Tuesday, December 16, 2008

leaving Melbourne

I will catch the flight tomorrow. I will be back to Melbourne by 8th February 2009. I might not be able to blog as frequently as I should.

Good bye smile

Saturday, December 13, 2008


- 2 days overdue. Take focused hx, do ex and Ix.
- Interpret partogram and CTG. Discuss appropriate management of prolonged bradycardia

- There are 5 photos. Diagnosis, DDx, and management. ?Chicken pox, Mongolian blue spot, nappy rash, Eczema, ?erythema toxicum.

- Abdominal mass. DDx, Symptoms of fibroid, Mx of fibroid in someone who want to get pregnant.
- Pap's smear on a pelvic model. Manouevre to locate the cervix if could not find the cervix for the first time.

This was the hardest OSCE ever. We were allocated 9 minutes per question and there was no pre-reading time.

You just knock the door and straight away launching yourself to the unknown situation. You will be given the question from the examiner, and the time is ticking while you read and think on how to answer the question. You will be asked several questions and there was no turning back or any second chance. Once you answered the question, the examiner will move on to the next question. If you are wrong, you don't have time to reflect on that. The clock is ticking. 9 minutes is not that long. Scary.

I definitely failed the station on prolonged pregnancy. Everything on history is normal and I'm not sure what else to ask. Perhaps the topic that needs to be discussed with the patient is the induction of labour or complications from prolonged pregnancy. It was the hardest OSCE station in this exam.

For neonatology, I might be correct for 2-3 pictures and the rest were spend on guessing the diagnosis. The conditions were rare and not clinically significant.

Gynaecology stations might be the only chance for me to get at least enough mark to pass this OSCE. However, I'm not sure whether I did well in gynae stations. Pap's smear was awkward and I made few mistakes.

The end of this semester exam is marked with sombre mood. I'm not sure whether I would pass the exam and it has been raining non-stop since yesterday. This is certainly not a good way to end this obstetrics, gynaecology and paediatric block. Hopefully I would pass the entire exam.

O&G written exam.

There were 30 questions that need to be answered within 3 hours. There was only 6 minutes per question. The best part of it, most of the question came from the question bank and we were already given access to the question bank. So, if you have answered the questions from question bank before the exam, and memorised the answer, this exam will extremely easy.

It was an exciting exam since I just need to write down anything that I have memorized before the exam. If you could not remember the answer, you can either move on to the next question or try to write a little bit and come back later. This is the first time that I don't need time to think how to answer the questions but instead try to write as much as I could remember.

At first, I thought that the exam will be finished in 2 hours. Thus, for the first 2 hours, I was writing extremely fast without stopping for a break. If I could not remember the answer, I used the general approach. Take history, do physical examination and ask for investigation. You can always order for FBE and UE in most of the situations biggrin.

At the end of 2 hour mark, my fingers were stiff and I was out of breath. My right hand was shaking and I could not bend my arm for the next few minutes. Perhaps there was not enough blood flow to my fingers wink.It was like doing a marathon of answering lots of question in a short amount of time. My forearm muscles were exhausted and my handwriting were getting worst towards the end of the paper. Hopefully the examiner could read my handwriting.

Then, I realised I have another hour to go. I spend the last hour in improving my answer and checking for any mistakes. There was one grave mistake that was so funny that I had to suppress my laugh during the exam.

This was the question.
Outline the management of...yell0w-green discharge....
The moment I saw the word yellow-green, I instantaneously wrote; this is malrotation with volvulus until proven otherwise and I proceed on how to manage malrotation. I had perfect answer for this and could literally fill the entire page with the management of malrotation.

In the middle of writing the answer for malrotation, I caught a glimpse of the question again. Yellow-green discharge from the EYE.

This is a different medical problem and I had wrote the wrong answer. Malrotation with volvulus is a surgical emergency of the gut, but the question is asking on the problem with the eye. Fortunately, I have the time to rewrite the entire answer. This must be one of the embarrassing moments for me during this exam.

p/s: If you see any green-vomiting from an infant, you need to think of malrotation with volvulus and this is a surgical emergency. Unfortunately, the question is not on vomiting but asking on eye discharge rolleyes

Moral of the story: read the question carefully and that includes reading the question until the end mrgreen.

Paeds written exam

There were originally 10 questions and one question was cancelled last minute. 3 of the questions were surgical. Overall, the written exam was weird.

The first question was on ethics. I was surprised when I saw this question. I never thought that we would be asked on ethics. I was guessing all the answers and trying to remember all the four principles of ethics.

The next few questions were a bit OK and somehow, I think (hopefully), I have wrote enough points to get at least a pass in the exam. There was one question which was annoying. We didn't learned anything on how to answer the question and hopefully they will reconsider the question again.

In conlucsion, the paeds written exam is a bit OK.

Paediatrics OSCE and slide exam.

There were 4 stations

1. Vomiting and diarrhoea in 2 year old boy. Take hx and discuss management.
2. Surgical stations.
- Abdominal pain in 4 year old boy. DDx and initial management. Likely Dx and how to manage the condition.
- Exomphalos in term baby at rural hospital. DDx, initial management. Management of hypoglycaemia. Other risk factors associated with the condition.
3. Do cover test and describe the interpretation of the test. Diagnose type of strabismus from video and picture shown. Discuss DDx, Ix and management.
4. Take short hx from adolescent coming for vaccination of Boostrix (DTPA). Perform immunisation procedure and discuss risk associated with the immunisation including anaphylaxis.

Personally, I think the hardest station is the surgical station. The examiner keep asking what else I would do to diagnose the problem. It is hard because the time constraint and the nervousness of the exam.

Slide exam. We were shown pictures or videos for few minutes and need to answer the questions as soon as possible.

  • Breath-holding spells. DDx and what would you tell to the parent.
  • Eczema, principles of management, management of infected eczema, management in adolescent with eczema
  • Down's syndrome, other anomalies associated with the syndrome. discharge plan from GP
  • Oedema at eye, DDx and management of this condition
  • Nut allergy, management of anaphylaxis, discharge plan.
  • Developmental milestones. Normal range for walking. Three broad clinical conditions associated with delay in walking.
  • Fracture of femur, describe appropriate analgesia
  • Torticollis, Likely Dx and diagnose the abnormal side
  • Imperforate anus, other associated anomalies
Hopefully I will pass this OSCE and the slide exam.

Friday, December 12, 2008

the exam is over

Alhamdulillah, now my summer holiday can really starts. There will be several tasks that I need to do during holiday and hopefully I will be able to complete the tasks.

I will write about the exam later. Right now, need to sort out few stuffs.

Wednesday, December 03, 2008

Revision Day 3

Today is the last day of formal revision. It was on gynae and I was surprised to know that I don't know much about oral contraceptive pills. Despite it is one of the most common drug prescription, we didn't learn in detail on how to prescribe it including telling all the side effects, contraindication and anything that might interfere with its efficacy.

I won't be blogging until my exam is over. That is until 12 December. Good bye for now...

Tuesday, December 02, 2008

Revision Day 2

Today was the revision for Obstetrics, Gynaecology and Neonatal Paediatrics. It started at 8am and finished by 12.30pm. There were lots of topics covered and at the end of the day, my fingers were extremely exhausted from copying down the notes. This was a good exercise for my fingers before answering the written exam on next week.

Now, I am quite nervous thinking that there are lot of stuff to be remembered. I wish my brain cells would retain as much information as possible until the end of next week.

For Obs and Gynae exam, there will be 30 questions in 3 hours. There will be only 6 minute per question and it will be a race against time next week. I now need to find a good comfortable pen for the coming exam. If not, my fingers will be extremely stiff like today. Wish me luck smile

Monday, December 01, 2008

Revision Day 1

We will be having three day of formal revision with the lecturers prior to the exam. Today is the first day and the revision was on paediatric and adolescent health.

There were many topics discussed and at the end of the day, I realised that there are lot that I don't know yet especially dermatology. The dermatologist showed us lots of pictures for spot diagnosis.

There are several differential diagnosis said by the medical students and most of the term were quite unfamiliar to my ear except one, Trichotillomania. I mentioned this condition earlier this year biggrin [read the post].

Trichotillomania is common among students who will be sitting for exam and I had to laugh when the dermatologist suggest for psychologist referral for someone with this condition. I don't think it is a serious condition unless you lose a lot of your own hair.