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Sunday, May 10, 2015

ceritera exam cardiology

this time osce cardiology pulak,
sama macam kes yang lepas, list nama atas2 tapi masuk exam last sekali, walaupun tak de lah lewat macam dulu

dan alhamdulillah, aku tak nervous sgt, masuk tu rileks je

question: auscultate the mitral area
salah tangan bila nak palpate apex of ptt, prof tanya :are u left handed?"
"eh, sorry doc, i'm not" cepat2 tukar tangan sebab masa tu tangan kanan tgh pegang stethoscope

me: S1 is muffled, S2 i'm not sure because the sound is hard to hear, pansystolic murmur ..bla bla propagate to (alamak tak check pulak sampai ke axilla, kantoi)
prof: in MR is it possible all murmur will propagate to axilla?
me: not (confidently, walaupun tak tau the reason)
prof: why?
me: emm.. (serious memang tak tau kenapa)
prof: the propagation is due to direction of ejection right? (prof cuba membantu)
me : what doctor, i still can't get it (serious memang tak tahu sebab mmg xpernah spe2 ajar pon psl reason propagation ni..adoi)
prof: i know, this question is very hard. let me explain, it is because when the ahterior leaflet is affected, the direction will be toward the axilla, but if posterior leaflet affected which is not
me : ohh.. this is really new information for me


prof: during auscultation, u palpate also the carotid..why?
me: to make sure the timing of murmur is systolic which will synchronize with carotid pulsation
prof: when u palpate the carotid sometimes its dangerous. why?
me: eh.. (terkejut, xboleh palpate carotid ke) because the brain will not get the blood supply (jawpaan paling noob..keke)
prof : no no.. because it will stimulate vasovagal reflex that will cause bradycardia, especially with patient with v tach, we can do carotid massage
me: ohhh.. we can also put the ice..
prof: your method is correct to know the timing, i'm not saying that's wrong but actually u can make sure the timing by the type of murmur (obviously if harsh is MR, while rumbling is MS) or by the heart sound itself..lub dab
me : yeah doctor, but actually i can't hear clearly the murmur (patient tu obese kot, ingat sng nak dengar..susah giler nak detect..bunyi nya dengar tak dengar je)

konklusinya, soalan yang aku dapat kali ni agak rare..
dan paling best, i got many new information that i will not get in the class.. cool prof ni

inilah exam yang i dun care what marks the prof will give, its just like i'm happy with this kind of situation during exam.. learning something new, having discussion

because actually entah kenapa rasa down.. mood tak stabil
minta doa dari mak n family.. alhamdulillah everything going smoothly
whatever the result will be, i'm trying my best to be positive and struggle toward the success..

next mcq n problem solving exam..pray for me

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