For paeds exam, we have to do a Long case and MCQ.. i was in the group for the 1st of long case..at around 9.00am
So, on the day, i went there at 8.55am..and rush into 6S (ward) and look for any familiar faces. Hmm, saw my colleagues clerking (the ones at 8.30am) ..i tried to look for someone to tell me where to wait ..so i walk to the counter and saw a Dr. in charge of our year..i asked him and he told me to go to the Department..
went there, saw my other colleague waiting as well..a few minutes later, a MO (medical officer) came and told us to follow him. We were brought to our respective patients. My colleague was just opposite of me. so we begin our clerking.
My patient was a 10 years old boy and his guardian was not around (she went to the bathroom)..so i asked the boy (patient) instead.. was asking his chief complaint = fever and abdominal pain...so i ask further details.. was clerking half way, then his guardian came back.
So i ask his guardian about the boys condition.
She told me straight away that he had Hemophilia A (a disease that causes reduction in factor VIII - had bleeding tendency) ...ohh shit.. i was first thinking of fever or other things, suddenly he came in because of swelling of the ankle (haemarthosis).. what a big difference. If i got the chief complaint wrong = sure fail lo.. so faster clerk the details on hemophilia.
while i was still clerking, i noticed that my colleague on the opposite bed had already finished...she started on physical examination(PE)...oh..i got to hurry...not much time left...after finishing with my history i moved on to PE. i was stunt at first, dunno where to begin.. so i start with the CHIEF COMPLAINT, the ankle swelling.. i just did a very very brief examination...because everything is mostly normal.. apart from the presence of excessive bruises.
Finished with my HISTORY and PE...time to arrange everything.. wat a mess, i got this problem with clerking, i wrote it everywhere..im now confused which is which..look so un professional..but nevermind , i hurry up with the opening speech.." patient was apparently well until..." times up..so i waited eagerly for my doctor to come and access me.
After waited sometime, came a Prof..luckily he was not my examiner..."lega"..=) , later came a Dr which i havent seen before for the whole posting...Dr S.. she spoke with my patient and then she told me to present.
History was a mess...but i kept on talking as if i know alot...=) luckily i wasnt stopped.. then, PE , i even forgotten to present the vital signs..the most important aspect of PE..., luckily , i wasnt stop as well...she just listen and didnt speak a word. After the PE, she asked me about the differential.. i told her Haemophilia, Septic Arthritis, Leukaemia.. she continued to investigation..
I blunderred here, because i wasnt very sure about Haemophilia . i told her that Haemophilia is a autosomal reccessive inheritance...=(.. she ask me again are u sure? then i quickly changed to Sex-linked reccesive...lol.. asked me about investigation to confirm diagnosis..i told her that we should do genetic studies..lol...what a fool..she laughed.. then, i remembered i should do the Bleeding Profile instead... Prothrombin Time and Activated Partial Thromboplastin Time..she asked me which will increase or decrease? i told her both...wrong again..=(.. actually is Aptt prolonged.. because hemophilia A affect Factor VIII of coagulation cascade.. intrinsic factor.. she told me that u are all mess up...u should study about this disease because it is quite common...
after that, she asked about what that i m going to tell the patient before we discharged him?... luckily i was told by the guardian about what he cannot do and so on..
I told the doc that, he must not involved in aggressive sports, if there is presence of swelling and bleeding, he needs to come to hospital immediately, tell others people about his condition, so he can avoid certain condition..
thats all for my clinical...i didnt do very good in my opinion..but i luckily i got a so called "benign" doctor... if not confirm fail lo..=P
Next posting is surgery..
