Medicine Shortcase Exam

well ytd i had an exam with Dr. LP Tan and KT Chua and i have no reason to be afraid as both of them are so nice and loved by students.

Well i was the last to be examined and they asked me to do a CVS examination
Practically im very confident with the flow of my examinations as it acts like a good impression, by just showing some showmanship.

Well it went quite smooth until i saw the pulsation at the neck. well it can either be JVP pr carotid. Well i had to commit to carotid as although it has 2 pulsation, they were palpable, doesnt decrease with inspiration nor increase with abdominojugular reflex..

Then there was a murmur. out of every freaking common pansystolic murmur.. they gave me early diastolic murmur that was very soft. Well it has to be an AR...

when i was about to check the leg oedema, Dr. KT Chua stopped me and asked me " how would you like to finish the examination"
and i said by checking BP Temp and urine for hematuria..
then he said "no before that???"
there i was.. stood like an idiot trying to gather my thought. what he wanted was actually bibasal crept..
basically this was the moment that i know i screwed up. how the heck i supposed to know whether the patient is in failure or not..

so lessons of the day
1. always say what else i wanna do although he asked how im gonna end the examinations
2. i sux when the lecturer ask to present positive finding and relevant negative.. clearly in this case he wanted to know about AR.. causes of murmur.. whether he in failure or not and whether he developed IE or AF.
3. do more readings
4. examine more patients

BTW the diagnosis i should have mentioned would be

"This patient has a valvular heart disease , AR and the main etiology would be rheumatic heart disease. He doesnt have any evidence of IE and he is in failure"
yes yes i know im a failure

p/s: just got back from watching Prince of Persia in cineleisure and it was superb! well that should put aside the depression for now i guess..


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