the scenario given was not too difficult. u may answer it too if u calm down and not get nervous. actually, all the short case conducted not very hard for student. maybe, because of severe palpitation some answer that u know cannot answer during that time. im very sure, u will know the answer after the short case settled.
For this post, i would like to share my experience from my short cases that i have encountered last year and this year with same examiner.
Last year scene..
A patient given LMP and i count the POA was 28 weeks. when i inspect the patient, a transverse scar noticed at the suprapubic area (that means a ceaserian scar). then i palpate the patient i noticed theres a hard rounded mass at the left lumbar region and i thought that was the fetal head. then i try to do pelvic grip and i dont find any presenting part at the pelvic area. so my conclusion it may be a transverse lie.
when i present this case to prof, she asked whether im sure or not that was transverse lie because she didnt know actually where the head is! (so, i was trapped there). then, i starting to wonder if my palpation gone wrong. she started to ask the definiton of lie and i cant answer it correctly.
after that, i was given a situation if this patient goes bleeding. so, she asked me:
Prof: what is your first diagnosis come to your mind?
Me: i think about placenta previa
Prof: do you think this patient diagnosed to have placenta previa?
at first, i didnt get it what she means...so i try to answer it(actually thats not the answer she wants).
Me:because this patient has no pain. :))
actually the answer is because we dont diagnosed a patient placenta previa before 28 weeks. we will called it low-lying placenta! haha..i forgot it at that time.
the she asked what risk factor in this patient did u see that she can get low lying placenta?
that time i was very confused. how can i know the risk from physical finding? so, i told her that i dont know..she was very upset and walk away after that. =(
so, after that last, i started to revised back my notes about placenta previa. then i know the answer was the patient has a previous scar! ohh...how come i didnt think about it???
allright..thats was my last year scene..i learned a lot from that mistakes. i try to study hard and understand from what i learned today. actually medicine is not that hard if u try to understand a process behind it. it is not about memorizing but it is about understanding. (thank God, Allah give me a chance to do medicine again and i hope i will use it wisely until the end)
so, lets continue from my 2nd short case.. u may find it different from the last year.
i was given a case of normal pregnancy. a primigravida.
first, i was given LMP and i count her EDD is on 3 September 2010. i tell prof that her EDD was on 5th syawal...hehe..luckily prof was buying that joke.
so i got her CFH at 32 weeks and singleton longitudinal lie with cephalic presentation. head 4/5 palpable not engaged.
prof: give me 3 causes why fetal head not engaged.
me: for that question, i think about what can prevent the fetal head enter the maternal pelvis. firstly, in this case, pregnancy at 32 weeks so, the fetus still premature. secondly, it must be a thing that prevent the head from engaged like placenta or fibroid.
prof: give me 1 appropriate investigation to rule out this causes
me: the answer is ultrasound. because i want to know the fetal well being, is it correspond to date. then locate the placenta. and find any abnormal mass like fibroid in the uterus.
prof: how u can find there is abnormal mass inside the uterus from physical examination
me: the answer is from CFH. if there was a additional mass in the uterus, the CFH should larger than date.
then, prof said it was finished. i startled at myself.."is it finished? and i answer all the question?" i found is not hard. u may say "of course la, u are repeat student.."but its not completely true because last year i found myself dont know anything like this even that is simple. i really learn a lot this time.
If u learn something to understand, u will find it easy and interesting. if u learn something just to pass the exam, u will not understand anything and it will be boring...
