:: sharing knowledge :: all medik-ukm, please read ::

Assalamualaikum / salam sejahtera.

Untuk mukadimah, saya nak cerita sikit tujuan blog persiapbba0611.blogspot.com ini dicipta dan bagaimana ia tercetus.

Idea ini tercetus ketika wardround di HKL dalam posting internal medicine dalam bulan Jun 2010. ketika itu, saya terfikir bahawa tidak semua info dalam teaching dan wardround ada dalam buku teks atau internet. Dan tidak semua yang di dalam buku atau internet adalah praktikal di Malaysia umumnya atau di HKL atau HUKM khususnya. Jadi apa yang kita belajar ketika teaching atau wardround adalah sesuatu yang relevan, penting, praktikal dan common. common is common. exam pun keluar soalan yang common dan yang selalu ditekankan ketika teaching atau wardround. tidak semua pelajar mendapat peluang untuk teaching atau wardround dengan pensyarah yang rajin berkongsi ilmu. dan tidak semua juga yang tahu bagaimana untuk sharing knowledge with others. so di sini blog ini dijadikan medium untuk berkongsi ilmu. apabila ilmu ini dikongsi, sedikit sebanyak ia dapat membantu rakan2 yang akan menghadapi posting berikutnya dan juga membantu junior2, serta membantu diri sendiri untuk persediaan peperiksaan melalui quick revision of common practices. ketika teaching dengan prof norzi semasa study week yang lepas, beliau terkilan kerana merasakan bahawa pelajar tidak berkongsi apa yang mereka belajar dengan orang lain, dan ini membuatkan orang lain terkapai2. beliau meminta sangat2 pelajar untuk share apa yang telah beliau ajarkan kerana adalah mustahil untuk beliau buat small group teaching dengan semua pelajar di ukm. harap anda semua faham apa yang berlaku di sebalik sejarah blog ini.

antara pelajar yang terlibat dalam peringkat awal blog ini ialah saya, loh jia hui dan alvis. kemudian beberapa orang rakan batch saya turut serta menyumbang dalam blog ini. (maaf tak dapat nak namakan sorang2)

sebelum pro exam saya ada berbincang secara tidak formal dengan exco PERSIAP tentang blog ini. saya bercadang untuk jadikan ia medium sharing knowledge especially yang dapat ketika teaching atau wardround kepada semua pelajar medik ukm. kita tak perlu copy paste dari internet atau buku bulat2 mengikut tajuk tetapi kita letakkan apa yang praktikal dan common in the best way.

blog ini bolehlah dianggap sebagai blog persiap dalam tujuan untuk sharing knowledge. (blog persiap.wordpress.com tu pulak blog untuk sampaikan informasi.)

Berikut ialah perancangan untuk blog persiapbba0611.blogspot.com

1. Menukar alamat blog kepada alamat yang lebih universal. (optional)
2. Merekrut wakil2 tahun 1-5 yang berminat untuk perbincangan lebih mendalam.
3. Menjemput pelajar2 tahun 1-5 melalui wakil2 tahun untuk menyumbang dalam blog. Setiap pelajar boleh menyumbang menggunakan emel masing2 (melalui jemputan co-author)
4. Menyusun kembali label dan page dalam blog. cadangan saya ialah bahagikan kepada 3 bahagian utama iaitu pre-clinical, clinical dan graduates. untuk preclinical, akan dibuat division mengikut modul (CVS, Respi dan lain2) atau mengikut subjek (anatomi, farmakologi, pathology dan lain2). Untuk clinical, akan subdivision mengikut posting (tak perlu bahagi ikut tahun 3,4 atau 5 sebab apa yang dipelajari mengikut posting adalah sama saja antara tahun). Untuk graduates, ia adalah ruangan untuk MD UKM yang dah graduates (including my batch) untuk berkongsi info alam pekerjaan. namun begitu, tidak semestinya pelajar clinical hanya boleh menyumbang dalam ruangan clinical, mereka juga boleh menyumbang dalam ruangan preclinical. pembahagian ini hanyalah untuk memudahkan pelajar mencari maklumat yang diingini.
5. Mewujudkan ruangan history (supaya pembaca tahu susur galur blog ini) dan juga download (untuk meletakkan apa2 yang perlu didownload).
6. Meletakkan ruangan bloglist untuk senaraikan blog2 pelajar medik ukm mengikut batch.
7. dan lain2 cadangan bernas....

ini hanyalah peringkat perancangan saya. sekiranya ada cadangan atau komen, sila comment. saya amat berharap idea untuk mewujudkan blog yang lebih universal ini tercapai.

terima kasih.

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Peperiksaan Ikhtisas Akhir MD UKM Batch 2006/2011

Wish all of us all the best!
MD UKM 2011


14 March 2011 (Monday)
Unmanned OSCE
20 stations

15 March 2011 (Tuesday)
Key Features Questions 1
10 Questions

16 March 2011 (Wednesday)
Key Features Questions 2
10 Questions

17 March 2011 (Thursday)
One Best Answer & Extended Matching Item 1
60 Questions

18 March 2011 (Friday)
One Best Answer % Extended Matching Item 2
60 Questions

21 - 25 March 2011 (Monday - Friday)
morning : 1 long case
afternoon : 4 short cases

30 March 2011 (Wednesday)
Results!

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Manned OSCE - Suicide Risk Assessment

Score >7 = high suicide risk

updated from here

--------------------
MANNED OSCE
--------------------

1. Have you attempted suicide?
# A : No --> low risk
# B : Yes --> higher risk

2. Have you thought about dead?

3. Have you thought about suicidal (suicidal ideation)?
# No : lower risk
# Yes : higher risk

4. If yes to questions (3) :
# what kind of thought?
# method? (> serious/dangerous method, > higher risk)
# how often you thought of it?
# any specific plan?
# have you told others about the plan?
# have you actually ever attempted? (to reconfirm back with patient)
# what stop you from attempt suicide? (protective factors)
# have you make any suicidal note?
# have you make the will?
# conditions
***if patient method is to drink paraquat, have he bought the paraquat?
***if patient want to jump from high places, ask him whether he live in terrace, condo, apartment

5. ask this to patient who had attempt suicide previously (additional)
# what is the method? evaluate how dangerous is the method
# what is the chance of dying? (lock door, nobody at home, alone, etc...)
# what is the chance of rescue? (anybody at home? has tell others? etc..)
# intention of attempt? (very high? not really want to attempt?)
# what is his/her feeling after being rescued? (relief? angry to the rescuer? etc..)

6. ask to all (other factors)
# psychotic illness?
# severe depression
# alcoholism / substance abuse
# physical illness
# severe stressor
# no support
# live alone
# others.......

In the exam, evaluate this patient suicide risk subjectively based on the answers you get from the patients.
No need to use scale or score in the manned osce.
Use logical thinking. ^_^

Teaching from Prof Maniam.
A115262.

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Unsure of date

Shortcase O&G

Examiner :
You may ask her one question. What would you ask?

Student :
Last Menstrual Period (LMP)
* any women patient especially with O&G examiner, the most important question is LMP.

Patient :
Unsure of date of LMP

Examiner :
So the patient is unsure of her dates. You may further ask her 4 questions now.

Answer :
1. OCP use which produce anovulatory cycle.
2. Breastfeeding --> hyperprolactinemia --> inhibit FSH/LH --> Anovulatory
3. If IVF was done --> when is the embryo being transfered?
4. Date of quickening
5. Regularity of menses
6. Any early ultrasound scan result
* the 1st 4 questions are more important

Examiner :
You may proceed with the abdominal examination (examine in usual manner as obstetric examination)

this is our mock shortcase O&G with prof a**** last week.
A115262

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SHORTCASE : STOMA EXAMINATION

THIS IS MOCK SHORTCASE ONLINE.
please try to answer orally in front of your screen. timing yourself.
when you are done, look for the suggested answer below.

Inspect the patient's abdomen.
Do running commentary.

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Counselling: Trial of Scar

1. Introduce yourself
   
2. Confirm the patient's name and problem
   
3. Inform the patient that it is good to have her husband together during the discussion
   
4. Ask patient whether she knows about her condition, any preference in her option
   
5. Inform the patient of the options that she has:
   
   • vaginal delivery --> Trial of Scar 
   • LSCS
     
6. Tell patient that we need to assess the patient condition first whether the condition is favourable for:
   • any short stature -->CPD 
   • pelvic cavity size 
   • exclude placenta previa 
   • exclude other contraindication
     
7. Explain that there is risk in every procedure
   • risk of scar dehiscence 0.5% (if use oxytocin 0.8%, if use prostaglandin 2.45%)--> Therefore need to deliver in tertiary hospital where OT ,NICU and blood bank available
   •  we will monitor her closely (baby and vital sign to see sign of uterine rupture ie tachycardia, hypotension, vaginal bleeding, sudden loss of contraction, scar tenderness, continuous abdominal pain in between uterine contraction) 
   • can give option to patient for epidural 
   • however there is still risk of failed TOS --> need to proceed to LSCS
     
     
8. Explain pro and con TOS
   • fast recovery 
   • but we don’t know exact time for delivery, need to see progress of labour
     
9. Explained another option (LSCS), also explained pro and con
   • risk of adhesion lead to difficult surgery 
   • risk of injury to bowel and bladder 
   • risk of bleeding and blood transfusion 
   • the advantage is operation is done in planned environment 
   • explain that 2nd LSCS will limit family size 
   • if want to do BTL, can do together 
   • explained that the next pregnancy should be manage by LSCS
     
10. Give opportunity to patient to ask any further questions
    
11. Ask patient preference whether have decided or not
    
12. If can’t answer question from patient, get an appointment to refer patient to senior colleague or consultant for better picture
    
13. Provide patient pamphlet for any further information

Source: Teaching with dr nasir (this is one of osce question for pro exam last year,2010)

Hanisah A115275

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Counsel for blood transfusion

1. Introduction

-To patient and verify patients identity

-Include husband if husband is around

1. Ensure privacy

2. Explain current condition and indication

-Pre-existing anaemia

-Primary PPH

-Post-partum Hb 6g/dL

-She got symptomatic anaemia

3. Explain procedure

- Cross match blood

- Infection screening of blood product : HIV, HepB, HepC

- Transfuse 2 pints of pack cells

- Duration 6 hours/pint

- Diuretic in between to prevent fluid overload

- Repeat FBC after transfusion

4. Explain complication

- acute transfusion reaction

-blood-borne disease : HIV, HepB, HepC

- ABO incompatibility

-volume overload

- need for further transfuse if Hb level not satisfy

5. If patient refuse???

- ask the reason why?

-re-explain and convince the patient

- explain the complication of anaemia : heart failure

- if patient still refuse --> refer to other doctor / specialist

source: workshop

hanisah A115275

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