My clinical examination was scheduled on Wednesday, so I have a back-to-back continuous exam one day after the other without a break – a break which I badly wanted to prepare for my clinical examination. But Allah knows best, Wednesday is my exam day. The morning before clinical exam, I could not take any food despite feeling very hungry for not eating even from the day before. I could not tolerate even a sip of water. Wretching is common in any clinical exam, therefore consuming any amount of food or drink carries a high risk of regurgitation or worse off, vomiting.
So I went to the exam with an empty stomach, a tachycardic heart, a laboured ventilation, and a mounting tawakkal only to Allah. I called my parents to ask for their prayers as well.
In the quarantine room before my longcase, I flipped through the topic ‘Nephrotic Syndrome’ from the Paediatrics Protocol, deep down hoping that I would NOT get a Paediatric case since Paeds was the least I prepared for. So I was brought to the exam hall, with “Allahumma yassir, wa la tu’assir” repeatedly chanted. When the screen was uncovered, there laid a boy with a Cushingoid face, “Hah, a Paediatrics case!”. Again, Allah knows best. And subhanallah, it was a case of Nephrotic syndrome, which I skimmed through just before the longcase. The memories of my previous Paediatrics exam came flashing back as I recalled Prof Wahab’s advices.
This poor boy had steroid-resistant nephrotic syndrome. The questions asked were directly from the Paediatrics protocol. Alhamdulillah Allah helped me answer the questions well. I also stressed on social aspect of the patient – his deteriorating academic performance, steroid side-effects on his daily activities, declining health, family support, financial problems, effect of the illness to patient and his family, etc. I think these had managed to capture the examiner’s attention.
Among the questions asked were:
- Pathophysiology – starting from loss of negative charges, etc
- Secondary causes of nephrotic syndrome
- Complications of nephrotic syndrome
- Complications of steroids
- Difference between stunted and arrested growth
- Surgical complication (Asked by Dato’ J) – spontaneous bacterial peritonitis
- Meaning of remission, relapse, frequent relapse, steroid dependant, steroid resistance, etc
- How to manage relapse
- Histological types of nephrotic syndrome
- Side effects of cyclosporin, cyclophosphamide
- Mechanism of action of cyclosporin, cyclophosphamide
Alhamdulillah, Allah eased my long case.