WeLcoMe To mY wOrLd

Holla!! at last i got mood to update my blog.. before i write bout my super boring holiday, let me recap about the exam 1st..

Theory: the MCQ was supeeeerrrr hard!! i dun think there’s qs that i able to answer confidently…most of it i just hentam saje T^T (dr shaila once convince us that the qs actually 60% are easy and for everyone’s level..i bet she’s must be kidding rite?? duhh) btw as for the MEQ i guess still ok la..act got 1 qs that i totally blank..dunno wat to crap..its actually bout the “tumor lysis syndrome”…1st glance of the qs actually i did think of it, but i juz ignore it & focus on other qs before go back to that qs..end up i didnt have enuff time to review back @.@ (i also juz realize that the qs act same as past year..lol!!) lastly bout the LEQ, hehe i think a bit confidence on my LEQ this time..dunno maybe bcoz the new style of answering make me have much time to think and not panic =.= (but , i almost lost FREE marks when i didnt realize the qs actually got 2 sheets!! lol!! patutla everyone still writing non-stop..i tot why the hell they’re still writing when the qs only asking about differential diagnosis!!?? haha i juz realize bout the 2nd sheet when the time left less than 5 minutes i guess..and the qs that i actually need to answer was bout the management of  Hyperosmolar Hyperglycemia Non Ketotic Coma… u guys dunno how fast my hands and brain worked at that time..fuh nasib siap on time!)

haha i guess i looked like this boy kot XD

 

OSCE:

10 - my 1st station “shingles”..hehe nasib “sempat diskus”, if not i really dunno what i’m gonna crap about the picture that showing the skin lesion..

1 - ECG : “anteroseptal ST elevation MI with reciprocal ST depression at inferior leads” - dunno lah correct or not, but according to Mr K thats the answer la..screw me coz i actually write “refractory” instead of “reciprocal” lol..

2 - ECG: “Atrial fibrillation”.. haizz i omost write something bout the hypoK or hyperK.. but still stuck in the qs that asking bout the causes of AF..i managed to answer thyrotoxicosis and MI..other 2 just hentam =.=

3 - fundoscopy picture: haizzz WTH la.. i really dunno how to differentiate whether the picture actually showing about diabetic retinopathy or hypertensive retinopathy..i juz hentam diabetic..if salah means the management also gone laa.. dengar2 the anw is hypertensive..haizz

4 - interpretation of data.. hypochromic microcytic anemia..ok lah

5 - active station.. instead of intubation that we all expecting,it turn out to be lumbar pucture!!!! LOL!!! i actually didnt read anything bout it! juz rely on my prev 4th year knowledge..but i think i did better compare to last experience during CSP exam! haha the examiner and the qs was the same.. this time i manage to control my nervousness and keep on explain bout the procedure to the grandma..i really not focusing on how to do the lumbar puncture, i just explain the procedure..then try2 la to pok the mannequin…mane tau got luck kan..haha but as expected failed to withdraw the csf fluid..but still i’m stuck at the same qs when grandma ask what i’m gonna do after done with lumbar puncture..i did think bout the reposition the pt into supine position for 5-10 minutes for the pressure,but i did not mention it!! i tot that’s not the answer..haizz next time just try and error la!

6 - interpretation data..this time here come CSF lab result! haizz thanks god got normal value given..but still i cannot sure what is the real dx..i just hentam meningitis, encephalitis..haizz the Mr K once again said that he super confirm it is TB meningitis..so the further ix sure bout the AFB workout..i didnt mention bout it..juz simply write bout ct brain..haha

7 - CT scan..ok the clue given pt have right hemiplegia..so for sure the lesion is on left side rite..haizz but when i look at the ct scan, i describe hypodense over the RIGHT brain..(dah ler unable to think of part of the brain like temporal, occipital,frontal etc..haizz just simply write brain..haha bengong)

8 -  Picture… “acromegaly” LOL!! didn't have any clue bout it coz i never read bout it..but if i did, i actually can answer it coz the clue given ady clearly lead to the dx..pt cannot fit the wedding ring and her old shoe..then the picture also showing the broad hands..and guess what i’m thinking that time.. “cushing $” =.=….. but quite weird la coz the picture really focusing on the hands..definitely not a typical cushing features! haizz.. wanna know what i describe bout the hands?? “swollen hands” lol!!! i really suck in describing things! x_x

9 - CXR: showing homogenous opacity over the left upper lobe..since the marks allocated for the radiological diagnosis was 4..i oso put 4 differential..broncogenic Ca, TB, lung fibrosis, lung abscess

VIVA:  haizz punyerla stress nak penuhkan logbook MSP yg super byk procedures yg perlu dipenuhkan..but as usual la, brape sgt ler procedure yg betol2 dibuat & observe kan..haha.. ok for the MSP viva it actually not as stress or strict as PSP (Paediatric)..time PSP dulu byk giler soalan dr thawdar bom..as for MSP plak, we only req to explain bout 1 procedure..yeahh 1 only ok..somemore my gp got dr Aye Aye Mar..so the choice is on us! so i decide to choose BMA (bone marrow aspiration)..haizz but dr actually not interested to listen, she seemed tired and can’t wait to finish it..haizz penat je tau..semangat giler nak cerita time tu..i hope i able to get good marks..coz most people say dr really generous in giving marks hehe..hopefully ^.^

Long Case:

SCLERODERMA!!! oh emmm gee!! ok bertenang nurul bertenang..u ady study bout it rite, trust in urself..be calm and just clerk as usual..ok here i go..haiizzzz seriusly i didnt expect that i got scleroderma pt as my long case!! somemore i never had any experience in clerking this kind of pt..oh my~ what shud i ask??? but the good thing is, i did have experienced in presenting this case during case presentation..actually fara did the clerking bcoz she’s the one that saw the pt in clinic..at first i was assigned to present the literature part, but since it was dr rachel’s CP, usually she’s the one that would present the part..so we only handle the history and physical examination part..so since i never saw the pt, fara prepared the hx and PE part..so i just did the ix and mg part..sengalnye my part got 2 slides only..haha so its better 1 presenter present the whole things rite..so end up fara asked me to do it..at first i refused..but when think bout it, i shud show some effort rite since she ady clerk the pt..haha actually really thanks to her coz give me the chance to present..at least i got some idea bout the disease..

i also did review few times about it before exam..thanks also to dr rachel bcoz her teaching session make me understand more bout the disease..what i clearly know is it involves multisystem..but the prominent features definitely is the skin manifestation.. “skin tightnening, bird facies looking,small peak nose, microstomia, sclerodactyly, raynaud $, CREST $ & etc” somemore once u saw the pt u sure know she’s got scleroderma..

during the clerking i actually bit blur coz the pt currently don’t have any complaint..so i just focus on when she 1st dx with the disease, progression of the dz, the follow up, medication that she took and bla3..otherwise other hx are not significant.. as for the PE plak i really dunno what shud be check..but as it was long case so i better check all the systems rite..i actually focus more on her general appearance..i did check for any signs of pulmonary hypertension but of coz ler dont have..actually during that time i did not aware about the “lung fibrosis” bcoz i keep focusing on Pulm HPT..i did listened carefully her lungs but seriously cant find any abnormality..other system also normal..

finished examine, i try to make the summary and write bout my findings..i tot there still around 5 minutes, but suddenly the abang pop up and asked me whether i done or not coz left 2 minutes…what!!?? omg! i start to freak out!

but the abg cool me down and said that i’m lucky coz i got the sempoi examiner..he mentioned about dr Kanan…i’m like what!!??o_O then the 2nd examiner…haizz disaster….Dr sandra..till now i dun really sure how to pronounce her name..juz called her Dr S la..she’s the dermatologist and claimed to be the coordinator for MJP in Sandakan..her look looks like indian/pakistan..but she’s actually a Myanmar..lol..but she speaks well..

i actually did really bad during presenting the history..haizz its my first time to present bout a case of scleroderma..ayat tunggang langgang..but the best is dr kanan really showing that he interested to listen and pay full attention until i finished presenting..haizz as for Dr S plak i’m not sure if she really understand what i have presenting..haha..

then i continue presenting bout examination finding..first ady stuck at the general appearance.. from what i examine the skin tightening involved below the elbow, below the knee and face..so she definitely have “Limited systemic sclerosis” rather than diffuse rite?? but then dr seemed not agree with me..Dr S la especially..she then ask me what i understand bout “limited”..haizz i try to explained by describing the extend of skin tightening..but she said i didn’t answer her qs..hayoo stress..end up i just said limited is not diffuse..dr Kanan burst in laugh after he heard my answer..haha lol..(buat lawak bangang di situ =.=)

another thing is when i told them that i could not elicited any abnormality in the respi system, they’re like what?? really? did u really examined her? so when both examiner showed that kind of expression..i know i’m screwed ady..but seriously its normal what..huhu how la jugak nak crap..hayoo..then dr kanan ask me what i expect to find in her lungs..haizz thanks god i know how to answer..actually that time i just think bout the interstitial lung disease and lung fibrosis..fiuhhh..Dr Kanan seemed relieved when i did managed to answer it..he said at least i know what to find..

then proceed to the investigation.. for the confirmatory i just know bout the anti-scl 70 and anticentromere..others are more on target organs related..but dr did not satisfy with the ans.. actually dr K want to lead me to mention bout to rule out other connective tissue dz by doing antinuclear factor..but he subconsciously told me the answer..haha so nice leh dr K..but dr S seemed to be irritated and said “u actually teaching her..she did not mention bout the antinuclear before”..huh @.@

huhuhu i really worry bout my long case coz i did not even discuss about the management of this patient..somemore i also confused bcoz Dr K said the ix result of this pt turn to be anti-scl 70 positive..so she definitely has “diffuse systemic sclerosis”..that’s why la dr a bit shock when i said the PE findings are normal..i guess the case note did mentioned something bout “lung fibrosis”..duh screwed me.. (but yonlek, she also got same pt, said that the lungs are clear..no signs of fibrosis..huu bit relief to hear bout it..at least got people that same findings as me..so dr cant accused me bluffing..haizz this the prob when examiner did not see the pt =.=)

as conclusion i dun have any idea whether i could pass this long case or not..dr K seemed nice and dr S seemed killer..but we never know how they give mark rite..huhuhu pleasseee let me pass T^T

Short Cases:

Examiners: Omg got dr Timothy and dr bunga.. did have experienced presenting with dr timothy..haizz habisla if i failed to impress him this time..

1. Cardio case - i examined as fast as i can until i missed soooo many important things!!! hayoo nampak sgt jarang practice short case.. i actually forgot to check the radio-radial delay, radio-femoral delay, peripheral pulses, collapsing pulse and doing the auscultate manoeuvre.. but dr only realize bout the collapsing pulse and the manoeuvre things..he didnt tegur bout the peripheral pulses..i hope they really didnt realize bout it..if not really super screwed la me!! since i finished fast, dr ask me to re-examine again so i only do the manoeuvre..that time dr also didnt tegur bout the collapsing pulse and i totally did not aware bout it.. so during the re-examine, i try to elicit other murmur than PSM..i actually did think of aortic regurg..but really cant elicit it so i just present bout the PSM..haizz actually i think that uncle did have “corrigan’s sign - the dancing carotid pulse” which i tot his JVP =.=

hayooo buat penat je hafal 17 signs of aortic regurg..end up i cannot “show off” my talent lol!!! so my dx only lead to mitral regurg..the good thins is i did managed to discuss until the management.. yeahh thanks to dr timothy coz he teach us to keep on talking till end..haha..hmm dr also did not said anything bout the aortic regurg…huhu dunno la, but other students said the uncle did have aortic regurg..haizz..dr bunga plak did not ask anything..she only complaint that i speak to soft..haiz sorry dr..

2. SUPRISED!! - guess what..same as in PSP previously where i got the same case as in long case..so here i am the same “akak scleroderma” which i got in long case just now.. at first i would like to req to change pt, but i tot arghh let it be la.. hmm since i did examined her this morning so i did not too panic..haha so i just examined as usual la..like the way examined the rheumatoid arthritis..but at first dr ask me to examined and described the face.. actually i did mentioned bout the hypopigmentation..but dr tot i mentioned hyperpigmentation..haizz…tu lah next time speak clearly nurul..

i also managed to discuss until management..somemore still got few minutes left..so dr timothy did gave me advices to not repeat the silly mistakes again (haizz the cvs case la..so many things i missed to check)..he did said that i did well in my 2nd case..as for the 1st case, really sayang la coz missed so many things rite…haizz i guess i got my lesson already.. huhuhu again please let me pass my clinical exam T^T

 

p/s: That’s all for now..i will talk bout my super boring holiday in the next entry lah ya.. ciau!!

 

haizz hopefully not so teruk  la =.=

 

 pray hard and tawakal!!

“Ya Allah, semoga Engkau berikan kejayann buat kami semua..amiinnn..”