Showing posts with label past year questions. Show all posts
Showing posts with label past year questions. Show all posts

Saturday, June 6, 2020

Consent for Bone Marrow Aspiration - Peds


Pediatrics Consultation Session

1: Ask for a chaperone

2: Talk to the parents/ guardian who bring the children
    - Ask if they know about bone marrow aspiration
    - what are their concern
    - will they need another person to sit in and listen

3. Describe reasons for having a bone marrow aspiration
    - to confirm diagnosis
    - to check iff there are any blast cell
    - after retrieving the samples, it will be sent for culture, biochemical test... ...

4. The way procedure was done
    - Sedation for kids? 
    - local anesthesia?
    - are parents allowed to be in the room
    - any media distraction for the child while procedure is ongoing

      


5.  Time and Cost
    - how long is the procedure
    - the cost, and ask if parents are able to pay for the procedure
    - recovery time after procedure 

6. Any complication?
    - possibilities of infection if not deal with care
    - child need to be put in a position that can be uncomfortable.
    - try to reassure the mother/father about the success rate of bone marrow aspiration
            - that it is safe
            - eg. cases like this are common

7. Ask if they have any questions
    - be patient and confident in what you say (make sure it is right)
    - try to comfort the parents
    - no big medical term.
    - always ask if they understand what you say


8. Ask for consent and permission
    - Do you agree?......


This template can be useful for lumbar puncture for children after a few minor changes.
TQ and good luck!

 

Wednesday, May 13, 2020

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. 
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





Major Depressive Disorder (MDD) Management




Reference: 

Friday, May 8, 2020

Sample Answer - S2&3



Station 2 

Question: 

Answer: 




Station 3 

Question: 


Answer 


Return to previous post

Friday, April 24, 2020

Test yourself - Pelvic Bones

Test yourself  - All about pelvic bonesss

You think you know it all? Try these and prove it !

Q1. Name the pelvic lines 



Answer:

A: Ilioischial line
B: Posterior rim of Acetabulum(ischio-acetabular line)
C: Shenton line
D: Iliopectinal line
E: Roof of Acetabulum
F: Anterior rim of Acetabulum (acetabulot-obturator line)
G: Shenton line
H: Tear Drop


Q2. Name the structure below


Answers:

A:  Right hemi-pelvis
B: Left hemi-pelvis
C: Sacroiliac joints
D: Sacrum
E: Pelvic Ring
F: Pubic Symphysis
G: Obturator Foramen

Q3. Name the structure and muscle attached to it


 Answers:

1. Iliac crest - abdominal muscles
2. Anterior Superior Iliac Spine : Sartorius muslce
3. Anterior Inferior Iliac Spine : Rectus femoris muscle
4. Greater Trochanter: Gluteus medius and minima
5. Lesser trochanter: Iliopsoas
6. Ischial Tuberosity: Hamstrings
7. Pubic Symphysis: Adductors

Other Notes:


 Muscles connected to the pelvic bones. 











This is a post specifically to help you revise what you know about the pelvic area, specifically for orthopedics. 

This is very important and popular to be asked in exam. 

I am sure you already know this structures from medical school, hope this exercise helps you to remember them again😁

Good luck!



Saturday, March 28, 2020

USM OSCE - EPR 2019 Dec

Past Year Topics for USM OSCE - 2019 - Part I

Hi all, in this post I am going to share the topics they have on year 2019 for Examination for Provisional Registration-/EPR. (the year I took my exams😁Thank God I passed)

** EPR is a special exam where International Medical Graduates must take to get full licence to work in Malaysia. 

So I will provide more details on how the questions were asked and what I experienced specifically for the USM December 2019 session. However I won't be able to recall the questions fully word by word, but will try my best to explain what was being asked.
The other session for 2019 are USM-Feb  and IMU-July will be posted in another post.

Reminder:

You have 1 minute to read the questions outside the room and once the bell rang, you have 9 minutes to finish the station. the second bell will ring, and you will have to move to the next station quickly to read the next question.

USM (December 2019)

Emergency medicine
1. Patient involve in motor vehicle accident, access the patient and do immediate management
   - Emergency management of Pneumothorax
   - Name all the equipment needed in ED (we have to name the equipments shown on the table)
   - explain the safe triangle position in detail
   - perform the procedure from the safe triangle


Orthopedics
2. Patient involve in motor vehicle accident and have problem walking, you are require to do a lower limb PE
  -  identify short limb gait (at least that is what I think it is) ** real patient walking
  - so I proceed with full lower limb physical examination and LLD(Limb Length Discrepancy) diagnosis
  - Physical examination necessary to identify LLD

3. Hip X-ray with a problem, patient short history provided
   -  Describe the X-ray, give a diagnosis and explain your further management
   - identify all structures shown in the picture and explain their functions.

P/S: remember to check patient name and date


Internal medicine
4. Patient with chest pain and SOB, take the history and explain further management if needed
  - history taking and I suspect its AMI

5. Interpret chest X-ray and give diagnosis with treatment + physical examination of the chest
   - Tips: there is a mass in the chest x-ray

P/S: treatment plan must be specific***


Surgery
6. Patient present with mass at inguinal area, diagnose and focus physical examination
  - Inguinal Hernia - after history taking, ask for permission to do examination
  - physical examination is done on the manikin. (you can refer to this to understand the scoring)

** The examiner asked the differences of direct and indirect hernia physical examinations and their respective treatments.

7. Pneumoperitoneum - X- ray interpretation and management plan
  - management is specific

Tips: if you plan to have iv fluid, what do you want to do? (is it fluid bolus? how much you want to give? how long you plan to administer the fluid? etc.)


Pediatrics

8. Growth Chart interpretation
  - scenario given was about short stature. (explain the cause, QOL, management)

 Tips: calm the child down first so they can cooperate

9. Lumbar Puncture Consent from Parents
  - get the consent is the aim. make sure you explain all about lumbar puncture from the cause to the treatment values.
   - reassure the patient


OBGYN

10. Bimanual Examination
   - there is a huge mass in the manikin.
   - explain your examination specifically on inspection and palpation,
  - the examiner will ask for your diagnosis and your management plan for the patient

11. Patient complain is stomach pain and discomfort (a little aggitated)
  - After history taking, i suspect its a Placenta Abruption case.
  - the examiner asked for our diagnosis
  - present your case from history taking
remember to include: Gestational age calculation, GPO - all OBGYn necessary history
  - treatment plan

*P/S: I finish this station when the bell rang for us to leave the room. We only have 9 minutes to do all the above, make sure you manage your time well. 


Anesthesiology

12. Patient need to prep for surgery, as a junior doctor apply adequate oxygenation before anesthesiologist arrive.

  - full airway assessment and use the Bag valve mask (if  you observe well, you will see it lying on the table beside the manikin) -explain the indication and possible complications.

*P/S:   - the procedure was easy as i did a lot during my internship in china (finish smoothly in a few minutes), but the examiner asked a lot of questions and fully utilized the 9 minutes. Be ready to answer a lot of questions and make sure you know what and why you do what you have done.


Psychiatry

13. The patient is very sad and depressed. If you have good observation, you will see a plaster on her wrist.

 - The patient has history of suicide, so after accessing the patient and confirm it is related to suicide, I used the suicide risk assessment to confirm the diagnosis.
 - the examiner will ask how you come out with your diagnosis, luckily i still remember the specific components for the assessment. (the examiner asked how I get the score)


ENT

14. ASOM
 - acute suppurative otitis media

* I am very thankful to be able to work as a clinic assistant for an ENT doctor for almost a year. 
Really grateful I know how to use the equipment, give diagnosis, explain the cause, complication and management to the patient very quickly and specifically. I spend a lot of time sitting outside the station to wait for the next bell to ring.😄Thank you Doctor Koay! 


Radiology

15. Two CT was showed
 - I suspect it's a CT with Epidural hematoma and subdural hematoma
 - we are require to explain the CT in detail to support our diagnosis

 *P/S: this is the only station I don't know if what i did is right or wrong. because he is not satisfied with the answer i gave, and when I asked the other students, they say the same thing.. 
 Until now I still don't know what the doctor showed us, because I forgot how the CT looks like... (sad)


Community Medicine

16. Consultation on family planning
 -  asking for pregnancy advice and how to have a healthy

*P/S: the patient has diabetes after minutes of asking... So I have to quickly brief her the pros and cons on the complication of pregnancy while having an uncontrolled diabetes situation. 


If you have more questions can leave a comment below, I will try to reply as soon as possible.
Good luck!



2018 OSCE Past Year for EPR

Past year OSCE 2018

This is the past year topics asked in USM 2018 and specifically for those who took the examination for provisional registration. I didnt have the past years from those who took the exam in IMU, so if there is anyone who took the exam that year and would like to share, you are welcome to share it in the comments.^^



If you are interested in what they asked in 2017, refer to the previous post.


USM EPR OSCE questions 2018

Gynecology
1. COCP
2. Speculum Examination and high vaginal swab

Pediatrics
3. ORS usage advice for children
4. G6PD counseling

Orthopedics
5. neurovascular examination (lower limbs)
6. Elbow Joint Dislocation (interpret the X-ray)

Psychiatry
7. PTSD

Emergency Medicine
8. CPR
9. Mallampati classification + Airway assessment

Internal Medicine
10. Hypertension
11. GI perforation
12. Pneumoperitonium

Opthamology
13. Visual Acuity Test (patient with hypertension and diabeter)

Surgery
14. DRE
15. Colonoscopy consent

Others
16. ABG interpretation and Heart attack evaluation

Saturday, March 21, 2020

2017 OSCE Past year

Past Year Questions Year 2017


The topics below are the topics from the students who took the  Examination for Provisional Registration(EPR) OSCE on 2017. I do not have the specific questions but having a main topic is sufficient for me to prepare for exam after knowing the rating rubrics for osce.

Study each topic in detail to make sure you get it.
&
Hopefully it is helpful for you!

P/S: For reference only!

IMU July 2017 OSCE

1. Hemiplegia
2. IDA
3. Cataract
4. AOM (Acute Otitis Media)
5. Rib Fracture
6. Diabetis Mellitus foot ulcer
7. MMSE + Bipolar
8. Constitutional Small gestational Age (SGA)
9. Thalassemia
10. Hepatomegaly
11. PUD
12. Contraceptive methods
13. Nephrotic Syndrome
14. Gall bladder Stone
15. Break bad news (Patient diagnosed cancer)

USM Jan 2017 OSCE

1. Schizophrenia
2. Bipolar
3. GCS and its usage
4. Snellen Chart
5. Nephritis
6. Hepatomegaly
7. Septal Deviation
8. Hemiplegia
9. COPD and Lipoma
10. choledolithiasis
11. Diverticulitis
12. HPN + IUCD
13. Fundal height (Prenatal check up)
14. Dysfunctional Uterine bleeding
15. Knee Physical Examination

Good luck!