i had localised headache (?migraine) for around an hour before our summative results were released yesterday afternoon.

so I PASSED!! and am now a year 4 medical student-to-be! All glory to God =)

in a way, i’m thankful that MBBS is not assessed using a bell curve (eg continuous distribution) but rather there is a cut-off passing mark of 60. so i technically don’t have to compete with my classmates in order to get to the next year (although there are still incidents of our class gmail account being hacked/frozen/with its contents deleted every year nearing final exams)

But they do have interesting ways of assessing us.

For year 3, there are basically two parts to our exam: the written paper and also continuous assessment.

As the name suggests, continuous assessments are assessed throughout the year, based on our performances in tutorials, our overall attendance and our clinical competency test (CCT) at the end of every rotation. The continuous assessments are not that scary in my opinion; CCTs might be a bit daunting if one was to be examined by a professor (eg a more notorious/malignant one) with a risk of failing if some physical examination is not performed in a particular way suited to their liking.

The written part consists of three papers which are examined in three consecutive days at the end of year 3. SAQ, minicase and MCQ/EMQ.

SAQ (short answer questions) are mainly regurgitation from lectures/based on common sense. MCQ/EMQ (multiple choice questions/extended matching questions) would be, as a Malaysian would say, hantam only (just pick at random lol) but they usually set more detailed questions compared to SAQ.

minicase is where the fun really is.

in the minicase paper, we are given 3 separate cases to “solve”. (i have heard countless doctors comparing the medical profession to that of detectives solving a crime. they always ask us if we read Sherlock Holmes LOL. anyway i dont xd)

obviously for it to be a case, information is revealed bit by bit. so in the first page, you get some basic information about the patient, his/her chief complaint, what is your differential diagnoses, what questions would you ask and what physical examination you would like to perform.

and then after the time limit of probably 8-20 mins (depending on the length of the questions), they take away your piece of paper.

*take a deep breath*

aaand the give you the next page. with the RELEVANT history taken and physical examination done. so you know what you did right/wrong. almost immediately.

and then they ask you what investigations you would do and quiz you on some medical knowledge along the way.

our first minicase this year nearly killed everyone. i had no idea what was going on until the very last page!

so this is a rough sketch of the case:

first page. 50 year old woman presenting with one week of 39 degree fever. she had been unwell for several years and is unable to walk.

[a picture of bilaterally swollen legs up to the thigh]

question: what is the abnormality seen. what might be the possible causes of the abnormality.

okay so the fever might be infective/neoplastic. one week? and no other foci of infection? or none mentioned? with bilaterally swollen limbs?

we learn that bilateral means that the disease is systemic. and it’s usually heart failure/renal failure/liver failure/severe malnutrition. okaaay but infective??? how how how

anyway i just answered (BILATERAL!!??!) lymphedema due to neoplastic (those that would cause lymphadenopathy eg lymphoma) and infective cause (TB?). cause these seem to me that it would relate to fever as well. just that bilateral lymphedema is just so ODD.

second page. she is from Vietnam (? or some other southeast asian country i forgot). she has splenomegaly. reduced serum haptoglobin (indicating intravascular haemolysis). anaemia.

question: what two causes would explain the reason for the anaemia? how could these new information relate to the abnormality seen in page 1? what would be the next investigation you would do?

FINE. you don’t tell me what’s going on. just keep asking me questions la. for the anaemia one i just answered what i saw in the page, eg pooling of blood (hypersplenism) due to splenomegaly and also intravascular haemolysis. but i was still thinking along the lines of lymphoma and how it could have been lymphedema and the haemolysis would be AIHA? (autoimmune haemolytic anaemia?) like cold agglutinin disease or something. and since i was thinking along the lines of AIHA, i decided to do Coomb’s test.

third page. a peripheral blood smear was done.

facepalm. so it’s malaria!!!! gg. which led to renal failure and hence the swollen legs. gosh i didn’t even know malaria would cause renal failure, only haemolysis.

note: i couldn’t remember the case in detail so i think i missed out quite a lot of questions ><

anyway. just posted it up as a case sharing i suppose. and also it’s alright that i didn’t know cause i still passed anyway *does crazy dance*

one more week of lazing around at home before my sarawak attachment in june! i’ll make sure to check for malaria if i ever see legs that swollen again lol.