Final Professional Clinical Examination

My long case exam (Mr Shukrimi, Dr Husin Imam, Prof Zalina, Dr Ramli, Prof How):

A case of 13-year-old Malay boy from Pekan, in his day 42 admission; presented with painful and erythematous swelling at the distal third of right leg for 4 days prior to admission which later progressively spread to the proximal third of the same knee and the patient was unable to mobilize. It was associated with high grade fever without UTI or URTI symptoms. There were constitutional symptoms and the patient were brought to hospital due to shortness of breath.

Debridements were done twice on him due to unsettling infection. He was treated with IV cloxacillin 1g QID.

He has no history of trauma, insect bite, diabetes mellitus type 1 or other chronic diseases.

On examination, there was wasting of the right quadriceps muscle and the right leg looked swollen. There were multiple clean incisional wounds over the medial part of the right leg. There was no bony tenderness or bone discontinuity noted. The power was 5/5 with intact sensation. The peripheral pulses were present.

DDx : osteomyelitis, osteosarcoma, DVT with pulmonary embolism

The discussion were mainly about the investigation and management of osteomyelitis.

- FBC, RP, se albumin, RBS, ESR, Blood C&S
- CXR, XR of right leg including the knee and ankle joint in AP and lateral view

- debridement
- IV antiobiotic
- prevention of fracture : splint, crutches

Alhamdulillah~

My short cases examination (Prof Hamizah, Prof Kyaw, Dr Marzuki, Dr Aye Aye, an external):

1. CVS (Paediatrics)

A young Malay boy with mitral regurgitation and not in failure. No other discussion~

Alhamdullilah.

2. OnG (Uterus larger than date)

A young Malay lady, G3PO+2 at her 34 weeks POA with uterus larger than of 48cm SFH and difficulty if palpate the fetal part and positive fluid thrill.

We discussed about MOGTT, ultrasound findings in polyhydromios and expected fetal anomalies in GDM mothers.

Alhamdulillah.

3. Respiratory examination (Medical)

An elderly and obese Malay lady with grade 1 clubbing and reduction on chest expansion as well as coarse crepitation at the left lung field.

Causes of bronchiectasis : recurrent pneumonia, pulmonary tuberculosis, pertussis

Alhamdulillah

=))

Thank you examiners for your trust to me. Most importantly, I have to work hard to strengthen my knowledge and skills.

25200 Kuantan

Be Calm

Today, the Final Professional Exam result will be released in the afternoon.

So, now I'm still in palpitation and tawakal mode.

The key of this exam especially the clinical exam is to be calm and get ourselves relax on the day of examination.

I really meant it.

Take a deep breath before the exam and relax. Smile. Smile. Smile =)

Be prepared to face any case.

Clerk the case as our usual routine during posting and end-block exam. I did not really feel the difference while clerking the case. The difference was only felt when I presented the case to 5 examiners.

The examiners were so different than during the end-block exam (provided we presented the case satisfactorily).

They were trying their best to help and guide us to the right way.

If they said something that contradict with our statement, they were usually right and they just wanted us to say it so and be agreed with it. A lot of hints and guidance throughout the presentation. Thank you Allah for this nikmat.

I was so touched when the my examiner in short cases, Prof Hamizah offered herself to prop up the bed for me for respiratory and cardiovascular examination. Thank you very much Prof. ;) I learned another lesson; be humble in any situation even to your own student!

I thank Allah for giving me such a kind examiners.

Thank you Prof and Dr, for not making my way difficult and always said to me throughout the exam to just be calm and relax. Thank you very much. It is only Allah can give the best reward to all of you.

I am waiting patiently for the result and I'm hoping for a good news =) Insya Allah.

25200 Kuantan

Note : My examiners were Mr. Shukrimi, Dr Hussin Imam, Prof Zalina, Dr Ramli and Prof How (long case), Dr Marzuki, Dr Aye Aye, Prof Hamizah, Prof Kyaw and an external examiner (short case).

My Final Posting Examination

I just discovered Pediatric is interesting after I left the ward after examination yesterday.

Pediatric was once down in the list of my interested topics =p

Whatever it is, I'm done with examination. Thanks to Allah for everything.

For my long case, I got a very typical and common case; a 5-month-old Malay girl in her 35th day of admission (with 1 month stay in PICU) who presented with mild grade fever, shortness of breath and cyanosis for 1 day prior to admission. No history of cough, foreign bodies ingestion and congenital heart disease. No history of intubation or assissted ventilation during admission to PICU. The mother had history of GDM during the pregnancy with controlled blood sugar level and she was born full term via emergency LSCS due to poor progress and fetal distress. On examination, the OFC was between 55th and 95th centile but the weight and length was below 3rd centile. She was active, not in respiratory distress with occasional rhonchi heard in all the lung fields. Other system examinations were unremarkable.

For my short case, I also got a typical case of spastic quadriplegic cerebral palsy in which I was asked to perfom motor system examination. A 5-year-old malay boy with microcephaly and nasogastric tube in situ was lying comfortable with abnormal posture; extension of both wrist and fisting of both hands as well as slight extension of the hip and dorsiflexion of the feet. The patient had muscle atrophy (most probably disuse atrophy) with hypertonia and hyperreflexia. However, there was no clonus and there was downgoing toes upon plantar reflexes stimulation (huhu..it should be present to indicate that there was an UMNL, but when the examiner reconfirmed it, the finding was the same as mine). There was no scissoring, but there was loss of head control and presence of trunchal hypotonia.

Alhamdulillah, everything went well.

Now, I'm looking forward for my Final Professional Examination.

25200 Kuantan