associated with too much uric acid in the blood, which is deposited in crystal form in
the synovium.
Ø An irritable bowel is based on a functional disorder of the intestine. Typical symptoms

include abdominal pain, gas, and diarrhea or constipation
Ø Vocal cord nodules (screaming or singer nodules): thickening at the

Vocal folds as a result of incorrect vocal technique or vocal overload.

poly trauma
patient
First name, last name: Benno Fischer, age: 27 years, height: 158 cm, weight: 67 kg
- Bee stings with anaphylactic shock, so always wear it

adrenaline pen
- Brown patch with erythema redness
stimulants
ÿ Nicotine consumption: non-smokers
ÿ Alcohol consumption: Schnaps once a week
ÿ Drug use: Occasional joints at parties.
social history
He is a student, studies educational science, single, lives in a flat share.
family history
§ Mother: suffering from a scotoma, loss of visual field in the left eye (no organic cause was found. The
doctors assume a psychosomatic cause. The stress factor is the daughter's illness)
§ Father: Zn bypass operation 2.5 years ago (due to angina pectoris. No history of a heart attack) with
sternum osteomyelitis and inflammation of the breastbone as a postoperative complication (had to stay
in the hospital for 2 weeks)
§ Twin sister: suffer from panic attack

previous operation)
Mr. Fischer is a 27-year-old patient who presented to us today as an emergency because of 5 hours of pain in
the head, right upper arm and stabbing abdominal pain after a fall from a bicycle on the right side of the body.
(He was on his way home from a party and missed a construction site. He suddenly braked to avoid the
construction site, which is why he fell. According to the patient, he was not wearing a helmet and injured
his head as a result.)
The pain intensity was rated 4 out of 10 in the head, 7 out of 10 in the upper arm and 5 out of 10
rated out of 10 on a pain scale in the upper abdomen.
The patient noticed the following accompanying symptoms: congrade

Amnesia Memory loss of the injurious event, vertigo dizziness, nausea nausea ,
Syncope unconsciousness for a few seconds, single emesis vomiting after the accident

and excoriations abrasions / abrasions, hematoma bruising / bruising, swelling edema
of the affected parts of the body and restricted movement of the right arm.
The vegetative anamnesis is unremarkable except for insomnia, sleep disturbance and constipation
Constipation.

• Hypothyroidism Hypothyroidism, V. a. Thyroiditis Hashimoto 9 years ago, • osteitis
pubis pubis for 3.25 years (because of playing tennis. He played away because of that and he
is better),
• Otitis externa diffusa Eczema of the auditory canal for
3 years, • Pyelonephritis , inflammation of the renal pelvis 5 years ago, was treated with
antibiotics, • Nocturnal calf cramps for 12 years.
He was operated on at the age of 8 for a phimosis of the foreskin .

medication
- Euthyrox 75 ÿg 1-0-0 -
Magnesium bB (every one to two weeks because of calf cramps)

The anamnestic information most likely points to a TBI, first degree concussion / commocio cerebri,
right shoulder joint distortion, blunt abdominal trauma.
Intracranial cerebral hemorrhage, skull fracture, ruptured spleen, rib fracture and shoulder joint
fracture should be considered in the differential diagnosis.
Proceed further:
1. CU:
- Neurological examination: pupillary reaction, muscle reflexes
- pDMS, certain/uncertain fracture signs
- Examination of the musculoskeletal system: passive and active mobility
on joints, axial load on the spine, muscle strength
2. Laboratory: small BB, CRP, ESR, coagulation, electrolytes, blood group
3. FAST - sonography 4.
CT skull, abdomen and shoulder joint right.
5. X-ray and MRI if necessary
Therapy:
1. Protection, cooling 2.
Vital parameters (heart - respiratory rate, blood pressure, body temperature and saturation)
control 3. Two venous
accesses, fluid intake

4. Prepare blood and, if necessary, transufusion

5. Pain-adapted analgesia 6.
Thrombosis prophylaxis with low molecular weight heparin (after excluding the
splenic rupture / hemorrhage)
7. If necessary, surgery on abdominal organs or the shoulder joint.

1. How do you go about your first action?
o Physical examination (neurological examination, pDMS, safe/unsure
fracture sign).
2. What painkillers would you give?
o Metamizole, paracetamol, diclofenac, ibuprofen.
3. Why will you do CT?
o CT examination counts as the gold standard in the case of polytrauma. With the help of CT, we can quickly visualize the
internal structures and organs and rule out possible life-threatening complications such as intracranial hemorrhage,
pneumothorax and splenic rupture.
4. Why did you want to order sonography?
o FAST sonography formulates a standardized procedure with ultrasound for the initial clinical examination of a trauma
patient. It focuses on 4 regions where free fluid can collect after an accident event. The FAST method is used for the
rapid detection of haemorrhage or pericardial tamponade and is regularly used in the initial examination of polytrauma
patients in the shock room.
5. Would you also like to do an X-ray examination?

o If the CT examination cannot be reached quickly, we can also do an X-ray examination
carry out.
6. How will we do chest x-ray?
o In two levels
-What does that mean?
o 1)Anterior-posterior (front to back)
o 2) Lateral (sideways)
-When inhaling or exhaling?
o When exhaling, because the small pneumothorax are often only visible during expiration.
7. What does party drugs mean?
o Methamphetamine
o LSD
o joints
Comment!
I took the FSP today and passed. My case was polytrauma after a Zn bicycle fall.
It was just like the protocol. The review panel was very nice and everyone spoke clearly. Although I wrote down to the
differential diagnoses in the second, it wasn't bad. I documented everything in the file. You can still survive.
I mentioned several differential diagnoses and investigations in the third part.

I didn't write the mechanism of the accident, but I explained it in the third part

INFO!
Ø Educational science is a social science oriented to the analysis of education in
organizational institutions ( kindergarten, school, etc.) in which education takes place and
is interested in people who practice education as a profession (professionalization).
Ø Residential community (WG for short) describes a form of living in which several people live together
independent tenants share an apartment.
Ø A bypass operation is understood to mean the vascular surgery of a stenosing blood

vessel section through an endogenous or exogenous bypass vessel (the bypass). The
therapeutic intention of the intervention is to improve the lack of blood supply behind the
stenosis.
Ø Depression is a serious mental illness that can occur at any age. The patients feel very
depressed, lose their interests and are exhausted and listless. The disease persists for a
long time and usually does not improve on its own without treatment.
Ø Syncope (circulatory collapse) is a short, spontaneously reversible loss of consciousness

as a result of impaired blood flow to the brain (cerebral ischemia). It is accompanied by a
loss of postural control.
Ø Amnesia is a form of memory impairment in which there is no memory:

- before a damaging event - retrograde amnesia
- to the damaging event - congrade amnesia
- after a damaging event - anterograde amnesia
lying loss of information.
Ø The sternum osteomyelitis is an inflammation of the sternum caused by a disturbance of the

Wound healing occurs, without therapy the mortality rate is very high.
Ø The panic attack is a sudden and temporary alarm reaction of the

body with anxiety and vegetative symptoms.
Ø Otitis externa diffusa is an inflammation of the skin and subcutis

in the external auditory canal (meatus acusticus externus).

Spleen Rupture (My Case)
patient
First name, last name: Franziska Lehmann, age: 27 years, born on April 19, 1995 (but the patient
said 2005 on purpose because she was excited) height: 165 cm, weight: 81 kg
- Amoxicillin with pruritus itching and exanthema rash on the upper body (was
angina tonsillaris taken in childhood)
- Statements of lactose intolerance with meteorism flatulence (that's why the patient is vegan and
tried not to eat dairy foods)
stimulants
ÿ Nicotine consumption: non-smoker for 4 years. Before 4.5 PY (15 digits for 6 years)
ÿ Alcohol consumption: a glass of wine a day
social history
She is a conductor at DB (shift work) , divorced, lives with his partner, has a daughter (from her first husband)
who suffers from strabismus and wears glasses.
family history
§ Father: colon cancer treated with chemotherapy Colon cancer 2 years ago. § Mother:
coxarthrosis hip joint wear on both sides, condition after hip TEP on both sides.
§ Twin brother: bronchial asthma.

previous operation)
Ms. Lehmann is a 27-year-old patient who came to us as an emergency because of increasing, pressing upper
abdominal pain on the left that has been present since yesterday afternoon and is radiating to the left shoulder
after falling from a skateboard to the left
introduced page.
(The patient reported that she was skateboarding home from work yesterday afternoon. She had to avoid
a dog. As a result, she fell and hit a fire hydrant with her upper left abdomen. She was wearing a helmet
and had been vaccinated against tetanus, but had not had her tetanus protection boosted.)
Pain intensity was rated 7 out of 10 on the pain scale
According to the patient, the pain got better yesterday after the accident, but for the past 5 hours the pain has
suddenly increased again.

The patient also noticed the following accompanying symptoms:

hematoma bruising / bruising on left upper abdomen, hematuria blood in urine this morning and abdominal
edema swollen abdomen (his abdomen has become fatter)
The questions about tachycardia, head injury, paresthesia, hypoesthesia were answered in the negative.
The vegetative anamnesis is unremarkable except for insomnia, sleep disturbances (because of atopic
dermatitis, which manifests itself with pruritus) in the form of disturbances in sleeping through the night and
meteorism, flatulence.
The patient is known to have the following pre-existing conditions:
• Atopic dermatitis for 10 years (with pruritus on the face and hands on both sides),
• migraine every 2 months,
• Hemorrhoids for 4 years (Pat. said - since pregnancy and your daughter is now 3 years old), treated
with ligature.
She had been operated on for a right ankle fracture in a Zn skateboard accident 3 years ago and a
laceration on the head in a Zn skateboard accident 2 years ago
Medicines:
- Fatty ointment (can't remember the name) bB (from the family doctor)
- ASS 500 mg + caffeine bB (self-purchased)
- Ibuprofen 800 mg bB (She said max dose)
- Espumisan - chewable tablets bB (because of meteorism)

- Emulsions (can't remember the name) bB (she's vegan and takes emulsions to compensate for vitamin/
micronutrient deficiencies)
- lidocaine ointment bB (was used because of laceration on the head)
The anamnestic information most likely points to blunt abdominal trauma.
A rupture of the spleen and a rib fracture should be considered in the differential diagnosis.
Proceed further:
1. CU:
- On inspection and palpation - Pallor, tachycardia , rapid heartbeat, tachypnea , rapid breathing,
pressure or percussion pain and defensive tension in the left upper abdomen, increase in
abdominal circumference.
2. Laboratory: small BB, CRP, ESR, electrolytes, coagulation, blood type.
3. FAST sonography
4. If necessary, X-ray
thorax 5. If necessary, CT abdomen

Therapy:
1. Protection, cooling
2. Vital parameters (heart - respiratory rate, blood pressure, body temperature and
saturation) check 3. 2
venous accesses, fluid supply 4. Prepare
blood and transfusion if necessary
5. Pain-adapted analgesia 6. If
necessary, surgery – organ-preserving surgery or splenectomy.

1. How the accident happened, age of brother, daughter ..., previous illnesses, medication, etc.
2. Why is it so important to know if the patient was traveling to or from work?
o Yes, because of BG accidents, this is very important. The professional associations (BG) are responsible for
the statutory accident insurance and bear work-related risks such as accidents at work, accidents on the
way to and from work and occupational diseases.
3. Why did the patient feel better and then suddenly worse?
o I think this is due to two-stage rupture of the spleen
4. Why two-stage?
o In bistage splenic rupture, only splenic parenchyma ruptures, but splenic capsule remains intact
from several hours to days. This can lead to secondary rupture or expansion of the hematoma,
hence the development of hypovolaemia.
5. Is this life threatening
o Yes, can cause hypovolemic shock

6. What signs of hypovolemic shock can we see in patients?
o Pallor, tachycardia, arterial hypotension
7. What actions should be taken?
o KU, laboratory, vital parameters, installation of venous, pain-adapted analgesia, accesses,
sonography after FAST, CT
8. What is noticeable at KU?
o In hypovolemic shock - tachycardia, hypotension, pallor.
o On palpation – DS over the left upper abdomen, if necessary defensive tension up to peritonism.
9. What's in the lab?
o Routine BB, CRP, ESR, BGA, electrolytes (if because of shock electrolyte replacement therapy
may be clinically necessary in this case)
10. At BB what do you expect because of
shock? o decreased HB and erythrocytes
11. What does HB mean?
o Hemoglobin is the red blood pigment in the erythrocytes. It
enables oxygen transport in the body via the bloodstream.
12. If Hb is less than 8 what should you do?
o I have to prepare the blood supplies, a blood transfusion is necessary here due to shock

13. What is visible in sonography?

o Hematoma in the splenic parenchyma or subcapsular o
Accumulation of free intra-abdominal fluid
14. Which vital parameters would you like to check?
o Heart - respiratory rate, blood pressure, body temperature and saturation
15. Sonography after FAST?
o FAST sonography formulates a standardized procedure with ultrasound for the initial clinical examination of a
trauma patient. It focuses on 4 regions where free fluid can collect after an accident event. The FAST
method is used for the rapid detection of haemorrhage or pericardial tamponade.
16. What is the ligature?

o The ligature is the constricting ligature of hollow organs or pathways.
17. CT reconnaissance?
My comment!
My commission counts as "the most difficult", but I don't understand it at all. They were nice and friendly like all the other
commissions. During the performance, I talked a lot about myself and my future goals. The patient spoke quite normally and
clearly without dialect.
I didn't ask for anything that often, but still only made it as far as Noxen (I think because of medication and small things). In
any case, it's not that important. In the 3rd part I may have spoken with technical terms and with C1 structures. I think I wrote
the letter well, but maybe there were mistakes.
1. The exam is only about language, less medical knowledge, but it also plays a role.
That's why you try to speak German a lot every day and to learn something new.
2. I find internships very important to improve language and medical skills. Daily communication with colleagues and patients
is very helpful.
3. You should never hear anyone. A lot of people are always trying to demotivate you. Things like "this exam is so difficult or
impossible to do", "the examiners let you fail on purpose" are nonsense. If you have already learned everything well and
prepared well for the exam, then you cannot fail anyone. The examiners always have slips of paper with important points and
tick these points if they would conduct a correct and detailed anamnesis interview. (sort of like notes)
4. Practice a lot and do simulations!
I basically prepared for this exam myself (with the help of notes I wrote myself). To start with, I attended a course in Azerbaijan,
but basically I only improved in simulations. (Detailed anamnesis with all the little things is very, very important!!).
I wish you success!
Shamil Gurbanov

INFO!
Ø The reversal sign is the radiation of the pain to the left shoulder with accompanying
hyperesthesia, which is evaluated as an indication of a rupture of the spleen.
Ø Conductors are people who use public transport

Sell and control tickets.
Ø Vegans are people who do not use animal products such as meat, fish meat, milk
and consume eggs.
Ø Strabismus (squinting) is a disturbance of the balance of the eye muscles or a faulty

motor coordination of both eyes.
Ø Coxarthrosis (wear and tear of the hip joint) is a degenerative, slowly progressive, non-
inflammatory disease of one or both hip joints
Ø A total endoprosthesis, or TEP for short, is an artificial joint replacement (joint

endoprosthesis) in which the entire joint, ie the joint head and the joint socket, are
replaced.
Ø Hemorrhoids are arteriovenous vascular cushions that are located in a ring shape at the
transition from the rectum to the anal canal.

1. Pain history
! Where? Can you pinpoint the exact location of the pain, please?
! When? /Trigger? How long have you had this pain? How did the pain start? (suddenly strong after exertion or incorrect movement
or slowly gaining weight?) Is there anything that alleviates or increases the pain?
! pain scale? How bad is the pain on a pain scale of 1 to 10, with 1 being mild and
! What? Could you please describe the pain more precisely, is the pain rather dull,
! Course? Has the pain gotten better or worse over time? Is the pain stress related? Have you had pain like this before? Have you
already due to this
pain visited a doctor?
2. Sensitivity and motor skills
- Have you noticed numbness, tingling or paralysis? Where exactly - do you have a
restricted movement?
3. Additional questions
- In the case of a cervical disc prolapse - Do you have neck stiffness?

Cervical disc herniation

patient
First name, last name: Simon Mayer, age: 23 years, height: 175 cm, weight: 82 kg
- Solar urticaria sun allergy with vesicles vesicles

- Lactose intolerance with abdominal pain Abdominal pain
stimulants
ÿ Nicotine consumption: non-smoker for 6 weeks. Before – 16 PY for 8 years.
ÿ Alcohol consumption: 1-2 beers a day.

ÿ Drug use: Hashish several times when I was young (I used to smoke weed)
social history
He is a team leader at a building cleaning company, single and lives alone.
family history
§ Father: surgically treated basalioma white skin cancer in the temporal region of the temples
§ Mother: breast cancer, Zn 2 chemotherapy cycles a year ago, (therefore
she suffer from alopecia and wear wig)
§ Step-sister: drug addiction

previous operation)
Mr. Mayer is a 23-year-old patient who presented to us because of shooting, pulling, increasing cervical pain
that has been present since yesterday afternoon and is radiating to the left arm and between the shoulder blades.
(The patient said that yesterday he helped a friend change the winter tires on his BMW.)
Pain intensity was rated 8 out of 10 on the pain scale.
He mentioned that he had neck tension from work for the past 3 weeks.
He took diclofenac 50mg last night and again this morning but it didn't help.
He also noticed the following accompanying symptoms: stiff neck, paresthesia, tingling in the forearm and
fingers on the left, as well as hypesthesia, numbness and monoparesis, paralysis of the left arm.
The vegetative anamnesis is unremarkable except for insomnia . (he suffers from stress because of his work
and his mother)

He is aware of the following pre-existing conditions:
• Functional extrasystole cardiac stumbling 6 months ago (was therefore examined without
conspicuous findings),
• Eczema in the interdigital spaces between the fingers on both sides (because of the chemical agents in the
Work),
• Dog bite wound on right forearm 6 months ago, was treated as an outpatient
treated.
He had had an arthroscopic operation 2 years ago for a cruciate ligament rupture on the left and hernia
inguinalis inguinal hernia on the right in childhood.
Medicines:
- Diclofenac 50 mg. bB
- Fat ointment (not remembered) bB
- Nicotine patch bB
The anamnestic information most likely points to the cervical spine disc prolapse.
Spinal canal stenosis and cervical spinal fracture should be considered in the differential diagnosis.
Proceed further:
1. KU (neurological examination, inspection, palpation):

- Inspection: shape and course of the spine
- Palpation: pain on percussion or pressure over the spine
2. pDMS (sensitivity and strength of the key muscles)
3. Laboratory: small BB, ESR, CRP, liver and kidney values
4. Rö-HWS: to rule out a fracture
5. MRI-cervical spine (imaging of choice)
Therapy:
1. Early pain therapy (NSAIDs – for acute pain, opioids for severe pain
pain symptoms.)
2. Periradicular therapy (injection of glucocorticoids to the nerve root)
3. Physiotherapy (physiotherapy, heat therapy, massage)
4. Exercise therapy (daily activities, no bed rest)
5. Paravertebral blocks under CT control
6. Possibly operations (if there is no improvement with conservative therapy)

- Minimally invasive discectomy
- Percutaneous nucleomy


1. What did the patient do? Why is he in pain?
o The patient said that yesterday he gave a friend the winter tires on his BMW
helped to change and suddenly expressed the pain in the neck.
2. What does buddy mean?
o That means friend.
3. Why does he have paresthesia and paralysis?
o Due to nerve root compression.
4. Is sun allergy a real allergy?
o Is a reaction of the skin to sunlight. However, it has not yet been clarified whether this reaction is actually
caused by an allergy.
5. Why is the patient suffering from stress?
o Because of his work and mother.

6. What happened to his mother?
o She suffers from Mamma CA, therefore has been treated with chemotherapy, therefore has
got alopecia.
7. Why is his work stressful? o I didn't
ask about it, but I would like to clear it up during the KU.
8. MRI reconnaissance
9. Why does he have eczema?
o Due to contact allergy to cleaning agents.

10. What is your VD, DD and Why?
o Because of the information mentioned, I suspect a cervical spine disc prolapse. This is supported by the
complaints of patients such as: localization and character of pain, neck stiffness, monoparesis, tingling
and numbness.
o The following can be considered in the differential diagnosis: spinal canal stenosis and cervical spine
Fracture.
11. What would you like to continue doing?
o Initially KU (neurological examination, pDMS, inspection, palpation), then laboratory and

then imaging procedures such as X-ray cervical spine and MRI of the spine.
12. What do you watch out for?
o Reflexes, peripheral circulation, motor skills and sensitivity (pDMS)
13. How do you check sensitivity?
o We can have superficial and deep sensitivity using either the head part of
Reflex hammer or your finger.
14. What therapeutic measures will you carry out?
o First conservative therapy: pain therapy with NSAIDs or injections of cortisone and physiotherapy. If that's not
enough, then we can do operations like discectomy
carry out.

Comment!
Hello dear colleagues, Yesterday I took my technical language test for the second time and thank God I
passed it.
Like the first time, the examiners were very nice and spoke very clearly. When I took the first FSP I couldn't
speak fluently and my doctor's note was very messy. If you make a mistake with the computer, it's easy
to correct. Based on my experience, I recommend writing the doctor's letter with a laptop. You just have
to practice a lot to master the keyboard.
Because of my visa, I wasn't able to do an internship, but I did a course with Ms. Beate Pabst. I also
practiced a lot with colleagues who have taken or will take FSP.
I could not have passed the exam without her help.
I wish you success!!
INFO!
Ø Urticaria solaris is an acute reaction of the skin to (sun)
Light. The skin typically reacts with wheals, reddening and itching.
Ø The professional profile of the building cleaner includes the cleaning of interior spaces,
Facades and other exterior areas of buildings of any kind.
Ø Mammary carcinoma is the malignant degeneration of cells in the mammary gland. It

is the most common cancer in women.
Ø Drug addiction is a disease in which the person concerned loses control over the
consumption of a certain stimulant or intoxicant.
Ø Extrasystoles are heartbeats that occur in addition to the normal heart rhythm.
Those affected often feel them in the form of heart palpitations or heart failures.
Ø Nicotine patches release the nicotine slowly and continuously through the skin into the
body off. They are available in different dosages
Ø A stepchild is a child from a previous marriage, love relationship of

spouse.
Ø The bite wound is a wound caused by the mechanical impact of animal or human teeth
on a part of the body. The bacteria in the mouth are transferred to the bite victim and
can cause local or systemic infections.

Lumbar disc herniation

patient
First name, last name: Eva Haas, age: 49 years, height: 175 cm, weight: 80 kg
- Hazelnut pollen with exanthem rash and pruritus itching

- Amoxicillin with anaphylactic shock (amoxicillin was taken after an operation 2 years ago
given and he expressed shock)
- Intolerance of raw foods with meteorism flatulence
stimulants
ÿ Nicotine consumption: 2-3 cigarettes a day for 15 years ÿ Alcohol
consumption: a glass of dry wine a day
ÿ Drug use: marijuana at a young age.
social history
She is an engineer, married, has 2 sons, one of whom is a latecomer and is suffering
live under Balbuties stuttering
with his family.
(the patient was very stressed about it) ,
family history
§ Father: suffer from hip dysplasia malformation of the hip joint on the left, hip TEP planned.
§ Mother: suffer from macular degeneration retinal diseases of the eye bds.

previous operation)
Ms. Haas is a 49-year-old patient who presented to us because of stabbing, shooting lumbar pain that has
existed since yesterday and is radiating to the lateral area of the thigh and lower leg (outer side OS and US, like
a uniform stripe) up to the little toe.
(She reported that she planted the flowers while gardening yesterday and wanted one
Lift flower pot. After that, when he was lifted, he had acute pain in the lumbar region
felt.)
Pain intensity was rated 8 out of 10 on a pain scale
In addition, the patient noticed the following accompanying symptoms: pain-related restriction of movement in
the lumbar area, paresthesia, tingling on toes on both sides, and hypaesthesia, numbness in the lateral area of
the right leg.
In addition, she added that she had had the lumbago on occasional physical exertion for the past 3 months.

The vegetative anamnesis is unremarkable except for pain-related insomnia sleep disturbance in
the form of difficulty falling asleep and meteorism flatulence.

• Type 1 diabetes mellitus from childhood, • Arterial
hypertension , high blood pressure for 7 years, •
Hypercholesterolemia , increased blood lipids for 7 years, •
Tinnitus in the ears / ringing in the ears for 1.5 years as a result of the status
after sudden hearing loss, • Status after a shoulder joint fracture , shoulder fracture 2 years ago, was treated co
(he fell off his horse onto his left shoulder)
She was operated on 2 years ago for bursitis of the right knee.
medication
- Insulin bolus 15 IU bB.
- Micardis Plus Telmisartan / HCT 40mg / 12.5mg 1-0-1
- Atorvastatin 10 mg 0-0-1
- Tebonine 120 mg
Suspected and differential diagnosis

The anamnestic information most likely points to the lumbar spine disc prolapse.
Non-specific low back pain, spinal column fracture and spinal canal stenosis should be considered
in the differential diagnosis.
Proceed further:
1. KU (neurological examination, inspection, palpation):

- Inspection: shape and course of the spine
- Palpation: pain on percussion or pressure over the spine
2. pDMS (sensitivity and strength of the key muscles)
3. Nerve Stretch Signs:
- Lasègue's sign (roots L5-S1) - Pain when raising the stretched
leg by the examiner
- Bragard's sign (L4 to S1 or the sciatic nerve) - (according to the Lasegue sign
examination) when the leg is stretched out and lifted, the foot is passively dorsiflexed
(positive for the pain in the lumbar spine).
- Kernig sign - pain when extending the leg bent at a 90 degree angle in the knee and hip
joint by the examination laboratory: small BB,
ESR, CRP, liver and kidney values
4. Rö-LWS: to rule out a fracture
5. LWS MRI (imaging of choice)

Therapy:
1. Early pain therapy (NSAIDs – for acute pain, opioids for severe pain
pain symptoms.)
2. Periradicular therapy (injection of glucocorticoids to the nerve root)
3. Physiotherapy (physiotherapy, heat therapy, massage)
4. Exercise therapy (daily activities, no bed rest)
5. Paravertebral blocks under CT control
6. Possibly operations (if there is no improvement with conservative therapy)

- Minimally invasive discectomy
- Percutaneous nucleoectomy

1. What is the patient's profession?
o She is an engineer by profession.

2. Why does he suffer from stress?
o One of his sons is a latecomer and suffers from balbuties. That's why she's stressed.
3. Which nerve in this dermatome?
o This dermatome is the sciatic nerve
4. What about parents?
o His father suffers from hip dysplasia on the left side and he is scheduled to have a total hip replacement.
His mother suffers from macular degeneration bds.
5. What previous illnesses does Pat have and what medication does she take?
o Please see “VE and ME” above
6. What is the effect of Tebonin?

o Tebonin - increases the fluidity of blood in the brain and as a result blood circulation is improved. The tissue can be
better supplied with nutrients and oxygen again.
7. What DD can you say here?
o Differential diagnosis includes non-specific low back pain, lumbar spine fracture and
Consider spinal stenosis.
8. Which diagnostic equipment and therapy would you carry out? o Please see “Further
procedure and therapy”
9. What does anaphylactic shock mean?
o Anaphylactic shock is the most severe form of allergic reaction that can quickly become life-threatening. The body
showed a hypersensitivity reaction to certain substances. e.g. insecticides (bees, wasps), food (peanuts, celery)
medicines (such as antibiotics).

Comment!
I definitely made a lot of spelling mistakes but I'm sure the grammar was almost perfect and I wrote
every phrase very clearly so that you could understand what I meant.
I made a huge mistake the only mistake according to the examiner I once wrote cervical instead of
lumbar but he said we already know they know the patient has lumbago because in the third part we
only talked about lumbar.
I've practiced all cases with colleagues at least once. I almost learned the explanations by heart, wrote
about 50 letters to the doctor, from Amboss all illnesses (allergies, pre-existing conditions, operations,
fractures), and read guidelines (abstract diagnostics and a bit of therapy) of course, the suspected
diagnosis should be learned well, so read everything and learn every word of the protocols in German
and Latin.
My advantage: I can already speak fluently and I use the accent as similar as possible to the German
ones (much HOME practicable word (per) word, I recorded my voice to improve myself. But when I
speak, I make mistakes with the declensions or also with the pronunciation, but the examiners said
that I speak very well and was one of the best (well, at least I was good, although I made a lot of
mistakes when I speak) so you don't have to be able to speak perfectly, but fluently and clearly , you
should try to speak as much as possible in the exam, you already know the topics and the words, so
you can already improvise a lot (you already know more or less which questions could come from the
protocols)
It is best to speak a lot with Germans, or watch films or series, so you learn how the language is
spoken, because it is different from what you learn in the German course.
Above all, I thank everyone who wrote their protocol.
INFO!
Ø Vegan raw food includes fruits and vegetables, all edible leafy greens,
Herbs
Ø Wines that have no or only a low residual sugar content are considered dry
have, referred to.
Ø Latecomer - a person who arrives by some distance last or very late at a meeting point,
lagging behind others (also used figuratively for objects and concepts).
Ø Stuttering (also Balbuties) is a disorder of the flow of speech, which is characterized by

frequent interruptions in the flow of speech, by repetitions of sounds, syllables and words.

Ø Hip dysplasia is a congenital or acquired misalignment of the acetabulum. With this

disease, the femoral head is no longer firmly in the acetabulum.
Ø Macular degeneration is a degenerative disease of the macula lutea, the yellow spot
on the retina of the eye. It occurs in old age.
Ø Tinnitus is the term used to describe noise impressions that are not triggered by a
sound event. Auditory hallucinations or hearing voices are not included.
Ø Micardis Plus is a combination drug used to treat high blood pressure.
Ø Tebonin® stands for herbal medicines that are used to treat forgetfulness and poor
concentration in old age, certain forms of dizziness, as well as ringing in the ears and
tinnitus.
Ø Non-specific low back pain – lumbar back pain that is not specific to any
identifiable cause.
Ø In spinal stenosis, the canal in the spine through which the spinal cord runs is
narrowed. The resulting pressure on the spinal cord, nerves and blood vessels
causes back pain and permanent nerve damage.

1. Pain history
- Where? Can you pinpoint the exact location of the pain, please?
began?

- History? Has the pain gotten better or worse over time? Do you have such
had pain before? Is that why you went to the other doctor?
- Trigger? Are there specific triggers for the pain? Eg food intake?
2. Nausea/vomiting
- Have you noticed nausea or have you already vomited?
- When and how often did you vomit?
3. urination
- Dysuria - Do you have burning or pain when urinating?
- Pollakiuria- How many times a day do you have to urinate?

- Hematuria- Has the urine changed in color? Eg blood in the urine?

urolithiasis
patient
First name, last name: Hubert Winkler, age: 47 years, height: 173 cm, weight: 80 kg.
- Wasp stings with anaphylactic shock (was treated in hospital for this reason)
- Grass pollen allergy with allergic rhinitis hay fever

- Lactose intolerance milk intolerance with meteorism flatulence and diarrhea diarrhea
stimulants
ÿ Nicotine consumption: non-smoker for 4 years. Before that 1.5 box/ 23 years, 34.5- PY
ÿ Alcohol consumption: 2-3 glasses of beer daily.

social history
He is a police officer, divorced, lives separately from his family with his dog (a poodle) , has 3 children, one of
whom suffers from ADHD. (suffer from stress at work and because of the son).
family history
§ Father: PAD shop window disease with leg ulcers , condition after large toe hamputation
to the right.
§ Mother: Scoliosis spinal curvature, condition after cataract surgery cataracts / lens opacity.

previous operation)
Mr. Winkler is a 47-year-old patient who presented to us because of a 2-hour history of sudden, colicky, severe
flank pain on the right side, radiating to the right groin and genitals.
In addition, he noticed the following accompanying symptoms:

dysuria painful urination, hematuria blood in urine, Pollakiuria , frequent urination in small amounts,
vomiting twice and hyperhidrosis caused by pain
The vegetative anamnesis is unremarkable except for stress-related insomnia sleep disorder in the form
of difficulty falling asleep.
Questions about fever, nausea and fatigue were answered in the negative.


• Arterial hypertension High blood pressure for 4
years, • Recurrent tendovaginitis tendonitis (due to a tennis match) on
right wrist for a month, wearing a bandage
• Morbilli measles with pneumonia pneumonia in his childhood,
• Rib contusion Rib contusion while playing handball, became conservative
treated
• Combustio burn on the right arm 1 day ago.
He has never had an operation before.
medication
- Diltiazem 90 mg 1-0-1 -
Valerian Dragees bB
- Diclofenac ointment bB

The anamnestic information most likely points to urolithiasis.
In the differential diagnosis, urinary tract infection and appendicitis should be considered.
Another ancestor
1. CU:
- On palpation: painful percussion of the kidneys, elevated bladder
2. Laboratory: small BB, CRP, ESR, electrolytes, kidney values (creatinine, GFR), uric acid 3.
U status: leukocyturia, microhematuria, crystalluria
4. Abdominal sono: urinary obstruction enlarged ureter ureter and renal pelvis,
Hyperechoic stone with the stone's acoustic shadow
5. CT abdomen - standard diagnostic method for stone detection
6. If necessary, X-ray examination - blank kidney recording (NLA) unilateral in the case of radiopaque
stones (stones containing Ca)
7. If necessary, urography with contrast medium – to visualize the urinary system
therapy
1. Pain therapy
- metamizole-1. Choice
- Alternatives – NSAIDs (Diclofenac, Paracetamol)
- Opioids
2. Conservative therapy (for stones <5mm)
- More exercise - Low
salt diet

- Increased fluid intake

3. Interventional therapy (for obstruction and urinary stasis kidney)
- Ureteral splint - Insertion of a double-J catheter
- Percutaneous nephrostomy 4.
Procedure of stone removal
- Ureterorenoscopy with stone removal - Percutaneous
nephrolithotomy - Extracorporeal shock
wave lithotripsy =ESWL
- Open and laparoscopic ureterolithotomy

From the patient:
1. What do I have, doctor?

o Mr. Winkler, I understand that you want to know the reason for your symptoms as quickly as possible, but in order
to confirm a diagnosis, we first have to carry out all the important tests, such as KU, laboratory, ultrasound. I
only have one suspicion at the moment
to a kidney stone. But that's just a suspicion and we need to prove it
still investigations.
2. If it is a kidney stone, what treatment options are there?
o It depends on how big the stone is. How severe is the urinary stasis on the ultrasound and the blood values. Most
stones are small and are cleared with the urine on their own with exercise and hydration.
3. What surgeries or procedures might be required if the stones are large?

o Other options such as ESWL, ureteral endoscopy and an external renal pelvis derivation. But, Herr Winkler, please
don't worry. Most cases, stones are small and will pass in the urine on their own with exercise and hydration.
4. ESWL assessment
o Please see explanations
5. It hurts so much, Doctor. Can you pass me the painkillers, please?
o The painkillers have been administered and you will be given one in a moment.
6. How long should I stay in hospital after the operation?
o This depends on the extent of the operation.
From the examiner:

1. What is the difference between pollakiuria and oliguria?
o Oliguria is less than 500 ml per day of the age-related physiological urine volume. Pollakiuria is characterized by
an increased frequency of emptying the bladder, usually with small amounts of urine.
2. Why did he have pneumonia? o Because of

childhood measles.

3. What is tendovaginitis?
o Tendovaginitis (tendonitis) is an inflammation of the muscle tendons and their sheaths.
4. Why does he have tendovaginitis?

o Due to a tennis match.
5. Difference between fructose and lactose?
o Fructose is the name given to the fruit sugar, which is mainly found in fruit and from it
manufactured products is included. o "Lactose"
is the milk sugar that is naturally only found in the milk of mammals.
6. Did father only have one toe amputated or several?

o Big toe only
7. What was the reason for the amputation?

o PAD with U. cruris
8. What should one do before telling the nurse to give a painkiller
should?
o Attachment of iv access
9. What are you doing next?
o IV administration of fluids + analgesia + antispasmodics and at the same time taking blood with laboratory tests: 2nd
laboratory: small BB, CRP, ESR, electrolytes, kidney values (creatinine, GFR), uric acid. Furthermore, U status
and instrument-based diagnostics.
10. Why do you measure uric acid?
o The stone may consist of urate (uric acid) in 5-10% of all cases, but 75% is
calcium oxalate stones.
11. What do the stones look like microscopically? o
As Hexagonal Crystals.
12. Which types of stones do you know?
o Strivu stones (magnesium phosphate) (10%)

13. Which imaging procedures do you do first?
o Abdominal sono
14. In what order are the organs in the abdomen examined with sono?
o Liver - gallbladder and bile ducts - spleen - kidneys - pancreas - prostate - urinary bladder (in
filled state) – uterus-intestine (only limited assessment possible)
15. What can be seen in the sono in urolithiasis?
o Urinary stasis dilated ureter ureters and renal pelvis, hyperechoic stone with the
Sound shadow of the stone
16. What is the name of the procedure when giving fluid and controlling diuresis?
o Fluid balance. In medicine, the liquid balance is the balance of the amount of liquid taken in and excreted or released.
17. What do you observe when palpating the abdomen?

o Percussion-painful renal bed, high bladder
18. What are the differential diagnoses for right crampy lower abdominal pain? o Intestinal diseases such as
appendicitis, diverticulitis, ileus and pyelonephritis

19. Which imaging procedure is required in this case?

o Abdominal ultrasonography and plain kidney x-ray.
20. What do you see in the x-ray?
o X-rays show stones as a radiopaque structure projecting onto the kidneys or ureters.
21. Would you use contrast media?
o No, because KM is contraindicated in obstruction

22. Which stones are visible in the X-ray examination and which are not?
o Stones containing Ca can usually be displayed very well
23. What speaks against pyelonephritis in this case? o No
fever and colicky pains
24. What are the palpation findings in appendicitis?
o Appendicitis is pain felt in the right lower quadrant on palpation (Rovsing's sign), an increase in passive extension
in the right hip that stretches the iliopsoas muscle (psoas' sign), or pain elicited by passive internal rotation of the
flexed thigh (obturator's sign).
25. What would be the ultrasound findings in appendicitis and cholecystitis?

o Wall thickening, fluid accumulation, gallbladder hydrops around the gallbladder or appendix, bile duct dilatation in
choledocholithiasis, cockade sign in appendicitis. The cockade phenomenon is a sonographic sign. In the
sonography, the intestinal section sees a ring-shaped course of the wall layers, which are alternately hypoechoic
and hyperechoic
26. What do you continue to do as therapy?

o First, analgesic drugs - Novalgin. Because of the acute condition, I would give it an iv.
27. Why don't we use Buscopan like we used to?
o Because of common side effects such as dizziness, fatigue, itching, hypotension and
tachycardia.
Comment!
Hello, I passed my exam on February 4th, 2022 for the first time. The Commission was very nice and spoke clearly. The
most important thing is to collect a complete medical history, the rest comes after that.
My case was urolithiasis and I have tried to write as much as I can remember. I hope it would be helpful.
Much luck!
INFO!
Ø A wasp sting initially produces a stinging pain. The wasp venom then leads to
immediate redness and swelling at the puncture site, which is also itchy and inflamed.

Ø Police officers maintain public safety and order. They fulfill a wide range of tasks: they
solve crimes, document traffic accidents and check suspects. At the same time, the
police are the first point of contact for citizens - they are the "friend and helper".
Ø ADHD Attention Deficit Hyperactivity Disorder is a behavioral disorder that occurs

primarily in children and is associated with poor concentration, motor hyperactivity and
increased excitability. However, motor hyperactivity is to be regarded as an optional
symptom, since a manifestation without hyperactivity (dreamers) is probably just as
common. Social behavior disorders are not uncommon.
Ø An amputation means the surgical or traumatic separation

a body part.
Ø A scoliosis is a lateral deviation of the spine from the longitudinal axis with rotation of
the vertebral bodies around the longitudinal axis and torsion of the vertebral bodies -
accompanied by structural deformations of the vertebral bodies.
Ø Cataract is an eye disease in which one or both lenses of the eye become cloudy. As a
result, the eyesight deteriorates and fine details in particular are no longer seen clearly.
Ø Measles is a notifiable, highly contagious infectious disease that is one of the typical
childhood diseases, but can also affect adults.
Measles are caused by the measles virus, the infection occurs through droplet infection.
Ø Burns Local damage to the body as a result of intense heat can occur in many ways,
for example contact with an open flame, hot objects, liquids or gases, but also through
electricity or mechanical friction. If the injury is caused by boiling water or steam, it is
referred to as scalding.
Ø Diltiazem is a calcium channel blocker and antiarrhythmic drug used to treat

Cardiovascular diseases is used.

Ø Creatinine is a metabolite of creatine from muscles. Creatine, in turn, is important for muscle contractions. In
medicine, creatinine is primarily used as a laboratory parameter for kidney function.
Ø The glomerular filtration rate (GFR) is the volume filtered per unit time by the glomeruli of the kidneys. It is
usually given in units of ml/min and is one of the most important parameters for assessing kidney function.
pyelonephritis
patient
First name, last name: Kai-Uwe Fuchs, age: 32 years, height: 176 cm, weight: 74 kg.
- Amoxicillin with exanthema skin rash all over the body, (in treatment of Lyme disease)
- Birch pollen with rhinoconjunctivitis hay fever
- Soy intolerance with meteorism bloating
stimulants
• Nicotine consumption: Shisha (water pipe) occasionally for 5 years • Alcohol

consumption: ½ bottle of wine spritzer 1-2 times a week. • Drug use: 1 joint
weekend since student time.
social history
He is a chemistry student in the 12th semester, single, lives with his girlfriend (their wedding is planned in 2
weeks), has a healthy 10-month-old son.
family history
§ Father: 73 years old, suffering from PAD intermittent claudication in left leg
§ Mother: 71 years old, suffering from lumbar spine herniated disc prolapsed disc for 3 months and
from adrenocortical carcinoma adrenal cortical cancer (carcinoma was an incidental finding on MRI
due to lumbar disc prolapse)


previous operation)
Mr. Fuchs is a 32-year-old patient who has been with us since yesterday afternoon because of progressive,
stabbing, cramping, severe flank pain on the right side that radiates into the pelvis and a fever of around 39.6°C
introduced.
In addition, he noticed the following accompanying symptoms: Nausea

Dysuria painful urination, pollakiuria frequent urination in small amounts hematuria blood in the urine , nocturnal
hyperhidrosis night sweats, and double vomiting vomiting.
The vegetative anamnesis is unremarkable except for stress-related insomnia sleep disorder (because of his
marriage in 2 weeks) and constipation for 3 years.
• Hypotension low blood pressure for 3 years with vertigo dizziness (he was in a motorcycle accident. He
fell off the motorcycle on his left side and injured his neck. He was wearing a helmet
carried. Since then he has been dizzy from time to time. He's taking Effortil and I feel better) ,
• Whiplash distortion 3 years ago in a Zn motorcycle accident
treated conservatively.
• Pyrosis heartburn occasionally, for 4 weeks, • Clavus corn

on the left little toe (It's a trifle - trifle) ,
• Lyme disease from Zn tick bite on left lower leg 2 years ago (just before his 30th birthday, his lower leg
was red, warm and swollen) was treated with antibiotics for 10-12 weeks.
He was operated on at the age of 29 for perforated appendicitis and a ruptured appendix .
medication
- Effortil 25 drops every 3 weeks

- Omeprazole 20 mg 1-1-0
- Valerian dragees 0-0-0-1
The anamnestic information most likely points to pyelonephritis.
Urolithiasis and appendicitis should be considered in the differential diagnosis.

Another ancestor
1. CU:
- On palpation- throbbing pain in the lumbar region
2. Laboratory: small BB, CRP, ESR, kidney values, uric acid, electrolytes
3. U-status: leukocyte, erythrocyte, proteinuria and nitrite
4. Urine culture with pathogen and resistance testing
5. If necessary, kidney sono: to rule out complicated urinary tract infection and reflux 6. If
necessary, CT kidneys
therapy
1. Sufficient fluid intake (at least 1.5 L/day)
2. Possibly analgesics (metamizol) + spasmolytic
3. If necessary, antipyretic (paracetamol) at T>38.5 C
4. Antibiotics
- Fluoroquinolones (Levofloxacin) – 1st choice
- 3rd generation cephalosporins (ceftriaxone) - alternative

1. Lots of little things like: What is the character of pain? When did the pain start? What other symptoms does he
have? How was the course of the disease?
2. When will he marry?
o He will get married in two weeks
3. Do you think that in 2 weeks he will already be healthy and fit again?
o Yes, actually after weekly antibiotic therapy he can get well again
4. How did he describe heartburn?
o Like uncomfortable burning sensation behind chest.

5. What does he take against
it? o He is taking omeprazole 20 mg 1-1-0
6. Does he have a prescription
for it? o I didn't ask about it
7. If he had no improvement in pyrosis, what would you recommend?
o I would recommend a gastroenterology presentation with EGD.
8. When did he discover the allergy to amoxicillin?
o This was found during antibiotic treatment for Lyme disease

9. What is Lyme disease?
o Lyme disease is an infectious disease caused by bacteria

is triggered. It can be transmitted by tick bites.

10. What is the difference between Lyme disease and TBE?
o Lyme disease is a bacterial infection (Borrelia burgdorferi, a motile, spiral-shaped bacterium) for which there is no
vaccine but is easily treatable with antibiotics. In contrast to TBE, which only occurs in certain regions (e.g. in
Bavaria). Tick-borne encephalitis (TBE) is an inflammation of the brain and meninges caused by viruses.
11. How exactly did he describe the hypotension and dizziness?
o He had a motorcycle accident. He fell off the motorcycle on the left side and injured his neck. Was wearing a helmet.
Since then he has been dizzy from time to time. He
I take Effortil and I feel better.
12. What are valerian dragees?
o Valerian is a herbal medicine and is used to calm down, lighter

nervous tension and insomnia.
13. What did the patient say when discussing Clavus?
o This is a trifle
14. Do you know what trivia is?
o It's a banality and doesn't mean much.
15. What is wine spritzer?
o A wine spritzer is a mixture of: wine with mineral water,

16. What's up with the mother?
o She suffers from lumbar disc prolapse for 3 months and from adrenocortical carcinoma.
Carcinoma was an incidental finding on MRI due to lumbar disc prolapse.
17. What is an MRI?
o MRI screening
18. What is claudication?
o Peripheral arterial occlusive disease (PAOD) is a circulatory disorder, mostly in the legs and much less often in the
arms. The cause is in the vast majority
Cases of vascular calcification, arteriosclerosis.
19. What is your suspected diagnosis? And differential diagnosis?
o The anamnestic information most likely points to pyelonephritis. o Urolithiasis and appendicitis can
be considered in the differential diagnosis
20. What are the complications of pyelonephritis?
o Chronic pyelonephritis leads to progressive loss of functional kidney tissue up to renal insufficiency. Complications
include urosepsis, paranephric abscess, atrophic kidney, and hypertension.
21. How do you treat pyelonephritis, especially in this patient?

o Pat is allergic to amoxicillin please see , we have to be careful with antibiotics. Otherwise
“Therapy”
22. What are the most common pathogens?
o Escherichia Coli (about 70% of all cases), Proteus mirabilis, Klebsiella.

Comment!
Dear colleagues, on May 5th I took the FSP for

the first time in Munich and thank God I passed. My case was poor Kai Fuchs with pyelonephritis.
The patient spoke clearly, beautifully but at a fast pace, there were many little things that weren't important, but they were
asked in the third part. You have to write fast and listen carefully, some details you just have to keep in your head for an
hour.
I introduced the patient in a hurry, the senior physician often interrupted me to ask me about little things, sometimes he
tried to confuse me (which other allergies does the patient have? only these two, no other allergies or intolerances)
A few questions about the medicine, I didn't know everything and just said I don't know, the most important thing is to have
a good medical history and to be able to answer the questions about the medical history.
My tips:
1- Take it easy
2- Emphasis on the first point
INFO!
Ø The soybean is a vegetable that belongs to the legumes and to the botanical
Belongs to the legume family (bot. Leguminosae).
Ø Chemistry is a natural science. It deals with fundamental phenomena and laws of structure, properties and
the transformation of substances in our environment through chemical reactions.
Ø Adrenocortical carcinoma (carcinoma of the adrenal cortex) is a malignant, parenchymal tumor which can
originate from any layer of the adrenal cortex (zona glomerulosa, zona fasciculata, zona reticularis).
Ø Whiplash (also called acceleration trauma) is an injury to the muscles, ligaments and tendons in the area
of the cervical spine (cervical spine), which is caused by rapid, severe bending followed by severe
overstretching of the head and a corresponding strain in the neck. The injuries are mostly uncomplicated
muscle strains or torn ligaments. Disc, bone, blood vessel, and nerve injuries only occur with whiplash
rarely on.
Typical complaints are above all movement restrictions, pain and muscle tension in the neck area (at rest
and when moving) as well as headaches.

Ø A clavus is a local keratinization disorder of the skin (calluses) that occurs as a result of chronic mechanical
irritation (pressure, friction) of the affected skin area.
Ø Effortil is a direct sympathomimetic that is used for circulatory problems (blacking out of the eyes),
hypotension, tiredness and dizziness. It is available in drop and tablet form.
Ø In clinical parlance, the urine status refers to the results of the examination of the urine. A urine status can
be used as a guide using a rapid test
or collected in detail in the laboratory.
Ø A urine culture examines whether the urine contains pathogens. In a laboratory, a sample of midstream
urine is placed in a container. Then plates with culture media on which pathogens can grow are dipped into
the sample and the container is tightly sealed. The urine culture is then placed in an incubator for 1 to 2
days. If bacteria or fungi are present in the urine, they can grow into colonies.

FSP in Bavaria 2023

angiology
Peripheral Arterial window sickness
Disease (PAD)
rhinoconjunctivitis hay fever
exanthema skin rash
pruritus itching
effluvium hair loss

edema swelling
paresthesia Tingle
hypesthesia numbness
insomnia sleep disturbance
diabetes mellitus diabetes
hypercholesterolemia Elevated blood fat levels
prostatic hyperplasia Enlargement of the prostate gland
Percutaneous Transluminal Coronary Cardiac catheterization with stenting
Angioplasty (PTCA)
pilonidal sinus Pilonidal sinus
phlebothrombosis Deep vein thrombosis (DVT)

exanthema skin rash
lactose intolerance Lactose intolerance
gastralgia stomach pain
diarrhea diarrhea
ADHD attention deficit/
hyperactivity disorder
mesenteric infarction intestinal infarction
coxarthrosis hip joint wear

varicose veins varicose veins
obesity obesity / obesity
Bariatric surgery edema Stomach Reduction Surgery
swelling
hyperthermia overheat

constipation constipation
Arterial hypertension high blood pressure
Recurrent tendovaginitis tendonitis

Eczema on the supercilium eyebrow
Distal radius fracture wrist fracture
the fracture of the os carpi wrist fracture
Leg Ulcer open leg
diarrhea Diarrhea
pruritus itching
erythema redness
apoplexy cerebri stroke
Scarlatina Scarlet fever
cholangiocarcinoma Malignant bile duct tumor

intestinal perforation intestinal perforation
anus praeter Artificial anus

ulceration ulcer
Medial malleolus inner ankle
Malleouls lateralis lateral malleolus
excretion discharge
edema Circumference increase/swelling
hyperpigmentation Brown skin discoloration
exertional dyspnoea exercise-related shortness of breath
exacerbation Relapse/worsening of symptoms

phlebothrombosis DVT
varicose veins varicose veins
polypectomy polyp removal
appendectomy appendectomy
otitis media otitis media
Internal otitis inner ear infection
otitis externa Ear canal inflammation

cardiology
Acute Coronary Syndrome (ACS)
abdominal pain stomach pain
erythema redness
mandible lower jaw
vertigo dizziness
nausea nausea
dyspnea Shortness of breath
nocturia nocturnal water lascivious
pediculosis capitis head lice infestation

acetabular fracture acetabular fracture
heart failure
erythema redness
mandible lower jaw
vertigo dizziness
nausea nausea
dyspnea Shortness of breath
nocturia nocturnal water lascivious

acetabular fracture acetabular fracture
exanthema skin rash
dyspnea shortness of breath/shortness of breath
cough Dry cough
quadriplegia Complete paralysis of all extremities

osteosarcoma bone cancer

Thoracic tightness chest sensation

orthopnea shortness of breath in supine position
edema swelling
vertigo dizziness
fatigue exhaustion/fatigue
nocturia Nocturnal urination
hypercholesterolemia Elevated blood lipids

pancreatitis inflammation of the pancreas
coronary angiography cardiac catheterization
pneumology
pneumonia lung infection
exanthema skin rash

meteorism gas
pneumoconiosis pneumoconiosis
adhesions adhesions
tachypnea rapid breathing

rhinorrhea flowing nose
Nocturnal hyperhidrosis night sweats
cephalgia Headache
chest pain chest pain
epistaxis nosebleeds
fatigue exhaustion / tiredness

meteorism gas
inappetence loss of appetite

Lentigo solaris age spots
Temporal region temple area
Burn Out Syndrome emotional exhaustion

Arthritis urica/uricopathy gout
Podagra gout attack
Chronic lumbago lumbar pain

thenar thumb ball
mucolytic expectorant
bronchial asthma

Allergen Immunotherapy hyposensitization
abortion miscarriage
rehab Treatment for addictions
nephrolithiasis Kidney stones
scotoma visual field loss
Thoracic tightness chest sensation

sputum sputum
cough Dry cough
expiration Exhale
Gripal infect A cold

cervicalgia neck pain
Panaritium nail ulcer
Bronchial hyperreactivity Sensitive bronchi
rhagade cracks
Os zygomaticum fracture cheekbone fracture
Corpus liberum / Arthrolith free joint body
gastroenterology
esophageal carcinoma esophageal cancer
rhinorrhea runny nose
epiphora teary eyes

exanthema skin rash
Gastric ulcer gastric ulcer

colon carcinoma colon cancer

dysphagia swallowing disorder
odynophagia Painful swallowing disorder

Hypersalivation/Sialorrhoea increased salivation
regurgitation Backflow of the contents of hollow organs
Globus hysteric lump in throat
melena tar stool
gag reflex retching
auricular dysplasia auricle malformation
extrasystole heart palpitations
rib contusion rib bruise

inguinal hernia hernia
bursitis bursitis
Gastric ulcer gastric ulcer

pruritus itching
exanthema skin rash
angioedema facial swelling
PAD window sickness
Leg Ulcer open leg
colostomy Creation of an artificial anus

Postprandial after the meal

melena tar stool
pyrosis heartburn
Inappetence loss of appetite

arterial hypertension high blood pressure
psoriasis vulgaris psoriasis

colon resection Removal of a portion of the colon

hematemesis Bloody vomit
phlebothrombosis DVT
urolithiasis urinary stone
thyroidectomy thyroid removal
cholecystolithiasis gallbladder stone

meteorism gas
colon resection Intestinal removal
leg edema leg swelling
Postprandial after the meal
nausea nausea
pyrosis heartburn
hypercholesterolemia increased blood lipids
disc prolapse disc prolapse
Unguis incarnatus Ingrown nail

appendicitis ruptured appendix
Chronic inflammatory bowel disease (IBD)

paresthesia Tingle
esophageal varices Varicose veins of the esophagus

ileus intestinal obstruction
emesis Vomit
diarrhea Diarrhea
hematochezia blood in the stool

inappetence loss of appetite,

arrhythmia cardiac arrhythmia

extrasystole heart palpitations
psoriasis psoriasis
septal fracture broken nose
herpes zoster shingles
meningitis meningitis
mandibular fracture mandibular fracture

paresthesia Tingle
diarrhea Diarrhea
colonoscopy colonoscopy
paradoxical diarrhea Alternating diarrhea and constipation

defecation bowel movement
reflux acid regurgitation

ructus burping
hematochezia blood in the stool
pyrosis heartburn
articulation of the humerus shoulder joint fracture
Cravings for sweets increased appetite for sweets.
GERD reflux disease

Frontal sinusitis frontal sinusitis
hypothyroidism hypothyroidism
exanthema skin rash
pruritus itching
lissencephaly brain malformation

Addison's disease adrenal insufficiency

listlessness no ability for goal-directed activity

facial edema facial swelling
cold intolerance intolerance to cold
Bradycardia slowed heartbeat
depressed mood dejection
dysphonia Hoarseness/Rough voice
alopecia hair loss on the head

onychorrhexis brittle nails
scaphoid fracture scaphoid fracture
hyperthyroidism hyperthyroidism

anorexia nervosa anorexia
peritonitis peritonitis
tremor Tremble
tachycardia tachycardia
alopecia hairlessness
myopia myopia
polyphagia Abnormally increased food intake
polydipsia increased thirst
low back pain Low back pain / lumbar pain

cholelithiasis gallstone disease
phimosis foreskin constriction
glaucoma Glaucoma / increased intraocular pressure
thenar thumb ball
myxedema connective tissue proliferation

exophthalmos Eye prolapse / googly eye
homogeneity similarity

hypoglycemia hypoglycaemia
diarrhea diarrhea
ocd obsessive compulsive disorder
Paranasal sinus carcinoma Cancer of the paranasal sinuses

tremor Tremble
hyperhidrosis sweats
palpitations palpitations
nocturia nocturnal urination
osteoarthritis ankle wear
Axillary tinea fungal infection in the armpit
arrhythmia cardiac arrhythmia

phlebitis phlebitis
hematology
Hodgkin lymphoma
generalized exanthema of full body rash
abdominal pain a stomach ache
laryngeal carcinoma Laryngeal carcinoma

hemorrhagic insult cerebral hemorrhage
more indolent painless
Lymphadenopathy lymph node enlargement

nocturnal hyperhidrosis night shit
asthenia powerlessness
hyperlipidemia High blood lipid levels
conjunctivitis conjunctivitis
boil purulent skin inflammation
Commotion cerebri concussion
pyelonephritis inflammation of the renal pelvis

acute leukemia Malignant diseases of the

hematopoietic system
thyroid carcinoma thyroid cancer
gingival hemorrhage bleeding gums

hematoma bruises
meteorism gas
Atopic dermatitis neurodermatitis
tendinitis tendinitis
intoxication poisoning
migraine
erythema skin rash
pruritus itching
meteorism gas
diarrhea diarrhea
anorexia nervosa anorexia
scoliosis spinal curvature
cephalgia Headache
nausea nausea
emesis Vomit
photophobia photophobia/photosensitivity
photopsia Perception of light phenomena such as
Flashes, sparks or flickers
vertigo dizziness
paresthesia Tingle
meteorism gas
Unguis incarnatus Ingrown nail

herpes labialis cold sores

epilepsy
exanthema skin rash
eyelid edema swollen eyes
cardiac septal defect cardiac septum defect
keratitis corneal inflammation
Corneal transplant/ keratoplasty corneal transplant
generalized full body
myoclonus muscle twitches
photopsia Perception of light phenomena such as
Flashes, sparks or flickers
cephalgia Headache
myoclonus muscle twitches
myalgia Muscle aches
diarrhea Diarrhea
Colon irritable irritable bowel syndrome
retroauricular behind the ear
acetabular fracture acetabulum
suppository suppository
alcohol intoxication alcohol intoxication

tonsillar angina tonsillitis

exanthema skin rash
meteorism gas
scoliosis quartz dust lung
strangulation ileus Intestinal obstruction with circulatory disorders
adhesions adhesions
Odynophagia painful swallowing
yellow nasal discharge yellowish discharge from the nose

sputum sputum
nocturnal hyperhidrosis
extremity pain body aches
cephalgia Headache
epistaxis nosebleeds

meteorism gas

Lentigo solaris age spots
Burn Out Syndrome emotional exhaustion

Podagra gout attack
nephrolithiasis kidney stone

thenar thumb ball
Infectious mononucleosis glandular fever

light eruption sun allergy
vesicle blisters
pruritus itching

Goiter malignant thyroid cancer

retinopathy retinal disease
retinal detachment retinal detachment
odynophagia pain when swallowing
cephalgia headache
Cervical Lymphadenopathy Enlarged lymph nodes in the neck
Foetor ex ore /Halitosis bad breath
meteorism gas
nasal septum fracture nasal septum hernia
achillodynia Achilles tendon pain syndrome

alcohol intoxication alcohol intoxication
Wrist fracture + rib fracture

Distal radius fracture wrist fracture
dyslexia reading disorder
basalioma White skin cancer
bulimia nervosa Bulimia nervosa
chest pain chest pain
inspiration breathe in
excoriations Skin abrasions/abrasions
hematoma bruises / bruises
edema swelling
Cervical disc herniation disc prolapse
Arterial hypotension low blood pressure

onychomycosis nail fungus
hidradenitis sweat gland abscess

Wrist fracture + hip joint distortion

distortion sprain
tinnitus tinnitus
melanoma Black Skincancer
hepatitis liver inflammation
excoriations Skin abrasions / abrasions
edema swelling
Pediculosis capitis head lice infestation

chronic sinusitis sinus infection
food poisoning food poisoning
cholecystectomy gallbladder removal
Patella fracture + hip joint distortion

patella fracture kneecap fracture

epiglottitis epiglottis
hypacusis deafness
parotitis Mumps / Goat Peter
edema swelling
crepitation Crunching / crackling noises
clavicle fracture break of collarbone
tonsillar angina tonsillitis
Corpus liberum / Arthrolith free joint bodies

ankle sprain ankle sprain
erythema redness
pruritus itching
hypacusis deafness
cataract cataracts / lens opacity

lens transplant transplant
breast cancer breast cancer
obesity obesity / obesity

Bariatric Surgery Stomach Reduction Surgery
edema swelling
cyanosis Blue rash / blue skin discoloration
diarrhea Diarrhea
meteorism gas
Podagra gout attack
disc prolapse disc prolapse

Colon irritable irritable bowel syndrome
vocal cord nodules Singer/Scream Nodule
bursitis bursitis
poly trauma
erythema redness
scotoma visual field loss
sternum osteomyelitis sternum infection

vertigo dizziness
nausea nausea
syncope unconsciousness
emesis Vomit


edema swelling
hypothyroidism hypothyroidism
Osteitis pubis pubic inflammation

Diffuse external otitis ear canal eczema
phimosis foreskin constriction
1st degree TBI Concussion / Commotio cerebri
shoulder joint distortion shoulder sprain
blunt abdominal trauma abdominal trauma
retrograde amnesia memory loss before an injurious

Event
Congrade amnesia Loss of memory of the damaging event
anterograde amnesia memory loss after an injurious
Event
rupture of the spleen ruptured spleen
spleen rinse
pruritus itching
exanthema skin rash
meteorism gas
strabismus squinting
coxarthrosis hip joint wear
hematuria blood in the urine
abdominal edema swollen

meteorism gas

Cervical disc herniation

Solar urticaria sun allergy
vesicles blisters
abdominal pain stomach pain
basalioma White skin cancer

paresthesias Tingle
monoparesis paralysis
Functional extrasystole heart palpitations
Eczema of interdigital spaces interfinger space

cruciate ligament rupture cruciate ligament tear
inguinal hernia inguinal hernia
Lumbar disc herniation

exanthema skin rash
pruritus itching
meteorism gas
Balbuties Stutter
hip dysplasia Malformation of the hip joint

macular degeneration retinal diseases of the eye
low back pain lumbar pain
paresthesia Tingle
meteorism gas

tinnitus Ringing in the ears / ringing in the ears
shoulder joint fracture shoulder fracture
bursitis bursitis

urolithiasis urinary stone

rhinitis hay fever
lactose intolerance milk intolerance
meteorism gas
diarrhea Diarrhea
PAD window sickness

Leg Ulcer open leg
scoliosis spinal curvature
cataract cataracts / lens opacity
dysuria painful urination
pollakiuria frequent urination in small amounts

emesis Vomit
hyperhidrosis sweats
tendovaginitis tendonitis
Morbilli measles
with pneumonia lung infection
Combustio combustion

exanthema skin rash
meteorism gas
PAD window sickness
disc prolapse disc herniation
carcinoma adrenocortical cancer
nausea nausea
dysuria painful urination
pollakiuria frequent urination in small amounts

nocturnal hyperhidrosis night sweats

emesis Vomit
hypotension Low blood pressure
vertigo dizziness
distortion whiplash
pyrosis heartburn
clavus corn

FSP in Bavaria 2023

reactions and empathy

Pains
I am in severe pain.
• Madam/Mr... I can tell you can't take the pain anymore . Do you want me to give you painkillers right
away or can you take the pain until the end of the intake interview
endure?
no i need one
• Can you please tell me if you have any allergies to painkillers? • You'll get one soon
Yes, I can take it

• I'll give you one as soon as we're done here.
stress and anxiety

I am stressed because of (work, family, illness etc…) • Sir/
Madam, how do you deal with it? • I understand
you, sir/madam... I'm really sorry. If you wish, I can organize psychological help (care) for you. • If you
wish, I can be happy at the end of the
admissions interview for your child/marriage/
Relatives recommend specialist care.
I'm afraid. (of examination/anesthesia/therapy ...)

• Mr. Mrs ..., I can understand your fear very well, but please don't worry!
There's no reason to be scared right now!
• Our team is highly qualified and experienced, so please calm down.
• You are in good hands and our team will do everything to make you healthy again.
I'm scared of radiation. / Is CT / X-ray examination dangerous?

• Sir/Madam... please don't worry. The exposure to radiation here is too low and
You don't almost always need a CT/X-ray scan.
Can it be cancer?
• I can understand your fear very well, but please calm down. You shouldn't start right away
think worst case
• There can be many causes for your complaints, so we have to look at a few first
Carry out investigations so that we can say an accurate diagnosis.
• Cancer is not 100% hereditary and I advise you to think positively as much as possible.

noxae
I do not smoke anymore.
• Mr/Mrs..., you have made a very good decision to give up smoking.

I think your decision is very important for your health.
If patient smokes less.

• Sir/Madam... you have made a very good decision to reduce your nicotine consumption
have. I think your decision is very important for your health.
Why are you asking about drugs? Do I look drug addicted?

• No sir/madam… of course you don't look drug addicted . • This is just a routine
question that we should ask of all our patients. Please take
Don't do that personally.
Nicotine/Alcohol/Drugs - Why is it important?

• Noxae count as risk factors for various diseases. That's why I have to be precise about Noxen
knowledge.
• Drugs/alcohol can interact with medication and this can be dangerous for you
be you
Can you drink a glass of wine every day?

• Sir/Madam..., there is an opinion that the small amount of wine actually has positive effects on health. On the other hand, one
should not consume wine excessively because it can have harmful effects on our health.
In emergency situations (ACS, polytrauma, rupture of the

spleen) • Mr./Ms.... Your case is an emergency, so we have to end our conversation here
and carry out other important diagnostic and therapeutic measures. But this is just an
exam, so we can continue the admissions interview.
! You should tell the Commission, even after the interruption, that you believe an emergency exists or may exist. Then you
can continue.
For insomnia / constipation

I have insomnia / constipation. • Sir/Madam,
if you like, I can do something for you about insomnia / constipation
administer
Diagnosis and further action

Do you already know what I have?
• Sir/Madam, ..., I understand perfectly that you need to find out the reason for your complaint as soon as possible
but I can't give you an exact diagnosis right now without further investigation.
• Based on the information mentioned, I only have a suspicion of ......, but that remains only as
suspicion. We complete all examinations first, then we can clarify your diagnosis.

If the suspected diagnosis is confirmed, is that dangerous?

• Sir/Madam... please don't worry. You are in good hands and the situation is
currently not life threatening.
What will you do next for me?
• First I will examine you physically, then I will draw blood and some
Arrange investigations (such as ...).
• Then I discuss your complaints with my senior physician and finally I come back and
we will discuss how to proceed.
Is this investigation really necessary?

• In your case, this examination is meaningful so that we can rule out the possible diagnosis
and continue to treat you properly.
Can I be given anesthesia or sleeping pills during this examination?

• No anesthesia or sleeping pills are necessary for this examination. If you want I can give you
but give a sedative.
Can this disease be treated without surgery?

• There are always conservative procedures as an alternative option to surgical treatment. The
Surgery is the last option to treat a disease because it cannot be reversed
be made.
• Of course, not every disease can be treated conservatively in every person, which is why we inform you about the possibilities
and opportunities, but also about the risks before treatment
become.
Why should you lie still during a CT/MRI?

• As long as the examination is ongoing, you should lie as still as possible to avoid blurry images
can be avoided.
Why should I take off all metal and electronic objects (e.g. jewellery, piercings, keys, hearing aids, pacemaker, watch, belt and
mobile phone) until the MRI?
• Objects such as jewelry and piercings should be removed as they can disrupt the magnetic field
can result, therefore, the image quality will be severely spoiled.
• In this case we have to repeat the examination.
What does sectional images mean?
• Sir/Madam... please calm down. This only happens on the computer and you stay as one
Piece.
I am afraid that I may get infections after the examination.

• All items used in the examination would be sterile, single-use items. This means that these items are intended for single use only.
In addition, our rooms and equipment are completely sterile. So don't worry!

In case of doubt
Can I speak to the senior / chief physician?

• Mr. Mrs ..., I can understand that well. Of course, everyone wants the best care, but you are in good hands. We always
work as a team and make important decisions
together with senior and chief physician.
• I ask you not to worry about this. We do the best for you!
Why do you often ask again?

• Unfortunately I didn't hear your answer correctly acoustically . Sir/Madam, can you please again
repeat?
• To be on the safe side, I have to ask again because this information is very important to me
is.
You look too young.

• I'm not as young as I look, I have enough experience and besides we always work
as a team, so if in doubt I can talk to my senior and chief physician.
Why are you asking so many questions?

• Ms/Mr..., I understand you quite well, but all these questions are very important to make the possible diagnosis. Therefore, we
can carry out proper examination and treatment.
• I need an overall picture of your condition because there are several factors affecting your situation
can influence.
• I promise we'll end our conversation as soon as possible.
situations
When the patient's birthday • Mr./
Mrs.... Happy Birthday!
If you don't know the answer
• Sir/Madam... That's a very good question, but can we finish our conversation first and then I'll be happy to answer all your
questions?
When the patient speaks quickly.

• Sorry for the interruption, but unfortunately I can't write everything down that quickly. All these
Information is very important to me.
• I would therefore ask you to speak a little more slowly and clearly.
• If I misunderstand something, that may lead to wrong diagnosis
If patient interrupts often.
• Mr/Mrs..., unfortunately our time is limited and if we were always distracting from the conversation , I would not be able to ask
all the important questions. • If you agree, we're more
than welcome to discuss everything at the end of our conversation.
When patient talks about unimportant topics

• Mr./Ms...., sorry for the interruption. All of this information is very important to me, but I would ask you to finish our interview
first. After that I can chat with you and answer all your questions
• I would now like to hear from you about current complaints /VE /ME….

When patient does not know the name or dosage of the medication.
• This is not a problem. Could you please give me the contact details of your family doctor? Therefore I can
contact him/her and ask all important questions about small things
Do I have to take early retirement then?

• In this regard, you should go to your family doctor and, if he finds it necessary, he will
submit an application to the pension institution .
• In any case, we will send the doctor's letter to your family doctor and he will take it with you
submit.
Inpatient admission and care

Do I have to stay in the hospital now?
• At the moment we can't say exactly whether you should stay here. First we have to do all the important
investigations, then we can made a decision.
I absolutely have to go home! My home alone

• Please don't worry about this. If you don't have anyone, we will contact social services and organize
suitable care for your children/parents/marriage/pets.
• We have a social service and we speak to the people in charge, they will then organize care for your
children/parents/marriage/pet , so please don't worry.
I have to go home to collect my stuff!

• Don't you have someone who can bring your things to you? •
You don't need any stuff from home, you get everything you need from us.
I have to go to work, I'm in trouble!

• Sir/Madam, please don't worry. You have to get well first and you will receive a certificate of incapacity for
work (sick leave) and we will send a copy to your employer. Therefore you will not have any problems
• Of course, I can understand that your work is important, but your health is even more important
pregnancy
In young women / If the patient is pregnant.
• I need to know if you are currently pregnant? • If you are
pregnant, we cannot do X-ray examinations on you
carry out because the radiation is harmful to the fruit.
• Also, some treatments/medications can be harmful to the fetus.
• We can do an MRI instead of a CT/X-ray scan.

FSP in Bavaria 2023

X-ray examination/CT/MRI
X-ray examination
X-ray is a modern, painless and non-invasive examination to visualize and assess organs and internal structures
using X-rays.
This examination does not require any special preparation.
The examination usually takes place while standing or lying down.
The device takes an image (of the skull, chest, abdomen...) and then displays it on a screen.
The X-ray usually takes about 5 minutes
Radiation exposure here is very low, so there is no complication
Computed tomography (CT)

CT is a modern, painless and non-invasive examination for the detailed representation and assessment of
organs and internal structures using X-rays.
They lie down in a tubular device. With the help of the device, many cross-sectional images of your body are
irradiated in layers from all directions and then displayed on a screen.
You must remain as still as possible during the examination. Sometimes it is necessary to hold your breath in
order to be able to produce sharp images.
In some cases, a contrast medium containing iodine must be injected into a vein or administered orally at the
beginning of the examination to improve the differentiation of certain structures.
Only in the case of an examination with contrast medium should you be sober for 2 hours before the examination
and you should check your kidney values and not be allergic to contrast medium.
It usually takes 5 to 10 minutes.
Theoretically, a few complications can occur very rarely (such as allergy to contrast media).

Magnetic resonance imaging (MRI)

Magnetic resonance imaging is a modern, painless, non-invasive, radiation-free examination to visualize and assess organs and
internal structures using the magnetic field.
This examination does not require any special preparation. You only need to put down metal objects as well as jewelry (pen, glasses,
belt, keychain, earrings, coins, etc.)
If you're scared, we can give you a sedative. You can also press the emergency button at any time and we will stop the investigation
and pull you out of the device.
They lie down in a tubular device. With the help of the device, many cross-sectional images of your body are irradiated in layers from
all directions and then displayed on a screen.
You must remain as still as possible during the examination. Sometimes it is necessary to hold your breath in order to be able to
produce sharp images.
In some cases, a contrast medium containing iodine must be injected into a vein or administered orally at the beginning of the
examination to improve the differentiation of certain structures.
Only in the case of an examination with contrast medium should you be sober for 2 hours before the examination and you should
check your kidney values and not be allergic to contrast medium.
It usually takes 20-30 minutes.
Theoretically, a few complications can occur very rarely (such as allergy to contrast media).
blood tests
Taking a blood sample
Taking a blood sample is a diagnostic procedure in which a certain amount of blood is taken
and examined in a laboratory. By taking a blood sample, the composition of the blood can be
checked and possible diseases or deficiencies can be identified.
The skin of the puncture site should be disinfected first. Then I will needle through skin into vein
introduce. It stings, but please don't be alarmed. I draw blood through the needle and right at the end I remove the needle. The puncture
site must then first be printed with a swab and then glued with a wound plaster.
Blood collection usually takes 3-5 minutes.
You should remain sober before the examination.

Blood gas analysis (BGA)

BGA is a blood test to measure the gas distribution of O2 (oxygen), CO2 (carbon dioxide), pH and acid-base
balance in the blood. Arterial blood, capillary blood and possibly venous blood are used as the material.
First, the skin of the puncture site must be disinfected. Then I'll go through the skin in the needle
insert artery. It stings, but please don't be alarmed. I draw blood through the needle and right at the end I
remove the needle. The puncture site must then first be printed with a swab and then glued with a wound
plaster.
Blood gas analysis usually takes 3-5 minutes.
angiology
Color-coded duplex sonography (FKDS)
Compression ultrasound is a modern, painless, non-invasive, uncomplicated and color-coded examination to
assess the structure of vessels. This examination also helps to determine the exact localization of circulatory
disorders. E.g. vasoconstriction and
lock.
First, a gel is applied to the transducer so that there is even contact between the transducer and the surface
of the body. The ultrasound machine sends ultrasound waves through the transducer into the tissue. The
ultrasound waves are reflected differently by the tissue depending on its structure.
The transducer catches these reflected waves and displays images on the screen.
The probe is pressed on the vein to be examined and its compressibility is checked.
- If the vein is patent, it can be fully compressed.
- If there is a thrombosis, then it is not or only slightly compressible.
This examination takes 20-30 minutes.
There are no complications and you don't need any special preparation.

Doppler sonography
Doppler ultrasound examination is a special form of ultrasound examination that uses the Doppler effect and
color coding to provide a visual representation of blood flows. This examination also helps to determine the exact
localization of circulatory disorders, such as vascular narrowing and occlusion.
First, a gel is applied to the transducer so that there is even contact between the transducer and the surface of
the body. The ultrasound machine sends ultrasound waves through the transducer into the tissue. The ultrasound
waves are reflected differently by the tissue depending on its structure.
Transducer catches these reflected waves and displays images on the screen. With color coding you can still
see and hear blood flow.
It is totally uncomplicated and you do not need any special preparation for it.
Angiography (CT/MRI)
This is a modern, painless, non-invasive examination of blood vessels using X-rays (CT) or magnetic fields (MRI).
Before the examination you need a special preparation. You should be fasting for at least 4 hours before the
examination and anticoagulant medication should be stopped early. Contrast medium is used for this examination,
so if you are allergic to contrast medium, you should let us know in good time.
General anesthesia is not necessary here. If you're scared, we can give you a sedative.
A needle is inserted into it, so the puncture site must first be disinfected. You will then be given a local anesthetic
so that you do not feel any pain when the needle is injected. We insert a special thin needle into an artery
(artery) / vein (vein). A thin, flexible wire is pushed into the blood vessels through this needle. A contrast agent
is then injected and a series of X-rays are taken immediately. Through these images we see and judge the
vessels.
The examination usually lasts 30-40 minutes. After the examination, you will stay with us in the ward for 12 hours
for observation. We're going to put a pressure bandage on the puncture site and it'll stay in place until the next
day.
In very rare cases, the following complications such as bleeding, infections, allergy to the contrast medium,
impaired wound healing, and vascular injuries can occur.

cardiology
Electrocardiogram (ECG)
ECG is a painless, non-invasive, uncomplicated, routine cardiological examination with which one
measure the electrical activity of the heart.
This examination does not require any special preparation. All you have to do is remove your clothes and
jewelry (pens, glasses, belt, keychain, earrings, hairpins, coins, etc.) and expose your chest.
With a resting ECG, you lie relaxed on a couch during the examination. First, some electrodes (metal plates)
are placed on your arms, legs and chest. The electrical impulses are derived via electrodes, measured by a
device and recorded in the form of curves.
After the examination, the electrical activity of the heart and possible cardiac arrhythmias can be assessed.
The examination takes about 5-10 minutes.
Stress ECG
Stress ECG is a painless, non-invasive, uncomplicated, routine cardiological test that allows you to measure
the electrical activity of the heart during exercise.
This examination does not require any special preparation. All you have to do is remove your clothing, jewelry
(pens, glasses, belt, keychain, earrings, hairpins, coins, etc.) and your chest
free.
Before the examination begins, some electrodes (metal plates) are placed on your arms, legs and chest. A
resting ECG is then recorded.
Then you start with a normal load (like walking) and gradually increase it. At each level of exertion, the ECG
of the heart is recorded and the blood pressure is measured. However, there are many patients who cannot
strain themselves as much. The examination is terminated earlier if shortness of breath, chest pain,
exhaustion, cardiac arrhythmia or other symptoms occur.
This examination usually takes about 30 minutes.

Echocardiography (Echo-KG)
Echo-KG is a modern, painless, totally uncomplicated and non-invasive examination to assess the structure and function of the heart
using ultrasound waves.
First, a gel is applied to the transducer so that there is even contact between the transducer and the surface of the body. The ultrasound
machine sends ultrasound waves through the transducer into the tissue. The ultrasound waves are reflected differently by the tissue
depending on its structure.
The Echo-KG usually lasts 15-20 minutes
coronary angiography
The cardiac catheter examination is a radiological examination that can be used to assess the patency of the coronary artery. Although
invasive, it is now the gold standard method for making a definitive diagnosis of CHD.
Before the examination you need a special preparation. You should be fasting for at least 4 hours before the examination and
anticoagulant medication should be stopped early. Contrast medium is used for this examination, so if you are allergic to contrast
medium, you should let us know in good time.
General anesthesia is not necessary here. If you're scared, we can give you a sedative.
The groin or the crook of the arm is then disinfected and locally anesthetized for the vascular puncture.
A fine catheter is then inserted into the artery and advanced through the vessel to the heart. With the help of an X-ray seed we can
localize the position of the catheter.
Then contrast media are injected into the coronary arteries to visualize them.
If there's a bottleneck in there, we put a stent (small tube) in there to get the blood back through
can flow.
The examination usually lasts 30-40 minutes. After the examination, we apply a pressure bandage to the puncture site to prevent
bleeding. In addition, you must remain in the hospital for 24 hours for further observation and observe strict bed rest.
In very rare cases, the following complications such as bleeding, infections, allergy to the contrast medium, impaired wound healing,
and vascular injuries can occur.

Pneumology/ENT
Spirometry
The lung function test is an examination that can be used to assess lung function.
You breathe in and out through a mouthpiece for about 5 to 10 minutes as instructed. This is connected to a
measuring device, the spirometer. The spirometer records the amount of air inhaled and also the speed of the air
flow. In this way, the lung volume and function of the lungs can be assessed.
There is no special preparation and no complications.
pulse oximetry
This is a painless, uncomplicated and non-invasive procedure with which the oxygen saturation of the arterial
blood (oximetry) and the heart rate (pulse) are determined.
A small device is attached to the finger that measures the light absorption by the blood and thus determines the
oxygen content and pulse.
Sputum Diagnostics
Sputum examination is an examination of the airways in which coughed up bronchial secretions (also called
sputum or sputum) are examined under a microscope in the laboratory. It is used to diagnose various lung
diseases.
There is no special preparation.
The sputum is collected by yourself. You will be given a sterile plastic tube (a cup).
First you need to rinse your mouth well with tap water. This is very important in order not to mix the sputum with
natural germs in the mouth. Then you should cough up and spit the sputum into this tube. This tube is sent to the
laboratory for microscopic examination.
Nasal and throat swab/ PCR TEST (Covid-19)

Nasal and throat swab means the removal of body material (swab) from the nose - usually for microbiological
examination.
You should relax and tilt your head back very slightly. I will gently guide the swab brush back through the nose to
the nasopharynx area. There, the swab is enriched with the sample material by rotating it several times. I then
immediately put the swab material into the sample tube with your data and send it straight to the laboratory for
further examinations.
It takes about 2 minutes.
There are no complications, but most of the time there is a slight burning sensation and tearing can occur.
Sometimes the test can also lead to nosebleeds.

gastroenterology
abdomen sono
Abdominal ultrasound examination is a modern, painless and non-invasive examination to assess the abdominal
organs and internal structures in the abdominal cavity using sound waves.
For this you do not need any special preparation and there are no complications.
Esophagogastroduodenoscopy (EGDS)
Gastroscopy is a modern examination to assess the inner lumen of the esophagus, stomach, duodenum.
You should fast for 8 hours before the examination. You can take water and medication up to 4 hours before the
examination.
The examination takes place lying down.
The endoscope consists of a flexible rubber tube, a camera with a light source and lenses.
The images are simultaneously transmitted to a screen.
After local anesthesia of the throat, an endoscope is inserted through the mouth and advanced through the
esophagus, the stomach, to the duodenum. If any abnormal changes are noticed, samples can be taken or
treated immediately.
The examination takes about 30-40 minutes.
Theoretically, there may be a few complications - bleeding, infection, mucosal injury, but this is very rare and
our team has a lot of experience.

colonoscopy
Colonoscopy is a modern examination to assess the inner lumen of the colon, which can be used to diagnose
many bowel diseases such as polyps, inflammatory diseases and malignant tumors (cancer).
You should fast for 24 hours before the examination.
You should take laxatives and drink a liter of water the day before the test and in the morning to clean the bowels.
Then you get some sleep. The examination takes place lying down.
An endoscope is then inserted into the anus and advanced through the colon to the end of the small intestine. If
any pathological changes are noticed, samples can be taken and/or treated immediately. (e.g. polyps)
The examination takes about 30-40 minutes. After the examination, you stay with us in the ward for observation.
Theoretically, there could be a few complications - bleeding, infection, mucosal injury, but this is very rare and
our team has a lot of experience.
Endoscopic retrograde cholangiopancreatography (ERCP)

This is a modern examination to assess the bile ducts, gallbladder and pancreas using contrast media.
You should fast for 8 hours before the examination. You can take water and medication up to 4 hours before the
examination.
The examination takes place lying down. You get a sleeping pill.
An endoscope is then advanced through the mouth, esophagus, stomach, duodenum to the opening of the bile
ducts and pancreatic duct. If there is something abnormal in the mucous membrane, eg an ulcer, a lump, we can
take a sample for histological examination.
The examination takes about 30-40 minutes. After the examination, you stay with us in the ward for observation.
Theoretically, a few complications such as bleeding, infection, injury to the mucosa could occur.

endocrinology
Thyroid Sono
Thyroid ultrasound is a modern, painless and non-invasive examination to assess the abdominal organs and
internal structures in the abdominal cavity using sound waves.
For this you do not need any special preparation and there are no complications.
Fine Needle Biopsy (FNP)

Fine-needle puncture is defined as a puncture in the thyroid gland using a special cannula to obtain tissue
samples for cytological examination.
This procedure does not require any special preparation. But if you regularly take anticoagulant medications,
you should stop taking these medications the day before the test.
You will be given a local anesthetic so that you do not feel any pain when the needle is injected. After the skin
has been disinfected, a fine hollow needle is inserted through the skin under ultrasound control and pushed
further into the desired area of the thyroid gland. This allows us to take a sample for histological examination.
Finally, after removing the needle, we place a swab on the puncture site. So that no bleeding occurs.
Half an hour after the examination, we check the puncture site again and if everything is ok, you can go home.
The examination takes only a short moment and is hardly painful.
There are also theoretically possible complications that occur rarely or very rarely, such as: infection at the
puncture site and bleeding

Scintigraphy
Scintigraphy is a modern, painless and uncomplicated examination method, with which it is
possible to assess both the structure and the function of body tissues at the same time.
The examination takes place lying down.
First an intravenous access must be made, then the radioactive substances are injected through the access into
a vein. After that, you need to wait for a certain amount of time until the radioactive substance arrives in the
target organ. The substance accumulates in certain areas that have particularly high metabolic activity and good
blood circulation, such as areas of inflammation or tumors.
At these points, the radioactive substances will decay. As a result, so-called gamma rays are emitted. They are
measured by a special (gamma camera) so that a computer can calculate an image from them.
The examination takes about 30 minutes and requires no special preparation.
In order to reduce the radiation exposure, you should drink a lot after the examination and go to the toilet
frequently to excrete the radioactive substances.
In very rare cases, complications such as feeling hot, skin reactions due to radioactive substances can occur.
hematology
Bone marrow biopsy
Bone marrow puncture is a modern and invasive examination method with which the bone
marrow tissue can be obtained and examined to rule out or detect diseases of the hematopoietic
system.
After the skin has been disinfected and under local anesthesia, a fine hollow needle is inserted into the skin and
advanced into the bone marrow. A sample is sucked into this area through the hollow needle.
Finally, the needle is pulled out again. The puncture site is covered with a plaster.
The sample taken will be sent to the laboratory. There the sample is under the microscope
examined.
The examination usually takes 15 minutes.
There are also theoretically possible complications that can rarely occur, such as: infection at the puncture site
and bleeding

Lumbar puncture
Lumbar puncture is a modern and invasive examination method with which the cerebrospinal fluid can be
obtained and examined to EXCLUDE OR PROOF of diseases of the brain or spinal cord.
The lumbar puncture takes about 20 minutes. This examination does not require any special preparation.
Anticoagulant medication should be discontinued early.
The examination takes place with the patient lying on his side. To avoid complications, you must arch your back
as much as possible,
After disinfection and local anesthesia of the skin, a thin hollow needle is inserted between two lumbar vertebrae
- usually between the fourth and fifth lumbar vertebrae - and carefully advanced into the spinal canal. Then
10-15 ml of liquid is sucked out using a syringe and sent to the laboratory for examination. Finally, the needle is
pulled out again.
After the lumbar puncture, you should rest in bed for at least half an hour to prevent circulatory problems and
headaches. is covered with a patch.
There are also theoretically possible complications that occur rarely or very rarely, such as: infection at the
puncture site and bleeding
neurology
EEG
EEG is a painless, non-invasive, uncomplicated, routine cardiological examination with which one
measure the electrical activity of the brain.
All you have to do is remove your clothes and jewelry (pens, glasses, belt, keychain, earrings, hairpins, coins,
etc.)
With an EEG, you lie relaxed on a couch during the examination. First, a cap with electrodes (metal pads) is
placed on your head. The electrical impulses are derived via electrodes, measured by a device and recorded in
the form of curves.
After the examination, one can assess the electrical activity of the brain.
The examination takes about 30 minutes.
There are no complications.

urology
Urine status (U status)
A urine status is used to diagnose or monitor urinary tract infections, bleeding in the kidneys or urinary system, and kidney or liver
disease. In order to perform U-Status, we first need to collect a urine sample.
Before the test, you should clean the genital area with water. In order to get an unbiased result and to avoid bacterial contamination,
you have to let the first portion of urine run down the toilet for about 3 seconds. Then pour at least 30 ml of urine into the cup provided
without interrupting the flow of urine. The rest of the urine can be flushed back into the toilet
drain.
A complete urine status is performed in a laboratory. It usually consists of three parts:

1. Evaluation of the color, clarity and concentration of the urine
2. Examination of the chemical composition of urine using a test strip
3. Examination of the urine with the microscope for bacteria, cells and cell components
urine culture
A urine culture is usually done to check for bacteria and fungi in the urine if a UTI is suspected. If bacteria are found in the laboratory,
it is usually checked at the same time which antibiotic can be used.
In a laboratory, a sample of midstream urine (according to the U-status) is placed in a container. Then plates with culture media on
which pathogens can grow are dipped into the sample and the container is tightly sealed. The urine culture is then placed in an
incubator for 1 to 2 days. If bacteria or fungi are present in the urine, they can grow into colonies.
Extracorporeal shock wave lithotripsy (ESWL)

ESWL is a modern and non-invasive therapeutic procedure for the treatment of kidney and
ureteral stones using sound waves.
You should fast for at least 4 hours before the procedure. Before the procedure begins, you will be given sedatives and painkillers to
relieve the pain of stone destruction.
You lie on your back on a special bed.
We first examine your kidneys with an ultrasound and determine the location of the stones. Then he sets them up
Sound waves directly on the stone.
The device focuses powerful sound waves onto the stone. The energy generated in the stone leads to the shattering of the stone.
The stone pieces can then be excreted with the urine through the urinary tract.
Depending on the size and location of the stone, the treatment lasts about an hour.
There are also theoretically possible complications that can rarely occur, such as pain in the flank, fever and blood in the urine.

medication
metformin
Metformin is a drug used to treat type 2 diabetes mellitus. Metformin lowers blood sugar by inhibiting the formation of new
glucose (grape sugar) in the liver. As a result, less sugar produced by the body enters the blood.
Important!
- In order for you to tolerate the drug well, the doctor will initially prescribe a low dose that is gradually
increased.
- Elderly people should have their kidney function checked regularly because the dosage of
Metformin needs to be adjusted if kidney function is impaired.
- Women with diabetes who are pregnant or planning to become pregnant and are being treated with
metformin should speak to their doctor. Insulin therapy is usually the first choice here.
- Before administration of contrast medium or planned operations, metformin must be paused due to the
risk of lactic acidosis!
- In combination with alcohol, the risk of lactic acidosis increases.
- Even when taking diuretics (“water tablets”), you should pay particular attention to signs of a
Watch out for lactic acidosis.
Lactic acidosis is a form of metabolic acidosis (over-acidification) that can occur when metformin contraindications are ignored.
It is caused by the accumulation of lactic acid and lactate in the blood. Main symptoms are muscle cramps, hyperventilation,
apathy, confusion, coma, hypoxia.
Marcumar (Phenprocoumon)
Phenprocoumon is used to treat and prevent blood clots in cardiovascular disease. The drug inhibits the formation of certain
coagulation factors in the liver. Due to the lack of coagulation factors, the blood no longer clots as easily.
Important!
- INR value: The prescribed dose of the drug is based on the measured INR value. This is a test for blood
clotting. The higher the INR value, the slower the blood clots. For example, for atrial fibrillation, the
value should be between 2 and 3. This must be checked regularly.
- An increased intake of vitamin K from spinach, broccoli or various types of cabbage can
Reduce phenprocoumon effect.
- Bleeding occurs as a side effect in at least 1 in 10 people. This can be nosebleeds, bruises and internal
bleeding. Your doctor will explain to you how to recognize bleeding and how to behave.

What must be considered!
- Doctors should know how long it's been Marcumargabe?
- Patients should always inform their doctors about the administration of Marcumar.
- Marcumar must be taken under medical advice and regular coagulation checks.
- Marcumar should never be discontinued without the advice of a doctor.
NOAC (New Oral Anticoagulants)
The anticoagulant is administered to prevent strokes as a result of atrial fibrillation or to treat leg vein thrombosis. Their effects
are based on the inhibition of blood coagulation factors. Unlike the vitamin K antagonists, they do not interfere with the synthesis
of the coagulation factors, but rather interact directly with the coagulation factors.
Factor Xa inhibitors inhibit Factor Xa, thereby increasing the conversion of prothrombin
thrombin does not take place. NOAC:
- Apixaban (Eliquis®)
- Edoxaban (Lixiana®)
- Rivaroxaban (Xarelto®)
Important!
- An increased risk of bleeding is the most important side effect of NOAC. Not just for injuries: that too
Risk of internal bleeding, such as a stomach ulcer, increases.
- In the case of severe or life-threatening bleeding, an effective antidote is administered in clinics. This binds NOAC in the
blood and neutralizes the anticoagulant effect.
- Take the drug at the same time every day, with or without food, so it works best.
- In the event of a planned intervention, inform the doctor about NOAK at an early stage. Possibly is
a change in anticoagulant treatment is required prior to treatment.
- In general, all NOACs are not recommended for end-stage renal disease (GFR <15 ml/min) or
contraindicated.

antibiotics
Antibiotics are medicines used to treat diseases caused by bacteria.
Antibiotics inhibit the growth of bacteria or kill them.
Important!
1. If possible, antibiotic therapy should be initiated after microbiological sampling
be started without delay in the case of a life-threatening clinical picture.
2. Empirical therapy with broad-spectrum antibiotics or combinations of antibiotics is only indicated in a few
clinical situations. These include, for example, the therapy of life-threatening infections or the treatment
of patients with a weakened immune system.
3. A positive microbiological result does not automatically equate to the causal one
pathogen detection.
4. Inconspicuous microbiological findings can help to rule out a bacterial infection and to end a therapy that
has been started empirically or calculated or not to initiate antibiotic therapy at all. In the case of
exclusively viral infections
Antibiotics ineffective.
5. Antibiotic therapy that has started should be re-evaluated after 2-3 days. Once the pathogen has been
successfully identified and the suspected infectious disease has been clinically confirmed, a switch
should be made to targeted therapy with suitable antibiotics, taking into account guidelines,
contraindications and interactions. Discontinue antibiotic therapy without confirmation of suspected
infection.
6. Symptoms and findings such as fever, leukocytosis and elevated C-reactive protein are non-specific
inflammatory markers that can have many causes and require further diagnostic work-up.
7. Depending on the infectious disease and the clinical situation of the patient, oral antibiotic therapy with
therapeutically equivalent substances is preferable to intravenous antibiotic therapy initially or in the
further course.
8. In general, the following principle applies to the duration of antibiotic therapy: as short as possible, as
long as necessary. For a number of infectious diseases, the duration of treatment is fixed. This must
also be observed if the patient is doing better and the infection parameters are declining sharply.

Physical examination
The physical examination of the patient follows the medical history. Even the first impression during the greeting can
provide information about the patient as part of the general inspection.
The physical examination according to the IPPAF scheme:
- I - Inspection: observation of the patient

- P - Palpation: Scanning or touching individual parts of the body
- P - percussion: tapping on body regions (e.g. thorax, kidneys)
- A - Auscultation: listening to body regions (thorax, abdomen)
- F - Functional examination: Testing of individual bodily functions (e.g. pupillary reflex)
Brief summary The examination

begins with the head, then the neck; for examining the thyroid, the neck may be slightly padded with a pillow to allow the
head to be further reclined.
This is followed by an examination of the thorax with lungs and heart. At this point it makes sense to have the patient sit up
so that the lungs can also be listened to (auscultated) from the back and the lung borders can be determined by percussion.
On this occasion, the vertebrae including the sacrum can be examined and tapped and the back muscles can be examined
for hard tension.
You also look at the veins in your neck to see if they are congested; if necessary, the patient is allowed to move into a 45-
degree incline back.
The physical examination is then completed with the patient lying down again. The extremities including the joints are
examined. The pulses are palpated in the arms, neck, groin, and feet, and the carotids in the neck are also auscultated.
Then the lymph node stations are all searched: on the neck, on the axillae and in the groin.
Finally, an orienting neurological examination of the own and external reflexes is carried out: if there is no evidence of a
neurological disease, one will limit oneself to the Achilles tendon reflex, the patellar tendon reflex, biceps tendon reflex and,
if necessary, forearm periosteal reflex and the abdominal wall reflexes in 3 levels. Examination of the nerves of the head
(including tenderness at the trigeminal exit points) is best done at the initial head examination.
Don't forget your height and weight, heart rate, temperature and blood pressure.

THE MAIN INVESTIGATION STEPS SCHEMATIC

HEAD NECK
Percussion pain in the skull, trigeminal pressure points (pain: indication of sinusitis), facial expressions (symmetry?
failures? possibly also together with the neurological examination, see below)
Eyes
Visual acuity (finger perimetry), pupillary reflexes to light and convergence, nystagmus when looking sideways ..., possibly
Thyroid signs in the eyes (rare blinking, exophthalmos, poor convergence, lagging of the upper eyelid when looking down...)
ears
Hearing (roughly: rub your fingers lightly in front of your ear: hearing loss?), dizziness when turning?
mouth / throat
Mucous membrane: dryness? (if so, also ask about dry eyes: feeling like rubbing sand?)
canker sores? Thrush? ...
Teeth, gums, palate, tonsils, uvula in the middle?
thyroid
Goiter, possibly retrosternal? Stretch your neck backwards, let it swallow (if necessary, put your fingers slightly over it)
lymph nodes
Submandibular lymph nodes, on the neck, supraclavicular, possibly immediately afterwards also in the axillae and
the last ...
jugular vein congestion

Whether blood is accumulating in the neck veins is checked with the upper body inclined at 45 degrees; unilateral congestion
(e.g. drainage problems due to goiter) or bilateral congestion (signs of right heart strain)?
THORAX
Thoracic emphysema with large depth diameter and horizontal ribs? Supraclavicular air pockets (in pulmonary emphysema)?
Asymmetry? Hunchback, hunchback, Gibbus? Respiratory excursions, respiratory rate? Gynecomastia in men?
MOVE
Spinal pressure and percussion pain, hard muscles (myogelosis)
kidneys
kidney palpitations
Only begin with pressure in the kidney areas, throbbing with increasing strength depending on the situation
Pain sensation (percussion pain in nephritis)
LUNG
Percussion of the lungs: sonorous, hypersonorous, muffled percussion sound, thigh sound?
Auscultation of the lungs: normal bronchovesicular breath sounds? Increased or decreased breath sounds? Background
noise (wheezing, humming, whistling, rattling noises)? (Indications of emphysema, pneumonia, bronchitis, pleural effusion]
etc.)
Vocal fremitus on the same side?

HEART
Heart auscultation: heart tones, heart murmurs, conduction of the sounds, heart percussion (heart borders:
widening?), heart palpation (lifting, widened tip shock? tapping?): indications of heart enlargement, heart strain,
heart valve diseases.
VESSEL
Pulse status: The pulses are checked at the various test points: available? Signs of peripheral arterial disease?
investigation into their quality. See here for more details. Pulse deficit, checked by simultaneous measurement
of the auscultatory cardiac action and the peripherally palpable pulse.
Auscultation (if arterial occlusive disease or arteriosclerosis is suspected) over the carotid arteries, the aorta, the
groins: flow noises?
ABDOMEN
Palpation for resistances, liver size, spleen size, hernias (umbilical hernia, incisional hernia, inguinal hernia),
circuitous circuits, meteorism, ascites, pain …
If necessary, put your legs up to loosen the abdominal wall: better palpation possibilities. Auscultation of the
intestinal peristalsis (spurting, strong, violent, ringing, rippling, rare, absent intestinal sounds).
It is best to check the hernial openings (groin, navel) immediately afterwards.
rectal examination
In older people, it is part of the full-body examination (assessment of sphincter tone, search for tumors (rectal
carcinoma), in men, prostate assessment).
EXTREMITIES
Mobility and tenderness of the spine, sacroiliac joints, large and small joints. Signs of poor blood circulation in
the feet etc.
SKIN
Psoriasis, eczema, urticaria, lesions (open spots, bedsores, etc.), stasis dermatitis, erysipelas, melanoma, liver-
skin signs …

NEUROLOGICAL EXAMINATION
The clinical neurological examination is relatively comprehensive and quite complex for the inexperienced. In general, it is therefore
recommended to adhere to an examination schedule that should always include the examination of the following aspects:
Neuropsychological functions and psychological findings
- Vigilance describes the quantitative state of consciousness of the person being examined. The patient may be awake, light-
headed, somnolent, soporous, or comatose.
- The orientation is usually only specifically queried when there is a suspicion - the previous anamnesis should provide information
about the personal, temporal, spatial and situational orientation of the patient.
- The patient's ability to cooperate is very important in neurological diagnostics - the

Willingness to participate in the study is a criterion for the significance of the data collected
findings.
- Language is the understanding and use of words in speech and writing. The anamnesis interview should provide information.
Accompanying booklet for the examination course
- Furthermore, it is checked for signs of neglect. Tactile, visual or auditory stimuli coming from a certain side would be less well
realized. The anamnesis interview already gives signs. The hint is the non-reaction to the address from a certain spatial
direction.
Examination of the head including the cranial nerves and signs of meningism
cranial nerves
I - N.olfactorius
- Asking the patient about changes in smell and taste perception (dysosmia/dysgeusia).
II—optic nerve
- Inspection of the pupils, direct and indirect light reaction
- Visual field by finger perimetry (separately monocular and binocular)
III, IV, VI – Nn. oculomotorius, trochlearis, abducens.
- Inspection of the eyelids, bulbi, head position
- Finger following movement, convergence reaction, double vision
- Saccades and spontaneous nystagmus
- Further oculomotor examinations: vestibulo-ocular reflex/fixation suppression,

Check for
- Nystagmus using Frenzel goggles
V—N. trigeminal nerve
- Motor skills test by jaw closure/opening

- Masseter reflex

VII—Facial nerve
- facial expressions
- further examinations: corneal reflex, question about excessive sound perception, testing
of taste, testing of tear secretion
VIII.—Vestibulocochlear nerve
- Finger rustling
- Further investigation: Weber and Rinne test, Unterberger stepping test, Romberg
Standing test, vestibulo-ocular reflex, nystagmus testI
IX/X—Glossopharyngeal and vagus nerves

- Mouth open: soft palate, let it swallow, tongue out (fascicu., atrophy, bite scars)
XI—Accessorius nerve
- Head turn against resistance and side-separated shoulder shrug
XII—Hypoglossal nerve
- The tongue is stuck out, moved in both directions. Deviation manifests itself ipsilateral to the lesion. Force test
by pressing against the cheek from the inside. Investigator counters from the outside
motor skills
In addition to muscle strength, motor functions also include muscle trophism, muscle tone, movement patterns and
motility (see also movement tests on extremities as part of the general physical examination).
reflexes
With the help of a reflex hammer, the so-called intrinsic muscle reflexes, such as the biceps tendon reflex, are
tested. In the case of the so-called foreign reflexes, the reflex response does not occur in the stimulus-perceiving
organ.
sensitivity
The neurological examination includes the examination of touch (esthesia), pain (algesia), temperature
(thermesthesia), vibrations (palesthesia) and the sense of position, each with indication of the localization (ideally
skin nerve and dermatome allocation).
coordination
The correct temporal and spatial coordination of voluntary, goal-directed movements presupposes intact afferents,
undisturbed central motor structures, normal cerebellar functions and intact motor efferents. A disturbance of these
systems can manifest itself as ataxia, instability in standing, walking or posture as well as tremor.

Pointing attempts and diadochokinesia are evaluated on the extremities to detect ataxia. A
Rebound indicates cerebellar affection.
Furthermore, stance and gait and thus also balance are examined.
Vegetative functions i
As part of a neurological anamnesis, questions are also asked about vegetative functions.
With regard to neurological diseases, in addition to sleep, digestive functions, weight and sexual functions, the
following functions are of particular interest:
- the pupillary motor function (ÿ pupillary disorders)
- the cardiovascular function (ÿ heart rate analysis, orthostatic function tests)
- the sympathetic sudomotor function (ÿ sweat secretion tests).

FSP in BAYER 2023 (1) Translated

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Heart Failure .....................................................................................................................................33

Pneumonia / angina tonsillaris........................................................................................................40

Esophageal Carcinoma .....................................................................................................................................53

Hodgkin Lymphoma ................................................................................................................................95

Angina tonsillaris / pneumonia ............................................................................................................118

Wrist Fracture + Rib Fracture ......................................................................................................130 Wrist

Cervical Disc Prolapse................................................................................................................................159

Physical Examination ........................................................................................................................225

It's time to change all that!

I would now like to go into them briefly.

I wish everyone good luck!

1 FSP IN BAVARIA 2023 | Shamil Gurbanov

- It is not entirely clear if there is a “colon carcinoma” protocol as it does not

2 FSP IN BAVARIA 2023 | Shamil Gurbanov

technical language test

Part 1: Doctor patient conversation

Part 3: Doctor-doctor communication

Below is a short list of questions and tips for writing documentation!

3 FSP IN BAVARIA 2023 | Shamil Gurbanov

Part 1: "Doctor patient conversation"

Age/Birthday How old are Size Weight

Current complaints Associated Complaints

Vegetative anamnesis If necessary, women's medical history

45 > Are your periods regular?

noticed? When was your last period?

Have you gained or lost weight lately?

Do you have trouble sleeping? Do you have trouble

Pre-existing illness medication

4 FSP IN BAVARIA 2023 | Shamil Gurbanov

- In the case of fractures: which side? How did this happen?

- In case of drug allergies (NSAIDs/antibiotics…):

social history family history

Do you have children? is everyone healthy

The meaning of the medical terms is given in red letters .

5 FSP IN BAVARIA 2023 | Shamil Gurbanov

Part 3: “Doctor-doctor communication”

Anamnesis (current complaints)

Pain intensity was rated X out of 10 on the pain scale.

Vegetative anamnesis if necessary, women's

6 FSP IN BAVARIA 2023 | Shamil Gurbanov

The following illnesses were found in the family: - The father

presumptive diagnosis differential diagnosis

- The anamnestic information indicates on

Proceed further therapy

Example - case "PAD"

7 FSP IN BAVARIA 2023 | Shamil Gurbanov

He is allergic to pollen . The allergy manifests itself with rhinoconjunctivitis.

He was vaccinated against all childhood diseases and against Covid-19 .

The following illnesses ran in the family :

The anamnestic information most likely points to PAD .

DVT and diabetic polyneuropathy can be considered in the differential diagnosis .

8th FSP IN BAVARIA 2023 | Shamil Gurbanov

! radiate? Does the pain radiate to other parts of the body?

walk without the pain appearing?

- Have you had an accident? (DD with fracture)

9 FSP IN BAVARIA 2023 | Shamil Gurbanov

- Pollen allergy with allergic rhinoconjunctivitis hay fever

ÿ Nicotine consumption: non-smokers

ÿ Drug use: Hashish in his youth