UNHAPPY TRIAD

Close to 3 months since graduation, I still wonder how I manage to graduate. It was not easy. God I am thankful. So decided to write on the different components of our final exams. About 2 years ago, Sem 10 exam was merely an exit exam. It was the sem 9 finals that were considered stressful and painful for students. But in keeping with LAN’s requirements, Sem 10 now is considered a professional exam. I know because I was still in the student council when the change took place.

1) CFCS viva
Stand for Community and Family Case study. Students are paired up in their third year and they take on a patient for 2 years. My partner and I chose a case of Down’s Syndrome. The 2 years were good. We got along well. My darling patient now 6 years old and his family were really cooperative. At the end of 2 years, I came up with a 120 pages report. My journals include correlation of cancer and Down’s Syndrome, role of nuchal translucency test in pregnancy and the role of the new quadruple test in pregnancy in determining Down’s Syndrome. The viva was in May. I had Dr. Sheila (OnG) and Prof. Moti (Paediatrics) as examiners. Before entering the room, I seriously thought I had it. Down’s syndrome and pregnancy testing?? These are subject experts we are talking about. Questions I got?

i. Eating habits in Down’s Syndrome and its importance
ii. Diagnostic test for Down’s Syndrome and it’s duration
iii. The 3 studies I mentioned above

I am counting my lucky star that the interview went through smoothly. Came out with an 80 plus if I remember correctly. I was delighted. The 2 years effort paid off.

2) Long Case
This is a new component introduced in Sem 10 finals 3 batches ago. This was to us the killer of all. Students were divided over 4 days. As my sir name starts with a ‘W’ so it’s no surprise my exams would be on the last day. But it was cool, that day we had YC, HL, Steven, CK, Teng, Teresa, KY, ZS, Annas.. We were quarantined together. By lucky pick each student would be assigned to a room. Each room had a patient in it. It can be anything ranging from psychiatry, medicine, surgery, OnG or orthopedics. WE WOULD NOT KNOW!! Till the minute we walk into the room of course. So students were given an hour alone to take a history, examine, plan the investigations and management for the patient. Then we would be taken to another room where the examiners are waiting.

You know the night before I was praying so hard. I was like “God, give me anything but an orthopedic case.” I hate orthopedics. Too many, it is one of the easiest subject, but it is the only posting I failed in my 5 years of medical school. So you can imagine how traumatized I was with it. I was actually hoping hard for an OnG case. Haha.

So when I walked into the room, I saw a young guy (a policeman) and I asked for his problem, the answer I got?? “Sakit lutut!!” I seriously nearly fainted. Just to be double sure “U datAng hari ini kerana sakit lutut sahaja?” he nodded. For a moment, I thought I was doomed for good. All those thoughts of failing my finals were starting to crawl in. I breathed, told God that he has a weird sense of humour, told myself I can do this and got started. The female nurse chaperon I got was sweet. After history and examination (thank goodness I manage to stay calm), I realized his knee was LOOSE. It took awhile before I realized he had what we call ‘AN UNHAPPY TRIAD.’ Torn ligaments and meniscus. That took most of my time, but the good thing of orthopedic, investigations and treatment need not require too much time as long as the principals are on the finger tips. The bell rang right on the dot when I completed running through everything mentally once. Walked into the examiners’ room.
Facing me was Datuk Shong (orthopedics), Dr. Lionel (surgeon) and Dato Jai (paediatrics). Yes it was intimidating having all the big shots but truth is, I can’t ask for a nicer combination of examiners. They were so nice especially when I personally think my orthopedic knowledge is completely zero. All 3 took me back to the patient. They wanted to see my knee examination skills. After awhile I actually told Dr. Lionel “I am exhausted carrying the patient’s knee.” It was seriously hard work when I had to examine every ligaments and meniscus of both knees under pressure. Not to mention that the patient was a nicely built policeman. Read an x ray, MRI, gave my plan of management and I was out of there. I was so panicky that I forgot what RICE stood for at that moment. Rest, ice, compression and elevation.

Arghh… The only thing that seen me through this exam? My dad had a knee injury from a previous hockey game. So I had played around with my daddy’s knee a couple of time. It has helped. Other exam cases varied from schizophrenia, cholangiocarcinoma, gouty arthritis, COAD, colon ca, portal hypertension, thalassemia, Pott’s disease, benign prostate hypertrophy, CML, pregnancy, PPROM, small for gestational age, VSD, hemophilia, Dushenne’s disease (crazy), opiods dependence and loads more..

3) Portfolio viva
We were given 5 minutes break after the long case and we were whisked off to another exam room for our portfolio viva. Each student having done 10 portfolios throughout sem 10 would now be questioned on their work. We were to know all 10 of our patients to the very minute details. Facing me this time was Prof Boo (an external from HUKM, paediatrics, no she is not our Prof Boo, a different one), Prof. Esha (medicine) and Prof Ramesh (Paediatric Surgeon). Gulp! Anyhow the 2 portfolios I got asked on were G6PD deficiency (paediatrics) and bronchial carcinoma (medicine). Questions I got:

i. Can we keep mothballs at home if the child has G6PD def? NO!!! It evaporates on to the mother’s clothes. The child is at risk of inhaling it.
ii. Differentiate hemolytic jaundice from other causes of jaundice.
iii. Different causes of red colour urine in a child.
iv. Principal of blood transfusion in a paediatric patient
v. How to follow up on patients with hemolytic anemia
vi. Drugs to avoid in G6PD def.
vii. Different types of bronchial ca, how to diff them by presentation, management and prognosis
viii. Smoking and lung cancer. Other risk factors?
ix. Palliative care/DNR
x. Spread of lung tumour. Pancoast tumour/ trachea/esophagus/blood vessels…
xi. Role of bronchoscopy.
xii. My journal on usage of staphylococcal antigens as pleurodesis

There were loads more questions but I can’t remember. It was not too bad since I knew my patients well enough. But the half an hour felt like a year. And the questions came on like a bullet train. I was just regurgitating answers based on memory. I wasn’t even thinking.

Seriously I am only grateful that I made it through. Sem 10 was not as relaxing as it seems. Probably with the new requirements and all. The examiners I got were great each time. I am actually proud to say that I am an IMU product. Regardless of what others might say, we were trained well. Do not think that we’ll lose out when we step out into the society. And they released 90 plus of us out there. Only had wish if the other 7 had joined us. So the joy was short lived for many of us friends. But ask me again to go through Sem 10 finals? I would probably not make it the second time. STRESSFUL TO THE MAX!

For those of you guys going through it early next year, ALL THE BEST and will pray for you. Lots of love..