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Today is my internal med paper. I’m starting to think that both my examiners till now are those poker face type (po.. po.. po.. po.. po.. poker face).

The previous batch that had this exam told that most of the time the interns will kinda help out a little bit you are in trouble. Hehe. Let’s listen to my part of this story.

I reached around 8am, went in the room, took my slip and my patient’s name. I went up to the ward, and a big bouncer intern came stopped me.

Bouncer : “Where are you going?”
Me : “824, my patient is there.”
Bouncer : “Okay, go see the intern first, she has something for you.”

I went to the ward, and a female intern was there standing, pulled me aside, and when she was about to say something, another 2 fellas came asking for her helped. I waited for quite long as they started asking her about those small things. (Walao, anamesis also wanna ask, go ask the patient yourself la!)

Since I got kinda bored waiting. So I just went to the patient. After clerking, when I was about to exit the room, the examiner approached me, and told me to present, in a not fully prepared stage!

Me : “Can gimme 2 minutes so that I can write down some stuffs?”
Examiner : “You already wrote down, let’s present and see what you have.”
Me : (-_-’) ” Okay.”

The process was uneventful. Pretty straight forward angina pectoralis. But the patient is not so pleasant to talk to. Grumpy and all but I think I know the Russian style pretty much. (Just talk and ignore the face).

Came out, filled in the paper, and got back down to take my theory questions.

Nothing really special except for one part. I got xray for osteoarthritis of the knee joint, and extrasystole + anterior (-) Q infarction.

The analysis is funny. I appreciated the anemia, hyperbilirubinemia and the decrease time of erythrocyte resistence. And because of this, i started to think of the possible causes - both congenital and acquired, spherocytosis la, sickle cell la, thalassemia la, G6PD deficiency, drugs induced, warm cold autoantibody.

Teacher : “Tell me the diagnosis.”
Me : “I think this is analysis is not complete…. (wanted to continue)”
Teacher : (with the face like i stepped on her shoes) “Tell me the diagnosis!”
Me :”This is hemolysis but the cause is unclear…”
Teacher : “The diagnosis please..”
Me : (-_-’) (habis, hancur, can see any diagnosis from the lab test meh?)
Teacher : (waited impatiently)
Me : (sweating)
Teacher : “Hemolytic anaemia”
Me : (wtf!)

Well, she didn’t considered I didn’t know as I already told her what I think and etc. So she is pretty lenient with the mark for that.

Got a question on hyperosmolar coma in diabetic patient. Also a bit of poker face there when I say out the dosage of the insulin. Sometimes it is really tricky.

Teacher : “How much insulin to give?”
Me : “6 unit bolus and then drip together with the saline later on”
Teacher : “How much insulin to give? (see she likes to psycho me!)”
Me : “6 unit bolus (answering again, i thought she didn’t heard!)”
Teacher : “How much insulin to give? (with the tone like wanna kill)”
Me : “6 unit!”
Teacher : “after bolus how much?”
Me : (cham, don’t really know, usually depends on sugar level)
Me : (tembak lah!) “6 units also, thru out the hour.”
Teacher : “you are suppose to say, according to sugar level! But 6 is too much, usually 2-4 units.”

Okay I admit maybe I a bit too gan cheong. Sometimes it is really good to say what you think to the examiners. Let them know how you think and maybe your unimportant process of thinking is the answer itself!

I got an endocrinologist for me to answer my questions. Talking about answering to the experts.

Anyway. Marks are good. 3 down. 2 left to go!