Pre-Exam Maniac Syndrome (PMS)

Exams in 5 days time. I think I am starting to have my PMS again. Yet, where's that rush of adrenaline? Geez, I think I have aged tremendously.

Having survived my previous medical posting EOP genocide, I am so grateful that I had made it with unexpected results. I had been thinking that I had flunked it, but then I passed. :) Splendid. Anyway, my theorectical part was ok since I had anticipated most of the questions (except for acromegaly). My clinical portion however was disasterous, except for the OSCE, and it still haunts my mind whenever I think of it. Sigh.

My long case was a tuberculosis patient, whom having completed his anti-TB regiment and came up for follow-up in the hospital, was unfortunately bribed with RM50 to become a subject of molest. Yet, it was not a tough task to manage him; garrulously cooperative, he began yakking about his disease -- how he came to it, how he got rid of it, how he felt about it, etc. -- and I miserably scribbled everything down. Not bad. Next was eliciting some physical signs. Hmm... wait a minute, there's nothing! Chest was totally normal. Then I came to realize that probably the history and examination were not really that crucial in this long case. Strategically I planned and prepared myself for the artillery bombardment... Lucky for me, I was the first candidate for my easily-irritated examiner (Dr. Annuar) and his autistic colleague (Prof. Jo); I did not aggravate him much and I could answer most of his questions, although I try to bear with him ridiculing with the answers I made. Phew, I think I had passed my long case.

Next was the short cases. Catastrophous. Sigh.

My first patient was a lady who presented with hypertension and hence I was requested to examine her abdomen. Hmm... HPT in a middle aged women eh? Mechanicaly, I started to run a few differentials in my mind.

• Renal Artery Stenosis (Middle aged woman. Ok. Most likely-lah)
• Conn's Syndrome, Phaechromocytoma and other disorders of the Adrenals (Probably?)

Ok. My guess was RAS. So I started my examination. Routine inspection revealed nothing. No clear obvious distension. Time for palpation then.

*Press Press* + *Squeeze Squeeze* + *Poke Poke*

Jesus christ. What is that big fat thing in the right side of the abdomen. Ok. Let's try more. Hmm.. moves with respiration eh? Oh. Dull on percussion. Affirmative for hepatomegaly. Let's see if there's anything else at the left side.

*Press Press* + *Squeeze Squeeze* + *Poke Poke*

Ok. Spleen is normal. Let's ballot the kidneys then. Oh... nothing extraordinary.

"WHAT! YOU CANNOT BALLOT THE KIDNEYS!?!?!?!" That was what my examiners responded, with a shocked facial expression and a widdened oral fissure.

"Yes. I cannot ballot the kidneys doctor." I replied firmly, thinking it was another trick to perplex me.

"COME. PUT YOUR HANDS HERE. OK, CAN YOU FEEL THE KIDNEY BALLOTING AGAINST YOUR HAND NOW?" Dr Anis put my hand on the left abdomen and his hands started poking posteroanteriorly at the renal angle. "Don't you know anything about Adult Polycystic Kidney Disease?"

OMG. SOB. PKM (Pukimak). CCB. etc. All of those sprouted out in my mind. That was the end of it... 1st short case: RcKs dead.

Ok. Cripply traumatized, I approached the second patient and Dr Mra started to pinpointed out her questions. Well, she led me throughout the entire course of action. Now I started to wonder if my exam then was another bed side teaching.

"Tell me what is this pulsation at the neck? Feel the pulse and tell me what you feel. Auscultate here and tell me what murmur is that? Feel the femoral artery and explain what sign is that? What is your diagnosis?" A series of questions leaked out from her and I answered them staggeringly. It was a case of Aortic Regurgitation.

She looked pleased. Alhamdulilah. Yet. 2nd short case: RcKs resurrected but still commatosed.

Defeated, I packed my things and miserably lamented for my imminent funeral. Yet, as I turned around and walked, I was recalled again.

"Last chance. Tell me what is that swelling is that patient." Dr Mra pointed at another male patient at another corner of the ward.

I knew it was my last chance of redemption. Firmly I cornered the swelling and scrutinized it with all my might and wisdom. Eureka, it is a splenomegaly. I answered her and justified my findings. Finally... I can see a smile at my examiners face... It was like a glaring ray of light, indicating dawn has arrived in a cold frosty winter night. My shoulders sank with relief and I almost passed out. 3rd case: RcKs is alive!

"OK. You can go now." My examiners waved me off. I trudged back to the waiting room; there was a feel of relief; sweet like morning dew in a dry spell. What can I say... I think I passed my clinical portion now.

Aftermath:

Many a people responded to my encounter as a sign of favorism from Dr Mra. Well, I can't agree more on that. Not all of my other colleagues who were stuck in that circumstances got a 3rd case (final chance) when they flunked the 1st case. Life is never fair. So why complain?

Nonetheless. Hey, should I be blamed because I am beautiful? Is it my fault that everybody likes me? Haha. Geez I am so vain! I love myself. :)