2 weeks to come before my final professional exam and anxiety is building up..And I did not even dare to go home for de-stressing myself. Thanks to my last Surgical posting exam that I did it horribly (seriously no kidding!). Here a little bit of what happen during my last exam.
Me: I'm presenting my patient 55 years old Malay lady from KT, Para 3 came w complaint of per rectal bleeding for 1 day duration.
Mr C: Why did you mention about Para 3? Does it relevant? (I kept silent)
Mr N: We are not gynecologist.
Me: Oh ok I'm sorry.
Mr C: You're wearing long sleeve or short sleeve? You should not fold up your sleeves. Button it properly!
Me: Sorry Dr. (OMG...
previously I've been scolded for not standing straight, now this? I curse my bad attitude.. In instance, all my confidence had been flushed away)
Summary of my case...
55/M/Lady came with painless fresh per rectal bleeding for 5 episodes in a day that was not mixed with stool. It associated with passing out blood clots, abdominal discomfort and symptoms of anemia. Patient also had loss of weight but no anorexia. Known to have DM and hypertension. On examination, she was pale and per rectal examination revealed there was altered blood.
My diagnosis was anemia secondary to bleeding hemorrhoids
Well in my presentation, I did mention about tenesmus...
Mr N: What is tenesmus?
Me: Feeling of defecation but no production of stool..
Mr N: No..So what is tenesmus? (I think more than 3 times he asked me)
In my history I did say patient had undergone banding.
Mr C: Why did you said that? Did patient see it? Is patient is a doctor?
Mr N: What is the treatment of hemorrhoids?
Me: Sclerotherapy, banding & hemorrhoidectomy...
Mr C: Yes.. May she undergone sclerotherapy..you never know.
Mr N: Ok.. what are the causes of massive per rectal bleeding? 4 causes..
Me: Sorry Dr. I did not know.
Mr N: You are 2 weeks behind professional and you did not know? (This time around I know I flunked it). In this patient what is your diagnoses?
Me: Hemorrhoids, angiodysplasia, colon cancer, diverticular disease.
Mr N: Yes.. At least you should know that for massive per rectal bleeding.
Mr C: Your history has many loop holes & you are assuming too much...What you want to do for this patient?
Me: Resuscitation, admission, blood transfusion...investigations, proctoscopy and colonoscopy.
Later the discussion mainly about colon cancer
Mr N: What is the surgical treatment of colon cancer.
Me: Right & left hemicolectomy, anterior resection, anteroperineal resection.
Mr N: Yes, so that why you have to know what is tenesmus...because if tenesmus occurs, patient may have sphincter involvement.
*sigh*
Then move on to short case, well it was Prof S & Mr Z.
Prof S: Examine this patient upper limb.
I did examine the patient horribly...partly because the patient unable to understand my instructions...when I asked her to grab my fingers, she just pull my hand..seriously it look totally bizarre even from my own perspective.
Mr Z: What are you doing? (Hmm..sorry Dr)
I continued with my examination & found that patient had hypertonia & hyperreflexia of the right upper limb.
Prof S: So what is your diagnosis?
Me: Upper motor neuron lesion involving right upper limb. (The bell rang..time out)
Prof S: Why did you say that?
Me: Because of hyperreflexia & hypertonia on the right side.
Prof S: What else? Ok last question, did you know difference between rigidity & spasticity?
Seriously at this point I have mental block. It is the same question during our teaching. So I ended up resiting for another short case..*sigh*
So moral of the story never ever let your anxiety control your mind or you will end up talking/doing bizarre things...and always be prepared. My poor preparation prove it all.
p/s: tenesmus is a feeling of incomplete defecation. Patient may feel like going to defecate but no passing out motion. If you have any more info do response ok!
[update: Mr C said that tenesmus is after defecation, patient feeling there is still something inside]
