OSCE VIDEO 1 (epr malaysia)

This is a sample video which can be helpful for you to imagine how it is like during the exam.

Just for your reference, 

and

credits to the students, doctors and the volunteer from IMU. 

Thank you for making this video. 

Question in the video

**P/s: this is exactly what happens to my OSCE exam when I took EPR OSCE on 2019. Although the venue is different (in USM), the way they conduct the exam is the same.

There will always be a doctor in each room to evaluate your performance and ask you questions after you finish the task.

Make sure you organise your time well. For sample questions you can refer to my other posts here.



Good luck!

Will EPR exam be postponed?

To all readers,

I am sure a lot of you are wondering if Examination of Provisional Registration (EPR) will be postponed this year.
Let me tell you the trend, usually the first batch who took step 1 on March will have their OSCE on July while the 2nd batch is on September and December for step 1 and step 2 respectively. 

It is almost the end of May 2020 now, and there is still no news of the examination date for EPR OSCE. So, there is a high possibility that it could be delayed. Furthermore, with the PKPB - pergerakan rentas negeri restrictions, I don't think students will be able to cross state borders to take the exam if they wanted to host it by July this year.

News about PKPB

Reference: https://umno-online.my/2020/05/16/jangan-rentas-negeri-patuh-sop-pkpb/

https://www.hmetro.com.my/mutakhir/2020/05/580354/jangan-ambil-kesempatan-rentas-negeri-polis

I suspect they could delay the exam and host it around the end of the year (December) or next year on 2021. Just a wild guess since SPM is delayed to the first quarter of year 2021 (news on April 15th).
In the end it is still best for you to ask the person in charge from the MMC office. 

• For any queries kindly contact Ms Fatim Nasuha Badaruddin at fatim.mmc@gmail.com

https://www.thestar.com.my/news/nation/2020/04/15/pt3-upsr-cancelled-spm-stpm-3rd-semester-exam-pushed-to-q1-2021

Since there would not be any OSCE exam soon in the next few months, the hope of having the EPR Step 1 for batch 2 graduates are very slim. 
So there is no confirmation if there will be another theory session this year EITHER.

However all this are subjected to change based on how the Covid-19 situation goes.


What we can do now is pray to God that everything can goes smoothly under this new normal, 
and grab this opportunity to study more and be prepared when the time comes. 

(Those who are not prepared should start preparing soon.😁) 


Stay Safe and Stay home!

CTG report basics

Cardiotopography (CTG) reporting - basics

CTG: to record fetal heart rate during contractions
When reviewing the CTG trace, assess and document contractions and all 4 features of fetal heart rate: baseline rate; baseline variability; presence or absence of decelerations (and concerning characteristics of variable decelerations* if present); presence of accelerations.

1. check baseline rate

• normal rate: 110bpm to 160bpm
• continue usual care as the risk of fetal acidosis is low

2. Baseline Variability

• normal: 5bpm - 10bpm
• increased: >25bpm

3. Acceleration

• to be cautious and take necessary actions when
• >15bpm
• >15s
• The presence of fetal heart rate accelerations (if it is constant with contraction and within range), even with reduced baseline variability, is generally a sign that the baby is healthy.

4. Deceleration

• to be cautious and take actions when 
• >15bpm
• >15s-40s
• uniform and repetitive
• If it occurs with contraction < 20s, it is called early deceleration
• need constant monitor and stand by for Mx

5. To monitor frequency of contraction

• is it present or absent?

Notes:

1. If CTG is normal, can reexamine again in 7 days time. it varies and depends on situation 

2. If it is difficult to categorise or interpret a CTG trace, obtain a review by a senior midwife or a senior obstetrician

Tips:

1. Document the condition of the woman and unborn baby (including cardiotocography [CTG] findings)systematically every hour, or more frequently if needed. 

2. CTG findings alone could not determine what is the next action that is needed for the mother.

3. Take into account the mother's condition, any antenatal and intrapartum risk factors, the current wellbeing of her and unborn baby and the progress of labour. 

4. Ensure that the focus of care remains on the woman rather than the CTG trace.

5. Remain with the woman in order to continue providing one-to-one support.

6. Talk to the woman and her birth companion(s) about what is happening and take her preferences into account.

More explanation on the different types of situation click here.

References:
1. https://www.nice.org.uk/guidance/cg190/resources/interpretation-of-cardiotocograph-traces-pdf-248732173
2. Video: https://www.youtube.com/watch?v=N9hNCjaL_dE 

Depression and suicide risk

This post mainly focus on how medical students should do when they are asking for the patient's history, especially those suspected with depression. 

It is important to know if the depression that they are facing will lead to serious issues like harming themselves. 

In normal hospital setting, you can see that it is quite often that physicians tie this two together, so we can access their situation in one session. 

Try not to ask their history multiple times as it could affect the way they answer the question. 

History taking always starts with 

Remember to always be caring and a helpful listener.

1. Introduction

• Name, age, occupation, marital status

2. Ask for chief complain.

• complain + duration
• Depression duration: >2 weeks >1 symptoms

3. Present History 

• ask symptoms that could help you differentiate depression from other diagnosis
• they are helpful to differentiate the other diseases related. 
• you can refer to the notes in this link 

4. How to diagnose depression?

•  Remember : SIG CAPES
• If they have >1 symptoms 
• Check if they have
• Sadness
• Insomnia
• Guilty feeling
• Observe 
• Concentration
• Agitation
• Psycho-motor system
• Energy
• Suicidal idea
• Check if there are any manic involve. it is important to use it to differentiate between bipolar or depression
• Depression : 
• no manic
• not under medication or drug usage (cannabis)

5. Check for their suicidal risk

• Any signs of them trying to harm themselves? if yes check the below

• Suicide assessment (5 points)

	Details	For example:
Ideation	Idea of trying to harm themselves	e.g. to jump off the plane,  etc.
Plan	Any realistic plan to harm themselves?	Booked a flight ticket
Means	Do you have the materials?	Already have a knife at home.
Intent	Do you intent to, when?	By next month
History	Past history	Prior suicide attempts, abort attempts, self-harm

• SAD PERSONS scale is needed to further evaluate their risk.
• Then you should check with the SAD PERSONS scale to figure out their score if they need further treatment or not.
• score  >7 : 
• Admit them immediately and get consent from them or their family members 
• Bio-psycho social therapy : relaxation technique, CBT, systemic desensitizing, BZD, SSRI, 
• Family support

Overall Management

Reference: http://www.smj.org.sg/article/managing-depression-primary-care

Major Depressive Disorder (MDD) Management

Reference: https://www.researchgate.net/figure/Treatment-algorithm-for-MDD_fig1_283155381

Reference: 

1. https://www.porticonetwork.ca/documents/366159/1073220/Suicide+Assessment+Five-Step+Evaluation+and+Triage+%28SAFE-T%29%20Booklet/00b209ca-3078-45db-a175-6983c6962166

2. https://www.healthline.com/health/suicidal-ideation

Pocket notes - Post Traumatic Stress Disorder & OCD

Post Traumatic Stress Disorder (PTSD)

&

Obsessive Compulsive Disorder (OCD)

Another list of mnemonics I found useful 

Pocket notes - Psychiatry and related diseases

This post is mainly explaining the differences between 

Dementia

Bipolar disorder

Schizophrenia

Depression

& also

some things to take note of when we are asking for patient's history.

I remember them through mnemonics, hope you find it useful too!

Chronic Obstructive Pulmonary Disease (COPD)

Pocket notes Series:

COPD : Chronic Obstructive Pulmonary Disease

 

COPD Assessment

COPD: chronic obstructive pulmonary disease; 

GOLD: Global Initiative for Chronic Obstructive Lung Disease; 

mMRC: modified Medical Research Council dyspnea scale; 

CAT: COPD Assessment Test; 

FEV1: forced expiratory volume in one second; 

FVC: forced vital capacity.

Reference:

1. https://www.ncbi.nlm.nih.gov/pubmed/30286833

2. https://goldcopd.org/

3. https://goldcopd.org/gold-reports/
4. UptoDate 

Sample Answer - Station 4

Station 4

Question: 

Answer:

Sample Answer - S2&3

Station 2 

Question: 

Answer: 

Station 3 

Question: 

Answer 

Return to previous post

Sample answer- Station 1

Station 1

Question:

Answer: 

Return to previous post

EPR OSCE sample - I

In this post I would like to share some examples of how the OSCE will be asked during Examination for Provisional Registration (EPR) part II.

Start practicing with your friends and think how will you manage your time to answer the question within 10 minutes.

Station 1

Answers - S1

Station 2

Station 3

Answers to S2 & S3

Station 4


Answers-S4

Their respective answer can be found after you finish reading the questions.

It can be quite difficult to try practicing this by yourself as you have no real patient, so it would be good if you can find friends who could play the role as the patient and the examiner.

This is for your reference only, to help you get prepared for the exam. 

References: IMU OSCE 2008 

Orthopedic OSCE notes

 My Pocket Notes: Orthopedics OSCE

I always have this pocket notes in handy so I can study them without bringing the books along. They are useful when I need a quick glance and remember them quickly.
Especially the day before exam when we need to read a lot of information,
could not afford to waste any of those precious time for revision!

If you do not understand what I wrote about in the notes, you probably need to reflect and start studying the real books instead !

Community Medicine - Pre-pregnancy care

Some of my friends asked what is included in this section during my exam, so i decided to share with the others what I know about it. 

Community Medicine is concerned with the prevention of disease, the determinants and natural history of disease in populations, and the influence of the environment and of society on health and disease.

and one of the most common problems in community medicine is 

Pre-Pregnancy Care. 

1. Access risk

• age : <18 or >35
• lifestyle: smoking, drinking, substance abuse, etc.
• Sexual history
• BMI: obese? lack nutrition?
• Pets : cats or birds
• Past history : hypertension, DM, infectious disease(hepatitis, HIV)

Specifically for woman with history of 

- Diabetes
- Seizure
- Hypertension
- Heart disease

you will need to counsel them about the risk for their child and to themselves if they are going to get pregnant with the disease they have. Table below will help you to get an idea what you should counsel them. Each of the patient are different, and it is important that you are able to convey the message clearly.

2. Scenario

If a lady is just here to ask your(GP) opinion about the pregnancy plan you will need to ...

1. General screening
  -  History taking: past history, medications, surgical history, family history and related OBGYn history
  - physical examination
  - access the risks
2. Lab test: Blood tests - blood glucose,etc.
3. Access knowledge about health, pregnancy and child care
4. Referral if there are any abnormalities with the blood test

3. Counsel content:

1. about birth and pregnancy

• folic acid 3 months before pregnancy, stop anti epileptic meds
• breast feed knowledge
• child birth preparation

2. lifestyle changes

• diet : control/refrain from smoking, alcohol, substance abuse, caffeine use
• social life: extreme activities

3. Genetic factor: anyone from the household has genetic disease ?

4. Family planning : COCP

5. Screening: pap smear, STI, DM, Hypertension

Try to calm the lady to reduce their anxiety (if there are any complications that could effect the pregnancy). Always ask if they are comfortable to proceed with the consultation or they need their family to be with them.

6. Are they fit to get pregnant? Do they need constant follow up? 

Set up a follow up date if they really need one. 

Remember to always be caring and be patient with your patients. 😀

Reference:
1. https://www.ncbi.nlm.nih.gov/pubmed/6585101

2. http://www.myhealth.gov.my/en/pre-pregnancy-care-ppc/