نافع لغيره – BeNeFiCiaL tO OthErS

I Wish I Could Run Back

The time flies by. And it is my time to experience what others had already experienced.

………………………………………………………………………………………………………………………………….

Yesterday was a hectic day for me. Not because of the continuous lectures, or seminar. But due to first practical exam of medicine of which I had already taken today. It was a nerve-wracking day and quite tiresome for all of our batch.

The exam started early in the morning, somewhere around 8.30am. So we had to be prepared early as there were still more things and stuffs to be revised again and again. The preparation on the night before exam was still not sufficient. Early morning reading is a must, although during our sleep, the things we read are converted into long-term memory and stored in the organ called ‘the brain’.

Accompanied by the super-duper-cold-weather-of-the-winter, we traveled our way to the medicine ward (sounds like a far journey right? haha). Everyone had already been there, waiting nervously for the real test was about to begin. All of us read as much as possible before the exam started. The cooler breeze made their journey through the group of students preparing their final study. That’s why we shivered excessively.

And the exam started when the PG students gave the instruction to us about what to do in the ward. They told that if you don’t know, just say don’t know. Examiner will change the question. If you are still trying to answer, you are digging your own grave. Just be safe. If we know the answer exactly and confidently, only then we have to say something.

We were given 2 short cases and 1 long case. For the short case, only general examination is required. No need to go further to systemic examination. For the long case on the other hand, we had to take full history of the patient till the systemic examination. Only 15 minutes were allocated for the long case. We had to be faster then.

For the long case, I got the case of ascites due to liver diseases and chronic renal failure. As foreign student, we were required with a sister working in the ward, for language translation during history taking. It was such a relief and really helping for me.

The history taking were going quite smooth, although I felt like I was the slowest as I still got more to write on the paper and at the same time had to perform few clinical examination. Still, I managed to complete writing the case but the handwriting was in total mess.

The chief complaint of my patient were :

  1. Distension of the abdomen since 1 year.
  2. Breathlessness since 1 year.
  3. Retention of urine since 1 year.
  4. Cough with thick sputum since 1 year.

The abdomen is distended and the umbilicus everted. It ruled out the collection of fluid in peritoneal cavity. As abdomen distended, there is shift of diaphragm upwards causing breathlessness (dyspnoea). There is retention of urine, where we can see from the decreased urine output (oliguria). It is hardly 50ml per 24 hours. Just imagine how he lives his life, without the ability to urinate. =(

He is a known case of hypertensive. He is also a known case of chronic renal failure. That’s why the patient is on dialysis weekly to remove the toxic waste from the body and to maintain electrolyte balance.

On examination, shifting dullness and fluid thrill present which rule out the ascitic condition. There were 2 scar marks on both iliac region, indicating that ascitic tap was done to remove the excess fluid.

There is oedema of both lower limbs, pitting in nature. It ruled out the possibilty of liver diseases and also renal failure in this patient. Pitting oedema gives the idea that there is accumulation of excess protein in the interstitial fluid, could be due to increase capillary permeability.

After finishing the long case, I went to next 2 patients for short cases. Only general examination is required like, assessment of pallor, icterus, cyanosis, clubbing, lymphadenopathy, respiratory rate, pulse rate, blood pressure and peripheral pulsation. Everything has to be remembered and no need to jot it down.

Then, the case presentation to the internal and external examiner. It was so tense moment you know, in the sense that theory knowledge is strongly required. Plus, ability to think fast and correlate the symptoms with other systemic diseases. Everyone got asked so many questions. It’s like being ‘tortured’ mentally. It’s for our own good.

Before my case viva, the patient of whom I took his case, shook my hand and said, “Good Luck”. I felt a little bit relieved as I got little more strength to overcome my nervousness and anxiety. When the examiner walking towards me, the pressure started rising. Dub dab dub dab..I believed in myself and started the presentation…

In the middle, they asked me to show how to palpate the liver. So, we have to start from the right iliac fossa region and go upwards, as the liver enlarges downward. After that, question came out. What is the causes of hepatomegaly (liver enlargement)? Questions more on liver problem and few about cyanosis (bluish discolouration of the skin and mucous membrane).

For acute liver injury, we have to do prothrombin clotting time as the liver produces clotting factor. While for chronic liver injury, do the albumin test to check for serum albumin level as there is bilateral oedema of lower limbs, indicating accumulation of protein in interstitial space.

After completing the long case presentation, half of the burden had already lost. Thank God.

Next, after lunch, we had to take another 4 table viva.

Those are instrument, ECG (electrocardiogram), X-ray, and lastly Drug viva. Every table got 1 examiner and series of questions are asked accordingly.

After the table viva, the practical exam for Medicine is over.

Alhamdulillah. After a long and hectic day, we managed to face it. Whatever the result, we hope for the best.

Hopefully everyone will be success in the exam. (^_^)

p/s : 3 more to go. Next one, Surgery exam. Pray for us.

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