Thursday, November 29, 2012

The Result

Alhamdulillah..

ps. Out of 33 students, 8 failed the exam (4 brothers and 4 sisters) and they have to repeat posting, maybe in the end of Year 3.

Sunday, November 25, 2012

Of The IM End Block Exam




Although the exam period (1 day for PMP/MCQ/OBA and 1 day for LC/SC) was very short, it was seriously unnerving. Here's a brief review on the exam questions.

Monday, 19/11/12

1) PMP @ 9.00-10.30am

PMP is like PBL. We had to answer three sets of questions based on cases given.

The exam was six days ago, I could not quite recall the exact questions, though. If I'm not mistaken, the first question was about Diabetes Mellitus.

There's this one question asking about 8 signs that you might want to look for, regarding the patient's long-standing DM. In other words, the complications of Diabetes Mellitus.

I mentioned about signs of Diabetic Retinopathy, Neuropathy, Nephropathy and Infections. That's all I could think of.

Then, the question asked about the modifiable and non-modifiable rick factors of DM, advice you would like to give to the patient and a few more.  

Second set of question involved Hepatitis/Chronic Liver Disease/Hepatic Encephalopathy.

Remember this pakcik?



Last one was on Rhematoid Arthritis. That reminded me of this makcik, seriously.



Z deformity/Swan neck/Boutonniere deformities, Ulnar deviation, Palmar subluxation, Joint erythema/swelling, Palmar erythema, Tinel's sign.... You have to remember those!  

2) OBA + MCQ @ 2.30-4.00pm

15 Multiple Choice Questions (MCQ) and 10 One Based Answers (OBA) were a bit tough. The questions were easy, but the answers.....not!!

This one question made me go... Wow. It was about the side effects of Anti-TB drugs! I totally forgot about those! Well, I did read about them, but I could not seem to remember.

Rifampin - Orange discoloration of urine, Hepatotoxicity
Ethambutol - Optic Neuritis (remember E for Eye!)
Streptomycin - Ototoxicity, Kidney damage, Skin complications
Pyrazinamide - Hepatotoxicity, Gout
Isoniazid - Hepatotoxicity, Peripheral neuropathy

Read more about them from reference here.

If you are so dedicated to answer past years questions, there's a few repeating questions asked like what are the causes of irregular pulse. (I was only sure about Atrial Fibrillation, the irregularly irregular pulse)

I did not do the senior's compilations much (with so little time and so much to read!), and now I kinda regret it. If only I was more hardworking back that time. 

And there's this question about the signs of hypothyroidism that made me smile.

You know why? The loss of outer third of eyebrows ;)



We had met this very similar-looking makcik before in the ward. The resemblance was amazing! :D 

The opposite of hypo, it's hyperthyroidism! 


Picture source: X'Press Revision in Short Cases, Aids to Undergraduate Medicine by Chew Nee Kong and Lim Kheng Seang. You can buy the book from Syarikat Kamal, KL.

Seriously I tell you, you should totally get this book as it is very very useful!


Wednesday, 21/11/12

1) LC with Dr. Yousuf Rathoor @ 9.00 - 11.00am

Long Case (LC) session was a bit hectic. I did not get my patient's diagnosis at first, since she came in with fever, sore throat, vomiting and diarrhea. I really thought it was a case of Acute Gastroenteritis. Pneumonia? But she had no cough.

On examination, there was no findings at all. I really wish she had bibasal crepitations at least. But she didn't. I thought she had mild splenomegaly?

I asked her whether had the doctors told her that she had big spleen, or she had lung infections of some sort? She said no.

I was like, Hmmm..... 

Half an hour before the time ended, she mentioned about her high glucose level on admission (it was 30 mmol/L), then I was like, that's it!! 

I asked her about polydipsia, polyuria and nocturia. Oh, it was Uncontrolled DM rupanya!

When I was busy constructing my sentences on paper, Dato' Sapari and housemen came to the patient for their round. I managed to hear Dato' mentioned that her lungs were clear and she told the makcik that she had acids collected in her body, due to her DM.

Oh, her diagnosis was Diabetic Ketoacidosis!

Dr.Yousuf came in to hear my case a bit late, so I had ample time to prepare and write my sentences carefully. I was thankful that I got an easy case to start with. 

I did okay in Long Case, I think.

2) SC with AP Dr. Khairul Azhar @ 11.15am

Well, I admit that I didn't do well in Short Case (SC). I was quite nervous, actually.

I had to examine a middle-aged Malay man with a 16cm sternotomy scar and 51cm scar from left leg up to thigh. On CVS examination, thrills were palpable at mitral area. First and second heart sounds were heard. No murmur. Other than thrills, no other significant findings were found.

What do you think this pakcik had?

I was not able to answer regarding his diagnosis, so I looked at his case file after the session finished. The diagnosis was Acute Coronary Syndrome.

By looking at his sternotomy scar, maybe this pakcik have had CABG or Valve Replacement before, and there might be recurrence of his heart problems. Ah, I should have think of that.

Here's a few tips when you have AP DKA as your examiner:
1) When you get a patient with scars, bring out our measuring tape and measure the scars!
2) Make sure you get your techniques right. Especially on how to do the Collapsing/Bounding Pulse!
3) Do not wait for doctor to ask you about your provisional diagnosis after you present the case, just mention them straight away! 

Since this was our first examination, we had a hard time adjusting. But I am sure we could do better next time. Once again, I'd like to wish you happy holidays!

Oh, and have a look at this:


Hehe ;)

Thursday, November 22, 2012

A Break




I was thinking of writing a post about my exam, which just ended yesterday. 

 But that can wait.


You know the reason why ;)

Happy holiday, everybody!

Monday, November 19, 2012

Exam Week.. and Here I Am




Awak ni tak penat ke asyik2 datang sini? Hari tu dah datang dah.. Kalaulah ada Clerking Note awak tu, mesti Doktor dah letak kat depan ni dah... Lagipun, Clerking Note tu spatutnya student tak akan dapat balik...

Kak, memang saya penat pun drive datang JHC. Saya baru je lepas jawab exam MCQ/OBA kat IMC kak, pastu terus saya datang sini. Tapi saya tak kisah pun kak. Saya tak kisah pun datang semata2 nak amik Clerking Note saya.

Saya tau memang Doktor2 lain tak bagi semula Clerking Note pada student. Tapi Mentor kitorang tanda Clerking Note yang kitorang hantar. Saya mana la tau bila masanya Dr. da siap tanda kertas saya, itu yang saya datang je ni, just in case.

Penat saya buat Clerking Notes tu tau, kak. Kadang2 stay up malam2 nak completekan semua. Saya nak la balik semula kertas2 tu untuk dijadikan rujukan, bukannya saya saja-saja je siapkan, semata mata nak penuhkan requirement. Bagi saya, Clerking Notes tu sangat2lah berguna, kak. 

Saya dah abis posting IM da kak, akak jangan risau. Lepas ni saya tak ganggu akak dah ye. Terima kasih banyak2 akak. Saya mintak maaf kalau ada salah silap. Inshaalah kalau panjang umur, kita jumpa lagi tahun depan.

Then again, I was not so brave heartless to reply back to her. Instead, I smiled and went out of the office, feeling moodier than ever.

I passed by the IM Board.

Oh.... so this is how it's going to be... ***Nervous
Which doctor is our Examiner? Cuaknya.... X__X

Speaking of Clerking Note, here's an interesting case to share.


CT brain revealed intraparenchymal hematoma in right posterior parietal region with associated perilesional edema and extension of bleed into right lateral ventricle. The body of right lateral ventricle is compressed. The left lateral ventricle is prominent suggesting early hydrocephalus. No midline shift. The sulci are effaced suggesting right cerebral edema. No fracture seen.



See the outline of prosthetic valve there?
This patient underwent Mitral Valve Replacement (MVR) Surgery in 1992.


I guess that's all for now. I should study. Wish me luck.



God, I don't ask for much. Please let me pass this exam. Just a pass will do. Just a pass. Please.

Tuesday, November 13, 2012

10th in 10




Just finished my 10th (Thank God it's the LAST!) Clerking Note.

My head is spinning.

Padan muka sape suruh buat kerja last minute?! -..-''

Adeh.


ps. This is our last week (Week 10) before end block exam next Monday. Study week pun rasa macam bukan minggu untuk belajar and stay dalam bilik untuk study je, but still kena pegi JHC, ada klass, huhu

Tuesday, November 06, 2012

Friday, November 02, 2012

Short




1) Met a 23-year-old kakak with PDA at 7C.

2) Clerked a kakak with Lupus Nephritis this morning.

3) Followed Ward Round Dato' Sapari, Dr.Che Rosle and Dr.Ainon.

4) Tutorial Cardiac Arrhythmia with Dr.Wan Syahril this evening.

5) We were advised not to be too stressed up about CWU.

6) Been told that our exam questions will be a bit tough.

7) How bit is bit, Doctor?

8) Next two weeks : END POSTING EXAM 

9) Worried.




Work extra hard now, will ya? *pat shoulder