Emergency Med & Musculoskeletal OSCE

7 minutes each station...

Station 2:
Assoc. Prof JC Theis

Tell me about this Xray

1) # of mid shaft of clavicle, transverse #, angulated but not displace. how would you manage? conservative. how? rest pain relief splint (huhu..xtau. guna splint ke? mcm yg no 8 dalam buku tu ke?)

2) supracondylar # of the humerus. 100% displaced, angulated. how would you manage? open reduction internal fixation. (nak ckp ke guna K wire? tapi nanti salah rugi lak huhu. tapi mmg budak perempuan yg datang clinic tu pakai K wire) what would you worry about? (teringat kat budak tu.. die kene fasciotomy oh!) nerovascular structure, compartment syndrome. what artery and what nerve? median nerve. good. (err,, nk ckp ape, radial artery dekat midshaft of humerus...try je la. blh plak lupa brachial artery yang dengar untuk blood pressure tu la..ish)

3) lateral Xray of spine: what do you see? ostephytes, subchondral sclerosis, loss of joint space? haa yeaa... (huhu) diagnosis? OA of spine.. yeahh definitely. (huuh)

4) # of distal radius. it's impacted and angulated. minimally displaced. probably it is Colles #. It is a Colles # (huhu) management? closed reduction, put in a cast. (patut jawab manipulation and closed reduction oh!) what is the complication? Joint stiffness. yea2.. (alamak lagi ape?) mal-union etc etc...huhu

5) intra-articular # NOF, subcapital. minimally displaced with varus impacted (err varus ke valgus ni) management? hemiarthroplasty. why? (eh salah ke saya jawab) it is correct hemiarthroplasty but why? because she is elderly in rest home and it only last for 5 years (suka hati je saya jawab mcm ni... mmg xlogik gak la)

6) radiograph of ankle joint. it is weber B or C ankle # with # of distal fibula (mmg la weber classification of ankle # kat fibula huhu) with talar shift. what other structure would be damaged? deltoid ligament err err... (nape tak ingat syndecmosis tadi) management? open reduction internal fixation. yeaa.. screws and plate.. hmmm

7) shoulder dislocation. what else? coracoid? nope. acromion? nope (huhu) it is avulsion # of greater tubercle. (oh dah xsempat dah)

Station 6
ED

hey Siti, come in.
i thought i should be waiting outside.
no no,, you are welcomed (baik nye die ni)

ok, here is the scenario... (consultant ni pun membaca kuat2 untuk saya,, biar betul, xde lagi osce mcm ni)
ok, what is you initial managemnet?
ABC!
can you expand a bit more.
A .....
B .....
C .....
DEFG. before give fluid, take blood, for FBC, U&E, cross match, and and blood... blood... blood cultures? oh tidak... Dont Ever Forget Glucose! (nape saya lupa gak sebenarnya huhu..exam stress)
Disability. (ni apa maksud die duhhhh) name 2 ways to assess LOC.. huhu GCS and and... A,,, err
ok, look at the Xrays, what the most obvious you see? increase lung opacity, widened mediastinum. caused by? (peliknya takkan orang tadi bleh ada chest mcm ni?)

another Xray, avulsion # of ulnar/radial styloid. (huhu..apakah)

Station 4
Dr S. Stebbings

(waaahh,, ni doktor yang pernah marah saya dulu..huhu. ni plak patient yg pernah saya kenal waktu integrative week,, apakah)

ok Siti, this is Igrit. Please examine her hands.

Hi, My name is Siti. I'd like to examine you today, is that all right with you?

(pada Dr Stebbings) Err... i usually use a pillow. Do you have any? (demand lak saya ni, mana tau ada markah ke pakai bantal hihi)

(okeh... LOOK, FEEL MOVE)

(dah abes, mcm dah buat sume je tapi ada masa lagi ni.. tanye function die, buat screening movement kat bahu die.. hihi..)

so, what is your diagnosis? (erk, bukan ke patient ni mmg ada RA dulu tu, pelik je tanye diagnosis lagi. lagipun RA kan kene buat blood test sume... apa2 jelah) Rheumatoid Arthritis

wah rupa2 nya ada gak yang tertinggal... huhu.. biasala exam xpenah perfect

*****
lepas abes, students sume gi staff cafe bercerita pengalaman osce masing2..hihi

Station 1
Mr D Gwynne Jones

tidak dapat hadir, diganti oleh Mark, the reg.
student masuk (aik, where's Mr Gwynnes Jones, where's the patient, mungkin menyorok bawah kerusi, or bawah meja :D)

Mark: I'm the patient. Take hx from me and examine me (hihi... very classic carpal tunnel syndrome. tap3 for tinel's test... aaaauuch - dgn suara yg mengantuk. 5secs Phalen's test... aaaaaa - suara mengantuk lagi)

*****
the next day...
MCQ...
tak tau nak kata ape.. nape susah sangat ni. bende2 medical pon tanye. yang tak belajar pon ada. jawapan boleh tau terus pulak tu (sebb buat kat komputer lab). sedang dh banyak jawab, rasa macam dh banyak salah jugak... risau nye tak lepas. huhu...
Tapi alhamdulillah banyak revise pathology n rhemotology sket2. Amek ppt kat kelas tu membantu sangat2... Alhamdulillah,,, Allah selamatkan saya lagi. Allah yang bagi ilmu kat saya dan guide saya yang mana saya perlu belajar :)
Semoga Allah tetap membimbing saya dan kita semua, ameen...

Ok tunggu PASAF (Professional Attitudes & Summary of Achievement Form) dengan Mr Dunbar plak next week. Kan bagus kalau sume surgeon mcm dia ni. Allah dah bagi ketetapan yang terbaik untuk saya lagi. Alhamdulillah... Allah sangat tau yang terbaik untuk saya :)
Kalau results tak ok pon nanti, iAllah itu yang terbaik untuk saya juga. At least saya dah usaha, iAllah.

Saya akan miss orthopaedics! It's a nice run alhamdulillah.

*****

note: # ialah singkatan untuk fracture