Professional Exam Episode IV: The VIVA

A bit sharing on the 4-VS-1 VIVA session...

SURGICAL

Examiner: What is the current most common Ca in Malaysia?

Me: Male – colorectal; female – breast Ca

Examiner: Is there anything you can do for common Ca?

Me: Screening

Examiner: What are the pre-requisites before you do screening?

Me:

- We need to have data, i.e. the Ca is common

- The Ca is treatable, if not curative pun we can offer treatment modalities

- The screening tool is available, with acceptably high SPECIFICITY & SENSITIVITY

Examiner: What can you offer in screening for breast ca?

Me: US if <35y/o. Mammogram if >35y/o

Examiner: How frequent do you screen?

Me: Generally yearly beginning at the age of 40-59, since the incidence is highest in those age-group, then can probably reduce the frequency

Examiner: What are the disadvantage of mammogram

Me: radiation, especially if done yearly

Examiner: What else can you offer other than imaging?

Me: Genetic studies e.g. BRCA 1, BRCA 2

Examiner: So, would you offer a prophylactic mastectomy if they have BRCA 1 & BRCA 2 genes?

Me: (Owh, ni soalan dpt masa seminar breast Ca masa muda2 preclinical dulu. Soalan yang ditanya oleh wani Ca). Erm, that’s a very controversial issue (jawapan politic). I think, 1^st we have to counsel the patient (goreng...), advice on yearly screening and regular BSE ke, if a lump is detected, then...

Examiner: Nevermind, I agree with you that it is a very controversial issue. How about the screening for colon Ca?

Me: For low risk group, advice start at the age of 45 or at least 50. For high risk group (e.g. FAP, HNPCC); FAP screen at the 10 years old, HNPCC start screening for Ca at the age which the 1^st family member develop Ca

Examiner: How do you screen? You don’t do colonoscopy in everyone do you?

Me: No, we can offer FOBT

Examiner: How often?

Me: Same, depending upon low & high risk group

O&G (tak ingat sangat, sorry)

Examiner: Tell me what you know about cervical cancer. The pathology behind it.

Examiner: What are the treatments available

Examiner: Prevention? – HPV vaccination

Examiner: How does the vaccine work?

MEDICAL

Examiner: 39 y/o Malay gentleman, come with palpitation. You check his BP, it is 150/90. Persistently high. What do you think?

Me: I’d like to ask further Hx, PE... (Sebenarnya examiner nak dengar Pheochromocytoma but I was blur...)

Examiner: How do you treat AF?

Me: Rate & rhythm control, bla.. bla.. bla..

Examiner: Other drug in treating AF?

Me: Warfarin

Examiner: How do you administer warfarin, monitoring, etc...

Examiner: If patient refuse drugs, how do you treat? – radio-something... err, can’t remember, never heard of it

Examiner: What is the latest drug to treat AF in the market now? – Don’t know (tak ingat Dato’ mention ubat apa)

PAEDIATRICS

Examiner: Since 2008, you know that there have been changes in the immunization schedule in Malaysia. What are the changes, and why?

Me: Hep B previously 0,2,3,5 months, currently 0,1,6 months (more effective?). Dulu 3 in 1, now 5 in 1. Dulu OPV, now IPV (less vaccine-associated poliomyelitis). Dulu cellular pertussis, now acellular (less side-effects). I can’t remember the exact reasons...banyak goreng...

Examiner: Let’s say you are a houseman in the ward, there’s this boy with thalassemia, come for blood transfusion. Blood running, you wait for 10 minutes, patient ok. So you go to your room to take a rest. Suddenly the SN call and told you, “Dr, this patient develop sudden HGF with chills & rigors!” What are you going to do?

Me: I would go to the patient, assess the ABC...

Examiner: No, what are you going to tell the SN there and then on the phone?

Me: STOP the transfusion

Examiner: OK. You go to the patient and examine, he has urticaria rashes all over the body. What to do?

Me: Give IV Hydrocortisone?

Examiner: How long does it take for IV hydrocortisone to work?

Me: I’m not sure

Examiner: 2-3 hours. So what else can you offer, one with more immediate effect?

Me: IV adrenaline

Examiner: OK. How else can you administer adrenaline?

Me: IM

Examiner: How else?

Me: Errr.. I’ve never heard of any oral preparation of adrenaline...?

ExaminerS: Gelak berjemaah. The answer was subcutaneous.

This distinction does not mean I’m smarter, neither am I any better in any way. Allah yang bagi, everything was by His Help, His Will, His plan.

"This is by the Grace of my Lord - to test me whether I am grateful or ungrateful! And whoever is grateful, truly, his gratitude is for (the good of) his ownself and whoever is ungrateful, certainly! My Lord is Rich and Bountiful." (An-Naml: 40)

Alhamdulillah ‘ala kulli haal.