1 year housemanship experience

Assalamualaikum... This just a random talk about my experience so far.

I'm a houseman for 1 year 2 months already now. Currently I'm in my fourth posting which is surgical. I went through orthopaedic, paediatric and O&G before. During my first posting, I learnt a lot about people and working life. I had a not-really-nice experience during the first posting. But I kinda miss my first posting though; I missed the teamwork I had during the posting. I worked with superb colleagues (but some are annoying) and also the nurses!!! I love the sister and nurses. They helped me a lot and gave strength to me to cope with the department cultures. Yeah, the department had some weird cultures and MOs wasn't so friendly that time. They just make a big fuss about anything during rounds and they won't help to present any single case during rounds. There's one day, left me alone in ward during morning round and I have to present all the cases. In ortho, you cannot refer to any notes while presenting case during rounds. Of course I couldn't remember every details of all 28 cases in ward hence I got screamed at. Haha. My memory wasn't so great though. >.<

My mentor in ortho, the best and kindest specialist in the department. I still remember how I cried in front of him. Haha. Hope he's in best health and be blessed always.

Then I went to paeds. I had a bit of culture shock with the bosses. Many of the MOs and specialist are so nice which unlike the previous posting. I enjoyed being in paeds except when I have to take blood from the NNJ babies. I love babies and children but I don't like to poke them especially those with hard-to-get veins. On my last day in the department, my supervisor asked me to join paeds and of course I'd love too however the thing that made me still thinking about joining paeds is how to deal with the needing to poke the babies????

How can you have heart to poke these too cute babies? I still remember how I cried together with the babies when I took their blood. So heart-breaking you know?!

My O&G posting is also a great experience for me. I love working at labour room but it's usually so tiring especially when its a jonah day. I love doing procedures in labour room but you know sometimes it's like a war zone there which made you feel overwhelmed. Nevertheless, I wont pursue into this field. For me, O&G is equal to medicolegal department. So many medicolegal issues the department encountered. Perhaps, patients like to sue O&G doctors for any slightest mistake. So, it's a nay for O&G.

Me and colleagues during episiotomy suturing workshop.

Now I'm in surgery. Initially I hated this department. So far I will hate which ever department I going through during tagging time. Hiks! Now I kinda like it. The specialists are so cute like really cute. Some likes to shout during ward rounds (I found this cute too), some are just having serious facial expression all the time, some dressed up so nicely with pretty lipstick colour and high heels and some are just super nice, teaching during rounds and likes houseman to involve in deciding management for patient. I know all of them having a kind heart. I just know it from how they devoted their time for patients. They went back so late at night like at 11pm as they faced with difficult surgery which took hoursss to finish and if they are post call, they still works the next day as usual. They are so workaholic. May Allah bless all my surgeons!

As far as now, I met a very super super nice doctors and badas one. I kept questioning myself, how can this particular doctor, Dr S be so patient, talk so softly and teach anyone so nicely whereas another particular doctor so sarcastic, scream next to your ear and asked for explaination letter without checking properly into the matter. Surely I wants to be like Dr S but you know I got some temper sometimes. LOL

Now my concern is to finish my housemanship and get into any specialty. Somehow, I still do not know what specialty I should take. I really can't decide now as yet.

That's all for now peeps. Thanks for reading!

Professional examination OSCE for medical student

Olla peeps. It's been a year since I updated my blog. It's because I was coping with housemanship thingy as well as I forgotten my password to assess my blog. Just recently able to figure out the password. Haha..

So here, I just wanna share regarding my OSCE questions during my professional examination. Hope this can benefit anyone. Here you go...

LONG CASE: PP type 3 posterior

Causes uterine irritability

- braxton hicks contraction

- labour contraction

- uterine hyperstimulation by IOL

- abruptio placenta (usually hard uterus)

Methods use to detect fundus

- lateral grip

- fundal grip

- what else???

What can really determine uterus larger or smaller than date

- based on clinical fundal height more than 4 discrepancies not SFH

Possible causes of breech presentation for this patient

- Prematurity

- Placenta previa

- Congenital anomaly e.g. Neural tube defect (meningomyelocoele)

Other

- Polyhydramnios

- Multiple pregnancy

- Hydrocephalus

- Previous pregnancy with breech

- Abnormal uterus

Investigation to do

1. Full blood count- to check for anemia and maintain Hb > 10g/dL

2. GSH- if necessary, blood bank only hold pt’s GSH for 48hrs only

3. Fetal surveillance- CTG, US

When to transfuse blood

Women at or above 34 weeks gestation with haemoglobin less than 7 g/dL

Management: You’ve been called by a nurse informing that the pt develop bleeding. What are you going to do?

1. Attend pt immediately

2. Check amount of blood loss- might bleed a bit only

3. Put on CTG to monitor fetal heart activity and sign of labour (increase contraction)

4. Prepare patient for emergency lower segment caeseran section

  

SHORT CASES

1. Hand examination

- Present findings: pt has tenderness over distal radial side of wrist & +ve finkelstein test

- Dx: De quervain tenosynovitis

- Ddx: fracture of carpal bone

- Mx: rest, splinting, anti-inflammatory medication, injection of corticosteroid, surgical release of tendon sheath (rarely do)

- Cx steroid injection: tendon rupture, skin atrophy

2. Abdomen examination (obstetric)

- Calculate EDD and POA (at 40 w POA)

- Present your abdominal findings: scar, clinical FH 34w, SFH 35cm which is smaller than date

- Dx: Uterus smaller than date

- Causes: wrong date, oligohydramnios, congenital anomaly (renal agenesis)

- Questions u want to ask pt: ask whether she is sure of LNMP, does she has benefit of early dating scan, any hx gush of fluid (leaking liquor)

- Mx: to confirm date, to do VE in order to check any pooling of amniotic fluid, test fluid with litmus paper & nitralazine test and check bishop score. Give antibiotic to cover any infection.

- Bishop 4/10, what to do? – because cervix not yet favourable, IOL with prostin

3. History taking (psychiatry)

- Dx: OCD

- Ddx: GAD, panic disorder (pt has no symptoms to suggest MDD)

- Why panic disorder? – she has some symptoms of panic attack e.g. SOB, palpitation

- What organic cause could be for the symptoms? - hyperthyroidism

- What specific obsession she has: checking obsession

- How to mx? – give antidepressant such as SSRI, TCA and examples are fluoxetine, clomipramine

4. Examine motor & sensory of UL & LL

- Positive findings: reduced sensation over peripheral area

- What pt has? - Peripheral neuropathy

- Dx: peripheral neuropathy 2⁰ diabetes

- Ddx: peripheral neuropathy 2⁰ alcohol

These are simpler version of what I went through. Kindly read more about those topics and aim for distinction okayy?!

Best of luck all future doctors!!! ^^