These were the cases that came out during my Objective Structured Clinical Exams (OSCE) last week.
Day 1, Morning Session
- Smoking in Pregnancy - Obstetric (Women's Health)
- Meningitis - Paediatric (Children's Health)
- Dementia of Alzheimers - Psychiatry
- Hypertension - General Practice
Day 1, Afternoon Session
- Endometritis - Obstetric
- Simple Reflux in Infants - Paediatric
- Bipolar Mood Disorder - Psychiatry
- Erectile Dysfunction - General Practice
Day 2, Morning Session
- First Trimester Miscarriage - Gynaecology
- Acute Epiglottitis - Paediatric
- Drug-induced Psychosis - Psychiatry
- Hepatitis B - General Practice
Day 2, Afternoon Session
- Contraception Method - Gynaecology
- Child Abuse/Neglect - Paediatric
- Schizophrenia/Schizophreniform - Psychiatry
- Domestic Violence - General Practice
****
Day 1, Morning Session
The morning session was quite okay except for the meningitis case. The child, 1 year of age, presented with unresolving fever and drowsiness. What was running through my mind was it could be either underlying urinary tract infection or infection/septicaemia. Little that I suspect that it could be meningitis, because the admission physical examination and the preliminary investigation provide little clue for the signs of meningism.
Apparently, candidates were expected to make a diagnosis of meningitis and refer the kid to a tertiary hospital for lumbar puncture. The sign that you 're on the right track is you get a phone call from the receiving doctor requesting for summary of information and treatment plan. I, of course, on the other hand, didn't get the phone call. =(
The rest were quite straightforward. For Obstetric, I had to counsel a heavy smoker and intelligent young lady regarding the risk and complications of smoking in pregnancy. For Psychiatry, I had to take some history and perform a mini mental state examination in an elderly, delirious old man who had just lost his spouse.
For General Practice, I think I did quite well. The hypertensive patient was smiling and he understood my explanation.
Day 1, Afternoon Session
The patient for endometritis was quite emotional, blaming the doctor for her post-delivery fever and abdominal ache. I had to take history, list out the possible diagnoses and explain them to the lady.
For paediatric, I had to manage a case of continuous non-bile stained vomitting in an infant. It was a simple reflux disease and I had to rule-out the common surgical and congenital defects condition in the baby. The bipolar case was a give-away because it came out during our mock-test; the full diagnosis was Bipolar Mood Disorder Type 1 currently in Depressed Phase. Take history and manage the case.
The erectile dysfunction case was funny. I can't help myself but to grin and chuckle all the way through the consultation, because the patient too was smiling and being "goofy" all the time. He was a middle age successful businesman presented with distressing 'night' life and was really eager on getting the viagra from me.
***
Day 2, Morning Session
Ah, it was good! The cases were not as perplexing as Day 1, but each case needs a holistic, detailed and carefully designed management plan, none-the-less.
The examiner for Hepatitis B was no other than the Dean himself, Dato' Dr. Khalid. I had the 'oh crap!' kind of feeling when I first saw him in the exam room, but after a while, he was smiling to me and appeared to be satisfied with my treatment plan, so I guess it was okay. The patient was a Vietnamese migrant who was just had the mandatory annual medical checkup and was found to be positive for Hepatitis B.
For the gynaecology case, I had to manage a missed miscarriage. A young lady had her scan and the ultrasound revealed a singleton, normal growth-correspond-to-date foetus but, unfortunately, the heart beat was nowhere to be seen. I had to break the bad news to her and explain both the medical and surgical procedure of abortion. She was indeed very sad, perhaps because it was her first pregnancy.
The Psychiatry case was tricky. A teenage girl was brought to the hospital by a family member after she came home from a girl's night-out party. She was found to be confused and talking nonsense. The family suspected that she was drunk but afraid that she might actually did some drugs. I can't talk to the girl because she was too confused to talk and seemed 'wild' (heheh) so i had to plan my questions carefully to the relative. Not much insight can be gained from the relative because one; she hardly sees her around, two; the girl was quite secretive about her activities and stuff all this while. She was indeed seemed to be overdosed and high, and I had to resort to urine toxicology to screen for drugs and admit her to the ward.
Day 2, Afternoon Session
By this time, my brain was just too tired to think but I forced it to work extra-mile. I had to go all out this time. One last shot!
I had to counsel a mild intellectually disabled young lady regarding the options of contraception. She insisted on getting the pill, but I felt that the injectible hormones would be of a superior advantage for her since she was quite dependent on others, even in keeping her own hygiene.
The domestic violence case was quite interesting. I had to play some tarik tali (tug-of-war) game with the patient. She tried with all her might to conceal on what was happening at home, but the physical evidence was just too obvious. Multiple bruises of different sizes and colour, history of fractured wrist and insomnia were more than enough to raise the suspicion of abuse.
Initially she denied any conflicts in the family, but later she succumbed to her emotion and threw out a whole host of physical and emotional abuse from her husband. The problem is, or was, she innocently believed that her husband will change, some time soon.
Yeah, right.
I had to 'enlighten' her about the cycle of violence and begged her to realize that this thing will happen again and again, no matter how many times he said sorry or tried to make up with his sweet voice and nice gifts. He had many other risk factor like alcoholism, stressful job, unhealthy lifestyle etc., and exactly like a ticking time-bomb; he just wait for the right(or wrong) time to explode.
I think she accepted it.
The rest of the day was flowing smoothly and nicely. Alhamdulillah.
***
Overall, I'm quite satisfied with the OSCE. I hope that everything will turn out to be okay at the end of the day.
May the mistakes that I've done during the exam will always be a reminder for me and may the success be a reinforcement for me to keep my face up, back straight and walk tall through the upcoming life as a doctor.
I want to help people. Really.
Usaha, Doa, Tawakkal. Insha-Allah.
Apparently, candidates were expected to make a diagnosis of meningitis and refer the kid to a tertiary hospital for lumbar puncture. The sign that you 're on the right track is you get a phone call from the receiving doctor requesting for summary of information and treatment plan. I, of course, on the other hand, didn't get the phone call. =(
The rest were quite straightforward. For Obstetric, I had to counsel a heavy smoker and intelligent young lady regarding the risk and complications of smoking in pregnancy. For Psychiatry, I had to take some history and perform a mini mental state examination in an elderly, delirious old man who had just lost his spouse.
For General Practice, I think I did quite well. The hypertensive patient was smiling and he understood my explanation.
Day 1, Afternoon Session
The patient for endometritis was quite emotional, blaming the doctor for her post-delivery fever and abdominal ache. I had to take history, list out the possible diagnoses and explain them to the lady.
For paediatric, I had to manage a case of continuous non-bile stained vomitting in an infant. It was a simple reflux disease and I had to rule-out the common surgical and congenital defects condition in the baby. The bipolar case was a give-away because it came out during our mock-test; the full diagnosis was Bipolar Mood Disorder Type 1 currently in Depressed Phase. Take history and manage the case.
The erectile dysfunction case was funny. I can't help myself but to grin and chuckle all the way through the consultation, because the patient too was smiling and being "goofy" all the time. He was a middle age successful businesman presented with distressing 'night' life and was really eager on getting the viagra from me.
***
Day 2, Morning Session
Ah, it was good! The cases were not as perplexing as Day 1, but each case needs a holistic, detailed and carefully designed management plan, none-the-less.
The examiner for Hepatitis B was no other than the Dean himself, Dato' Dr. Khalid. I had the 'oh crap!' kind of feeling when I first saw him in the exam room, but after a while, he was smiling to me and appeared to be satisfied with my treatment plan, so I guess it was okay. The patient was a Vietnamese migrant who was just had the mandatory annual medical checkup and was found to be positive for Hepatitis B.
For the gynaecology case, I had to manage a missed miscarriage. A young lady had her scan and the ultrasound revealed a singleton, normal growth-correspond-to-date foetus but, unfortunately, the heart beat was nowhere to be seen. I had to break the bad news to her and explain both the medical and surgical procedure of abortion. She was indeed very sad, perhaps because it was her first pregnancy.
The Psychiatry case was tricky. A teenage girl was brought to the hospital by a family member after she came home from a girl's night-out party. She was found to be confused and talking nonsense. The family suspected that she was drunk but afraid that she might actually did some drugs. I can't talk to the girl because she was too confused to talk and seemed 'wild' (heheh) so i had to plan my questions carefully to the relative. Not much insight can be gained from the relative because one; she hardly sees her around, two; the girl was quite secretive about her activities and stuff all this while. She was indeed seemed to be overdosed and high, and I had to resort to urine toxicology to screen for drugs and admit her to the ward.
Day 2, Afternoon Session
By this time, my brain was just too tired to think but I forced it to work extra-mile. I had to go all out this time. One last shot!
I had to counsel a mild intellectually disabled young lady regarding the options of contraception. She insisted on getting the pill, but I felt that the injectible hormones would be of a superior advantage for her since she was quite dependent on others, even in keeping her own hygiene.
The domestic violence case was quite interesting. I had to play some tarik tali (tug-of-war) game with the patient. She tried with all her might to conceal on what was happening at home, but the physical evidence was just too obvious. Multiple bruises of different sizes and colour, history of fractured wrist and insomnia were more than enough to raise the suspicion of abuse.
Initially she denied any conflicts in the family, but later she succumbed to her emotion and threw out a whole host of physical and emotional abuse from her husband. The problem is, or was, she innocently believed that her husband will change, some time soon.
Yeah, right.
I had to 'enlighten' her about the cycle of violence and begged her to realize that this thing will happen again and again, no matter how many times he said sorry or tried to make up with his sweet voice and nice gifts. He had many other risk factor like alcoholism, stressful job, unhealthy lifestyle etc., and exactly like a ticking time-bomb; he just wait for the right(or wrong) time to explode.
I think she accepted it.
The rest of the day was flowing smoothly and nicely. Alhamdulillah.
***
Overall, I'm quite satisfied with the OSCE. I hope that everything will turn out to be okay at the end of the day.
May the mistakes that I've done during the exam will always be a reminder for me and may the success be a reinforcement for me to keep my face up, back straight and walk tall through the upcoming life as a doctor.
I want to help people. Really.
Usaha, Doa, Tawakkal. Insha-Allah.
2 comments:
I want to help people. Yeay, love the spirit!!
Alhamdulillah.alhamdulillah.
Haha.tak boleh how u grinned masa kes ED tu.
Hakim
Bro Hakim,
Thanks for the comment. hehe =)
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