My medicine end-of-posting test

My medicine end-of-posting clinical test is the worst clinical test in the history of end-of-posting clinical tests (except for that one our prof told us abt, where the patient passed away while his friend was examining and he din even detect it).

Firstly, I became a nervous wreck waiting outside the ward while Leonard was whisked away to do his long case. My first short case is a CVS case. I did a perfect examination to find a seriously complicated case which totally left me at a loss at what was the diagnosis. She had an almost non-palpable pulse and it was really difficult to get the rate. At this point in time, I was chided for exposing the patient. Anyway, she has THREE murmurs, (two of which I got) but hell, three murmurs??? Two in the same place?? I mean, I got an AS+AR before and I remember asking CBC abt it and he replied with his usual “can can�. But a MR+MS??? As differentials, I gave the usual mitral valve prolapse and AMI but the answer she was looking for was rheumatic heart. Can you believe it? If I said that to CBC I would have been slapped silly for “lack of perspective�. On top of that, the patient has AF! Jeez all I can say is, woe be to the students who will get her in the future.

My second short case is also the same patient. The instruction was to examine all the joints. There was a very prominent and very distracting hypertonic flexed wrist and fingers of her right hand so naturally I went straight to it. I supposed I spent quite a long time examining her right upper limb, which had lead pipe rigidity. Meanwhile, Dr Ng kept saying “examine ALL her joints. ALL!� And I thought, “all??? But there are so many joints!� I finally found a swelling on her left ankle after examining all the joints of both upper limbs. And all this while, she was asking me whether the tutors in Changi taught me how to examine joints. I said no (This was true). Then she asked whether I attended her lecture on joint pain. I said yes (This was not, inwardly I went like “huh?�) The diagnosis is gouty arthritis even though there are NO gouty trophi. Her hypertonic right UL was due to a stroke she had quite some time ago.

As though my short cases weren’t bad enough, my long case is an old auntie who spoke Cantonese and Hokkien only. I tried to take history in a combination of broken dialect plus Chinese but we couldn’t understand each other. I thought I got a presenting complaint of right chest pain but couldn’t proceed on from there. After she said “le mun hui gong cham liao lar� (which roughly translates into “you dunno how to speak you die already lar�), I went to get a translator. I started my history again but this time got a presenting complaint of SOB because ‘heart not strong’. When I asked if there’s any pain, the answer I got was knee pain. Then, I don’t know what the translator did or said but the auntie got more and more agitated and then straight out refused to talk to us and turned her back on me. And I wasn’t even at the onset of the SOB! (Man, I feel like sobbing now just thinking abt it) So I requested to do a PE and humptump a CVS and half of respi. There were no abnormal findings I thought except for gross tachycardia. Somehow I managed to coax out abit of social history but she got angry again at family history because her parents had passed away so she din want to talk abt them.

To my utmost surprise, I managed to borderline pass my long case, which I expected to fail badly and borderline pass the gouty arthritis. I failed my murmur case by 1 mark for which I felt really upset about. The marking scheme is seriously flawed.

I’m alright about redoing the medicine posting since I was intending to do medicine as an elective anyway. But I’m just super pissed that we had such a tough time while other people I know who also took their test in AH had one hour to do their long case and for short case, they examined on the same patient who obviously would not have any signs so they were just assessed based on their examination technique. I feel angry already, just blogging abt it. Ugh! Do not ask me about my test after you read this k, cos I’d most probably still be sore abt it.

On a different note altogether, can someone teach me how to put up a favourites column and link entries there?