F&C OSCE Nov 2012 (part 1 of 2)

Assalammualaikum!

Instead of talking about my personal life, I'll write out the questions I got for my latest Family & Children (F&C) module OSCE.
With this, any juniors or medical students can refer to this post. I've had a hard time looking for past years!

In Univ of Manchester, we get 1 minute to prepare outside the station after reading the question and 8 minutes to complete the station. 2 minutes before the station ends, there will be an announcement.

Day 1 (Paediatrics)

1. You are a medical student in Community placement. This is a mother whose 10 y.o son has been complaining of headaches for the past 6 months. His son is not with her. Take appropriate history from her and present your differential diagnoses and investigations you would like to do to the examiner.

      - Son headache for 6 months, worse past 2 weeks.
      - Start to vomit
      - No photophobia but complains eyes hurt (should ask about vision)
      - Son becoming more clumsy (either unsteady on his feet or cant see properly, need to differentiate these)
      - Headache worse early morning
      - The mother was quite cross, and anxious about her son
      - Mother was afraid it's brain tumour

2. You are a medical student in Community placement. This is a 10 y.o boy complaining of abdominal pain. Perform an abdominal examination and give your differential diagnoses to the examiner. Do not take extensive history from this patient.

       - Normal abdo exam. Causes of acute abdo pain in children.

3. You are a medical student in Community placement. This is a mother who came in to get her son's blood test result. Her son complained of tiredness and have been found to eat soil. Explain to her the results and address any concerns she might have.

      - Result given was FBC. All normal except for MCV, Hb and ferritin. Diagnosis: Iron deficiency anaemia.
      - Mother was worried it is leukaemia because she read from magazine.
      - Mother wants to know why son eats soil. It has been reported as a manifestation of IDA in children (weird eh?)
      - Mother wants to know what treatment. Tablet / diet modification / dietitian referral.

4. You are a medical student in Neonatal placement. This is a young lady who have just had a premature labour. Explain to her the complication of premature labour and address any concerns she might have.

      - Gave birth yesterday. Spontaneous labour, no history of trauma
      - Be sympathetic (haha)
      - Worried because doctor and nurse took the baby away right after delivery
      - Wants to know what is happening to baby
      - Wants to see the baby. Yes, nurse can arrange.
      - Explain lung isn't mature yet. Need special equipments to help baby to breath.
      - Mum asked whether can breastfeed baby. Ans is can and if baby is on ventilator then can give expressed milk.
      - Mum asked if baby will get cerebral palsy (shocked me. For a while I thought we were supposed to explain cerebral palsy, not lung prematurity. But then mum directed me towards other stuff)

5. You are medical student in Community placement. This is a boy who had murmur few months ago (cant remember exactly). He came for a follow up. Examine him and look specifically if the murmur is still present.

      - Normal cardiology exam.
      - Boy very shy lah. Didn't want to take off his clothes.

6. You are a medical student in Community placement. The parents of a school girl are worried about her growth. Measure her height, weight and head circumference and calculate her mid-parental height using the formula (they'll give the formula). Plot these information on the given chart. She is unaccompanied by her parents. Do not take extensive history from this patient.

      - This is one crazy station. The measuring was easy but I've never seen the chart. Didn't know where to plot her mid parental height. They didn't use the WHO chart so....

7. You are a medical student in Community placement. A father came because his son has been very breathless and feverish. Take focussed history and prescribe paracetamol for his son.

      - Not really sure what this station wants us to do.
      - Father talked a lot so I didn't have much time to prescribe the PCM.
      - Essentially son is having acute asthmatic attack secondary to chest infection. Father didn't think it's an asthmatic attack because son is coughing out phlegm. Usually son has asthmatic attack wout the phlegm

8. You are a medical student in Paediatrics placement. This is a parent whose son has
just been diagnosed with diabetes type 1. Explain to him the diagnosis and the management plan and address any concerns he might have.

      - Boy is 10 y.o
      - History of tiredness, weight loss and vomitting
      - Wants to know if boy can continue football
      - His own brother (boy's uncle) has DM type 1 as well. Some of my friends said his brother died of DM, but he didn't tell me that. Maybe I didn't ask but he didn't look distressed or worried. So diff patient might tell diff thing.
      - Father wants to know if son cannot go into any specific career due to the DM. I said I'm not really sure but you cant be a pilot if you have diabetes. And father said boy wanted to be a pilot. Explain about hypoglycemia and the danger.

I'm tired now.
I'll write about Day 2 (Obs and Gynae) tomorrow insyaAllah.

Diclaimer: The sentences used are not the exact sentences in the exam. I can't rmember the sentences exactly (who can under such tension?!). And anyway, patients will usually direct you towards the diagnosis. If you did not ask him/her, he/she might ask you.

All the best!

-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com

SSC 4th Year

Assalammualaikum!

It's that time of the semester again! The time period after my OSCE exam and before my semester break. I've just finished the disastrous Paediatrics and O&G OSCE abt 1.5 weeks ago and my winter break is coming in 1.5 weeks!

So while waiting for our exam results (which I really really fear of this time), the school made us do 3 weeks of SSC. My first SSC as I wrote about, one year ago was on Pathology. The second one was on Oncology. This time around, it is on Psychology.
But I don't really enjoy the topic I am doing. However, the best part is I have to go to the hospital only two days in a week! That means, I am quite free on other days of the week; I occupied myself with reading to complete my report.

And that's all I would like to tell about my 4th year SSC.

And yes, I changed my blog layout again.
It might not last long, this one..

'til I write again!

-Because life is a test-


-AkMaR-
http://nur-akmar.blogspot.com

Emergency Demo For Gaza

Gaza, Gaza, Don't You Cry. We Will Never Let You Die

But can we really not let them die?

What can we do to prevent them from being shelled?
It's not like we have an army to deploy to their rescue.
We have no white knights with shining armors.
We are not the world order.
We do not have the UN under our command.

Gaza is Under Attack

Yesterday, the world sees Gaza being attacked, again.
The last huge massacre was 4 yrs ago in December 2008, for 22 days Gaza was shelled and bombed, children and babies die in their own homes. They were made orphans if not deformed.
That was the time I started being active in the blogging world.

Last night, I saw an event in Facebook, an emergency demonstration for Gaza in Piccadilly Garden!
I see that as a very good opportunity for me to show my solidarity.

The Palestinians will not directly feel the effect of me being there, but being there with abt 100 ppl, will raise some awareness amongst the Mancunian (it's what u call Manchester people).

The press might not be there, but restaurants around have customers. Customers are people. People get nosy. Add that with curiosity and the internet, you get news. Soon enough, really nosy and curious people know more about Palestine and the inhumane attack. The more people know, the better.

Why?

The more money can be collected and channeled for the Palestinian cause.
More volunteers will be produced for the Palestinian cause.
More flotillas, aids, and convoys can be deployed.
More healthy politicians and lawmakers can be trained.
If, more people know.

Anyway, today I got up feeling really motivated.
The exam is next week (see the ticker up there?), today was supposed to be my rest + study-to-the-max day.
But since I want to go to the demo at 5, in Manchester, I need to set off from home at 3pm. I need to finish revising by 2.30pm.

I've called my brother, Wasil to come to the demo as well.
I've been feeling very steadfast the whole, determined to go.
But guess what, once I got onto the bus from home, to go to Preston bus station, I started to waver; I started thinking why am I putting myself in such a difficult situation, spending 2 hours journey to go Manchester, when my exam is in 5 days time?

Why can't I just call Wasil and tell him how much I want to donate, and let him pay on my behalf first?

I kept telling myself, "Ni setan ni...ni setan yang make you feel this way ni...."

After much thoughts and reflections, I came to the conclusion that I am going there because of I:

1. Think I have been very "dormant" and "distracted" for the past year.
2. Want to experience a Gaza demonstration in the UK.
3. In Malaysia, you'd see mostly Malays. I want to see if I'll see only Indian / Pakistani here or can I also see the whites and the black together with the browns and yellows.
4. Regarded myself almost like a journalist, so I am there with a mission and am going to write about it in my blog so that people who can't be here today can read how it was like.

The Demo Itself

I reached Piccadilly Garden at about 5.15pm.
By then, there were about 100 people there, with their Palestine scarves and flags, and banners and hailers.

And it felt lively. A lady was giving a speech in front, I do not know who she was.
She went to Gaza before and she was telling what she saw there, what was happening and all.
And one thing I remember she said, "Remember those (Israelis) nuclear weapons...."

Her speech was then followed by a speech by Dr. Thariq. I really can't hear neither understand much what he was saying, he had a very thick Arabic accent in his English that some times I almost convinced myself that he was speaking Arabic. But he is a Palestinian.
The next speaker was a school teacher. I think he is English.

I think he said he did not pay much attention to the conflicts in Gaza but after seeing horrible pictures of children and babies bombed to pieces, he was outraged.

And I think that was what brought him here. I liked his speech, it sounded so genuine.

He mentioned that he can't bear the thoughts of people bombing and shelling babies and he was also embarrassed by being the citizen of a country, Great Britain who apologised for and supported the atrocities of Israel.

According to him too, Facebook brought down some of the heartbreaking pictures of babies and children being bombed, under the excuse that those pictures are not suitable to be displayed. And I liked what he said about that. He said if Palestinian children are forced to see those deaths, we have to see those images as well. And I second that. Why must we protect our minds from these images?

I went for my Maghrib and Isya after some time in Muslim Youth Foundation (MYF), a place I recently discovered :)



By the time I got back, they left the site they gathered previously and have started parading around Piccadilly Garden.

They were behind RICE Restaurant.
From there on, we walked around Piccadilly Garden cheering for the Palestinians. It's different from the cheers in Malaysia.

There were:

"1, 2, 3, 4 ..... Occupation no more!"
"5, 6, 7, 8 ..... Israel is a terrorist state!"
" .......(smthing smthing I can't catch) .... minions, We are all Palestinians!"

At about 6.45, the parade stopped and the organisers thanked everyone for coming and for their supports. The same gathering will be held tomorrow as well, at about 5pm too. I don't think I can come tomorrow :(
At about 7pm, the crowd started to disperse.



And after that, the 3 of us went for our dinner :)

I think this is the only picture of me tonight.

The Police

Unlike in Malaysia, the police were not there anticipating violence.
I saw only two policemen tonight. In Malaysia, a demonstration like this will require at least 10 policemen.
I think this is something our country needs to learn; facilitate the demo and prevent violence rather than anticipate violence and act at the slightest hint of wildness.


And oh, we can HELP by:

1. Donating
2. Boycotting
3. Spreading the words and create awareness
4. Prayer. I like one of the sentences I found today on FB; "Tembak doa kita". Literally, that meant "Shoot them with our prayer"
5. Study hard, be a useful person in the future.

Goodnight!

-Because life is a test-




-AkMaR-
http://nur-akmar.blogspot.com

Manchester and the Joy

Assalammualaikum!

I am almost finishing the first semester of my 4th year, Alhamdulillah.
I'll be having my O&G mock osce today, having had my Paeds mock osce last Wednesday.
To my surprise, I did a lot better in my "talking stations" than my examination stations. In each OSCE exam, we will be tested on our talking skills and examination skills. Talking skills will include taking a good story from the patient- the reason they came to us and also to explain to a patient abt a diagnosis or disease or test results or a procedure. Examination station is, at the name implies, will test us on our competency examining a body, and decide what might be wrong with this patient.

I've always disliked the talking stations. Most of them are fake. Students who know how to talk well,even without good proper knowledge can score better than a student who can't speak well but knows a lot more.

Anyway, I am not going to talk about my exams today.
I am going to talk about what I did lately.

Did you know, my younger brother has recently come to Manchester?
Yes, he did! He secured a place in Univ of Manchester, studying E&E Engineering, sponsored by Yayasan TM.
He arrived about 2 months ago, after Raya.
Although we are in the same univ, I've seen him only 4-5 times, since I am studying not in Manchester but in Preston.

Last weekend, Diana Rizal, a dear old friend of mine came from Glasgow. We haven't met for a year! On Saturday, I brought her to Manchester for a walk around. That girl is one museum freak. I can bear museums, unlike some people who find museums dead boring and have to be literally dragged into a museum. But I don't go and look for a museum in a city I visit. I will only go if it is really interesting, like the Tower of London. Not because of the exhibits but bcos I want to see the inside of the castle.

So first we went to the Whitworth Art Gallery. And my my, having not even one artistic strand of hair on me, I cant relate or appreciate the drawings, and exhibits there. I am sure they are nice, expensive and appreciable. But they are just not for me. However, the best part was when a group of musicians started playing music. There were cello, violins, keyboard, drums and even flutes. It was such a freestyle performance, I felt so relaxed and I do not know why, warm at the same time.

After praying in my brother's hall, we proceeded to the famous Jazeera restaurant, and then to Manchester Museum. Too bad we didn't have enough time, I did not manage to have a proper look at the museum. And because there was a match btw Man Utd and Arsenal (which Man Utd won, heh) we cant visit OT.

So Diana, I am looking forward to your next visit, and we can spend more time in the museum :)

With that, bye!

-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com

Dear Surgeon, Would You Like to be ON THAT Table?

Assalammualaikum.

I am 3 weeks into Obstetrics and Gynaecology posting and I am already dreading it.
I come home everyday with shivers down my spine, recalling how the surgery went and imagining how it will feel like being in the patient's shoes.
I don't hate Obs and Gynae, I am just not interested in it, at all.
In contrast with Paediatrics posting I have just finished with, the patients in Obs and Gynae are all very erm...how do I describe it, "not cute"?

Birth Suite
Thank God I kicked off my O&G posting with one week in the Birth Suite. And when I say suite, I meant SUITE. The Birth Suite is a Consultant-led unit where there are 12 en-suite rooms with bath tub in the toilet in each room and the privilege of getting an epidural anaesthesia to cope with childbirth pain in contrast with Birth Centre where the unit is wholly midwife-led and no epidural can be performed. Midwives are allowed to prescribe limited dosage of diamorphine though. So my first week in O&G was filled with cute babies popping out of their mothers, painfully. But I can't help to notice the "bloodiness" of O&G. I helped with the delivery of the placenta and my hands were literally full of blood. Even my white plastic apron were blood stained.

And I witnessed one emergency Caesarean section where the mother was wheeled off to the theatre within 40 minutes of her arrival and recognition of fetal distress (because we can't feel the baby's moving and heart rate was bad). And it was bloody as well.

Gynaecology Theatre
After the one Birth Suite week, I started going into theatres and wards and clinics. And my my my, I can't stand the Gynae theatre. Most of the procedures were either laparoscopy or hysterescopy. When any procedure ends with -copy, it means we are viewing the structure, and most of the time it is via a camera rather than the naked eye.
So the camera will either be put into the patient's abdomen or through the women's vagina, cervix and into the womb to visualise the inside of the womb.

Both camera procedure will need clamping of the cervix. Yes, clamping.
I do not know if there is any specific medical term for it but a clamp (imagine a clothes clip) will be put onto the cervix and the cervix will be pulled up so that the womb will be pulled down so that the surgeon will not puncture the womb when she cuts through the lower abdomen to insert her camera and instruments.

And the sorts of clamps and theatre instruments used in the procedure are just freakingly traumatic! Traumatic to the cervix and vagina, I'd say.
They were merciless and vicious. Maybe because the surgeons did it so many times that they are doing it in an autopilot mode.
The surgeon need to clean the vagina before she starts any procedure to ensure the area she's working on is fairly sterile to reduce the risk of infection. And guess what, she shoved the instrument that was wrapped with cotton pads into the vagina just like that, mercilessly. Patient is asleep, of course. Patients are all under general anaesthesia. They can't even breath on their own, what more feel the clamps and pliers and needles. I'm sure the patient would have kicked the surgeon flying across the room if she was awake and knew what the surgeon did.

I know my description sounded very grim and horrible and cruel and I do not know if all surgeons do that or it's just this one but I doubt other surgeons take their time to clean the vagina gently, or clamping the cervix gently (if it can ever be done) when there are many patient waiting outside to be wheeled into the theatre.

And I doubt male doctors are any gentler, the one my friend was with certainly wasn't. He sounded even more vicious!

Whenever I see the surgeons clamping and shoving things inside there (which is almost 5 times a day), the question that was burning inside me will always be "Doctor, would you want THAT to be done to you?"
I can almost bet with my life that none of them will willingly want that to be done on them.

And I hope, I truly truly hope that none of my friends, family members, wives of friends and myself will ever get any kind of Gynaecology diseases that will need us to undergo these procedures. These procedures are not done for nothing, they have to be done. But they are unbelievably terrifying. And even though I know that our body has a remarkable ability to repair itself, the cervix can even dilate and thin out and the vagina stretch enough to let a 3kg baby out, a clamp and camera for 30 minutes are almost nothing but still, it's just......cruel.

End
I hope I won't get into trouble by writing this. I am always afraid my writing will one day drive me into some kind of trouble, revealing unnecessary things and this time, it might make some potential patient scared to death of a procedure she's about to go through. I am sure the doctors do not explain or show the instruments going to be used when they asked for her consent. Because if the patient knew, she will never give her consent unless she's too desperate to get sorted out.

And yesterday, I saw a baby being crushed and vacuumed out of her/his mother's womb. I might talk more about that later. I need to rest, and keep my mind clear of the traumatic look of the cervix (I had the chance to examine the patient while the surgeon was suturing). Bloody!

-Because life is a test-

[Image Credit]

-AkMaR-
http://nur-akmar.blogspot.com

Paediatrics Posting

Assalammualaikum.

This post was actually written about two weeks ago but I didn't have the time to finish it up so here it comes!

I've finished my 7-week Paediatrics posting and are now on my second day of Obstetrics and Gynaecology posting.
In the past 7 weeks, I felt as if I was thrown into a deep, dark hole and the cliff I had to climb to see the sun was just unbelievably demanding. However, it did get better towards the end, perhaps because I acquired new clinical skills and had tremendously sharpened my survival instinct.

In Paediatrics, I became used to running to the bus stop to catch the shuttle bus to Burnley. Used to pacing up and down the ward corridors because there was no patient waiting to be seen. I became used to talk and chat with the senior house officers (SHOs) when I used to fear them last year.
Used to make a cup of coffee while studying the doctor's room because there was no patient.
But most of all, used to be in Paediatrics and I must say, I actually enjoyed and loved this placement!

And to be honest, being in Blackburn is not that bad after all.
The room is good, though small. And we do not have to pay the utility bills and I can switch the heater on 24 hours. BUT, I do not want to stay here permanently. 14 weeks is enough, thank you.

Being in Paediatrics, I've seen a lot of things. I think this is the first time I am truly acknowledged as a medical student. I am doing things junior doctors do, although I do it either under supervision or I'll have to tell a senior doctor what I did so that they can check if I did it correctly.

Assessment Unit

I enjoyed the time being in the Assessment Unit, where unwell children who came in referred by their GP or after being through A&E are assessed whether they need to be admitted or are okay to go home.
I will first see these children, take history and perform some examination before presenting the case to a Registrar (a very senior doctor) and tell him what I think is happening to the patient.
Best of all, I can write on the assessment sheet, devise my own management plan, print my name and sign it off (although no nurse will actually act on my management plan, because the Registrar will review the child later and write his OWN plan). But still, I feel like I am part of the team. And the nurses and doctors were so nice to us. The only person that's not so nice to us are the parents. Some parents are just so annoying and frustrating!

Neonatal Unit

I had one week in the Neonatal Intensive Care Unit (NICU) in Burnley.
Here, I saw very small tiny babies, some are barely 500g!
And they have wires and tubes and needles attached to them, it's sad. I can't imagine what the parents especially the mother will feel seeing their babies in that condition. It must have been heart-breaking. These babies are mostly preterm. Term babies who are for some reasons can't breathe properly, can't get their blood pressures or temperatures maintained or any other problem will be sent into NICU.
One very sad baby that I saw was a cocaine intoxicated baby. I can't remember how many weeks was he but his mother was on heroine while pregnant and really could not be bothered about him. And she was a known sex worker. She did not attend most of her antenatal appointments and refused to see the social worker. She had two previous babies who she fed methadone to "help" them with their withdrawal symptoms and these babies have been taken away from her. This time around, this baby will also be taken away from her and sent to a foster home. They even put a warning not to let her visit the baby unsupervised.

The baby was so irritable and had severe tremor, he was obviously in withdrawal.
His cot had to covered by an opaque cloth so that he is in dark and his blankets wrapped around him and tucked underneath his mattress so that he is sort of "tied up" in the blanket. These measures are to reduce disturbances to him, and his cry was very different from other babies' cries.

It was so heartbreaking to see that innocent little human who suffered the aftermath of his irresponsible mother's action.
Few potential foster parents came to visit him but there have been some changes in plan so as for now, no one has agreed to take him in their care yet. And he was Hepatitis C positive.

I pity him, to the bottom of my heart. But I can't imagine myself adopting a baby like that. Perhaps it is because I believe nature and nurture come hand in hand. Even if I raise him perfectly, he might have the "not good" genetics and turned out bad. I know that's very cruel of me to think that way but I can't help but believe it. That is why our beloved Prophet's bloodline was so protected and they can trace his ancestors for more than 5 generations (I cant rmember exact number).

Perhaps I should end my rants here.
This post might be too long already.
Thank for reading and take care!

-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com