10th Batch MBBS IIUM Blog

Showing posts with label Exam. Show all posts

Professional Exam Episode V: Saatku disapa ujian HEBAT...

Tanggal 27 Mei 2011, aku diduga dengan sebuah ujian hebat yang bukan calang-calang, kukira ini antara uijan yang paling hebat pernah melandaku setakat hidupku selama hampir 25 tahun ini.

Allah telah mengujiku dengan menganugerahkan Distinction dalam final professional exam, sebuah ujian nikmat yang tak pernah kupinta, tak pernah ku sangka-sangka. Bahkan sebelum professional exam, aku sudahpun bersedia utk menghadapi apa sahaja kemungkinan setelah kuusaha sehabis daya.

Selama berbulan-bulan aku memohon dalam doaku, “Ya Allah izinkanlah kami satu batch lulus professional exam, itu pintaku ya Allah, Kau qabulkanlah”

Namun hanya beberapa hari sebelum exam, doaku bertukar, “Ya Allah, kurniakanlah apa yang Kau Tahu terbaik utk kami. Andainya gagal dalam professional exam itu yang terbaik untukku, maka aku bersedia menerimanya, kerana Engkau Maha Tahu. Namun Kau terbitkanlah redha dan sabar dalam hatiku”

Dan saat itulah, baru aku merasai kemanisan tawakkal yang sebenar-benarnya. Bilamana kita berserah sepenuh hati pada Allah... dan kita gantungkan semua harapan padaNya, sedang kita bersedia menerima apapun ketetapan yang Allah Tahu terbaik utk kita, sekalipun ianya pahit di hati kita, buruk di mata manusia...

Sesuatu yang nampak impossible, bilamana Allah mengatakan ‘kun fayakun’, maka terjadilah perkara yang paling mustahil sekalipun.

Awalnya kurasakan, aku tidak ingin pun distinction untuk diriku sendiri, apatah lagi bila ia mampu menerbitkan penyakit-penyakit hati yang tidak diingini. Namun andai distinction ni untuk Islam, untuk dakwah, ku berdoa moga Allah kurniakan yang terbaik. Tak penting pun bagiku, distinction atau tidak. Yang lebih penting adalah menjadi Dr dengan attitude yang distinction, dan seperti yang kunyatakan dalam ‘speech bidan terjunku’, yang paling penting adalah distinction di sisi Allah, dan itulah yang seharusnya menjadi target utama kita semua, insyaAllah...

Semoga kita semua dapat menjadi Dr luarbiasa, yang bukan setakat menyembuh manusia dengan izin Allah, tapi sebagai ‘agen’ Allah untuk menyembuh ummah dari segala penyakitnya, dan gemilangkan Islam di muka bumi ini... Ameen!

Category: Exam 1 comments

Professional Exam Episode IV: The VIVA

Hana Insyirah

A bit sharing on the 4-VS-1 VIVA session...

SURGICAL

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?

Me: Screening

Examiner: What are the pre-requisites before you do screening?

Me:

- 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, 1^st 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 1^st 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?

***

MEDICAL

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?

Me: Warfarin

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)

***

PAEDIATRICS

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?

Me: IM

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!

Category: Exam 1 comments

Professional Exam Episode III: The Day (Shortcase)

Hana Insyirah

Next came the short cases. My first shortcase was a uterus larger than date. The first time I examined the patient, I was ‘kicked’ by the fetus at the right iliac fossa. Initially I wrongly diagnosed the patient with polyhydromnios.

Examiner: Do you think in polyhydromnios, patient can be lying comfortably like this?

Me: Unlikely.

Examiner: Would you like to examine again?

Me: OK. Minta maaf kak, boleh saya periksa semula?

The second time I examined the patient, her second baby kicked me at the left hypochondriac region. OK. Alhamdulillah, again Allah helped me by giving a clue. Padahal tak rasa pun multiple poles! This has to be a multiple pregnancy. It was a twin.

Examiner: How do you manage this patient?

Me: I would like to know the patient’s chief complaint

Examiner: Patient is comfortable, no complaint

Me: In this case I would like to prolong the pregnancy until term. Provided that this is not a MCMA twin, and the leading twin is in cephalic presentation, I would like to attempt vaginal delivery and anticipate the complications associated with twin pregnancy including PPH (maternal) due to overdistension of the uterus and...

Examiner: OK2. How do you classify twins?

Me: According to zygosity, chorionicity, amniocity

Examiner: If you have a twin pregnancy, which one would you prefer?

Me: DCDA, since it is associated with the least complications

Examiner: What complications do you mean?

Me: TTTS for MCDA, cord accidents for MCMA...

I had a CVS examination for my 2^nd short case, the patient had a raised JVP, lower limb oedema, (and collapsing pulse which I failed to detect)... He had a displaced apex beat, thrills, various murmurs, MR, TR & AR. But I only detected MR & TR. Since he had multiple findings, I spent almost 8 minutes on examination alone, there were not much time left to discuss.

Examiner: So Dx?

Me: MR & TR and patient is in failure

Examiner: Only MR & TR? How about pulmonary area?

Me: Err...

Examiner: OKlah nevermind (he actually had an AR also, according to Dr. Hasnur). Differential?

Me: VSD, but unlikely since patient is old, but it can occur due to MI rupturing the septum

Examiner: So you say patient is in failure, give him one advice.

Me: Fluid restriction?

Examiner: OK

My third case was an orthopaedic case.

Examiner: Examine the left lower limb

Me: (I asked permission to be on patient’s left side, and then I presented by running commentary) There were limb length discrepancy, muscle wasting, old scar. PLUS old sinus. No active signs of inflammation. I proceeded with FEEL & MOVE (range of movement). Positive Galeazzi’s sign.

Examiner: How many types of scar?

Me: Two – from the lesion & from the external fixator

Examiner: What do you want to do next?

Me: Calculate the true length

Examiner: OK, lain?

Me: I would like to attempt to move the limb. There was a pseudojoint at the distal third of left tibia, moveable and PAINLESS

Examiner: Ok. What is your Dx?

Me: Non-union of distal third of left tibia secondary to OM

Examiner: What are the factors affecting bone healing?

Me: Can be divided into bone factor, patient factor, surgeon factor... bla bla bla...

Examiner: What do you think was the problem with the patient?

Me: Infection, probably OM

Examiner: How did he get the infection?

Me: He may have had an open fracture through which infection was introduced...

Examiner: How do you know he had an open fracture?

Me: He had an external fixator (from the scar)

Examiner: Ok, I agree. What else was the patient’s problem?

Me: Hmm, maybe patient factor, uncontrolled DM?

Examiner: Hmm, OKlah, what else?

Me: ???

Examiner: Look at the calf. Do you think the soft tissue was enough to cover his fracture?

Me: Oh, insufficient soft tissue cover.

Examiner: OK. Dah, cukuplah...

Alhamdulillah, I have never felt this calm in any exam before this (I mean, I was magically calm during the professional exam.. But before the exam, Allah jelah yang tahu...). In this exam, I felt confident, well-directed, Alhamdulillah my answers were mostly smooth, and at instances I even had ‘speech diarrhoea’ which almost never occurred before...! At one point I did not feel like myself, it felt like an external force was controlling my every movement and sayings. And NO, I do not have any other Schneiderian first rank symptoms. I just felt like Allah was with me in my every step, He was eyes with which I used to observe, He was my hand with which I examined the patients, He was my legs with which I walked, He was my tongue with which I presented and answered the questions, seriously! I did not feel like myself. Allah helped me all along, Alhamdulillah, thumma Alhamdulillah...

“My servant constantly approaches Me through supererogatory acts of worship until I love him, and when I love him, I become His eyes with which he sees, his hands with which he holds, and his legs with which he walks.” In another version, the wording is: “So through Me he hears, through Me he sees, and through Me he understands.” (Bukhari)

Tidak ada kedekatan hambaKu yang lebih Aku sukai melainkan dengan apa-apa yang Aku wajibkan kepadanya. Kemudian, hambaKu masih mendekatkan diri kepadaKu dengan amalan sunnah sehingga aku mencintainya. Apabila Aku sudah mencintainya, maka Akulah yang akan menjadi pandangannya ketika dia melihat. Dan Aku yang akan menjadi kakinya ketika dia melangkah. Apabila dia meminta perlindungan kepadaKu maka pasti aku lindungi. Dan apabila dia meminta ampunanKu pasti Aku ampuni. (Bukhari)

May we all become those whom He loves...

Category: Exam 0 comments

Professional Exam Episod II: The Day (Longcase)

Hana Insyirah

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.

Category: Exam, Long case 0 comments

Professional Exam Episode I: My Road to the ‘D’

Hana Insyirah

Please excuse me for the delay in sharing my Professional exam case which has ended more than 1 month ago.

Masih baru melayari bahtera rumahtangga,

Menghirup manisnya nikmat bercinta,

Dengan seorang jejaka,

Yang langsung tidak pernah dikenali sebelumnya,

Melalui satu-satunya saluran perCINTAan yang HALAL di sisiNya...

Maybe dah basi, but I promised myself I would share my experience in professional exam with others, and late is better than never. To begin with, I don’t have a proper study group like others. We met as rare as once a month or so. I could not commit to any study group due to other ‘co-curricular’ programmes I needed to attend almost every weekend, in Kuantan and in KL. The nights during my weekdays are mostly devoted to usrah, at least 3 times per week. Near the exam, I only managed to parasitically attach with other study groups, special thanks I bid for their willingness to accept this ‘parasite’.

I had to do most preparation for my wedding myself. I had to find the caterer, I had to buy and do the hantaran, make the invitation card, order and buy the doorgifts, buy and order my wedding attire, and about a week before professional, I had to buy a new lace for my wedding attire because the tailor wrongly sewed the original lace. 3 days before the big exam day, I was still searching for a house to rent in Selayang area for us to stay after our wedding (with the hope that I’ll get a placement in Hospital Selayang). Indeed, preparing for the wedding was fun and pleasurable, but thinking about the approaching professional exam gave me bees in the stomach...

More than once, being a mere human, I was engulfed by stress; I felt afraid and unready. No matter how far we tried to run away from the exam, the clock kept ticking, the professional exam kept chasing us from second to second. When I was conquered by anxiety, I just cried & turn to Allah and recite the Holy Quran. And He never failed to console me. I remembered once, I cried to my fullest and randomly opened the Quran, this was the first verse which my eyes caught, a relief from Allah:

(This is Allah's Way) regarding those who deliver the Messages of Allah and who fear Him, and fear no one else than Allah. Allah is Sufficient as a Reckoner [33:39]

“(iaitu) orang-orang yang menyampaikan risalah-risalah Allah, mereka takut kepadaNya dan tidak merasa takut kepada siapapun selain kepada Allah. Dan cukuplah Allah sebagai pembuat perhitungan...”

Subhanallah, Thank You Allah...!

The weekend before the exam (21^st & 22^nd May), I had yet another programme which I have to attend. It was a decision which tested my tawakkal, priority, faith and trust in Allah. I know well that Allah had promised, “O you who believe! If you support (the cause of) Allah, He will support you and make your foothold firm”. But knowing and believing are two different entities. When you believe, you need to prove it. Just like a delusion, due to the strong belief, patient will act upon it.

So although my professional exam preparation was hardly even 50%, I braved myself to go to the programme, with all the books and notes brought along, together with my forever supportive soulmates – iman, solehah, and kak mirah. When other people was fast asleep, I read my orthopaedic notes, topics I encountered for the 1^st time since Orthopaedics posting in 4^th year – yup, 2 days before the exam! And subhanallah, among the topics read during the programme was those which came out in my clinical exam. Alhamdulillah. Innallaha laa yukhliful mi’aad. Allah never breaks His promise!

Category: Exam 2 comments

hafal soklan group IM- aman

Hielmi Syaiful-Nizam

Category: Exam 0 comments

Soklan kena hafal and jadual clinical Group A- mimi

Hielmi Syaiful-Nizam

Category: Exam 2 comments

MCQ+ OBA+ OSCE OnG Gp A

Hielmi Syaiful-Nizam

link

Category: Exam, mcQ, Questions Bank 0 comments

Paeds Y5B4 questions

Afifuddin

Here the exam questions

Category: Exam, mcQ, Questions Bank 0 comments

Short Case with Prof Hamizah

Hielmi Syaiful-Nizam

Dr gave me the EDD and asked for POG… the pt’s was 35 weeks…

I was asked to examine pt generally….

Me: This is a lady in her..mid 20’s? medium built, conscious and alert. Hydrational and nutritional status fair. Not pale (no signs of anaemia sucha as angular stomatitis, atrophic glossitis)nor jaundice, no parotid, no thyroid swelling. No pedal oedema. Oh.. and the abdomen is distended…

Prof : *smiling* y do u think I bring u to this patient? What do you think I want tou to pick up?
Me: *slams my forehead* oh.. the patient has rashes found all over her face, forearms and legs *I’m so dead I thought*

Prof : remember hielmi, don’t be so caught up with the negative findings.. these rashes are obvious..
Me: Yes Prof

Prof : so describe the rashes…
Me: it is found most prominently on the face, multiple 2-5 mm, hyperpigmented, keratinized, looks healed… there are a few at the forearms and legs tho they look more healed?

Prof: what else do you want to do?
Me : I would like to check the trunk and with seeing the progression of the healing maybe can tell whether the pattern is centripetal or centri….*ak lupa dowh masa nie..prof pandang je lama plak tu*.. fugal?

Prof: good *phiuhh* what do u think is the cause?
Me: Varicella zoster?

Prof: ok, now examine the abdomen

The abdomen finding was uneventful… other than more rashes…. However halfway thru.. uterus contracts, so timing was done… prof prefers running commentary

Prof : so whats ur dx?
Me: seeing that she has contractions at 35 weeks, my dx is preterm contraction secondary to varicella zoster infection. However I need to complete my examination with VE and bishop scoring to see if she is in labour.

Prof: if I give u one chance… only one.. to ask a single question to the patient… what will it be? Do it…
Me: Puan, bila puan dapat ruam2 nie? Trimester pertama, dua, tiga?
Pt: baru je 2 minggu…

Prof: Ok, y that question?
Me: due to the complication it carries based on trimester.

Prof: elaborate..
Me: 1st trimester carries risk of teratogenicity…

Prof: but this pt got it at third so?
Me: hmmm.. the baby will be a carrier?

Prof: no… what do we worry bout? 10 days post delivery?
Me: fulminant manifestation of the dx on the baby..

Prof: elaborate..
Me: hmm… skin eruptions?

Prof: ok… skin infections.. anymore?
Me: lung infections?

Prof: ok pneumonia… one more we worry bout…
Me: *masa nie cuak.. mula pikir all the organs dalam badan…* brain?

Prof : so.. what brain? Be specific..
Me: hmm.. meningitis?

Prof: that is just the covering…
Me: owh encephalitis..

Prof: Yes… now one more chance to ask a question to patient..
Me: Puan ada makan ubat? Ubat apa? Tau nama ubat?
Pt: ada, antiviral tp tak tau nama apa.

Prof: but u know I believe… what is it?
Me: Acyclovir

Prof: how do u prescribe acyclovir for her?
Me: I’m sorry prof, I do not know.

Prof : ask the patient now, u will remember forever…
I start asking the pt and was told its 800mg 5 times a day for 5 days.. ak tak cek lagi…

Prof: will the treatment cure her?
Me: not entirely, the virus will remain dormant in the nerves ganglion and will resurface if the patient will undergo stress or immunesurpressed..

Prof: so whats the long term complication for this patient?
Me: it could resurface during next pregnancy and causes 1st trimester infxn and for the patient.. shingles..

Prof: what is shingles?
Me: the virus causes rashes along the dermatomal region it resides while remain dormant. Painful pustules.

Prof: which shingles are we afraid of?
Me: lumbar?

Prof: why? Its just the abdomen..
Me: owh, trigeminal nerve shingles… ocular complication leading to blindness?

Prof: yes… How do you think the patient get the disease?
Me: through contact with someone with the disease..

Prof: ask the patient…*basically one of her kids got it first*… what do u mean contact
Me: fomites? Touch? Clothes? Its not airborne..

Prof: what?*mata terbeliak* Are u sure its not?
Me: *ak degil ckp tak gak.. sebenarnya ya* hmm.. the virus resides in the pustules and contact with it causes spread of infxn..

Prof: hmmm… ok.. have u ever been infected?
Me: yes..

Prof: when?
Me: when I was 7

Prof: will u get infected now by her?
Me: no because one, I’m immune and secondly she is beyond her infectivity period because it has been 14 days..

Prof: so explain y she have it only now?
Me: she has never been exposed, this is her first infxn and also because she did not take the vaccination which at her time wasn’t in the immunization programme.

Prof:*asking the pt* pertama kali ked pt demam campak?
Pt: a’ah.. nie kali pertama..

Prof: you can go now
Me: thank you

Prof sgt2 baik.. tolong je… masa bincang ak atas kerusi while dia duduk atas katil..

Category: Exam, Long case 5 comments

My long case with Dr Muna

Hielmi Syaiful-Nizam

CC

A 38 y.o, Malay lady, from Felda Panching, G5 P1+3, a k/c/o PCOS with 14 yrs hx of subfertility, recurrent abortions dx with anti-phospholipid syndrome(APS) and valvular heart dx with LNMP 15/6/10 SOD, no contraception but irregular menses with benefit of early scan 10/52 confirm her EDD at 22/3/11 making current px at 37/52 presents 3 days ago for 3 days history of reduced fetal movement.

Dr: so in conclusion u have a very complicated case *smiles*
Me: Yes..huhu... but i will try my best Dr

HOPI

This is a very precious pregnancy.
Suspected when missed period, UPT done positive.
1st trimester symptoms = only breast engorgement.
No episodes of PV bleeding or abd pain during 1st trimester

Booking at 8/52 POA
-Obese = BMI 35
-normotensive, blood group cant remember, rheses +ve
-blood test = nonanaemic, VDRL, HIV. Hep B non-reactive
-urine = no glycosuria or proteinuria

Due to her dx of APS, given aspirin 75mg from 10/52-37/52. Self-administered s/c clexane given from 28/52.
Due to heart dx, visit MOPD and was told can cont with pregnancy and does not need combine care.
Due to obesity, MOGTT indicated, done 3 times @ 15, 24, 34 weeks.. all normal.

So far 13 followups(biweekly) at HTAA due to her probs, all uneventful.
Scans done on every visit – singleton, healthy, no congenital abnormality, normal growth, AFI good, placentation normal with no obvious calcification.

Quickening felt at 16/52. ATT completed.
Started on FKC at 34/52.
3 days ago, reduced fetal movement(do not complete 10 in 12 hrs), did not seek medical attention because of an upcoming followup. On followup, fetal movement returned normal but warded just to make sure.

Currently no sign and symptoms of labour, no PV bleeding, FM good.

On further questioning, denied rashes of face or anywhere else, no joint pain, no easy bleeding, no jaundice, no SOB, no calf tenderness.

Past Gyn + Obs (I decided to just combine the both to have smoother chronological flow)

Attained menarche at 12, regular till age 21 when turned irregular (every 1-3 months around 3-5 days) nor dysmenorrhea.

Was married for 14 yrs however conceived first child after 6 years of trying in which she got help of two cycles of clomiphine citrate (without any complication of OHSS) and an ovarian drilling. Dx with PCOS, other than the subfertility and irregular menses does have hirsutism(moustache), was on metformin.

Her first child was born full term 9 yrs ago with weight of 2.3 kg via elective LSCS due to oligohydramnios. On further questioning, no cause was found, she denied LL, GDM, PIH or congenital abnormality. No other cx antenat,intra,post-partum. Breast fed for only a week due to migraine.

Subsequently 3 miscarriage (2006(required D+C), 2008, 2009), investigated, dx with APS.
None of the pregnancy after the first was helped with induction.
Last papsmear 3 yrs ago – normal

Medical/surgical Hx
No significant hx

Family Hx
3/8 siblings. Both parents alive and healthy. Two other sisters have similar problems of subfertility.

No other significant drug hx. No allergy

Social Hx
Housewife, SPM holder. Live with hsband and daughter. Husband mechanic making RM1500.No high risk behavior.

PE

VS BP = 130/75 mmHg, PR=80bpm, RR=18bpm, T= 36.7oC
BMI= 42
Not pale, not jaundice, hydrational fair, No pedal oedema
Respi, thyroid normal.. denied breast examination
Heart = systolic murmur of the mitral region, radiating to the axilla, grade 3… no raised JVP.

Abd : distended due to gravid uterus. Pfannenstiel scar 20 cm, no scar tenderness, SFH 37cm, singleton, longitudinal lie, fetal back on maternal right, cephalic presentation , 4/5th palpable, adequate liquor with EFW of 2.8-3.0 kg. Can’t hear fetal heart due to thick abd.

Would like to complete with VE and bishop scoring…

Discussions

List the patients problems…

What is your concern now ?
Fetal wellbeing

How do you check for fetal well-being now?
Hx-FKC, PE-serial SFH(not relevant in this case), Ix- US and CTG.

Tell me bout FKC…

Tell me bout CTG and inteprete the pt's CTG….

What is APS? korang baca la ye sendiri pasal APS

How does it cause recurrent abortions?

What is done to this patient to maintain the px? How does it help?
Aspirin n clexane..bla2 ets

How wud u manage this patient?
-Seeing that the FM carry on till 38 weeks

Y c-sec? – very precious, dun wanna take the risk of vaginal delivery.

What risk? – untried scar, risk of rupture, no previous SVD before, so there is probability of CPD… again I stress it’s a precious pregnancy.

But is she contraindicated for SVD? No

How wud u monitor if pt keen on SVD?... S+Sx of impending rupture, prolonged active/2nd stage…

How wud you prepare this patient for C-sec: Ix : FBC, GXM, PT/APTT….Make sure anaes team comes… fasting… stop clexane on the morning of surgery.. bla2 ak goreng lagi ;P

What is the cx of the c-sec? anaes[mendelson(px)? Diff intubation(obese+px)? Difficult epidural(obese)], Hge, injury to other organs, bla2 etc….

After delivery, does she still need the anticoagulant? Yes, eventhough if the delivery is successful, she is still at risk of thromboembolism due to her obesity and APS…

So when do u wanna start? 6 hrs post-surgery..bolus 5000u and maintenance 1500u

What if tomorrow she complains of reduced FM? Put on cont CTG and if there is any sign of fetal distress EmLSCS..

thank you, u can go now

Category: Exam, Long case 0 comments

Group D Psy. Group

admin@10thbatch

from Hazlan, ketua posting psychiatry, group D..

Category: Announcement, Exam, mcQ 0 comments

MCQ OBA OSCE IM Y5B3

Hielmi Syaiful-Nizam

sorry lambat... MCQ+OBA+OSCE IM Y5B3.

Category: Exam, mcQ 0 comments

Group A..posting OnG...

Hielmi Syaiful-Nizam

MCQ+OBA
1. Tasneem – MCQ 1, OBA 10

2. Kamaliah – MCQ 2, OBA 10

3. Salmina – MCQ 3, OBA 10

4. Jetul – MCQ 4,

5. Nik Fatma – MCQ 5,

6. Jut – MCQ 6,

7. Len – MCQ 7,

8. Taan – MCQ 8,

9. Aishah – MCQ 9,

10. Asma – MCQ 10,

11. Wada – MCQ 11,

12. Hamimah – MCQ 12,

13. Husna –MCQ 13,

14. Amat – MCQ 14,

15. Ajmal – MCQ 15,

16. Azi – OBA 1,

17. Zarol – OBA 2,

18. Kak Nurul – OBA 3,

19. Helmi – OBA 4,

20. Zila – OBA 5,

21. Sam – OBA 6,

22. Najwa – OBA 7,

23. Hazri – OBA 8,

24. Razak - OBA 9

PMP
PMP 1

Trigger 1 : Tas, Jet, Wada, Razak

Trigger 2 : Sam, Ahmad, Chepon, Hazri

Trigger 3 : Sal, Kay, Nik Fat, Jut

PMP 2

Trigger 1: Azie, Zila, Mimi, Husna

Trigger 2 : Najwa, Asmaa, K.Nurul, Len

Trigger 3: Ajmal, Taan, Zarol, Cimee

OSCE : sume hafal last station korg....

pass rite after exam.. jgn tunggu2 ye.... clinical exam pass d softcopy to hielmi_nizam@hotmail.com

cooperation gr8ly appreciated... :D

Category: Exam 0 comments

Jadual Exam Paeds

Hamzah S.

Jadual exam paeds. Sori senget...

Category: Exam 0 comments

[Group B] Questions to be remembered & group C past questions

Afifuddin

Harap semua dapat hafal soalan masing2. sisters give your questions to Elmizah & brothers to Afif.

Ni soalan posting lepas. Terima kasih pada yg hafal...

Anyway good luck exam!

Category: Announcement, Exam, mcQ 0 comments

ADrive: Revised Question Bank (EXP: 3rd May 2011)

bolapi87

These are new ADrive links for past blocks year 5 questions:

mcq pmp osce IM Y5B1 2010.rar

mcq oba osce O&G y5b1 2010.rar

mcQ Paeds Y5B1 2010.rar

mcq oba clinical case surgery y5b1 2010.rar

mcq psy y5b1 2010.rar

mcQ IM Y5b2 2010.rar

mcq oba osce O&G y5b2 2010.rar

mcQ Paeds Y5B2 2010-11.rar

mcq surgery y5b2 2010.rar

MCQ psych y5b2 2010.rar

mcQ OBA OSCE IM Y5b3 2010

mcQ OBA clinical case O&G Y5B3 2011.rar

mcQ OBA Paeds Y5B3 2010

mcq OBA OSCE O&G y5b4 2010

mcQ OBA OSCE PMP Paeds Y5B4 2010

MCQ OBA OSCE Surgery Y5B4 2011

9th batch Question ONGPAEDSIM.rar

9th Professional Exam.rar

p/s: These files require extraction by Winrar, download Winrar and install

Enjoy ADrive..Tq

Category: Exam, mcQ, Questions Bank 0 comments

Past O&G Exam Group B

Afifuddin

Theory paper

Clinical exam

Thanks to all involved. Good luck for upcoming exam!

Category: Exam, Long case, mcQ, Questions Bank 0 comments

Mutiara berharga...

Hana Insyirah

Hari ini, seperti hari-hari lain dalam hidupku, Allah mengirimkan sebuah mutiara tarbiyah yang amat berharga… Setiap hari, bahkan setiap saat, Dia sentiasa menemani setiap langkah perjalananku, bersamaku dalam setiap hela nafasku, mentarbiyahku, tanpa jemu… Cuma bezanya, kadang-kadang aku terperasan tarbiyahNya, namun kebiasaannya, aku lalai dari petunjukNya.

Exam longcase Paeds ku tak berjalan dengan begitu baik. Walaupun dapat case simple (nephrotic), namun sebab dah tertau Dx, aku jadi bias dan terlupa nak rule out other causes of neck swelling which the patient presented with. Neck swelling tu sebab relapse of nephrotic, the fluid accumulated below his mandible, which is an unusual site for 3^rd space loss. Actually, 1^st impression when I saw the patient, dalam hati “Eh lymphoma ke ni”. Tapi once dah tau Dx, terus terlupa langsung pasal all my differentials including lymphoma & thyroid swelling. Dengan kehendak Allah, Dia telah membuatku lupa, so dalam HOPI tak rule out lymphoma & thyroid symptoms langsung.

Hari ini barulah aku mengerti apa bahayanya dah tau Dx patient. Apa akibat yang boleh terjadi kalau dah bias dengan Dx patient. Kerana kesilapanku sendiri, akhirnya aku hanya sekadar present history, prof dah suruh berhenti. Dia cakap, “Kalau you present macam ni pro nanti, you memang tak boleh pas… repeatlah 6 bulan”

“PE dan Ix tak payah present. Prof dah tau, you dah skewed to the Dx. Dah, go for your short case. Because we have nothing to discuss here”

Tak pernah exam longcase, aku hanya present setakat history. Aku bangun dan pergi meninggalkan prof dengan terpinga-pinga, membawa hati yang sarat dengan penyesalan… Kalaulah diberi peluang kedua…

Dengan kuasaNya, apa-apa pun boleh berlaku pada sesiapa pun yang Dia kehendaki… Kadang-kadang, bukan kita tak tahu, tapi kita terlupa. Kadang-kadang kita dah ingat nak tanya, tapi tengah-tengah clerk kita terpesong lalu terlupa. Kadang-kadang, kita dah prepare lain, tapi yang terkeluar benda lain. Kerdilnya kita, berbanding rencanaNya.

Sampai malam ini, masih terngiang-ngiang kata-kata prof, “Kalau you present macam ni pro nanti, you memang tak boleh pas…”

Tiba-tiba aku terfikirkan sesuatu…. Cuba bayangkan… Kalau depan Allah di Padang Mahsyar kelak.. setelah diperhitungkan satu per satu pahala dan dosa kita.. maka Allah mengambil keputusan…

“Kalau macam ni amalan kamu di dunia, kamu tak boleh pas, tak boleh masuk syurga…”

Cuba bayangkan andai ia benar-benar berlaku, di depan Allah Penguasa Hari Perhitungan… Dan kita tahu, andai tidak ke syurga, tiada pilihan lain melainkan ke…….

Lalu ketika itu, melututlah kita di depan Allah… menangis, merintih dan merayu…

Ya Allah, kembalikanlah aku ke dunia… Ya Allah, aku janji aku akan buat yang lebih baik… Ya Allah, akan kutaati segala perintahMu, dan jauhi segala laranganMu… Ya Allah, berikanlah aku peluang kedua, tolonglah ya Allah….

Tapi ketika itu, kita tahu… tidak akan ada lagi peluang kedua… ketika itu, penyesalan yang kita rasai, pastinya tak tergambar oleh akal fikiran ini… Na’uzhubillah…

Kalau di dunia, selagi nyawa belum sampai ke kerongkongan, selagi matahari belum terbit di sebelah barat, Allah sentiasa bagi peluang kedua, ketiga, keempat dan seterusnya. Kalau fail end-posting pun, ada peluang untuk perbaiki pro nanti. Kalau fail pro sekalipun, boleh repeat 6 bulan dan resit pro exam lagi sekali.

Tapi, kalau fail di akhirat nanti…?

Category: Exam, Long case, Tazkirah 5 comments

Hafal soalan Surgery

ash007

jangan lupe hafal soalan...nnt bg soalan kat ketua n penolong kite.... good luck smue...

Category: Announcement, Exam, mcQ, Questions Bank 0 comments

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Professional Exam Episode V: Saatku disapa ujian HEBAT...

Professional Exam Episode IV: The VIVA

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Professional Exam Episod II: The Day (Longcase)

Professional Exam Episode I: My Road to the ‘D’

hafal soklan group IM- aman

Soklan kena hafal and jadual clinical Group A- mimi

MCQ+ OBA+ OSCE OnG Gp A

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My long case with Dr Muna

Group D Psy. Group

MCQ OBA OSCE IM Y5B3

Group A..posting OnG...

Jadual Exam Paeds

[Group B] Questions to be remembered & group C past questions

ADrive: Revised Question Bank (EXP: 3rd May 2011)

Past O&G Exam Group B

Mutiara berharga...

Hafal soalan Surgery

Cloudy@10thbatch

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