Saturday, November 17, 2007

not-so lucky day!!!

exams are finally over... but wasnt lucky today... i have 3 short cases... one from Obs & Gynae, and one from medicine and lastly, orthopaedics...

well, it is lucky to get O&G, but i knew this was my very worst subject among all othe medical subjects. O&G is very easy and straightforward subject especially for undergraduates, but i really suck in it.... i felt it is away from other subjects and i couldnt reconnect between O&G and medicine. Well, for examination wise, gynae cases is something like we normally do for surgery but for obs... i really sucked at it!!!... i hate palpating mother's tummy and to find where was the head located, whether liquor was adequate, where is the back of the baby and lastly, to find the location of the baby's heart!!!!...argh!!!!!.. and when the mother is a placenta praevia( a low lying placenta which quite prone for bleeding), u must be very gentle palpating the mother's tummy...aisei... tat's why i really hate O&G....

i got a very nice panel (again!!)... Dr kautaman( HOD of medicine department),well, i have phobia towards him cause he is very strict in class and once, he sounded me and gave me a FAIL for my long case presentation. Well, i cried during that class but anyway, i learned how to take a good history from him..... he was very nice throughout my short cases and he guided me when i got stucked.... My second panel was Dr Tham( an O&G specialist who is known as a workaholic), very strict during class but very nice examiner!!!!..heheheehhe.. the other 2 were external which one of them is an orthopaedic specialist.

my first case was a pregnant woman a POG of 36 weeks with intrauterine growth restriction(IUGR) ... went kelam kabut cause it is a pregnant lady and shit..... i need to locate the baby head!!!!!!!! arghhhhhhh........ here was the conversation between me and dr tham:

Dr T: this is a G3 P2 mother with period of gestation (POG) of 36 weeks. .. do relevant general examination and abdomen examination..

me: ( i told all my findings) bla bla bla.... and fundal height is at 32 weeks and symphisiofundal height is 31 cm...

( in between, Dr Tham was motivating and very encouraging which makes u felt your adrenaline rush was lowered down)

Dr T: ok, then proceed with your examination... (i proceed by doing all the Obstretic grips andwent head- wired again!!!!!!... confuse with the heel of the baby and the head... my instinct told me that the head was at the bottom but the head seems to be engaged and very hard to feel... shit!!!! )

: erm.. ( i told my findings) ... and i think it is an oblique lie and the head is at the upper right of the abdomen....( was profusely sweating!!!!!!!)

Dr T
: u sure?.... do u want to recheck again?
( aha!!... got the clue here!!!... my 1st finding was wrong... guess i need to believe my instinct!!)

: ( recorrect my findings!!)...

Dr T
: so, what is your diagnosis??

: a singleton baby, with a longitudinal lie and in cephalic presentation...(hehehehe!!!)

Dr T
: good... so the mother is a POG of 36 weeks and your findings was 31 cm??? so what do u think?

: uterus doesnt correspond to POG and it is lesser than the POG....

Dr T: then, what is likely to be?

Me: IUGR, wrong dates and oligohydramnion...

Dr T
: what else?
(shit!!!!.... sudden thought block!!!!.. couldnt think any other reason!!!)

me:..errrrrrrrrr( really blurred!!!!)

Dr T
: u would only able to ask one question from the mother about her past Obs history??

me: ( i was totally brain dead)....

later, he asked me how to investigate the mother....... and i able to answer and later,the bell rang...

my next station was medicine and was praying NOT TO GET MURMUR!!!... well, yip-yip-hurray.... i got an abdomen case and it looks like thallasemia due to her features!!!... ok .. could pass that and Dr kautaman was nice ... hehehehe

bell rang and went to my final station ... my patient was a chinese man .... well, i thought it will be another abdomen case(surgical case), HOWEVER,......(questions are by the external examiner...)

Dr: this is a 50 year old gentleman with a history of an abnormal gait and right hip joint pain since 4 years old, currently comes in with bilateral hip joint pain.... do relevant HIP EXAMINATION... ( my heart just sanked..... cause i didnt practice hip examination or any discussion about hip joint with my friends during study break)

me:... i would like to assess his gait( i could only think of that!!!!)..
( saw his gait.. and was in a big shock cause it was my first time seeing that gait.... definitely, it was a short limb gait and some additional gaits which i could able to think of trendelenburg gait ....)

Dr: so what do u think .. or u still can assess his gait if you want to ....
( of course i wan to ask him to walk again!!!)

me: i will like to see his pelvis by asking him to undressed..( felt abit shy, but before that, i have answered short limb gait with trendelenburg gait)

Dr: ok, this patient has bilateral trendelenburg and short limb gait .. so, how do you do trendenlenburg test?

me: ( was showing the method to do the test but at the same time, the patient was obviously helping me out too!!!!.. told my findings )).... he has obvious trendenlenburg test positive over the right side but couldnt see the left side...( i felt suffocated!!! felt like killing myself!!!)

dr: it's ok .. it is really hard to see the left side, but anyway, he has bilateral trendenlenburg gait and short limb gait, so what do u called it?
( how nice of him!!!!1)

me:... waddling gait...( gait like walking like a duck)

dr: (he asked me a few more questions but couldnt remember....).. ok, let us proceed to the bedside ...

me:...( telling all the findings, and yeah... was doing my crazy stunts on the patient like squaring the pelvis, examine his range of movement and went into some discussion which final question i couldnt answer and found out from my lecturer that he wants OSTEOARTHRITIS of both hip joint!!!... argghhhhh......)

i was given a special treatment from the panels which they give me extra time for my last case ... was the last person to come out from the exam hall.... and felt like crying... discuss with Xinyi about my cases and hers too... she is a great listener and i felt relieved after talking to her...

well, the reassessment list for borderlines was put up ... well, my name was not in the list.... but it doesnt tell whether i pass... anyway, still with my finger crossed for hoping to pass.... maybe another 16 hours that the final results will be out!!!... gosh....scary!!!!

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