End Posting 9th term OBG

Erm, lambatnya update. 

Sorry, malas sungguh. Tapi, mengenangkan ini akan membantuku di kala nak dekat finals nanti, ku laratkan jugak. 

Kali ni dapat viva dengan cekgu old-school. The HOD. A very quiet male doctor. The only  old Beetle surrounded by Flowers in the OBG garden. Heheh. I wonder why they made him the Head of Department. Maybe he is guy? An d female can't take the post because they are too emotional and not as rational as the male colleagues when put under pressure? People keep saying that it is really distressing being in this specialty.

I got this  combination of worst case scenario during postings. A combination of many differential diagnosis and topics in both Gynaecology and Obstetrics. 

I think it is better to present the Obstetric case first as the questions are quite predictable.

Viva End Posting (Obstetrics)

Summary : 33 year old, G2P1L1  at 38 weeks 5 days of gestational age, with previous lower section caeserean section and overt diabetis melitus with single fetus, cephalic presentation and mobile head.

• Urine pregnancy test. Other method of confirming pregnancy.
• Folic Acid. Why it is given?
• History of fever with rash. How Rubella is manifested?
• Tetanus toxoid. Why it is given?
• History of pedal oedema(pitting type). Differential diagnosis of oedema in pregnancy.
• History of previous LSCS indicateed by Cephalo pelvic disproportion. Was started insulin after delivery. Stopped after 2 month. 
• What is Lower section caesearean section? Describe the incision made. 
• Past history of Diabetes melitus since 1 year.On Medication.
• On Examination: thyroid enlarged
• Inspection: overdistended abdomen, globular shape. Falnks full.Horizontal scar present 3cm above symphysis pubis measuring 13cm wide. No keloid, non tender scar.
• Palpation:

            Fundal grip: Soft irregular, broad mass suggestive of breach.

            Lateral grip: Right- Continuos uniform resistance with smooth hard surface                                             suggestive of spine.

                                 Left: Small irregular Knob like structures, suggestive of limb                                          buds.

          1st Pelvic grip: Ballotable mass, non enggaged.

          2nd pelvic grip : Fingers converged, not enggaged.

• Auscultation: Fetal  heart sound not heard. Why?

Viva End Posting(Gynaecology)

Summary: 53 year old(menopause) P3L3 with chronic cervicitis/vaginitis/endometrial polyp/adenomyosis/malignancy of cervix/endometrium

Chief complaints : History of passage of white discharge x 3 month

                              History of backache and abdominal pain x 1 month

                              H/o bleeding per vagina x 1 month 

• DDx of discharge per vagina. Colour? 
• What is clue cells?
• DDx of painful lower abdomen.
• DDx of mass in the lower abdomen.
• DDx of bleeding per vagina in menopausal woman.
• What is PID? Definition.

Lesson learnt: 

-Bring ALL books related. Even the note books. 

-Fight and dont give till the end. Open your mouth and speak clearly and loudly These people are getting old. Make their job easier. Dont say a word if you dont know anything. Just shake your head and ZIP your mouth.

End posting 8th term Medicine Unit 5

Alhamdulillah.
Segala puji bagi Allah yang memegang hati dan takdir manusia. Sesungguhnya, pencapaian dan pujian hari ini bukanlah milik mutlak bagi diri. Tetapi, milik Tuhan yang meminjamkan kekuatan untuk belajar.Yang menjadikan ujian itu setimpal dengan keupayaan diri. Saya mampu sebenarnya.

Tapi, hakikat manusia itu lemah dan tidak sempurna. Sesempurna manapun persiapan diri, masih ada kesilapan dan khilaf yang berlaku. Ye, saya juga manusia biasa. Buat silap dan tidaklah mahu berbangga dengan kesilapan itu... InsyaAllah, akan aku baiki diri dan tidak mengulangi kesalahan itu. Ya Allah, jauhkanlah aku daripada menzalimi diri sendiri dan pesakit-pesakitku kelak.

Jika aku jatuh dan berlemah hati, berilah aku kekuatan untuk kembali padaMu. Jadikan aku hamba yang bergantung harap sepenuhnya padaMu. Jadikan aku hamba yang bersangka baik dengan janjiMu.

Segala pujian di langit dan di bumi hanya padaMu.

Alhamdulillah.


Do not repeat this mistske.
B/p values never in odd number! Only 2mm calibration.
Dont forget history n sign of meningeal irritation.
Dont forget to write impression at the end of your case sheet.

p/s: Dr. S of unit 5 medicine said, "Good" at the end of case presentation.

Today is my first ever CNS examination.

Summary: Middle aged male pt came with h/o left sided weakness 5days back with history of inability to sit up from bed, drowsiness and past history of hypertension, smoking and alcohol consumption.

Impression: Cerebral thromboembolic stroke of left hemiplegia with lesion at level of internal capsule suggested by generalised motor deficit with sparing of facial nerve palsy.
 

End posting 9th term Paediatrics

Arghhh...

This time i didn't do well. I was told to read more. This is not enough. Yeah, i didn't come prepared. Not 100% prepared.

I left my notes and books at home.I shouldn't do that next time.
Geram geram geram....
Geram sebab kes ni dah banyak kali aku present. Pastu, still tak confident nak jawab apa cikgu tanya.

I've repeated my answer soo many times and yet she didn't understand. Maybe i spoke too soft? Too slow?Mumbled? My accent? Okey, i admit it was my fault... *sigh*

My patient this time is super cooperative and playfull but i screw things up. I knew it was my fault...

There is no next time. Because next time it would be real. I hope i will be better next time.

Viva Questions

• What is nephrotic syndrome? Give proper definition.
• What is remission? What is relapse?
• Treatment for first time episode of nephrotic syndrome.
• Rx for relapse?
• Rx for remission
• Rx for steroid dependance?
• Method of assessing organomegaly in presence of ascites.
• Child draw a stick man. Give the age of the child.
• Development - motor,fine,social,personal of 7 year old.

Actually i realised that this kid had supraclavicular pulsations and elevated JVP of which i didn't say because it is too risky and way beyond my expertise. So, i stated only the OBVIOUS and most common findings in nephrotic syndrome.

He has fast breathing >30cycles/min, tense, distended abdomen, positive fluid thrill, positive shifting dullness. Just not confident enough to mention that the kid had signs of hydrothorax. No hydrocoele. There is puffiness of the eyes, abdomen distention and pedal edema of pitting type. No organomegaly. No hematuria. No fever. No artralgia. Nails have white bands, pale palm. He had history of hypertension and maybe that's why he had elevated JVP.(well it looks like it)...(-__-)" im not sure....

Next time, be sure.Be confident. You will get this right next time.

Aminn.

 

Surgery : End Posting 9th term

Surgery end posting will soon come around the corner. What will i do?

Again, i'd like to write what i have to prepare for end posting which consist of viva  as well as case presentation.What shall i do?

First, prepare all the proforma for important topics based on Dass Surgery Clinical Manual. Reading proforma is much easier than reading right off the book.Read all the little notes you wrote.

Next, read the differential diagnosis part. You always left that particular part behind! Don't leave any SMALL printed words. It may come back to you some day somehow.

Prepare a bunch of viva questions in your mind. Don't slack off at the very last minute. Come On!! You can do it!

Practice the examination part and please remember all the test names! Don't confuse Brodie's-trendelenburgh test , Swartz and Perthe's test!

Last but not least, prepare the materials needed for physical examination. Don't forget to buy the AAA Batery for torch light!



P/S: Please read some theory part from Manipal Manual Of Surgery and SRB!!

CoMMed: The End Posting

At last.

Finished my postings.

Hell yeah, it was EASY.

I got the dark-bespectacled-short-dark-hair lecture.
I seriously forgot the name.

And so,we begin our end posting.Basically, it is about environment,water,housing and sosial health.

"Did you finish your record?"

"Yes sir."

"What type of family did you study?"

"Nuclear family sir. It consist of 3 member. Saji,Amitha and Sherine. The case sir."

Flipping through the pages.

"Owh i see. Okay, Tell me your observation ."

This is how you present your case.

"Sir, the family is nuclear type family, living in pucca house.The head of house is a bus driver,but the wife doesn't work. Hence the total income is around 8000 rupees( like 700ringgit per month). They spent the money wisely. No debts and had savings in account. They spent most of their money on food,fuel and house maintenance.."

He cut me before i could finish my presentation.

"Okay, tell me  the name of classification we used for assessing social class."

"Sir, its modified Kuppusamy scale sir.(Park:601 , Asma Rahim: 338)"

"Okay, what other classification you can name?"

"Erm...." totally blank.


"Its Pareek scale,Kulshrestha scale,Prasad scale..."

And i continued my presentation on my own.

"Sir, since the family spent wisely on food. There is no correction to be done regarding the menu. There is no deficit in nutrition requirement. They had balanced diet..."

He cut me again.

"Give me the total requirement of Vitamin A "

"Sir, for adult male and female its 600microgram for retinol and 2400 microgram for carotene.For children, it is 400 for retinol mcg  and 1600 for carotene." (Record 1 : 33)

He seemed to disagree.Aaargh, i didn't study the infant part because my case doesn't have an infant.

"How about infant?"

"Around 400mcg and 1600mcg..." totally from book, with slight alteration.

He disagree again.

"Look up for the answer in book okay?"

Waiting for another question, while he finished correcting my record.

"Finished sir?"

"Yes,you can go."


Hence, it is the very end of Community posting. Another term to go, one more community medicine posting to finish.I hope i've done well. Well, i wished i knew the answer for the vitamin part. Anyways, hooray! Finished commed posting already!