Ada sikit makluman untuk OSCE TropicalMed sem 8 2010.
Sekadar ulangan kepada sahabat2 yang memerlukan.
1. Ada 3 station (3 patient shj)
a. contoh-contoh soalan :
inspect the abdomen. palpate the liver. palpate the spleen. dsb.
b. soalan-soalan berbentuk direct dan specific,
tiada soalan seperti examine the liver [ = inspect+palpate+ percuss+ausculta te sekaligus ].
c. buat seperti OSCE InternalMed dulu tu:
greet patient, introduce, consent for examing,
do the question, COVER up patient afterwards, thank patient,
go to the assessor, report findings, answer prof's question.
d. each station is worth 10 marks.
2. Contoh-contoh soalan post-exam dengan assessor
a. causes of portal hypertension
[ pre-hepatic, hepatic (presinusoidal, sinusoidal, post-sinusoidal) , posthepatic]
b. complications of portal hypertension
[ splenomegaly, ascites, collaterals, etc ]
c. massive splenomegaly : causes, definition, etc...
d. treatment of sekian sekian
e. manifestations of sekian sekian
f. interpretation of findings sekian sekian
g. how to examine sekian sekian
h. why you choose to examine by this method instead of that
(the works la... macam biasa...)
3. Special circumstances for THIS osce
a. questions are made by Dr Sahar (female doctor waktu ILA tu) tapi
she will not be present at the time of our OSCE (travelling) .
instead Doctor Magdy Khilal akan ada (kalau tak silap).
b. regarding soalan PERCUSS the abdomen, assess wether it's mild or moderate.
MODERATE : shifting dullness
MILD : modified shifting dullness
PENTING : percuss at the DOME of the distension (regardless of supraumbilicus, infraumbilicus)
c. in patient suffering from tense ascites (maximum kebesaran la ni),
immediately do transmitted thrill. [ SKIP the shifting dullness]
d. regarding soalan PALPATE liver, tricky-ness #1:
- Some prof mahu the upper border sekali (which is a PERCUSSION finding)
(eg: the male assistant prof yang jaga midterm GroupB prefers this)
- But some tak mahu (because in OSCE, we must do what the question only asks of,
if we go "astray" marks are reduced).
(eg: Dr Sahar prefers this - but she wont be there that day, so... ? )
- Pandai-pandai la tafsir your assessor (try asking beforehand ke...). Rabbuna yusahhil
d. regarding soalan PALPATE liver, tricky-ness #2:
- read the question carefully
- maybe it will be super-specific, eg: "palpate RIGHT LOBE of liver".
- jangan la ter-palpate LEFT LOBE.
- remember which is our right and which is left.
e. regarding palpation, for any abdominal organ in patient suffering from tense ascites :
do dipping method immediately. [ skip the manual palpation, hooking... ]
f. reminder : inspect the abdomen question:
- must mention that "we should actually expose the area of ext genitalia,
but considering the dignity of the patient, it is not suitable to do so at this time"
- or any similiar sentence la.
g. reminder : dont forget superficial palpation at any "palpate" station.
h. time limit per station : unknown, but tak lama la.
- Dr Sahar tak tahu (masa ditentukan oleh the lovely Dr Fatma)
- avoid carelessness because maybe we won't have enough time to re-do our procedure.
- nasihat Dr Sahar : budget for 2 minutes tops
i. refer any InternalMed clinical textbook as a guide, and read a lot about:
- hepatomegaly
- splenomegaly
- portal hypertension
- jaundice
- liver failure and hepatic encephalopathy
- ascites and its complications
4. Berdoa pada Allah and bertawakal padaNya sejak dari permulaan usaha kita. After exam, continue our tawakal.
5. All the best to everyone. Sampaikan makluman ni pada kawan-kawan yang tak tahu, tak check email, tak perasan email, takde internet, dll.
Wassalam warahmatullah.
NHMF
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