Alhamdulillah, finally I have graduated from college with a medical degree (MB BCh BaO) on July 4, 2010. Although I am no longer a college student and awarded a title ‘doctor’, I still AM a medical student – for life! There are still A WHOLE LOTs to STUDY, to LEARN and to EXPERIENCE until we really become a safe doctor. Yes, a SAFE doctor – does his best to deliver the best treatment and least harm – to reduce patient’s sufferings (bi-izniLLah).
It has been about 1 month or so since my graduation day and I am still ‘rest-ing’ at home while half of my colleagues have already started working as housemans (interns) in government specialist hospitals throughout the country. To know the challenges they face everyday – ward work, tagging, on calls, scoldings from MO/specialists/nurses/patients – really ‘push me down’. It’s not that we did not know the reality of ups & downs of HO-ship, but now I realised that it is REAL and it is coming over me!
And now, everyone started to miss their college life! But to return to college would never be a choice. Therefore, we just need to go on, with Allah’s helps, of course.
Ok juniors, let me share some of my memories of final year examination. Here goes;
Station 1: “Examine her neck.”
– old lady, large solitary thyroid swelling, predominantly on the right side of the neck. (Continue with Prof PL’s proforma for lump & bumps). Trachea is deviated.
“What is the conclusion of your findings? What are your differentials?”
“What is Berry’s sign, and what it signifies?”
“How do you manage if it is positive?”
Station 2: “Examine the gastrointestinal system starting with general examination”
– mid-age gentleman, mild scleral icterus, tender RUQ, palpable vague mass on RUQ. (If patient is in pain and you find a mass, do not further palpate it and give your reason to the examiner. Remember, once the patient ‘ouch’, that’s it – FAIL!)
“What do you think the mass is?”
Station 3: “Examine the arterial system on his lower limbs”
– Likewise, just describe everything you ‘look, feel, move’. Do not forget to ask about pain before you do the Buerger’s test. Don’t do if patient is in pain, and give reason. Oh, please watch Prof KM’s video regarding PVD!
“Desctibe the location of the femoral vessels and nerve.”
“In ischaemic limb, does the pulse always not present?”
Mid-age Chinese gentleman present with painless jaundice.
History of biliary-colic-like pain on RUQ on and off for 3 months. Loss of weight. No fever/other history suggestive of infective cause or chronic liver disease. Non-alcoholic. Scan done – gallstone.
Murphy’s sign negative. No palpable abdominal mass.
“Diagnosis and differentials. How do you manage this patient?”
“If ultrasound shows dilated intrahepatic ducts, but common bile duct and gallbladder are not dilated, where do you think the obstruction is?”
“What is the most common cause? What is most likely Dx for this patient?”
Station 1: Examine the swelling (Paraumbilical hernia)
– Note the location, reducibility, pain, origin (umbilical or paraumbilical), patient’s body habitus, other swelling elsewhere. (Look up Ramachandran’s Clinical OSCE book).
– Management: When do we do conservative treatment and Surgery?.
– Advise to patients
– Complications of umbilical/paraumbilical hernia
Station 2: Examine this patient’s leg (Diabetic foot ulcer with gangrene)
– Describe (according to proforma), then give 3 differentials
– “Do you think there is arterial component in his case?” (Please note if there’s guttering of the vein or not)