Friday, June 10, 2011

End of Pediatric round examination :)

6th  June 2011 

End of pediatric’s round examination. Alhamdulillah, HE gave me the ability to sit for the examination. 

My first students..Pediatric recall my memory with them :)

4th June 2011.

Our examination was started by IMCI (Intergrated Management of Chilhood Illness) which contribute 10 marks  in the exam.Of course,all of us aiming for the 10 marks.Night before exam, I revise the scheme with Chaq(my housemate). We tried to solve the cases that we got from PERUBATAN e-learning based on IMCI. Quite tough for the first cases but later on we found it quite easy. For juniors (Zagazigian especially) IMCI is the easiest part in this examination like biochem practical examination because we’re allowed to refer the IMCI book during examination.

BUT, it requires your best  concentration on each symptoms & signs that are stated in the cases given. If you’re misinterprate,for the first clinical picture given,probably the consequence answers will be mistake. 45 minutes are given to fulfill the IMCI scheme based on the cases given.  Speed up the impulse to accelerate your action. 

Some of the data in the IMCI scheme form are in Arabic word. Sometimes I regret not learn Arabic well.  On the way home, I was quite frustrated towards my performance in the exam. Honestly, I can’t finish it within 45 minutes.huu..Some of previous examination,when I was unable to fullfil the answer within the time given, I told my father about that.But he said to me, 

“You will be a doctor.So you must think & act faster because your patient’s condition isn’t waiting for you”.

Thanks for the words abah. Recently,my doctor (Dr. Arafah,Internal Medicine’s doctor) train my friends & me to answer his examination within the time given. 5 to 7 MCQ with 2 written questions must be answered within 10-15 minutes. He said that, in RMCP examination,60 MCQ questions with narrow correct  answers margin,you must answer them within 60 minutes & choose the most accurate answer.

Time is ticking...From now, we must train ourselves to think & work faster for the sake of our medical practice soon..~ ~
5th June 2011

The day for MCQ,X-ray & Pictures examination with 55 marks as their total score. Alhamdulillah, although not all my answers are true,but I’m grateful because I got the satisfaction in answering the questions. I must learn from the mistakes because examination isn’t the end of medicine, and I also hope that all Pediatric lesson will stay in my mind for my practice later.

6th June 2011

The day for practical examination (15 marks). The patient will be the question for us. The boys were sent to nutritional section meanwhile the girls would be examined in hematological department.

I was the last candidate to be asked by the doctor. My patient was a boy, age between 10 to 12 years old. The doctor told me that I attend to his class, so his expect me that I can answer his question baed on his lecture.oops, I knew the doctor, but my memory lost about which topic that he taught us. ~~

He asked me to do general examination on the patient. I start to organize the answer in my mind & my hand start to touch the patient.

“ First, we’ll look for his appearance, the patient is conscious & cooperative. Then patient’s body built is average. We’ll look for three colours in this patient. First, for jaundice, I’ll examine his sclera & oral cavity to see the palate. No jaundice in this patient”.

During examining his sclera, there was red spot in his sclera. “What is this? “ the doctor asked me. I try to answer but the doctor’s voice superimposed my voice. He told me that it was subconjuntival hemorrhage. Then I continue to check for any signs of pallor. I look into his conjunctiva & inner aspect of lower lip & nail bed, & when I compared his palm with my palm in front of the doctor, suddenly I noticed that my palm is more pallor than the patient. “ Haha, your palm is more pallor than him”, the doctor said to me.Pallor’s sign for the patient is negative but for me is positive..

The third colour is cyanosis. I examined his tongoue, nail bed,ear lobule & skin of his hand for detection of  bluish colouration in those sites. If the bluish colouration involve tongoue, it indicates central cyanosis.
After colour, I search for any special decubitus & facies of the patient. “No special decubitus & special facial character in this patient”, I told the doctor.

The doctor asked me, to do head to toe examination.

I started from his hair & face. After comment on them, the doctor asked me to do Lymph nodes examination.

I  started to palpate the horizontal lymph nodes group which are submental,submandibular,jugulo-digastric,pre-auricular,post-auricular & oocipital. “No enlargement of the LNs”. Then I continued for vertical group of cervical LNs. I palpate along the sternomastoid muscle from anterior & posterior. The doctor said to me, we must ask the patient to tilt his head toward the site of our palpation & after that you can palpate it. “No LNs enlargement of vertical group of cervical LNs”.

Then, I continued to examined the epitrochlear & axillary LNs. When I wanted to continue to palpate for inguinal & popliteal LNs, the doctor said that I forget to palpate the most important LNs whis supraclavicular LNs. Thank you doctor for remind me J    

During examining the supraclavicular LNs,the doctor also taught me that I must asked the patient to raise his shoulder before palpate it. After that,the doctor asked me about the drainage system of Right & Left Supraclavicular LNs & diagnostic finding in each site if there’s enlargement.

“ Left supraclavicular LNs takes its supply from lymph vessel of abdominal cavity & its enlargement indicate the presence of cancer in abdomen. The right side takes its supply from lymph vessel of the chest & its enlargement is an indicative for the presence of inflammation or cancer in the chest”, I answered his question.

“Now, I want you to examine the rash on patient’s forearm”.

I examined the rash to confirm whether the rash is purpura or caused by flea bite. 

“ The rash isn’t blanch on pressure, not elevated, non pruritic & the rash also presence in unexposed area. The rash fulfilled the criteria of purpura”, I told him.

He taught me again that some rash can be elevated in vasculitis cases.Thank you doctor for the information.

The last question he asked me,what are the causes of purpura?

“ Purpura can occur due to defective in platelet’s function (thromboasthenia) or due to decrease in palelets’ number (thrombocytopenia)”.

“ You answered like what I teach you in the lecture. You can go now”.

“Thank you doctor”.Alhamdulillah. I hope that this clinical round will remain in my memory to be practiced soon.

Alhamdulillah, I’m quite sad for the first day of examination. When I see the spiritual statement in the FB wall of the 3rd year after having their paper one pharmacology paper, I regain my spiritual again. Thank you very much.

Super senior :)

My father always remind me that, the success I get today isn’t depend only on my effort but the people around me. They also contribute for your success. Thank you for being around me.InsyaAllah,may we get  success  fiddunia wal akhirah.   

my family :)

Duratul'ain Bt Mohamad Nazri
5th year Medical Student
Faculty Of Medicine,Zagazig University
10th June 2011, 3.30pm

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