Okay sekarang nak cerita pasal exam. Exam 2 hari je, isnin dengan selasa.
Day 1
First paper, PMP (taktau panjang dia apa hihi)
Consisted of 3 questions. The first one, pulmonary tuberculosis.
Second one, poststreptococcal glomerulonephritis complicated with hypertensive encephalopathy.
Last one, menigitis.
Serius wei tak cukup masa sejam setengah nak buat 3 soalan ni. Anak-anak dia banyak pastu jawapan nak berjala. I iz sad. Ada yang takleh jawab. Tak ingat cerebrospinal fluid punya analysis dengan cerebrospinal fluid circulation. Main tulis je apa yang ingat dalam kepala. Habis exam sedih. Rasa tak buat sehabis baik pun :(
Second, third and fourth paper sekali harung dalam masa sejam sepuluh minit; MCQ, OBA, EMQ
Rasa yang petang ni punya lagi okaylah compared to morning tu. Inshallah pass teori. Ive done what I can kan now kite serah jelah pada Yang Esa.
Day2
Ada long case dengan short case. Long case sejam termasuk clerk patient dan buat physical examination. Habis sejam 20 minit present dan discuss dengan dokter. Short case right after long case, 10 minit je. Aku group first, start pukul 10 pagi sebelum pukul 12 dah habis dah.
Aku pagi tu 3 kali kot pergi toilet bapak nebes gila namateyyy. Aku taktaulah kalau hari aku kawin ke nak bersalin kepe nanti
Long case
Controlled asthma on omalizumab
(Dr Naseer - an Egyptian)
Mak sangatttt baikkk dia siap tunjuk gambar ubatt. Kronologi cerita yang sangattt jelasss. I terharu sobs.
Patient datang sebab appointment to take omalizumab takde attack of asthma kepe. So HOPI cerita pasal asthma jelah. She was diagnosed with asthma since she was 5. Now 7. Masa mula tu took budesonide (everyday never missed) and salbutamol. But then at the age of 6,due to uncontrolled asthma changed to ubat warna purple (tk ingat nama dia), salbutamol and montelukast. Uncontrolled lagi so starting from Dec 2014, changed to prednisolone taken everyday orally. 2 weeks ago start EOD. Pastuuu sebab tak berapa nak controlled start taking omalizumab once a month from Sept 2015. Mak dia kata sebab IgE dia tinggi sangattt. Bagus mak cani membantu sangatt. Uncontrolled asthma dia semua adaaaaa! Kecuali yg lung fx test kepe tah tu mak dia taktaulah tp daily nocturnal symptoms semua ada. Mmg severely uncontrolled ah senang kata. Triggering factors, debu, cold weather, cold food, takleh lari lari and so
Vaccination up to age kecuali MMR (takleh bagi live attenuated vaccine dekat orang yang tengah amik steroid, absolute contraindication) sebab dia on prednisolone kan.
Birth history unevenful.
Family history pun eventful. Terkejut ittew takde history of atophy (resdung, eczema, asthma, gatal-gatal mata) semua takdee dia sorang je.
Developmental assessment
Dah sekolah tp selalu absent paling lama 3 bulan sebab asthma. Dia kawan batuk sikit je pun dia dah kena attack. Takleh kena hujan. Academically and socially well tapi takleh masuk sport.
Ayah tak smoke.
PE semua berjalan lancar alhamdulliah. Vital signs mintak tolong student nursing hihihi. Dah dorang duduk kat situ memain dengan patient tu mintaklah tolong sikittt. Pastuuuu nak habis clerk semua tetiba ada ward round. HO present kekuat kite pun salin jelah apa lagi.
Okay nebes nak present kat dokter.
Rasa smooth je kot masa present tu.
Dr: why asthma from the history
Bagi jelahh jawapan based on history tu bla bla bla pastuuu terdiam. Lupa nak cakappp pasal need for reliever. Dr yg tambah hmm :(
Dr: what are signs of asthma
Aku jawab yg part resp distress rhonci bla bla
Dr: what are the causes of asthma
Haaa yg ni blurrr :( pastu dr bagi clue genetic ke environment
Aku jawablah environment but genetic can also ( taktau dr tanya in this pt ke general sbb in this pt kan takde family history)
Dr pun cakaplah multifactorial
Yes dr multifactorial
Dr: how to differentiate asthma and bronchiolitis
Haaaaa yg niiii cuma ingat age dgn signs jeeeee padahal asthma kan ada recurrent attack dgn family history hmmm ni pun dr yg tolong cakapkan. Benda senang cani pun boleh blank sobs
Dr: investigation
Ha yg ni aku confuse nak general ke in this pt. aku terus cakap chest xray dgn skin test. Dr lagi yg added fbc dgn IgE level padahalll mak dah cakap dah pasal IgE tu sedihhh bertambah lagi sobs
Dr: management of this pt
Aku cakap balik semua ubat yg pt tu dapat
Sedih kot benda senang cam asthma ni takleh jawab. Short case pulak blank blank lah apa memang melelehhh aaaahh keluar ward.
Short case
Spastic cerebral palsy
(Dr Aye Aye- a Burmist)
Memula dokter tanya long case dapat case apa, cakaplah asthma. So sebab dah respiratory dokter nak buat short case system lain pulalah. Nampak patient cerebral palsy terus berhenti dekat depan katil dia dan suruh inspect.
Dr: Inspect
(running commentary)
A: This patient is lying on the bed, conscious.
Dr: This patient is conscious? You say this conscious? What is the Glasgow Coma Scale?
A: 8/15
Dr: What makes 8/15. Tell me
A: (aku taktau nak buatpe kat situ bukannya tak baca, baca tapi entahlah masa nilah nak lupalah apa. 8/15 tu aku main bantai je sukati je nak assume hmm macam ni nak jadi a good doctor blah) Bla bla bla dr i dont remember how to calculate gcs
Dr; You dont remember? Okay proceed
A; The child is lying on the bed. No respiratory distress, no dysmorphic features. There is nasogastric tube attached to the nose and branula attached to the dorsum of right hand connected to normal saline 35cc/h. The body size is not appropriate to age (umur 10 tahun tapi badan macam budak 3-4 tahun) but i would like to confirm by plotting the growth chart.
Dr: Ha dont need dont need just proceed. What other thing that you see? Look at the head. Measure!
A: (aku pun measurelah kepala dia 39cm) 39cm dr, there is microcephaly. And there is also strabismus. The child is lying on abnormal posture. There is muscle wasting. The legs is clasp knife. The limbs look stiff.
Dr: So what examination that you want to do?
A: general examination first dr?
Dr: No no. Neurological examination. Ha do do.
A: Upper limbs or lower limbs dr?
Dr: Both both.
A: Okay dr (buat tone, power, reflex dekat upper limb dulu. Patient punya tangan sangatlah keras gila so hypertonia. Power takleh buat sebab dia takleh gerakkan tangan dia langsung. Reflex pun tak dapat pasal keras sangat). There is hypertonia of upper limbs. The power is 3/5.
Dr: You say the power is 3/5 (nak marah) (aku blur gila kot mana boleh 3/5 kan dia takleh gerakkan tangan sendiri tu main bantai je 1/5) Dr marah lagi 1/5?
A: Okay dr 0/5.
Dr: Haaa
A: reflex cannot be done dr.
Dr: Okay proceed to lower limbs.
A: (buat benda yang sama macam upper limbs) There is hypertonia of both lower limbs. The power is 0/5. There is hyperreflexia noted. No clonus. Babinski sign positive.
Dr: So what is your diagnosis?
A: My diagnosis is cerebral palsy
Dr: What type of cerebral palsy
A: Spastic cerebral palsy dr.
Dr: What type of spastic?
A: Hemiplegic dr
Dr: Hemiplegic? (nak marah)
A: Eh sorry dr, quadriplegic (aku rasa semua limbs dia tkleh gerak dan stiff tapi nape tah dr macam tak puas hati hmm :( )
Dr: what other type of spastic?
A: Haa yang ni aku taktau (taktaulah dr nak yang ataxia, dyskinesia tu ke yang monoplegia, diplegia and so hmm ) lama terdiam hmm. Pastu cakap I dont know dr,
Dr: You dont know? Hmm okay thank you.
Sedihhhhhhhhhhhhhhh sebab tak dapat jawab semua soalan dr. Long case pun sama. Rasa memang failllah block ni. Keluar je ward masuk bilik pendidikan terus meleleh air mata. Nanges gila-gila kottt. Sedih gila. Nilah study malas tau tidur je mana nak pandai buat semua nii. Padan muka.
Jumaat depan result keluar.
Takutttt. Ive done my best. Moga Tuhan beri kejayaan yang setimpal.
Amin.
Nak balik rumah ni cuti seminggu lebih.
Nanti- nanti :)