A bit sharing on the 4-VS-1 VIVA session...
Examiner: What is the current most common Ca in Malaysia?
Me: Male – colorectal; female – breast Ca
Examiner: Is there anything you can do for common Ca?
Examiner: What are the pre-requisites before you do screening?
- We need to have data, i.e. the Ca is common
- The Ca is treatable, if not curative pun we can offer treatment modalities
- The screening tool is available, with acceptably high SPECIFICITY & SENSITIVITY
Examiner: What can you offer in screening for breast ca?
Me: US if <35y/o. Mammogram if >35y/o
Examiner: How frequent do you screen?
Me: Generally yearly beginning at the age of 40-59, since the incidence is highest in those age-group, then can probably reduce the frequency
Examiner: What are the disadvantage of mammogram
Me: radiation, especially if done yearly
Examiner: What else can you offer other than imaging?
Me: Genetic studies e.g. BRCA 1, BRCA 2
Examiner: So, would you offer a prophylactic mastectomy if they have BRCA 1 & BRCA 2 genes?
Me: (Owh, ni soalan dpt masa seminar breast Ca masa muda2 preclinical dulu. Soalan yang ditanya oleh wani Ca). Erm, that’s a very controversial issue (jawapan politic). I think, 1st we have to counsel the patient (goreng...), advice on yearly screening and regular BSE ke, if a lump is detected, then...
Examiner: Nevermind, I agree with you that it is a very controversial issue. How about the screening for colon Ca?
Me: For low risk group, advice start at the age of 45 or at least 50. For high risk group (e.g. FAP, HNPCC); FAP screen at the 10 years old, HNPCC start screening for Ca at the age which the 1st family member develop Ca
Examiner: How do you screen? You don’t do colonoscopy in everyone do you?
Me: No, we can offer FOBT
Examiner: How often?
Me: Same, depending upon low & high risk group
O&G (tak ingat sangat, sorry)
Examiner: Tell me what you know about cervical cancer. The pathology behind it.
Examiner: What are the treatments available
Examiner: Prevention? – HPV vaccination
Examiner: How does the vaccine work?
Examiner: 39 y/o Malay gentleman, come with palpitation. You check his BP, it is 150/90. Persistently high. What do you think?
Me: I’d like to ask further Hx, PE... (Sebenarnya examiner nak dengar Pheochromocytoma but I was blur...)
Examiner: How do you treat AF?
Me: Rate & rhythm control, bla.. bla.. bla..
Examiner: Other drug in treating AF?
Examiner: How do you administer warfarin, monitoring, etc...
Examiner: If patient refuse drugs, how do you treat? – radio-something... err, can’t remember, never heard of it
Examiner: What is the latest drug to treat AF in the market now? – Don’t know (tak ingat Dato’ mention ubat apa)
Examiner: Since 2008, you know that there have been changes in the immunization schedule in Malaysia. What are the changes, and why?
Me: Hep B previously 0,2,3,5 months, currently 0,1,6 months (more effective?). Dulu 3 in 1, now 5 in 1. Dulu OPV, now IPV (less vaccine-associated poliomyelitis). Dulu cellular pertussis, now acellular (less side-effects). I can’t remember the exact reasons...banyak goreng...
Examiner: Let’s say you are a houseman in the ward, there’s this boy with thalassemia, come for blood transfusion. Blood running, you wait for 10 minutes, patient ok. So you go to your room to take a rest. Suddenly the SN call and told you, “Dr, this patient develop sudden HGF with chills & rigors!” What are you going to do?
Me: I would go to the patient, assess the ABC...
Examiner: No, what are you going to tell the SN there and then on the phone?
Me: STOP the transfusion
Examiner: OK. You go to the patient and examine, he has urticaria rashes all over the body. What to do?
Me: Give IV Hydrocortisone?
Examiner: How long does it take for IV hydrocortisone to work?
Me: I’m not sure
Examiner: 2-3 hours. So what else can you offer, one with more immediate effect?
Me: IV adrenaline
Examiner: OK. How else can you administer adrenaline?
Examiner: How else?
Me: Errr.. I’ve never heard of any oral preparation of adrenaline...?
ExaminerS: Gelak berjemaah. The answer was subcutaneous.
This distinction does not mean I’m smarter, neither am I any better in any way. Allah yang bagi, everything was by His Help, His Will, His plan.
"This is by the Grace of my Lord - to test me whether I am grateful or ungrateful! And whoever is grateful, truly, his gratitude is for (the good of) his ownself and whoever is ungrateful, certainly! My Lord is Rich and Bountiful." (An-Naml: 40)
Alhamdulillah ‘ala kulli haal.
***Special special specialll thanks to najwa, naz & nabilah who provided a mock VIVA for us all-me, maryam & AJ- it was really really helpful!