Still A Student

Assalammualaikum!

I'm really enjoying my life now, because I have finished all my clinical placements and am now in the honeymoon period - except for the fact that I have thousands of things to pack into boxes and ship back to Malaysia, it has started giving me headaches plus the fact that money is always a problem and I can't go travelling as much as I want because it cost a lot.

My sister is coming over mid June and we will go travel together, my mum and aunts joining us early July for my convocation and we will be sightseeing again! So I have been spending the past month worrying about planning the trip and the past two days actually planning and budgeting it.

I am officially still a student until June 6th, when I am no longer a student of University of Manchester.
So I have about one week left. After that, I am an officially unemployed female - looking for a job in Malaysia. Hmmm... being a doctor is quite nice so I hope I can get a post.
If I don't, I will consider being a temporary school teacher AND a private tutor. Life goes on you know?

Today I plan to stay at home and rewrite my notes. Yes you read it right - "REWRITE.MY.NOTES"
Every placement/semester I will have this mini notebook that fits into my scrub pocket for me to bring around the wards and clinics etc. I will jot down random facts that any consultant/doctors/nurses/patients blurted out.
But not all the pages are filled with facts. Some of them were artworks - those flowers and houses and rivers I drew during boring clinic hours or lectures or PBL discussions.
Some of them contained conversations with me and my clinical partner e.g. "Dr ni byk ckp la, I boring" or "Lps ni u nk buat spa?" or "Mat salleh ni sume ckp je lbih" or "I ngntukkkkk".
Some of the pages were just blank pages as I tried to make the notebook "more professional", containing many sections e.g. Pharmaco and Patho and Physio but it always ended up in vain because doctors just do not blurt out facts according to sections of the textbooks and I do not have time to flip my notebook to that section in time.

So...all these mini notebooks that I have collected over the past three years may contain duplicate facts, many empty pages but also memorable conversation pages. I cannot bring all of them back home, they take space and weight.
So I plan to rewrite them all into a proper notebook AND this time, really organise them into the sections I mentioned.

Wish me all the best!
May the force be with me today! :D

I am now downloading You Are All Surrounded Korean drama - it's 91% now.
I might have to take an hour break to watch it haha..

'til then.

-Because life is a test-

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

Half Day On Call

Assalammualaikum.

Two days ago was my Simulation Session; Bleep Day.
All fifth years who are on the hospital block will get a bleep day, and on this day as the name suggests, we will go and collect our bleeps from the simulation suite.
We will be the "on call F1", and we are on call for everything; surgery, medicine, obs gynae or even orthopaedics.

I'll tell you a little bit about our Simulation Suite. Our hospital boasts our well equipped, high-tech Simulation Suite. We have at least two very expensive mannequins and these mannequins talk! They have a speaker attached to them and someone behind the scene will speak. The mannequins can breath (the chest can expand), they can shake like rigors, they may vomit (said the man, I've never seen it yet), they can bleed (I've not seen this too), and they can die. We can attach cardiac monitors, ECG, blood pressure cuff and oxygen saturation device to this mannequins and the readings will appear on the screen. All these numbers will be controlled by someone from the control room. See the excitement?

Well, the concept of this day is, while carrying our bleeps we should follow our normal routine in the hospital ie we stay in our own wards and whenever we are bleeped, we should answer it.
Various cases will be presented to us, we may get a phone call from a "nurse" asking advice about a patient etc.

I am free on Tuesday mornings, I am not sure what my consultant does on Tuesday mornings, but he has clinic in the afternoon.
Anyway, I collected my bleep at 9am and was nervous since then.
I do not know what to expect, what kind of patient will they "give" me and what kind of scenario will they put me in.

My first bleep was just them making sure I know how to answer a bleep. Lol.. My heart almost jumped out when I got it.
I was sitting quietly trying to digest the "Emergencies" section in my loyal Oxford Handbook.

My second bleep was a phone call from a "Staff Nurse" saying that the registrar (a senior doctor, at least 4 yrs ahead of me) said that one of the patients can be discharged if the blood tests came back fine. So I was asked to review the blood test results. Well, everything was quite normal. The FBC was fine, so were the electrolytes. And I said carry on, discharge the patient.
Then only I realised I didn't even ask who was the patient. The most I know was he was a chap who came in drunk last night and is now stable. I immediately recognised my mistake and was really contemplating whether I should call the "nurse" back and asked further details. Heck, I didn't even ask what was the liver function, alcoholic patients might have very deranged liver enzyme.

But I didn't.

My third bleep was a post-op patient having low BP, 90 systolic. Our normal range is about 120-140 systolic, so you can imagine how low it was.
I asked the nurse to administer 1000ml fluid to be given within an hour first, while I get to the simulation suite. As I walked from Education Centre 1, where the library is to Education Centre 2, where the SIM suite is, I flipped through the pages of hypotension in OHCM. I didn't realise I should have given 250ml stat (ie in 15 minutes) rather than straight away 1000ml in one hour, although both of them are the same. I knew I have to, it just didn't occur to me that I knew it. I panicked.
When I get there, the patient was still responding to me. She was desaturating, her BP was low and she was tachycardic. I asked the nurse to give high flow oxygen, and wait to see if the IV fluids brought her BP up. I examined the abdomen as she just had her abdomen open 12 hours prior.

After a while her BP came up again and I asked to continue the fluids and monitor her urine output (ie measure every drop of urine she passed). Sometimes if people develop kidney failure, they don't wee. If after 1000ml of fluid she still doesn't wee, I will be concerned.

Then I left.

My third bleep was a patient who was pyrexic (spiked temperature) 30mins after blood transfusion being commenced. Everything else was normal, said the nurse.
So I ordered the blood transfusion to be stopped and call the transfusion nurse for advice. Truthfully, I don't know what to do. I know I have to stop the transfusion but spiking temperature after transfusion is quite normal, I am not sure if we can recommence the blood transfusion in 30 mins or so? That's why I asked the nurse to call the transfusion nurse. Oh God.

10 minutes later the "nurse" called me back. He said he can't get hold of the transfusion nurse and now the patient has started to be agitated and started to drop her BP.
I had to rush to the SIM suite again. This time, I read the blood transfusion reaction page on OHCM.

While walking from EC1 to EC2, I really hope I bump into a familiar doctor so that I can get a friendly advice on how to tackle this problem. But none passed by. Haih.
When I got there, I had the same page of OHCM opened in my hand, but was unable to understand anything. My mind just went blank.
I've been thinking what is it that this patient is having? Contaminated blood? ABO incompatibiltiy? Simple febrile reaction? Anaphylaxis?
When I got there, the patient talked to me but in a while she quickly deteriorated, she started to wheeze, shakes (yes, the mannequin shook!) and I was like "Oh God...is this anaphylaxis?"
So I ordered epinephrine 500mcg IM, hydrocortisone and chlorphenamine (Piriton) IV and another lot of epinephrine after 5 minutes, seeing the BP has not gone up yet.
I don't know why, I have ABCDE in my mind but I can't remember where to start. The only thing in my mind was the mental image of putting my ears near the patient's mouth and at the same time look at the chest to see any expansion. But the patient has oxygen mask on, how do I assess the breathing? Can I just use the monitor? Her saturation was dropping and respi rate was high. But is that all? How do I assess Circulation God, I forgot! So I just stood there, and then say "Lets call the anaesthetist!". Haih... Anyway I think I could have done much better but being nervous really hit me hard that day. Mike (the SIM coordinator) still say I did a very good job during managing that patient. Nope, I dont think so. But I was too hungry to keep the discussion any longer.

I hope they have more of this SIM sessions. I really do.

-Because life is a test-

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

95% a Doctor

Assalammualaikum.

I have finished my electives, and I am back in the cold land, UK.
I have even finished my Student Assistantship placement, wow.

I have only one month left, to be called a medical student.
InsyaAllah, in June I will be an official jobless post-medical student but not yet a doctor.

I can't believe my medical school years are almost over and I am going to be a doctor soon, bearing the huge responsibility of dealing with life and death.

I did not finish my Istanbul experience, my psychiatric institution as well as my electives experience.
I have so much to tell about my Student Assistantship experience where, for the first time I voluntarily stayed in the hospital till 10pm, because one of the patient that I have been seeing for the past 3 weeks had to be wheeled off to the theatre for an emergency operation. That night, I held in my hands, human fat tissue, intestines, abdominal wall and even some shit (literally!).

I really need to put pieces of my life back together.
I have been a useless person since the end of my exempting exam.
I went thru my days as a bare minimum person, not wanting to do any more neither can I do any less.
Anyway, that's the emo side of things.

The bright side of thing is, I will be home in Malaysia for good, by Eid this year!
I will surely miss this place. UK is where for the first time I tasted privacy and personal space.
Maybe I'll talk more about that in next posts.

For now, let me dwell with useless stuff.

'til then!


-Because life is a test-

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

Hospital Bahagia Ulu Kinta

Assalammualaikum wrt wbt.

This is my third day in Hospital Bahagia Ulu Kinta (HBUK), Perak.
For those who didn’t know, HBUK is the first and the biggest mental health institution in Malaysia. It reached its 100th birthday in 2012. When it was first built, it was called Federal Lunatic Asylum. Interesting isn’t it?

Syahidah and I will be spending a few weeks here, for the first block of our elective placement. We rented a room in the hostel for only RM6.50 per night, but no beddings, blanket nor electrical appliances i.e. kettle and iron provided.

The Hostel

There are two blocks of girl’s hostel. I think there are 4 floors altogether, including the ground floor. But only the ground floor is occupied. I think there are 10 rooms on this floor but only 4 are occupied (including mine). There are 3 beds in each room; and I share a room with Syahidah. That means, there are maximum only 11 people in this huge building!

On Sunday, there was no one in the building. It was very scary. By 8pm, one by one of the occupants arrived. Perhaps they went for CNY break. They are freshie nurses. And that night, I couldn’t sleep! There were so many mosquitoes!! (I wish I can put that whatsapp emoticon here, u know the one where the yellow head has its yellow hand on its cheek like “aaarrrggghhh” with bluish forehead and big white eyes)

The next day, while talking to one of the staff in the hospital, they were surprised that we are staying in the hostel. They told us to “be careful”, the building has been empty for a very long time. And when I went back to the hostel, I asked one of the nurses and she said they have been here only for the past 2 weeks. Well, enough reason for us to be scared. That night, we recited Yaasin. I imagined a cold hand running its fingers down my sole while I was trying to sleep. Thank God it was just my imagination, but just thinking of it froze me up.

Until now, we have not been “disturbed”. Alhamdulillah.
And re the mosquitoes; we bought the Ridsect Lingkaran Penghalau Nyamuk, and even mosquitoes didn’t come near us. Alhamdulillah too.

My Electives

On my first day here, I didn’t get to see any patient but rather was given an overview of the psychiatric service in Malaysia. I am actually amazed at how well developed our psychiatric service is. We have home visits, by thoughtful Medical Assistants, we have walk-in specialist clinics, and all GHs and some District Hospitals will have a Psychiatric Unit. <br /> <br /> We do not have much deliberate self-harm (DSH) cases here in Malaysia (or at least in HBUK), unlike in the UK, thankfully.

Over the next 3 days, I see more patients but I can’t really disclose much about them; due to the confidentiality principle. But enough said that the patients I’ve seen in these 4 days (I took one day to write this!) are very variable. I didn’t see much female patients. The males are either laughing inappropriately (at the same time lifting up my mood), or scolding doctors inappropriately, or trying to go near a female nurse (disinhibited maybe?) or keep changing stories, making his mental illness suspicious.

My Food


Haizzz…
This hostel has no cooking facilities AT ALL.
No fridge, oven, microwave, kitchen hobs. Nothing!
So I can only boil some water in the morning and make my 3-in-1 Old Town White Coffee with some buns that I bought previously. We then had to go for proper breakfast in the main canteen. Lunch in that canteen as well.

We will then drive out to look for dinner.
For the first two days; we don’t really feel the burden. But now, after 4 days having to spend for all the 3 meals, I started to pity my wallet. I spent a lot for food!! It was the same when I was in INTEC, wasn’t it? But somehow it felt worse now. I felt poorer than when I was in INTEC 5 years ago. OMG, 5 years already??!

Yesterday we went to Ipoh Parade for dinner and window-shopping. But the surau was closed! OMG, I was so frustrated and disappointed with the management. They should have opened a temporary surau while renovating the current one. We arrived at 7pm, thinking we can pray Maghrib there. After knowing the nearest mosque is next to the Ipoh GH, far enough that it can only be reached by car (Msian definition of far), we had quick dinner and rushed like crazy monkeys to the mosque. I drove so fast and we managed to pray just before the azan for Isya. I can feel such serenity when praying in the mosque. I’ve not prayed in a Malaysian mosque for over a year! I really missed it.

Anyway, I need to sleep now.
I know I still owe this blog the Part 2 of my Turkey trip.
It’ll come, I promise!
But I really need to sleep now. Goodnight!

-Because Life is a Test-

My Post-Exam Turkey Trip – Part 1 (Istanbul)

Assalammualaikum wrt wbt.

My exempting exam finally ended on the 15th of January.
Let’s not talk about how the exam went; it was both a mess as well as a smooth sailing.

On Saturday the 18th, my housemates and I set off for our trip to Turkey! Our flight to Istanbul was on the morning of 19th at 6.35am! Since the Tube does not work 24 hours, we had to reach London Luton airport on the 18th night and spend the night in the airport.

Day 0; Saturday 18th January 2014

I had my lunch at the Malaysian Hall café near Queensway. I was so disappointed that their food now is way more expensive than it was one year ago. When I was there in August, the café was closed. The receptionist in Malaysian Hall said the café is in the middle of renovation because they are offering the tender to someone else. This new restaurateur is quite stingy and greedy. Hah! Jahatnye ckp mcm ni. But imagine, I asked for a plate of rice, and they gave me some fried cabbage for complement. Fair enough. I then asked for half of the salted egg and some sambal belacan. That cost me £3! I also asked for some beef rendang, the girl behind the counter said the rendang is sold separately, as a side dish for £2.50. Guess what, the bowl was only ¼ full! I made a small fuss at the cashier, “Ni je? Ni je £2.50??” Then the auntie cashier said she did not count my sambal belacan, and she is giving me very cheap price already. I put up a disbelief face, and she asked how much am I willing to pay for all the food. I said give me more rendang and I’ll pay the £2.50 side dish. Even after adding some more, the bowl wasn’t even half full! I hope they will be more considerate and not so greedy the next time I visit them. It wasn’t that the price was a lot cheaper before this but at least the men behind counter scooped a lot of rice and dishes into the plate, so the price was worth the food.

Where we spent our sleepless night in Luton

That night, we slept in London Luton airport. I felt so homeless. But what to do…..no money to rent a hotel room nearby the airport. What la easyJet. So odd timing one? But the journey to Istanbul itself is 4hours, maybe that’s the logic behind it.

Day 1; Sunday 19th January 2014

We reached Istanbul airport at 1220hrs Turkey time.
I paid for a tour package which includes transfer from Istanbul Sabiha-Gokcen airport to our hotel, transfer from our hotel to Otogar to take bus to Denizli, the bus ticket to Denizle, transfer from Denizli to Pamukkale and tour in Pamukkale, followed by transfer from hotel to Denizli airport and lastly the flight ticket from Denizli to Istanbul. All in all it was €131 per person, which was not bad actually. My tour company is Troublefreeholiday. I think the man did quite a good job so, if anyone wants a tour in Turkey, I think this company is reliable and cheap too.

Once we come out of the arrival gate, I saw my name written HUGELY on the board a man was holding. Hahaha.. It felt so weird. The man then brought us to his van that will drive us to our hotel in Istanbul.

Where are you?? -said the Turk.

We stayed in Cordial House Hotel. I think this was a good hotel too. I mean, it is as good as the money I paid. It was €8 per person per night, there were 4 of us in the room with a shared bathroom outside (I think this is the downside, if the bathroom is in the dorm; it’ll be better).

After solat, we went for lunch (at 4pm!) and then walk around Istanbul. I find Istanbul very beautiful! The city is beautiful, as well as the building and the park. The people were nice too; they kept asking “Malaysia? Malaysia?” to us and when we said yes, they seemed very happy! I think there must be a looooot of Malaysian visiting Turkey. They recognised us just from our appearances. Most of them can’t really converse in English but they did try their best. The man who fetched us from airport asked, “Where are you?” joyfully. I think he meant to ask, “Where are you from?” Haha.. He’s nice.

And I am glad there were no drunken people. I mean, I didn’t feel unsafe walking at night. Usually in the UK (Preston esp), the only people walking out at night are those who are going to the pubs because all shops are closed by 6.30pm. But in Istanbul, all the food outlets and markets and small stalls were still open and families with small children walking and running around happily the park. Of course, I still clutch onto my bag tight; let’s not take THAT risk ok?

What do you fancy eh?

Us! Comel kn kitorg?

The incidental bazaar

The Blue Mosque at night

Surprisingly, by 6pm we were very tired and can’t wait to go back to the hotel and sleep. The sleepless night in Luton airport must have worn us out. By 8pm we were in the hotel room, ready to sleep. At 8.30pm, we got hungry. Haha… None of us actually said we were hungry, I think because all of us know everyone else were tired. So when I suddenly quietly say “I feel like eating…I’m a little bit hungry”, my friends jumped out of bed and said, “Let’s go eaaatt!” . No one wanted to trouble each other rupanye. So 3 of us went out to buy food and ate in the hotel room. Syahidah was too tired and wasn’t hungry enough to eat.

Day 2; Monday 20th January 2014

I had a bad dream and woke up at 5.30am. I couldn’t remember what the dream was but when I woke up, Kiew was wide-awake. I thought she could not sleep; I know she does not fall asleep easily in a new place, unlike me; I can sleep anywhere. Turns out she cant sleep the whole night as she had severe vomiting and diarrhoea. Poor her! She said she had to run to the toilet many times. I was surprised, we all ate the same thing, why was she the only affected? I fell asleep after telling her to drink lots of water – sorry Kiew, my eyelids defied me.

When I woke up properly for Subuh, she was half-asleep. She didn’t have the energy to walk around Istanbul so she booked another single bedroom for €22. We were supposed to check-out at 11.30am and leave our luggage in the store and walk around Istanbul. At that time, she was pale, but had enough energy to go down to the café and have breakfast. She could still laugh. The Turkish breakfast was so weird. It consists of bread, tomatoes, cucumbers, olives, butter spread and chocolate spread. We paid €4 for the breakfast. €1 is equivalent to 3 TLR (Turkish Lira) and most shops accept both € and TLR.

Before breakfast, I locked my luggage using the built-in coding system; I left my passport and GBP money in there. And guess what, after breakfast I can’t unlock the code! I am sure I got the right code, but the lock just wont budge. All of us tried to unlock it, it became a mission for everyone to try and unlock my luggage. Even the reset button did not work. Haiz… It was a new bag! I bought it during Boxing Day and this was the first time I used it. It wasn’t too cheap (but cheap enough to convince me to buy it). So at last I carried the bag down to the reception and asked the man behind the counter to open it for me. He can’t and he wasn’t very helpful. We asked if there is any luggage shop around that might be able to help us but either he did not understand my question or he did not want to entertain it. But thankfully he was kind enough to call a very helpful friend of his- the man behind the bar. He really tried to unlock my luggage. He cant speak English but we can communicate enough. When I told him he can “destroy” the coding system, he looked pleased and went away to get his tools. Well, I can always go back to the shop I bought the bag from since it is still under warranty. He then brought back a screwdriver and simply peeled the lock away. Aargh I don’t know how to describe what he did but he managed to unlock it la. That scared me actually. Seeing how easy it was for him to unlock my locked luggage with just a screwdriver.

Grand Bazaar

After the incident, we had to bid goodbye to Kiew. She said it wasn’t a food poisoning episode, most likely it was because she was too stressed lately that her GI system wasn’t working well. Well that’s good news. Food poisoning will last at least 48 hours, but stressed GI system can recover earlier. So we left her to recuperate in the room.
And where did we go to?
The GRAND BAZAAAAAR!!

Oh I love the Grand Bazaar!

There were a lot of entrances. We enter the complex to see a huge stretch of lane in front of us. I think that was the jewellery zone since all the watches and jewelleries were there. There were many smaller lanes perpendicular to the huge jewellery lane. I think someone told me there were 69 streets altogether. When I was told that we could get lost in there, I did not belief them. I thought, if we pay enough attention to where we came from and what we see, we will know our way back. Turns out, we can’t pay enough attention to the roads. Because the things sold were too attractive for my eyes.

The hugeee and looong streets

It was fun, exhilarating as well as scary. Most of the shopkeepers recognise Malaysians. So they kept pulling us to their shops. Whenever I made eye contact with the shopkeeper and he started to smile, I quickly looked away and turned away. They were very good salesmen! Once we stop at their shop, they will show us a lot of their scarves. They will open the scarves one by one and tell us how nice we will look in them. After just 5 minutes, there will be 20 scarves laid out in front of us and if we did not buy anything, it will be so awkward. To be honest, I was afraid that the shopkeeper will be angry too if I suddenly say “No, thanks. I am going away” after he laid open 20 scarves for me. So we dared not stop at many shops. We touch, and go.

We spent hoursss in the bazaar. Syahidah, Ibrizah and I all spent a lot. Scarves and sejadah and blouses. I bought a nice table cloth for my mum! It cost me 100TLR. My God. That was definitely not in my budget. I had no money to buy as much scarves that I planned to after that. I was planning to buy scarves for some important people.. Sorry la, money finish adi.. Keychain je eh? But I did not regret it. The table cloth is very nice. It was a handmade patch-work and was big enough to fit my 8-people dining table at home. My mum will be delighted! Sorry ma, xde scarf utk mama.

After lunch, we went back to the hotel for Zuhur-Asar. Kiew looked much better. She didn’t even have proper lunch, she was afraid she will be sick again. So she survived on the brioche we bought in London. All 4 of us then went to visit the Blue Mosque aka Sultanahmet mosque. Everyone are required to wear decently with a headscarf to enter the mosque. Considerate Kiew, she brought her scarf for this reason. When I lilit the scarf on her, she looked so cute! The mosque was huge from outside but we could not go into the whole complex. We can only enter one block – the main block used for prayer. The interior was very beautiful with many domes. I don’t completely understand why is it called the Blue Mosque – it wasn’t THAT blue…

The interior of the Blue Mosque

Anyway, we then walked towards Hagia Sophia. Funnily, we did not know which one was Hagia Sofia until we asked the man selling corns at the roadside. But we were too late, it was already closed. So I can’t find the famous cat that has been inhabiting the complex. Let me tell you something, the corns were horrible. I think it was boiled rather than the steamed corns that we were used to. And it wasn’t sweet. It took me so much effort to even finish a quarter of the cob. Fortunately Ibrizah is a good eater, she does not waste food and thus, she finished the corn. We bought only one cob – fuhhh…

After buying dinner, we went back to the hotel for Maghrib-Isya prayer. At 1930, someone from the tour company should fetch us to Otogar to catch the night bus to Denizli. I don’t know what Otogar means; it either meant a “bus station”, or the name of the place, like Puduraya.

Sharp at 1930, the man arrived and gave me our bus tickets together with our flight tickets. And we were brought to Otogar by a van. My God, the roads in Istanbul were horrific! It was like a snake been hit (read: bagai ular kena palu). The van turned and turned and turned, from a highway into housing area, into motorway again. Haihh.. We arrived Otogar an hour earlier than our bus time; 2030.

At 2130, we boarded the bus to Denizli.
I’lll talk about this journey in a diff post.
You must be tired by now. Haha..

Part 2 is here!

Bye!

-Because life is a test-

The Happy Faces~

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

Year 5 Exempting Exam; Univ of Manchester

Assalammualaikum.
My exempting exam is Day 2, in South.

I tried to remember as much of the wordings of the questions as I could.
I know it is easier to practice when we know the question structure.
To maintain confidentiality, where possible I will not disclose the patient's gender as well.

Station 1

Please examine this patient's cardiovascular system.
You may need to tailor your examination according to your findings.
Please tell the examiner what you are looking for and what are your findings.

The patient's blood pressure is normal.
An ECG taken last week is provided for you to refer to.


Ok, this was apparently an AF station.
When I felt the pulse, at first I thought it was irregular.
But when I tried to tap the rhythm with my head, it became regular. Haih~
So the chest was clear, I could not find any other signs.

When I was given the ECG, it was clearly AF.
But the examiner challenged me saying I did not pick up the AF while examining the patient.
But he wasn't mean. He asked why wasn't I able to get the irregularity of the rhythm.
So I mentioned the patient might be having paroxysmal AF and when the bell goes off, I managed to say "because he has been rhythm controlled!!" literally while walking out of the station.


Station 2

This patient had a cerebrovascular accident (CVA) affecting one or both arms.
Please examine the patient's arms.
Please tell the examiner what you are looking for and what are your findings.

At the end of the station, the examiner will ask the nerve and muscle groups that are affected.

OK.
So this is quite a straightforward upper limb neurological examination.
I performed only the motor bit, I did not do sensory or coordination.
It was UMN signs on the left arm.

For the muscle groups and nerve, I managed to say deltoid, biceps, triceps, anterior compartment of the forearm, posterior compartment of the forearm, and lumbricals for shoulder abduction, elbow flexion and extension, wrist flexion and extension and fingers abduction and adduction respectively.

The examiner did not prompt me of the nerve supplies. I am not sure if that means she is satisfied with my examination/answers but to be fair, I only had like 30secs left.

My friend said he would have done the coordination and some sensation as well.

But I did offer saying I would to do sensory of the upper limb and full neuro of lower limb to see if the CVA has affected the legs as well.

Station 3

You are the Foundation Year doctor in the general practice.
This is Natasha XXXX, a 28 year-old woman who has recently given birth and is now breast-feeding.
She is here for oral contraceptive pill.

Please discuss the options available for her.

It was an SP.
Since the question specifically mentioned ORAL PILL, it became a lot easier.
Pt is breast-feeding so we cant give the oestrogen bit, and I don't have to explain all the implants and coils. Only PILL.

Pt asked about:
1) Side effects - irregular bleeding.
2) Immediate protection - yes if taken on day 1 menses.
3) What happens if she vomits aft the pill - if within 5 hours, u may need to take another dose. Check the leaflet in the box.
4) Does it protect against STI? - No. (I cant understand why she ask this. She's married! Ok, being judgmental here. Anyway...)
5) Why can't she go back to her microgynon (a COCP) - bcos oestrogen affect breast milk production.


Station 4

This is XXXXX. She was admitted 4 days ago for severe iron deficiency anaemia.
She was given blood transfusion and an upper GI endoscopy was normal.

She is going to be discharged today.
A colonoscopy has been arranged for her as an out-patient next week and she has been given sachets for bowel prep.

Please discuss with her about the discharge issues and the colonoscopy.

Woohooo...
New type of Q from the university!
Discharge planning has never came out before.
When I knew it came out in Day 1, I was so surprised and luckily I read about it.
Or else I would not know what to say.

Well basically just ask how she is feeling, is she ready to go home..
Who is at home with her - husband.
It was all okay until I asked, "Is your husband well?"
Then only the drama begins...
"Oh..my husband has severe Parkinsons......."

She asked about:
1) I am the patient, but I don't need carer. My husband will need carer. Can the ward arrange carer for my husband? - I dont know the exact ans for this.
2) What will the social services do? - plan care package, tailored to individual needs.
3) What does OT do? - come to ur house and see how they can help with the condition of the house to make it easier to live in.
4) What is the bowel prep? - STRONG LAXATIVES to empty your bowel.

I FORGOT TO ASK ABOUT MEDS! Haih~
DC planning will always include meds changed in hospital stay.


Station 5

This patient has pain in the right hip.
Please examine the patient's hip.
Please tell the examiner what you are looking for and what are your findings.

Again, a straight forward ortho exam.
My patient was a medical student I think.
He understood all my instructions. So nice~

Was asked by the examiner what is the diff with true and apparent leg length.


Station 6

This patient have difficulty passing urine.
Please take history to find out how it was diagnosed, include discussion about complications and any plans for definitive treatment.

This was a REAL patient, without scripts.
I don't think I can divulge the case here, since it's supposed to be confidential.

Enough said that I think UoM is trying to test us on how we communicate with actual patients.
All this while we are tested on our ability to EXAMINE real patients, but never actually TALK to them.
So I really felt like those days where I spend a very long time talking to patients in the ward, that most of the time they didn't understand what you asked and went completely off-tangent.
Sometimes you can't even understand what the patient said.
It was exactly that same feeling just now - the difference is there is someone watching you from behind and ticking the boxes.

My pt knew quite a lot of things - it was almost just a case of me sitting there listening to his story.

Station 7

This patient has pain in his/her legs while walking.
Please examine the arterial circulation of the patient's leg.
Please tell the examiner what you are looking for and what are your findings.

There is an Duplex provided. You need to use the probe.

At the end of the examination, the examiner will ask what your diagnosis is and next management plan.

Again, a straight forward PAD exam.
This was a real patient.
I cant feel pt's pulses - all the way till popliteal.
But apparently no one couldn't.
But the arterial flow via Duplex was very clear.

Examiner asked Dx: PAD
What to do now: Straight leg raising, as it is one of my differentials. ABPI. Fasting glucose and lipids.


Station 8

Please examine this patient's hands.
Please tell the examiner what you are looking for and what are your findings.

At the end of the examination, the examiner will ask your diagnosis and the conditions associated with this findings.

When I was outside the station, I was very happy thinking it is going to be a RA hand. I hummed pulmonary nodules, pulm fibrosis, vasculitis etc to myself.

But when I got in and started inspecting - turns out it wasn't RA.
At first I thought it was trigger finger but then I realised this is Dupuytren's!

So I did the hand exam just like I would for RA. But it was very hard because patient's hands were in severe fixed flexion deformity.

Qs: What is this? - Dupuytrens
Where can u find this? - idiopathic, cirrhosis bla bla bla
How would u say the severity of this contracture? - moderate
Rx? - reconstructive fasciotomy


Station 9

You are the FY in A&E.
This patient has blurred vision last week, but it has resolved since.

Please examine the patient's visual field and perform fundoscopy.
You are not required to examine the visual acuity and pupillary reflexes.

Please tell the examiner what you are looking for and what are your findings.
At the end of the examination, the examiner will ask for your findings, and diagnosis.

Again, straightforward eye exam.
Examiner very nice~~~

All normal, I can't visualise the optic disc.
Was asked:
1) Present ur findings
2) If the Hx is blurred vision for one week and has resolved since, what do you think is happening? - Optic neuritis.
3) Cause? - MS
4) Ok, if it is MS, what findings will u expect? - Central scotoma, pain on eye movement and I just simply said blurred optic disc. Truth is, I dont know! What is the findings on fundoscopy in optic neuritis? I forgot. You better check.


Station 10

You are the FY in A&E.
This patient has come in with acute chest pain.
Please take a focussed history and perform a focussed examination on the patient.

Please tell the examiner what you are looking for and what are your findings.
At the end of the examination, you are required to present your findings, diagnosis and management plan.


Acute chest pain.
Pt had this a few times for the past 2 weeks - all on exertion.
Usually it goes away with resting. Today the pain persist even after 2 hrs.

Obs given were all normal. I cant remember if they gave respi rate - sorry.

Examiner was mean.
Didn't even respond to me, I asked if I can get the observations and he pointed his CHIN to the wall. I didn't understand at first.
Then only I realised that the set of observation is pasted on the wall!!

Station 11

You are the FY in general practice.
This is Mrs XXXXXX.


Please take a history from her to find out the problem.
In the last 2 minutes the examiner will ask for your diagnosis and management plan.

I knowww....the question was so unhelpful..
I sat outside banging my head on the wall. Nothing to prepare.

Anyway, this pt kept saying she was very embarrassed to talk about this matter.
I thought she has dyspareunia or PCB or something.
Turns out she has heavy menses bleed.
Well to be honest, by this stage of med school, I am no more embarrassed about heavy menses bleed.

Remember ICE ICE!
Pt's concern was cancer - as usual...
I mentioned that cancer of the womb usually happens to older women, it is not the first thing that came to my mind for a woman of her age. But we will still do all the necessary investigations. She seemed very happy for that.

Examiner asked:
1) What pt has - menorrhagia
2) Possible causes - DUB, bleeding disorder.
3) Mx - bloods: FBC, U&E, TFT, Prolactin. What else did I say jz now? Forgot adi. USS to check endometrial thickness.


Oh...I'm getting more tired of typing now..

Station 12

You are the FY in general practice.
This is Mrs XXXXXX.

She has come today because she is feeling very anxious.
Please take a history from her.

In the last 2 minutes, the examiner will ask your diagnosis and the reasons.

Generalised Anxiety Disorder with secondary panic attacks.
Did some MSE but not risk assessment.
I wanted to explain the possible Mx but pt cut me off and jz said she wants leaflet. Weird..

Station 13

You are the FY in general practice.
This is Mrs XXXXXX.

She is a regular patient in the practice.
She usually sees Dr Rayburn.
Dr Rayburn is on leave today hence she has booked in to see you.

Please talk to her and discuss the reason of her attendance today.

Jz by reading, I know this is ethics adi...
Pt said she has STD, she doesnt want me to put this on her note bcos Dr Rayburn will know about it. Dr Rayburn is a close family friend and she doesnt want her husband to know.

I said I need to write about our consultation, it is a legal requirement.
And Dr Rayburn and I are duty-bound to keep the confidentiality. She wasn't convinced.

I asked how did she know she has STD - she said because she vaginal discharge.
I said she can go to GUM clinic to get treatment, everything there will be confidential. No letter will be sent to us. She said can I then not write anything about today, because she wants to go GUM. I said cannot, I have to write it down.
She said then no point she go GUM, I will write anyway.
I told her I don't know if she has STD. I have not tested her yet. So I cant write she has STD, I can only write that she suspects its STD.

Anyway at the end pt agreed to go GUM and did not make any trouble anymore. I managed to advise safe sex until complete treatment. She said it's gonna be very uncomfortable anyway with the discharge. Lululz~

Station 14

You are the FY doctor in the ward.
You are required to administer the first dose of IV medication for this patient that has been prescribed by a senior member of the team.

This medication is usually given as a slow infusion but for the purpose of this examination, you are to give it in a bolus injection.

You will all learn this in OSS block.. So lazy to write. Anyway, got Px chart but no BNF or product leaflet. Confirm with the examiner to mix the med with saline or water for injection and how much to mix it with.


Station 15

You are the FY in A&E.
This is a patient who came in because he vomited blood.
He is very upset.

Please take a focussed history and discuss the need of admission with this patient.
You do not need to examine him.

Weird Hx. At first I didn't know what was it at all. It didn't sound like ruptured varices (but pt is a heavy drinker) because pt shd not be able to talk to me if it is varices.
Didn't sound like Mallory-Weiss tear either. He vomited a pint of fresh red blood this morning! No stomach content. No assc pain, just some dizziness.

Vomitted once 7-10days ago, but small amount.

Halfway through I found out that he regularly takes Nurofen 2tabs 3x a day, every day.

So at last I can say we suspect you are bleeding from your gut. We may need to keep you in. And he was unhappy because his vry busy at work. But it didn't take him long to agree - because I said we need to pass scope in to see what actually is happening.


Station 16 AAAhhhh.. last one~

You will be given a case history of a patient together with blood results, ECG and CXR.
You have minutes to look at the information provided.

You should then tell the examiner what was going on and your next management plan.

Bloods: all normal apart from 8.5kPa pO2 on ABG.
ECG: AF
CXR: some say collapse, some say pneumothorax. Whatever...

I dont think I did well in this station.
Thank God it was my last one. I would have felt very stupid otherwise, while doing the other stations.

With that, I bid goodnight~

Hope this helps!


-Because life is a test-
-AkMaR-
http://nur-akmar.blogspot.com