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!!! ^^

Apa itu MD UKM AUCMS ?

Assalamualaikum

Sebelum melapor diri untuk bertugas di hospital pada hari Selasa nanti, eloklah untuk aku tulis entry yang dah dijanjikan ini. Yela, kang dah kerja nak bery pun tak sempat inikan nak menulis blog. Ihiks! :-B

Aku ni sejak kecil ditakdirkan untuk jadi pioneer. Pioneer untuk kelas rancangan khas, pioneer for math & science in English and the most recent is pioneer untuk program MD UKM secara kerjasama. Kerana batch aku ni pioneer, makanya bilangan kami hanyalah sedikit iaitu 31orang sahaja. Kalau campur dengan our counterpart in HUKM dan MD UKM UnPad jadi seramai 260+ orang. 0.o"

Mesti korang curious bagaimana kami terjebak dengan AUCMS ini kan kan kan... Actually, after dapat results SPM, kitorang laju-laju ke portal MARA dan memohon biasiswa untuk belajar oversea. Zaman hingusan dulu impian aku sangatlah menggunung, nak belajar kat oversea je barulah gempak... Hati teramatlah girang apabila mendapat tahu aku terpilih untuk interview MARA di UniKL. Beberapa lama kemudian, aku dapat surat tawaran:

AUCMS back then was known as ACMS. Mula2 tengok perkataan ACMS tu, aku & famili seakan pelik dan tertanya2, apakah itu? Namun, 07-07-08 ialah titik-tolak kami terjerumus ke lubuk AUCMS ni...

Pre-medical disini, waktu zaman aku tu, menawarkan untuk sambung pengajian di Indonesia, which is where I wish not to go for study (no offence ye). Kalau jalan2 best la kan... Tapi aku struggle habis-habisan jugak waktu premed sebab ada ura-ura boleh pergi Ireland. Gempak sihh kalau dapat buat medik di Ireland! Namun, suratan takdir aku adalah untuk belajar di Malaysia. Tawaran ke Ireland takde lagi waktu batch aku tu.. Aku pun tidak mahu ke Indonesia. Hati memberontak giler waktu tu. Kemudian, aku dipanggil interview untuk program MD UKM. Bagi aku, baik study di Malaysia ajelah begini.

Dengan berat hati, aku pun study kat sini...

Program kerjasama UKM ni, basically, semua modul pembelajaran adalah sama sejibik seperti di UKM Bangi cuma kami belajar di AUCMS Kepala Batas. All lectures given by UKM lecturers via teleconference. Tapi batch aku je yang ada teleconference, the next batches aren't allowed for that for I-don't-know reason. Kalau ada bab yang tak faham, kami tanya lecturers kat AUCMS ni.

For your information, semua exam papers came from UKM and their lecturers are the one who mark our papers. Sebab exam dia susah yang tak tersangka, ramai juga yang terpaksa drop year dan ada yang quit making us left with 31 orang je di final year.

Waktu Clinical Skills learning (CSL) module ketika di first year, kitorang pergi Hospital Kepala Batas. Semua masih innocent dan bersemangat waja ketika itu. ;p

Bermula tahun tiga, bermulah proses penghijrahan kami ke seantero dunia. Oh, bukan oversea, kami belajar hanya di Malaysia. Kami yang MD UKM - AUCMS ni posted at Hospital Kulim during our year three dan sebelum officially bermula telah ke HUKM untuk one-week basic clinical orientation. Lepas tu, kami kena pergi posting Jabatan Kesihatan Masyarakat (JKM) di Tanjung Karang for 7 weeks and one week at HUKM. Waktu ni lah kami berkenalan dengan our counterpart dan ada yang dari UnPad pun baru balik ke UKM. 

 Ni dah last day JKM posting. Gila kau, aku taknak balik Kulim kot bila dah lama2 kat sana.. :'(

Fourth year, kami ditempatkan di Hospital Taiping untuk posting ENT, Anaesthesiology, Ophthalmology and Psychiatry. Posting paediatrik dan orthopaedik, kami kembali ke Hospital Kulim. 

MUARC ni research conference. Memang modul wajib UKM untuk sape2 rasa nak graduate. Hihi.. Selesai MUARC, barulah officially kami mula posting clinical fifth year.

Fifth year pulak di Hospital Sultanah Bahiyah, Alor Setar. Kat hospital2 lain sebelum ni hanya kami je ada kat situ so tak rasa persaingan sangat tapi ketika di fifth year, ada kawan2 dari AIMST jugak. Sedikit competition untuk clerk patient berlaku tapi medical knowledge tu kitorang selalu share bersama. Aku pun ada sorang very good friend kat AIMST hasil sering bertukar2 ilmu. Waktu fifth year ni pun ada posting yang kena pergi ke HUKM, belajar kat sana seminggu or dua minggu then barulah baik ke Alor Setar. Banyaaakk sangat kami berjalan. Penat tapi best jugak.... :D

Memang kami kejap disana, kejap disini. Tapi kalau exam je, mesti lecturers dari UKM datang untuk assess kami. Dah kata MD UKM grads, diorang haruslah OCD untuk menjamin kualiti sebab tu sanggup turun naik flight jumpa kami.

Hari bersejarah- Professional examination results' announcement. Dean UKM pun datang Kampus Medik AUCMS di Kulim. Alhamdulillah, ramai yang pass. Yang tak pass tu, mungkin ada hikmahnya, dapat study lagi untuk 6 bulan di HUKM. It's still a precious experience though.

Personally, sekarang aku bersyukur tak study oversea sebab kalo study local, lagi cepat habis dan banyak exposure kat local hospital and diseases. Dulu memang memberontak tapi sekarang baru nampak apa yang Allah takdirkan untuk aku. Cumanya, aku tak nasihatkan for you to pursue your study at AUCMS sebab kolej tu macam tak stabil je sekarang. But the choice is in your hand.

In a nutshell, my batch is special and limited edition. We faced numbers of difficulties and challenges to reach where we are now and we hope to become dedicated and great doctors insyaallah. =)

Thanks for reading. ^^