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Author
The author is a paranoid, deranged and cynical misanthrope who records snippets of her life so that she will remember them when she grows old and withered. The identities of any names or initials on this blog are based on the assumptions of the reader unless otherwise specified, and the author claims no responsibility for them.
Reality
The author somehow got into medical school. Yes, you of the general public, shudder and fear the wrath of an inept doctor.
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Reading, Maisy (my dog), tea, writing (albeit badly), piano, music, junk food.
Hates
Almost everything else besides the things mentioned above.
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Bao Cheng' Bernice' Chien Young' Chun Hing' Claire' Faustina' Felicia' Ferly' Gloria' Irene' Irene & Jiaying' Jac' Jiamin' Jiasin' Jiaying' Lutheng' Karene' Marissa' Melesa' Mingyi' My fictionpress' Pamelia' Pei Rong' Qiu Ting' Rachel' Satires Site' Stasia' Sylvia' The Clique' Vinette' Wenjia' Xin Rong' Xue Ying' Yanne & I' Yanne & Jamie' Zeena' 203'
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Chat area
Just a quick post on my first (real) clinical exam yesterday (OSCEs):
Overall, I think it went ok. I strangely enjoyed it... I mean, it's one of the only times to really get 1-on-1 feedback from consultants who are experts in their field.
Gen med
The neurology station was quite alright... The patient was in pain because I think she had osteoarthritis. She had peripheral neuropathy, and I think I pwned the differential diagnosis that the examiner asked for. I started off by saying diabetes is the commonest cause in our community, then went on to list about 7 other causes. Bahahahaha. Hope that made up for forgetting to test for proprioception.
Respiratory was the best station. There're only a few chronic conditions they can give us, and very rarely acute ones (pneumonia). I admittedly kinda 'planted' a question when I mentioned I was looking for yellow nail syndrome in the hands (to check for bronchiectasis, which is one of the things that could potentially come up). Did everything in the exam I wanted to do, answered the questions well, treated the patient really nicely since I felt very sorry for her (I was the last student of the day and she was really tired and breathless from all the breathing in and out. She had COPD). Then... 'So what is yellow nail syndrome?'
Me: It is due to the hypoplasia of the lymphatic system associated with bronchiectasis.
Examiner: You are the 1st student ever who's been able to tell me that. I gave you full marks for this station.
BAHAHAHA. Nearly danced out of the exam place since that was my last station.
Surgery
The abdo x-ray station was pretty bad I think... I started off quite well, then said I thought it was an incomplete obstruction since there was some contrast going through. Examiner then told me it was complete since stools could never pass. Damn. He also asked me how the contrast is given, and I had a brain fart and said orally when I said earlier that it was a barium ENEMA. The examiner was nice though; told me to cut out a lot of my bullshit (eg: I'd take a full history and examine the patient) and get to the crux of the issue because he'd already seen 27 students before me (yes, he counted the number on his list). LOL.
Peripheral vascular exam started off relatively well... I noticed 2 bruises on the guy's abdomen and asked if it was from heparin but he said he was from insulin. Made a special point to look for neuropathic ulcers on pressure points in the foot/heel. Felt the abdominal aorta pulse...
Examiner: So do you think it's a weak pulse?
Me: Yeah... (but the patient is fat!)
Examiner: Oh, so ___ (patient's name) should be shocked to hear you say that! You're saying he's in shock aren't you? LOLOL
Me: What?!
He completely trolled me and kinda threw me off. At least he looked happy when I found that the right femoral pulse was weaker than the left. Not sure if I interpreted buerger's test correctly, but I thought it was positive.
The questions were completely screwed up. He asked me what I thought was wrong with the patient, so I said a peripheral vascular disease...?? (oh come on, that's the station) Asked me what else and I suggested peripheral neuropathy and basically dug a grave for myself. He asked me why and I said due to the insulin suggesting diabetes, and I thought the patient had a charcot's foot. Examiner asked me if I was sure it was a charcot's foot and I was like uh yeah...? He then said I was extrapolating since I hadn't done a peripheral neuro exam. Blargh.
Then asked me to localise where the 'lesions' were. I don't think I did that well. Lol.
And after that... He asked me to go back to the patient, and pointed at some freaking purplish/blackish non-blanching 2mm spot on his medial malleolus and asked me what it was. I was completely stumped. I mumbled Campbell de Morgan's spot, and he lifted the guy's leg up and showed me another 2 on his calf and asked me what it was again. I said... MELANOMA?! The examiner looked amused/pissed off.
And before I walked out the door, he asked if I thought the patient had an abdominal aortic aneurysm and I said no. I think I heard him tell the patient 'not bad' before I shut the door, so hopefully I passed.
Geriatrics
Had to talk to a patient about his incontinence issues, and the impact of the incontinence on his life. Not too bad... I timed myself to have time to present back to the examiner since he probably thought I asked a few strange questions (after asking about smoking history, I asked about dysuria and haematuria to screen for bladder cancer), but he LIED to me and told me I had more time, so I kept asking questions. Then 10secs into my presenting, the whistle went. Blargh.
Musculoskeletal
I had a rather stern Indian doctor who looked really pissed off. Looked at the spine xray, said I thought there was generalised reduction in bone density, and thought there was a fracture. She asked me to point to the fracture and I randomly jabbed. She looked annoyed (rolled her eyes and sighed).
Then asked me about osteoporosis risk factors. She would not accept broad answers. I rattled off a few things, thought it was enough... She asked for more. Said things like 'I'd ask about other medical conditions' and she asked what specifically. Mentioned malabsorption and endocrine disorders and she asked for specific endocrine disorders. Thankfully had a couple up my sleeve (Cushing's and acromegaly). Mentioned used of steroids and drugs. Asked what drugs. Again, thankfully knew a couple (anticonvulsants and heparin). She just kept asking for more and more risk factors.
Then asked for investigations. Started off with the obvious (DEXA), then went to the really minute and small. Like urine calcium. Oh, but that wasn't enough for her. She had to know HOW. So I said do a calcium/creatinine ratio and she was happy.
I think she was quite impressed with me because she looked a lot happier than when I first started. I handled the questions pretty well, but I know I stuffed up the pathology (she asked me to try looking for it again in the last half a min after I answered all the questions). She told me where the fracture was in the last 10secs. It was no where near where I randomly jabbed. LOL.
Infectious diseases
After the trauma that was MSK, I had a partial mind blank. Didn't help that the case was totally non-specific and unhelpful. And my examiner was bored stiff and wanted to poke some fun. One of the worst stations of the day for me, even though the examiner said I did well (don't believe him though; he was trolling me quite a bit during the questioning). This is probably the station I'd want to redo if I could.
Psychiatry
The patient and examiner looked completely bored. Think I covered the essentials... Couldn't answer the examiner's question at the end though. He asked what I'd ask in the developmental history for a borderline patient, and I said family situation, education/academic history and social function (friends). He then asked the question again. I said premorbid personality...? And he just said ok, thanks. No clue if I got it right. Might have been childhood abuse actually. Oh wells.
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I think I passed. If I were to fail any, it would be the surgery stations, ID and MSK. Given that I can only fail 2 stations, I damn well hope I passed at least 2 of those. At least I know I got 20/160 thanks to the full marks in the respiratory station. Lol.
And yes, this post was extremely polite. I would have used a few not-so-polite terms to describe a few of the examiners, but decided against it. Wouldn't want this dredged up in the future.
Time to go study for other papers before I fail them.
12:52 PM