Assalamualaikum..
Untuk clinical..ianya dibuat pada 25th November
2017 hari Sabtu.malam tu aku dengan roomies aku just study group main lempar2
soalan je.Mana yang terlintas tanya dan jawab.Malas nk buka buku dah.bajet
konon ilmu dah hampir penuh di dada.hahaha..Then malam tu..my tonsils buat
hal..aku terbatuk2 dengan kahak berdarah semua sampai ke pagi dan tak boleh
tidur nyenyak langsung..(Haih,tonsil ni pun cukuplah aku je gelabah yang kau
gelabah sekali kenapa?) .
Pagi tu kami diminta berkumpul di bilik seminar
auditorium pada pukul 7.30am. Aku boleh telan roti sapu jem dan milo je masa
tu. Risau sebenarnya ,ketaq nak exam,risau juga kalau examiner tak dengar suara
aku.
So,sampai je pagi tu,nombor giliran ditampal.oh ya..seminggu
sebelum exam kami kena cabut nombor giliran…aku dapat no 5 dalam group akhir.So,
setiap orang akan tahu long case dan short case mereka apa.Kumpulan pertama
start pukul 8 am..manakala aku kumpulan terakhir start pukul 10.45 am.
Susunan case yang aku dapat :
Long case 10.45 am:
Surgical
Short case 3.00 pm : Round 1 , Medicine Station 2
:Round 2
,O&G Station 1
:Round 3 , Paeds Station 2
Sepanjang menunggu tu aku pun bacalah sikit2 surgical case
yang common masuk exam.Contohnya ,thyroid swelling,breast ca,hernia, dan
colorectal ca.Puas menunggu,tibalah giliran aku bersama2 4 orang lagi batchmates yang lain.Naik je oncall centre tu,terkejutlah aku,Suasana oncall centre
sangat2 meriah. Ye la,banyak sangat doktor2,MO,matron,nurse,MA,student
nursing..OMG!
Lepas tu,ada bunyi loceng menandakan masa sejam untuk
clerking dah bermula.Masa aku masuk patient dalam toilet dan ada sorang student
nursing as chaperon .Tak apalah,aku susun2 dulu kertas dan rangka2
soalan.Oh,tengok2 patient aku Chinese uncle.Then,start la intro,consent dan
clerk.Uncle ni datang of course sebab exam.Tapi,main chief complaint adalah altered bowel habit,with bloody stool and
tenesemus for 2 months .Tapi dah undergone op and complete chemo. Uncle ni
sendiri kata dia ada kanser,which aku suspect colorectal ca..Dah habis history
semua dalam 20 minit,buat PE,uncle ada stoma! Chemoport! ..Laparascopy scar! habis
PE,aku p susun la ayat2 bagi kemas sikit.Then aku teringat yang aku tak ambik BP masa tu dan tak buat PR examination lagi! Request kat student nursing nak
sphygmomanometer ,glove, juga lubricant. Bergegaslah aku buat semua
tu..Akhirnya berjaya juga habiskan semuanya dalam masa sejam.Loceng berbunyi
sekali lagi menandakan masa sejam dah pun habis.
30 minutes discussion sangatlah mendebarkan ya adik2.Tapi
external examiner sangat2 sempoi..Apapun diingatkan jangan kau gelak sekali
dengan examiner sebab kadang2 laugh can be deceiving waktu2 macam ni.Tapi nak
senyum tu bolehlah.. So,present case dari identification data sampai ke Personal
and social history.
Tips penting masa present case :
-Jangan lupa buat systemic review.Don’t u ever forget!
-Jangan tunduk je pandang kertas,sila pandang muka examiner.
-Sediakan a few Ddx although you memang sure ni case
colorectal ca.
-Personal and Social history play important role here..make
it as details as possible..termasuk depression symptoms,financial,eating
habits…
Habis present suruh perform PE..abdominal examination..and
describe positive findings je..Masa ni colostomy dengan stoma kena tahu in and
out…rupanya uncle ni ada parastomal hernia..I did realize he got left inguinal hernia but didn’t notice
the parastomal hernia..alhamdulillah,im not penalized because of this.because
they said its ok, u had show that u try to elicit the findings ..Huwaaaa..
Then,discuss pasal management pulak…All the
management,anatomical wise..kalau left hemi kena ligate what artery ,this
surgery pulak ligate apa..Masa ni aku rasa nak cium peluk je study groupmate
aku,sebab we discuss this topic ! and Yes,I can answer it..Alhamdulillah..
Dukes classification ..ya..all about colorectal ca.Termasuk screening programme
sekarang..tidak dilupa colonoscopy procedure conduct macam mana,bowel prep
dll..banyak sangat soalan sebab bila aku keluar dari bilik tu aku sedar 45
minit rupanya waktu discussion aku dengan mereka..Huuuu..The perks being the
last group for long case.Adoi..
Habis dah long case,sampai bilik kuarantin 2 ..Kawan2 ramai
dah makan..sebab masa tu dah pukul 12.45 pm dan first group akan mula short
case pukul 1pm.. Aku tak boleh makan sebab..ya tonsillitis masa tu.plus
stress..sebab rasa memang tak boleh nak baca apa dah..I just manage to sip Milo
and eat some fruits.So..waiting and waiting..second group start pukul 2pm and
finally 3 pm..tibalah masa …
Round 1 , Medicine Station 2
Masuk2 bilik ,ada 2 external examiner ,nampak a male patient
already in prop up position.cardio ke? Yep,cardio examination.Perform and
illicit findings..displaced apex beat,PSM murmur radiated to axilla,accentuated
in exhalation,with irregularly irregular pulse (AF) and pedal edema
.Alhamdulillah,I think I did well in this station.
Second round : O&G.
I've kneeling for the whole 15 minutes . .hahaha..The external
examiner really 'garang' in this round.The patient is middle aged women with
mass.Its fibroid..surely fibroid..so,based on findings must justify why I've
said it is fibroid not other mass.Then investigations..followed by
management..Then,there' question 'if the patient doesn't want any surgical
intervention ,no myomectomy ,no hysterectomy,what do you want to do?'
'I'll give medical treatment such as GnRH analogue to her..for 6 months.'
'Why you give it for only 6 months?'
'It have side effects such as osteoporosis' (Ya Allah,thank you for make
me remember this😣)
Then,the ring bell...
Third round :Paeds
I've dreaded paeds since year 3. I'm hopeless in this.
There's 11 years old girl sitting on the chair,examine her neck.
(Urggh,why neck,why not thalassemia with splenomegaly😭😭😭)
I performed neck examination accordingly,but i think I spend too much time on
examination rather than discussion. Yep,definitely hyperthyroidism...with
proptosis, exophthalmos, tachycardic pulse and thyroid bruit..I think im
fumbling a lot ..but I managed to answer most of basic questions...
Finally ,the bells ring and it's over.
To be continued..
Lots of Love,
fatinajwa ,3