You Don't Need Luck ... You Need A Miracle .... Part II

This book served me well over the years. Check out the vintage. I bought this before my Finals. Don't ask me when because I'm old!

Thanks so much for indulging me and more importantly, for being patient. I was updating my slides for a tutorial I am giving to Anaesthetics Masters students tomorrow. Took me some time but finally got it out of the way. Let's get down to business.

Long case. You need luck for this one. You need to pray that the solitary case that you are going to have is on a subject matter at least you have a clue on. Luckily when it comes to medical cases, there aren't very many. Let's go through the system. By the way, I am not involved in recruiting any cases, even for my unit. I am just going through these by experience, and in no way indicating they will be asked. It is just merely a checklist for your benefit.

Cardiology - chronic IHD, hypertension, rheumatic heart, mitral stenosis, chronic atrial fibrillation. These should be familiar to you by now. Respiratory - asthma/COPD, bronchiectasis, TB. Gastro - chronic liver disease, viral hepatitis, peptic ulcer disease, inflammatory bowel disease, irritable bowel (if you are unlucky).

We move on to Neurology - Parkinson's, spinocerebellar disorders, facial/Bell's palsy, carpal tunnel, diabetic peripheral neuropathy. Endocrine - thyroid with or without eye disease, hypo or hyper, diabetes (obviously), hypertension (essential or premature eg Conn's, pheochromocytoma), Cushing's, hypopituitary. Rheumatology - rheumatoid arthritis, OA, gout, ankylosing spondylosis, psoriatic arthropathy. Renal - nephrotic syndrome, polycystic kidney. Haematology - thalassemia, CML, myelofibrosis, AIHA. Dermatology - eczema, psoriasis. Did I miss any major subjects?If you think you want to add something, just put it in the comment section below so we can all share it. You can add them anonymously, so don't worry.

MAKE SURE YOU KNOW INSIDE OUT ON DIABETES AND HYPERTENSION. Make sure you present, ask all about the complications and all aspects of target organ damages. So in diabetes, ask about current and previous treatments, complications as in hypo or DKA. Any retinopathy, IHD, nephropathy, neuropathy and peripheral vascular complications. Ask about the cardiac risk factors without fail - the major 5 - BP, DM, high cholesterol, smoking and family history. 

So you have 1 hour to talk to your subject. The first 2 questions should be 1) what medications are you on, 2) when was your last clinic appointment and slyly ask them which clinic. You have the diagnosis in front of you by then and gear your questions towards it but during the systemic review, ask everything. Always ask your patient before you go to the examination part, "is there anything else you would like to tell me before I examine you?". The examiners wold like to hear you discuss about the family history and social background. What is the occupation, how much do they earn, what kind of house they live in. Take a thorough family history. Draw a family tree.

After you finish examining, do the urine dipstick, measure the BMI, measure the BP, measure the PEFR as applicable. There is a reason why the equipments were provided. In diabetics, make sure you open their shoes and check the foot for neuropathy and ulcers! During long case presentation, if a diabetic was still wearing their shoes it means that you have not been thorough. Tolak markah!

You must then formulate your main diagnosis and list of differentials. When you present your management plan, always consider them in terms of pharmacological and non-pharmacological. Diet change, exercise, physiotherapy are just as good as using drugs. This pointers are not exhaustive. Please add anything you think is relevant in the comment section so that we can all share them. We'll talk short case tomorrow hopefully. I will be driving up to Penang after my tutorial. I will be blogging from there. In the meantime, happy slogging and burn them midnight oil! Adios!

You Don't Need Luck ... You Need A Miracle .... Part I

Saw this at MPH

Wow, the exam fever is effervescing in UMMC definitely. I felt the heat today when I offered to take a short case session and was politely declined. Everyone is clearly under stress. The usually calm boys and girls becoming kiasu big time. Everybody tak senang duduk! Received tons of SMS thanking me for what help I have offered but more importantly asking for forgiveness and blessings. Some asking for last minute tips and tricks etc. Rather than tell everyone individually, as a member of web 2.0 movement that I am, I decided to blog it. So, here we go.

There is NO substitute for a good solid base in physiology and pathology for answering the written paper. I am not going to lie to you guys, if you don't know your basics, you don't deserve to pass. Sorry to be blunt! But I am deluded. Nobody knows everything ... Dr Sangkar, my former colleague being the exception.  Written paper trick #1, what you can do at the last minute is to try out pass questions. People who knows the stuff, but doesn't know how to answer the question CAN fail. People who are not sure of their stuff, but knows how to answer USUALLY pass. A bit like the politicians la. Those who don't know their stuff still doesn't deserve to pass. So get hold of pass paper, try to answer them. If you don't have any, get a partner and practice asking and answering questions. But be certain and familiarise yourself with the format of the questions and what expected of the answers. After a while, you will manage to spot what's likely to come out and how to tackle them!

Written paper trick #2, highlight all the subjects you can think of, and then divide them into 3 groups - 1) MUST know, 2) HAVE to know and 3) 'if I got the time'. You will come up with around 60 big topics from all the specialties combined. OK, for the Medicine part, diabetes, asthma/COPD, hypertension and IHD etc should come under MUST know. Thalassemia, Parkinsons, Ca lung, nephrotic syndrome may come under HAVE to know. The others you will try to catch up with after the important ones have been sorted. If you don't know them, you may still pass the exam, but you will suffer from lack of confidence.

Written paper trick #3, make short notes on MUST know subjects. The notes should be on a single page of an A4 sheet. For best effect, you have to write it yourself though. In the panic of the exam, you will be able to remember each and every word on the A4 sheet verbatim if you it well enough. Trust your graphic memory. If you really struggle to do all that, find a group of friends, do it together, exchange notes etc. You don't have to do them in a boring room. Even Starbucks can do! This is the time when you will discover who your real friends are!

We will leave the tips for the long and short cases for later updates.

Have a good rest and eat well. It is easier said than done. I must confess that I learned more in the last five weeks in medical school than the previous 5 years. There are no perfect examination in life, and Final MB is certainly far from flawless. The subject scope of Medicine is huge. Passing this exam is a life-changing event, similar to having your first child. You will be under stress. But smart people will know how to handle it. From my observation, those that study in groups will do better. If it is not because they learn more together, they will certainly handle the pressure together as a clique. They will bounce off each other and pick each other up. There were times before exam that I felt like just giving it up. It was just too much stress. Luckily I have friends who helped me out. I also did my fair share of helping as well. Now they are all Neurosurgeons, cardiothoracic surgeons, Cardiologist, Paediatricians. That's who you all will be one day.

From an examiner's point of view, Final MB is not to be taken lightly. We are deciding the fate of the candidates, an we can't afford to be unfair at the same time. It is often difficult to weed out the good , the not-so-good and the awfully bad. Certainly not during the period of the exam, and worst still in the half an hour or so during the clinicals. The exam will never be fair. However, we also have a duty to the general public. I can't pass somebody that I don't trust to look after my grandmother to roam the ward as a doctor. It is a big responsibility. All I am looking for in the Final MB candidates is that they are safe, trustworthy and reliable! Do not lie to the examiners!

For the majority of you, the best of luck .... but for the few, you don't need luck, you need a miracle to make it through. For the Moslems amongst us, pray to Allah and He WILL answer your prayers. He can bless you in many ways, clear your head to study, have good health during the exam period (that is important), calmness in the exam hall and He may open the examiner's heart to be compassionate. They are all human beings, and Allah is the Almighty. Take advantage of tonight being malam Jumaat and perform Solat Hajat. I'm sure your parents would have done so!