Earth Hour Malaysia - March 27, 2030H - 2130H

Earth Hour is here again. Last year's Earth Hour had caused an intense debate among my peers regarding its role and impact. Some even argued that with all lights being turned off, crime rate will increase and many youngsters may get involved in immoral activities. Others responded that all those things can occur at anytime, any place even before and after Earth Hour. However both sides agreed that it's just a symbolic awareness campaign rather than having powerful impact by itself. However, this is the moment for us to show our solidarity and raise the awareness towards saving the Earth. We have observed how humanity had recklessly manipulated and squeezed the Earth resources to the limit. We have also observed so many destruction made by our hands. Now it's our time to do something to make sure that Earth is still safe for our future generations. We can make a difference - no matter how small it is, it really matters.

To all Malaysians out there, let's forget our differences and support Earth Hour. Just for one hour, please switch off the lights and don't use the cars starting from 8.30 p.m. tonight. Unless you have urgent matters, of course.

Post OSCE - Gloomy yet the light of hope still flickers

Yesterday was a gloomy day - literally. After nearly 5 hours of quarantine, soon the sky became gloomy and there were lightnings and thunders for approximately 30 minutes before the rain poured. And it suited my mood as well, after doing quite terribly in the OSCE Day 2. I was so silly that I missed to ask patient's name and RN before I perform venopuncture for blood test. And I made a mistake that could not be forgiven - defibrillation for unconscious patient with pulseless electrical activity (PEA) at the Accident and Emergency department (A&E) CPR station! I've cried enough for the spilled milk (terrible performance in OSCE). Hopefully I managed to secure at least minimum pass for OSCE and other components. I must focus on the upcoming rest of the clinical component i.e. long case and short cases.

OSCE Day 2

Station 1: Primary Care Medicine. Patient presented with urethral discharge and back ache for 3 days. Obtain the sexual history and advise the patient accordingly.

Station 2: Rest Station

Station 3: Otorhinolaryngology (ENT). Two exhibits. First, acute tonsilitis - we were asked about the clinical findings based on McIsaac score. Then we were asked about the first line antibiotics and duration of treatment. Second exhibit showed picture of ear toileting. Questions, what's the indications, precaution, and complications of the procedure?

Station 4: Anaesthesiology. Patient presented with trauma due to MVA. Suddenly developed respiratory difficulty. We were given arterial blood gases (ABG) results and had to interpret. Then followed by the management of the patient (ATLS - primary survey). After intubation and ventilation, another set of ABG results given for interpretation. Lastly, patient was put under FiO2 0.8. What does this indicates?

Station 5: Emergency Medicine. There's video showing patient with signs of paradoxical breathing. Asked about the diagnosis and further management of this patient.

Station 6: Otorhinolaryngology (ENT). Two exhibits. First: Inflammed inferior turbinate and it's management (medical and surgical). Second: Cholesteatoma, the complications, and whether the hearing loss secondary to it is reversible or not.

Station 7: Rest Station

Station 8: Anaesthesiology. Venopuncture for full blood count and renal profile. (Missed a lot of marks here. Silly mistakes, should have scored full mark!)

Station 9: Obstetrics and Gynaecology (O&G). Running commentary on how to prepare for episiotomy repair and demonstrate on how to do the suturing.

Station 10: Emergency Medicine. CPR and then given an ECG. What's further management? (Follow the algorithm). If VF or pulseless VT, defibrillate. If otherwise PEA or asystole, continue CPR and at the same time ask for assistant to give IV adrenaline 1ml. (I failed miserably despite practicing it so many times).

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Ok, now let's get back to business. Should revise more on managements of common diseases - starting from O&G first for tonight. But first I want to have some hearty meals for dinner... =)

OSCE Day 1 - Checked. 3 more clinical exams to go~!

I fell asleep relatively early yesterday, so I didn't have the opportunity to blog on that day. Now, the first part of OSCE is done, with 8 stations plus two rest stations. Tomorrow will be the second half of it, comprising of the remaining disciplines in the syllabus. As for today, the eight stations were as such:

Station 1 : Primary Care Medicine. A young male adult (Damn, I forgot to ask his name. I only introduced myself to him) presented with history of back ache for 3 days. After detailed history and physical examination, you have made the diagnosis of muscle sprain. However he requested for an x-ray. How do you respond?

Station 2 : Rest Station

Station 3 : Ophthalmology. Picture of cataract given (My friends answered with complete full mark i.e. posterior capsular cataract). We were asked about the findings and give the diagnosis. Then we were asked to list one local cause and 2 systemic causes. We were also asked to name two procedures that can be used to treat the condition and list 4 complications that may arise from the procedures.

Station 4 : Radiology. We were provided with two exhibits. The first one is a PA erect chest x-ray with haziness and consolidations all over the lung fields - diagnosis: miliary TB. Then what is the other test to confirm the diagnosis? - Sputum culture and sensitivity or smear to look for acid fast bacilli (choose one).

The second exhibit shows the x-ray of knee joints from two views, AP and lateral. A male patient in his 30's presented with history of sudden pain on the left thigh associated with swelling while he was playing badminton. Comment on the findings (AP view, no visible fracture but there is multiple cystic lesions on the distal part of the left femur. Lateral view, there is spiral fracture at the distal part of the femoral shaft of the left lower limb). What is the diagnosis? (Pathological fracture secondary to aneurysmal bone cyst).

Station 5 : Surgery. You as an HO in the ward saw Mr. Z unconscious following a surgery. Re-assess the Glasgow Coma Scale (GCS) level. It was written on the question "Treat mannequin as a real patient". After assessing, summarize the findings (supposed to be at the minimum, because a mannequin will surely not respond to any stimulus. Hence it will be 3 over 15.) . Then the examiner will give you another set of finding and asks you what is the GCS? Finally you will be ask what is the GCS level that you would intubate the patient? (I answered less than 8. But please check because I'm not sure. Some of my friends said 8 and below.)

Station 6 : Primary Care Medicine - Drug Prescription. 2 year old (weight and height provided) presented with history of fever. Prescribe antipyrexia for this patient from what is listed. Tablet Paracetamol, Syrup Paracetamol, Tablet Aspirin, Soluble tablet aspirin. (I'm sorry I can't recall the dosage.)

Station 7 : Rest station.

Station 8 : Ophthalmology. Do visual acuity test. Since the test was done in limited, confined space, mirror had to be used. ( I knew the "patient". She is a doctor. lol)

Station 9 : Psychiatry. Patient presented with history of low mood for three months, and had suicide intention for two weeks. Assess the suicidal risk in this patient. Use SAD PERSONS scale, and "SAMPAH" mnemonics to assess whether the suicide was well planned or just to gain attention from others. [S - Suicidal note. A - Avoidance (e.g. want to commit it in a locked room) M - Method (e.g. overdose, hanging, or slit wrist etc) P - Plan (when, where) A - Arrangement (I think it's redundant, but that's what the mnemonic is) H - Hint (e.g. by writing will, buy insurance).]

Station 10 : Orthopaedic Surgery. Patient had a fall and suffered anterior dislocation of the shoulder on the left arm. Ask for written consent for this patient for the close manipulation and reduction (CMR).

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So, for tomorrow there will be no more stations for Ophthalmology, Surgery, Primary Care Medicine, Radiology, Orthopaedic Surgery and Psychiatry. Let's revise for Obs-Gyn, Paediatrics, Emergency Medicine, Anaesthesiology, and Otorhinolaryngology (ENT). Medicine? I'm not sure, because some said that it won't come out because we have had our CPC under Department of Medicine (SLE with Anti-phospholipid syndrome). But, I think I still have to prepare just in case it may come out tomorrow. But for sure, I have to cover the rest first!

Let's do it...

p.s. Have to struggle for tomorrow because I think I'm not doing well enough. I must secure at least pass for this component. After this paper, there will be a gap before my long case paper on Tuesday and Short cases on Saturday (the last day!). Please, please, please, dear God please guide and help me to pass this exam and become a good and safe doctor. Ameen.

Wohoo... 2 days to go~

Yes, two days to go and yet I still feels 'empty' without much input for the last few days. Even though there's much progress but I felt like I'm not doing enough for this exam. Just like previous exams. Hopefully I will be able to pass this exam. I think I should stop from blogging for now. Maybe, just maybe, I will come back after I'm done with theory paper, the day before OSCE. Please pray for me.

Action plan:

1) Proceed with Past Years Questions attempt

2) Review on the investigations and their interpretation (including radiology)

3) Flip through short notes that I've prepared prior.


That's all for now. Till then, bye~

Graphics from HERE. Special thanks to Mr. Adnan i.e. the owner of the blog for the pic. Now it's my turn for the exam. =)

SIGECAPS - Mnemonics for Major Depressive Disorder

Another mnemonics. This time it's for symptoms of major depression and dysthymia.

S - Sleep disorder* (insomnia or hypersomnia)
I - Interest deficits (anhedonia)
G - Guilt (worthlessness*, hopelessness*, regrets)
E - Energy (lack of energy)*
C - Concentration deficit*
A - Appetite reduced*
P - Psychomotor retardation or agitation
S - Suicidality - (to assess suicidal risk, use SAD PERSONS scale).

NOTE: To meet the diagnosis of major depression, a patient must have four of the symptoms plus depressed mood or anhedonia, for at least two weeks. To meet the diagnosis of dysthymic disorder, a patient must have two of the six symptoms marked with an asterisk, plus depression, for at least two years.

Reference: American Academy of Family Physicians (AAFP)

An Act of Stupidity

As far as I can remember, I never openly call someone stupid. But this, I think, is an exception. There is no other suitable word that I can use to describe such act. It's a waste of valuable life saving resources. Allow me to enlighten you, if you are not following the news lately. Please read the news HERE. For English version, click HERE.



One could not imagine what's the rational behind such act. Even if there is any, I don't think it outweighs the benefits that can be gained should the blood were donated to the proper cause. It's a pity that even blood was used as political tools, when it was supposed to be used for greater life saving purpose.

[Special thanks to BangkokPost.com for the graphic]

5 days to go~

... before the beginning of the final professional MBBS examination. I hope that I can manage to pass the exam. Otherwise I will be spending the next 6 months for extension and resit for another exam (God forbid). And it won't be easy too. So, I will try my best to score as much as I can in the exam to the very last minute.

Our batch has created a history I guess, with the highest number of students being barred from the examination. However I could not be sure of that. But one thing for sure, it is a stark contrast as compared to the previous batch, whereby there was none of them being barred.

Most of them, not to say all of them, were being barred mainly because of lack of attendance. Our faculty has set up minimum 80% of attendance, and we were all had been warned of the consequences of failing to fulfill the requirement. Yet, obviously some of us were not bothered by such reminder. Hence, they were barred from sitting for the examination.

Some of them have their reasons, while the rest were simply not coming from the class for no reasons. Of course, they would be asked to write a show-cause letter. But unfortunately none of them were accepted by the dean's office. It's a pity for them, for not even having a fighting chance. It's a pity, because some of them are very,very,very knowledgeable as compared to myself. And one or two of them had once ridiculed me before for my "lack of knowledge and skills" - according to their definition. But that's another story. I don't mind, and of course I won't say to them "serves you right!". Yet, what really hurts my feeling is that they would still hope and pray that I would soon join them. They even sarcastically wish me luck by saying, "Nanti jangan tinggalkan kita orang jauh sangat ye. Jangan buat master cepat sangat."

I won't judge them, there's no point of doing so. It won't affect the outcome of our exam anyway. Some of them have their own reason and problems that hindered them from attending the classes. But it is all written then. I wish them luck, and of course I hope for the best of me too~

As for me, I will try my very best and leave the rest to God. I will accept whatever the outcome of the exam is, but I really hope that I will pass the exam and become a safe doctor once I've graduated.

Ok, it's time to get back to the business. Five days to go. I should bombard myself with past years' questions and quick revision based on them. This would also be the time for proper sleep hygiene and diet so that I will be at the best of my health for the upcoming exam. Ganbate~ Chaiyo~ All the best~ Bittaufiq wan najah~ Semoga berjaya~!!!

I would also like to take this opportunity to wish all my coursemates the best for the exam (if they happened to read this blog, obviously).

Mode: RED ALERT

Schneider First Rank Symptoms

This is the mnemonics of Schneider's first rank symptoms. Presence of these symptoms proves the likelihood of schizophrenia (but bear in mind that it is not diagnostic for schizophrenia).

A - Auditory hallucinations (third person, running commentary)
B - Broadcasting of thoughts (thought broadcasting)
C - Controlled thought (delusions of control)
D - Delusional perception.

and thought insertion, thought withdrawal

Possible OSCE question for Psychiatry; apart from SAD PERSONS, mental state examination, or mini ental state examination.

Mechanism of Vaginal Delivery

We can be asked by the examiner to demonstrate the mechanism of vaginal birth in the OSCE station for O&G. While explaining the mechanism, we would also have to use the exhibits (mannequin - baby's head, and pelvic bone). Here's the steps in the mechanism:

1. Engagement (definition)
2. Descent and flexion of fetal head
3. Internal rotation - fetal head rotate and assume occipito-anterior position, facing towards maternal rectum.
   
4. Delivery by extension - fetal head extended.
5. Restitution - Fetal head turns 45 degrees to the maternal right hand side, restoring normal relationship with the shoulder.
6. External rotation of the shoulder.

Then, we would assist the delivery by gently pulling the fetal head downward in order to deliver the anterior shoulder before we pull it upward to allow the passage of the posterior shoulder.

Bipolar Affective Disorder