May 10, 2012

Post orals rant

Kind of debating with myself whether or not to make my usual post exam rant. But heck it, this might be useful some day innit?

First thing in the morning we had session with patient. I was really nervous but the moment I entered the room and saw a very pleasant smile from the patient, it kinda calmed me down. Tried to hide my nervousness and went on and do the history and examination. The patient even made a remark "you look very calm" so I had to admit to her that I my heart feels like exploding already actually.

History and examination went on fine. I think I got the necessary things. And then the time's up, so the examiners came into the room. I got Prof S and Dr OS as my examiners and Dr B as the observer.

My brain started to be the scumbag as it always is and I got really really nervous. First mistake was addressing Prof S as Prof rather than Professor. That's kinda a no-no for him.

I presented my case to Dr OS. Patient with history of dry mouth. On pilocarpine, Bioxtra and Duraphat. She has a risk of developing primary biliary cirrhosis (or she has it already i'm not sure) so she had to do a liver function test every 6 months. Used to be really severe but now that she is being treated, it got under control. Tongue was heavily fissured as well. I think the presentation went on Ok-ish. Alhamdulillah my words came out OK eventhough there were loads of Ummm's in between my sentences. That's just like a habit I guess? She asked me a few questions like side effects of pilocarpine, cause of her xerostomia, Sjogren syndrome, some autoimmune diseases.

And then came the questions session with Prof S. I was asked about other causes of Xerostomia. The tests that I would do  - salivary flow rate test, biopsy of gland and what will I be expected to see histologically, full blood count for autoantibody screen Rheumatoid factor, anti SSA SSB, sialogram and how to conduct a sialogram which made me stutter because I don't quite know the exact procedure and etc. Other question why she need to be reviewed. Talked about possibility of infection and lymphomatous change. How to differentiate between parotid swelling caused by lymphoma and infection. How to do biopsy on parotid gland. How to treat infection anddd the time was up before he could drill me more. So that's about it.

The afternoon session we had another oral session without a patient. I was really really really nervous because I'll be having an external examiner as one of my examiner. The thought of having a person that I'm so unfamiliar with really made my mind wrecked and some of my classmates had quite a hard time with him. I used to "attach" with all other examiners so being around them felt much better. I was restless. So nervous.

Stepped into the room. Was shown a picture of generalised gingival swelling, had to come out with differential diagnosis. I came out with leukemic infiltration and Dr McC went on about leukemia - what is it, how to diagnose, how to manage. Then she gave me Equitamp - an absorbable cellulose used for post extraction haermorrhage, and we went on about bleeding problem, liver disease, splenomegaly, platelet diorder anddd coagulation cascade..which thank God I revised last weekend in our study group.  7 minutes up and it was the external's turn to question me.

"What do you know about the term Sialolithiasis"

Effed. I know this term. It's just that the brain was so overwhelmed with nervousness that I couldn't think well so I went on and answered...

"Urmm...I know Sialo had to do something with salivary gland..but I'm not quite sure about lithiasis..."

So he helped me out and came with the layman's term - salivary gland calculus. Talked about the gland involved which I messed up between sublingual and submandibular...ended up him giving me a 60 seconds anatomy lesson. Talked about type of secretion, how to diagnose, how to treat. How to do biopsy...againnnnnnnn sialogram which I messed up in the morning session, was asked! Stuttered a lot with him. He wanted me to come out with infection and antibiotic treatment but I was so dumb it took me a while and the time was up before he could ask me about the treatment. With him, I can feel that my face was reddening, felt so warm and I kinda feel like vomiting.Time flew and it finally ended.

Stepped out of the room, I must look really wrecked but convinced my classmates who were waiting outside that they'll be fine. I don't want to make them terrified but I knew my facial expression can't lie. I looked like I was just being tortured. Later that day I even got text from my classmate checking me out to see if I'm okay because I looked really bad after the oral.

I tried to remain calm and not to dwell too much on the orals. Tawakkal je yang mampu sekarang. Met Dr B, the observer of my morning session and he said I did really really well. That must be just him being nice to everyone but if I really did, I hope that could help me to pass this exam.

The orals were deliberated yesterday. None of us were in the borderlines pass/fail so this just means that if there's anyone that failed, they are nowhere near 48 or 49% No mercy on us only the borderlines got called.

Ya Allah please ease my way towards graduating.

4 more orals to go!

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