Showing posts with label usm. Show all posts
Showing posts with label usm. Show all posts

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: 

Saturday, April 4, 2020

USM Exam Part II Experience 2019

Examination for provisional registration

Date of exam                      : 3rd December 2019
Date of Intensive class       : 1st and 2nd December 2019
Duration                             : 3 days in HUSM
Transport                            : Flight from KL to Kelantan (around RM 500)
Exam Cost                          : RM 3000 for the exam, RM 1000 registration 
Utility Cost                         : Food RM100, USM Guest House RM 75/night (shared a double room)  
Past Year Question link      : USM 2019 Dec
Things to pack along          : Lab Coat, Stethescope, Pens, Snacks and sweets, Formal attire
                                              (pentorch, hammer will be provided if it is required in the station)

What happens after you pass?





So after you pass, you will need to wait for about 2-3 months before they give you a call to let you know the next exam date. DO NOT wait until they call to start studying, it will be too late >.<

After I receive the call, they send me the letter two weeks later (around 5th November). And we will need to:
 - confirm if we are going to take the exam
 - confirm if we are attending the intensive class
 - make payment

Letter Head of the Offer Letter



Part of the Letter


Accomodation

-They do not provide accommodation for us, so we call a few numbers below to ask for availability. If you know a friend who is taking the exam together, you can share a room with them. It helps to improve the atmosphere, or you will be nervous all the time, plus you will have a study partner too! 
After consideration, we choose to stay in rumah tetamu USM, it was more expensive but the room is bigger.
The double room we had even has a balcony and a pantry area.
I had a picture of the bed below, please ignore the mess we made. XP

Usm Guest House 

Itinerary

We reached one day earlier to settle in and get use to the place. It depends on you if you need it or not.
On the first day we are require to go to this pusat sumber pelajar for a briefing. It was in Hospital USM itself. Remember to bring a jacket, it is quite cold for me.

They also gave us a schedule of what we would be doing for the rest of the day, so we can get prepared. We are being reminded that this intensive course is not a class to teach medicine from A to Z, but a class to help us get use to how the osce is going to be done (such as the scoring, what they expect us to do in the exam venue, quick summary on what the examiner expect when you see them on the exam day). 
The intensive course was really useful, it help a lot to make us get use to the environment and the exam style. 


Intensive course Venue



Schedule for 3 days


Tutorial Hall

Practice Session
We are given some time to practice on manikins in a room (I am not sure what they call it)

Where is our exam hall? 





The pictures shared above is a sneak peak to where our exam was conducted. It was scary at first, but soon you will get use to the flow. I enjoyed the OSCE exam more then the theory, because it reminds me of my days as a student taking my final exam during my university years. So glad to be able to be one step closer to my dream after a year of waiting and studying!

If you want to know about how it was being conducted, check out this link.

Take Home Tips

- Read the questions properly. Think and try to recall the information you want to ask and present. 
- Always start with greeting, introducing yourself and wash your hands!
- Build good rapport and have eye contact with patient, respect the examiner as well.
- Take patient identification data! (name, age, marital status, occupation) follow by their chief complain
- Balance with open and close ended questions about the assessment. especially : mental assessment, suicidal risk, OCD criteria, trauma related. -- they are very important and often carry high points
- Always say thank you to the patient and also the examiner
- I know you will be nervous in the room, but try present your finding as organised as possible, so the examiner can understand you and it helps you with your diagnosis too!

I wrote a post on what came out on that day, you can learn more from here.


So try your best and have fun in the exam! You will meet a lot of new friends who are in the same situation. Get their contacts and keep in touch😁
Enjoy and pass the exam with FLYing colours!



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