Saturday, June 05, 2010

Exam 2

Jeng Jeng Jeng...

The two examiners, one of them was a familiar face.

The other was guy i think. Might be an external examiner, or someone new to exams la.

Anyway, they brought me to a woman, introduced as Ms Allen.

She presents with.................(cannot hear any shit....totally deaf)

..............'s cardiovascular system.

(Cardio? OH okok. Good la.) I go.

See hand....(Nothing).

Feel pulse....(Eii....macam got something...rate? 60ish...fuiyoh....and got a bit different feeling. Whats that leh? Argh, dun care)

Then go on....go on.....

Listening to the apex firstly using bell....( a murmur....OK! Lets feel the carotid to time it!)

I said: Can I just feel for the pulse in ur neck pls, if you dont mind...

Feel feel feel....


(Shit...should I feel again....but so far I have been super slick...should I really go and feel for the neck and get the pulse properly...?)

(ARGH. Dont want la. No need the carotid pulse la. Just pretend la. No idea at all how I came to that decision. Probably coz someone told me that there was a patient in Cardiff who fainted after the medical student repeatedly touch the carotid and gave her a vagal massage!)

(Murmur got....heart sound? Dont have wor...ARgh...)

(Systolic or diastolic leh? Ah...if my deaf ear can hear...surely must be grade 10/6 systolic la.)

Move on...go to axillae...(nothing)

Go to all four quadrants...(CANNOT HEAR A SHIT. NOTHING.")


Totally coma liau. Just like robot, pretend to proceed do all the position thingy like how i practice with imaginery patient in my own room...and sit the patient up....listen to LLSE for Aortic Regurg, in expiration...(still NOTHING.)

Go to the neck....

Still maintain that cool look.... "Ms Allen, if you dont mind to do the same. Deep breath in and all out and hold it there for me."

(WOW. got a murmur again.)

(OK> ANG. THINK! So far, heard dunno wat shit murmur at apex....and another one at the neck.)

Other than that, (nothing.)

ERMMMM>>>>>SHIT. No Heart Sound. No nothing. Deaf!

Go on la. Just check the lung bases. (Also cannot hear anything anyway. )

Check the leg....

Then, tershit, tercross eye with examiner newbie, he straight away said, "Do you want to tell me your positive findings?"

I smiled.

And then just nodded.

And didnt say anything. (Still thinking what to say...totally blank..nth came up to my mind)

Just cover the patient up.

And say, "Thanks very much Ms Allen."

Wash my hands.


( say...!)


(argh...farkit lla....)

I said: I would like to end the examination by having a look at the obs, do a urine dipstick, feel for the other pulses, and also an abdominal examination.

Examiner: Ok. thats fine. So what did you find?


and said

"It is a pleasure to examine Ms Allen." and turned to her and smile.

(Seriously dont know why I did that...)

Me: On auscultation, I found first and second heart sound. And, a pansystolic murmur loudest at the apex. and radiates to the axillae.

(ARGH! What the fark am I doing? I still have no idea why I said that....pansystolic? axillae? what? Committed to Mitral regurg?!)

Me: And....I also found another murmur, an ejection systolic murmur loudest at the aortic region and radiates to the carotids.

(WTF! ANG. what are you doing? Aortic Stenosis and Mitral Regurg!!???)

(I still have no idea why I said that....seriously....)

..........and...pause a bit.....

The examiner raised his eyebrow a bit, and

Examiner: which one actually?

Me: Ermmm...

(and pretend to put my hand infront, and intentional tremor to show that I am too nervous...actually I am not that nervous to have tremor la...but just nervous till the level of mental block. DOnt know wat to say. HAHAHAH. seriously. honestly. tak sangka the great Ang will reach this level of nothingness to say)

Me: Well, I found a murmur at the apex, a systolic murmur.....(then look at him....)

Examiner: systolic murmur, what other differential can it be?

(Oh....means is a systolic murmur memang!! Erm...he sort of didnt acknowledge it as a on ejection systolic aortic stenosis la ang....!!)

Me: be honest, I didnt listen to the axillae properly. I would listen to the axillae again. But I definitely heard an ejection systolic, loudly, at the aortic, and it radiates to the carotids. So probably it would be aortic stenosis.....

Examiner: Ok. So are there any other findings to support that diagnosis?

(other findings? OHYA. The slow pulse.....shud be kot...mampus...)

Me: Erm, yup! The pulse was slow................. and rising.

(That pulse was slow,....but wats rising...however, it feels like pushing against ur fingers tho....)

Examiner: Well done. Well done. It is aortic stenosis indeed. So now you have correctly establish her diagnosis,

(again, blank...kenot hear. What did he asked? AH...just say something la)

Me: Oh, I would do Echo to confirm the diagnosis.

Examiner: Nono, I asked what investigations you would not do?

(What I would do? CT? MRI? When in doubt, use your instinct)

Me: Errya.....i would not do...the....(my hand suddenly went to a jogging movement....) the exercise......

Examiner: yes yes yes. Treadmill testing. Good! Lets move on.

Jeng jeng jeng.....

I think I forgot to turn the bell to the diaphragm to start with.

Coz we only listen using bell on apex, and carotids.

Therefore I only heard two things.



"How about the second patient?" Third patient?

History station?

Prescribing station?

So far only tell the first 8-9 mins of my 60 minutes exam....

Am I not a good story teller?

Will my very limited knowledge would be sufficient to go tru this?

Coming soon...

Exam 3.....

Book ur ticket!

1 comment:

quarez said...

"It is a pleasure to examine Ms Allen"...hahaha..power sial..