Short Case Surgery

So, we had our 1st examination of the clinical years today. And, believe me, I will always remember how it went about...

We gathered in the tutorial room at 830am and started the heated discussion. Basically we were to be tested on history taking, physical examination, instruments and chest X-ray (CXR). We totally ignored the CXR as we thought might just be tailored for internal medicine posting.

I waited nervously for my turn as we were called name by name to the wards where the examination was about to be carried out. My chance came around 10am. We expected CXR to be tested as we entered the ward since we took a glimpse of the settings. There were totally no discussions or seminars or whatever lectures on CXR throughout the posting. Obviously, i was just about to be screwed.

Mr A (examiner 1) placed a CXR on the screen... 'you 3rd year right....okayyyyyyyy. tell me what you see' . I stood there dumbfounded. Nothing seemed to be getting out from my mouth. Mouth agape, and staring blankly at the flim, I told myself, you might as well fail me. Lets proceed to the next station. Anyway, I struggled to find words....and here was how it went...

me : this is a CXR , the trachea is not deviated, it is centrally located. The costophrenic angle is diminished on the right side. There is a visible gastric bubble which is a normal finding....bla bla bla
{how Mr A interprets my answer : I do not know anything about the X-ray.I'm just guessing}

Mr A : you are telling me everything everywhere. Please get organised. Start from inside out or outside in. What view is this?

me : okok... this is a PA view of the X-ray. The trachea.....bla bla bla...there is no cardiomegaly since the apex does not cross the midaxillary line ...
{how Mr A interprets my answer : Please fail me , there is no point in wasting your time assessing me }

Mr A : what ?? who taught you this...

me : Errr....my own understanding... *傻笑*

Mr A : Are there any fracture ribs ? Is this normal ? Can you see the border of the heart? What is this (aortic knuckle) ? .....

me : (listening to every word painstakingly. I do not want to fail... T.T) No rib fractures. It is not normal to have a bubble in the thoracic cavity...bla bla bla

Gosh, I slogged through the remaining questions and answered as if I was held at knife point. Indeed, I was !!

2nd station was about instruments. I failed to convince him about the central venous catheter. Luckily, he picked up a urinary catheter and asked me about it. To my relief, he finally seemed more comfortable. I can only say i did well for the urinary catheter.

I was told to wait for the next section, in which i had to take a history. Mr B was my examiner. After some anxious moments, he brought me to the female ward. As we walked there, he told me this horrifying statement : 'Mr A garang ke? ' me : er....sikit. Immediately, the only thing that rushed through my mind was -- I'm doomed

History taking was not pleasant as well. My patient was nauseatic but i still had to take a direct history from her. Mr B was however, quite friendly which indeed eased much burden and anxiety off me ! I started off confidently but the presenting part was...er... pathetic perhaps.

- I did not record anything i asked
- I had < 10 seconds to organise my thoughts

He guided me at first by asking signs of appendicitis. My patient is 36/M/female, presented with L and RLQ pain for 1 week. Thanks to his guide , i guessed correctly the diagnosis of a ruptured appendix, much to my relief...phew...I think I did just enough to pass the history taking but the outcome might be better if I had time to organise my thoughts.

Anyway, the nightmare is over, at least for now before i proceed to O&G. Certainly something I'm not looking forward as a pleasant experience. Ok, time to rewind and chill before another storm hits me with full force =D

yikping
1241am