MBBS FINAL EXAM NEPAL IOM
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Transcript of MBBS FINAL EXAM NEPAL IOM
FINAL YEAR- overview
BY SENIORS
All the slides of the presentation are based on the experience of 24th batch, any deviations from these
facts would be circumstantial; however any resemblance will be
savoured.
What r we expected?
Junior internship Internal assessments Final examination theory practicals
Junior internship
Postings Self study Classes
(anesthesiology)
No time to waste
postings
Attendance-is must except radiology Punctuality- on or in time but not late Know ur cases n what u r supposed to do Ask questions but not with empty mind to
teachers Note the favourite topics and questions and
replies, esp. morning conferences, GR
Try to answer the teachers No extra works e.g. always dressings Study charts, investigation forms, normal
values e.g. biochemistry, FP devices Practise examination long cases esp. ENT
short cases
Discussion among frens ; only most important topics; tell listen make them understand; don’t waste time, energy in non-imp topics
Don’t compare ur knowledge with ur peers Not only theoretical topics but clinical examination
be discussed n practice as well; use standard book as reference;
Ask any queries to seniors; don’t feel awkward; they had been through the same phase e.g. even mitral valve is on right or left side?
SHARE WHAT U KNOW
LEARN WHAT U DONT
Comprehensive- Its ur life, make it large.
Make the steps habit rather than rot memory so it comes naturally; try to be comprehensive as possible e.g.
Show me knee reflex: small things matter greatly
What u going to do?
Stand on right side of patient Greet n tell pt what r u going to do- hammer doesn’t hurt Ask consent n cooperation Expose the body part with muscle e.g. knee reflex Joint in mid-range of movement Hammer type The way I strike with hammer i.e. just release,
If u can’t elicit, Jendrassick (reinforcement) maneuver before u say reflex is absent- proper technique; just before striking as effect lasts a few seconds
Perform both sides Try to remember grading of reflex (not
mandatory) Beware of pitfalls; some common are:
Look for the muscle contraction instead of the movement of the joint (usually mistake in knee reflex)
Hit at the tendon not the muscle coz muscle contraction may occur even if tendon reflex absent if hit directly on muscle belly
Arrange n attend classes (middle of postings n before assessments) of
1. X-rays esp. medicine, surgery, ENT, ortho
2. Instruments- wards, OT
3. Important procedures as chest tube; tapping; • Can carry cardex know diseasewise drug n
their doses
Visit presentations- do not go unprepared
Know presentation topics in morning n visit if topic pertinent n of ur standard; eg thyroid examination by residents was good
Surgery third yr GR very useful- try to help the juniors; study about the topic well; note questions n answers n teachers
Group discussion in Postings
Self study
No stress Time mgm is life mgm Adequate rest, diet Stm stipulated time not enough but can be
covered later on on other postings or assessments e.g. pediatrics, medicine
Regularity continuity devotion
Perfection is unachievable yet we need to strive for it in life………………………………..
Why? Are we pigheaded? Are we dogs?
Because life is a journey not a destination.
notes
Class notes- Prof. Raut, Sayami, Khakurel, PRS, ENT
Self notes- imp. Topics 2-3 books, others one textbook
Know topics- must, better, nice to know How?- past questions, postings, seniors, cases No notes needed for ENT; add more information on
the respective pages; some throat sections Underlining wont pay much; no time later on for
revision; time will be crucial later on
How to prepare best notes?
Only for most imp. Topics Various sources- books, classnotes,
discussions at postings with residents practical tips, teachers
Format for answers (in note; or at least in mind): for theory, practicals n real life as well
Later if vague questions, don’t haste; if 10 mins allocated, 28 think-write rule rather than 82 write-repent rule
E.g. clinical features of Acute Myocardial Infarction
Pain- SOCRATES SOB, NV, fear, anxiety Tissue damage- fever Impaired myocardial fn- low BP, raised JVP, S3, lung
crepitations, cold periphery, oliguria Sympathetic stimulation- HTN, tachycardia, sweating,
pallor (ant. Wall MI) Parasympathetic stimulation- vomiting, bradycardia (inf.
Wall MI) Complications- MR, VSD Any comorbidities Any trauma or etiologies ppting AMI
Presentations-history
include all the heads n subheads e.g. even informant n reliability, religion, occupation, menstrual Hx (LMP must)
Specific instructions e.g. Prof. Khakurel don’t call a child a patient
Admitted …. Days back (rather than date) from ER/ward for
HOPI: Explore symptomatology (system, disease) Etiology, severity or stage, complications, risk factors,
rule out D/D, comorbidities, systemic review
Diagnosis- comprehensive
Disease, etiology, severity, complications, comorbidities; e.g.
Left sided ischemic stroke/CVA with right sided hemiplegia with global aphasia with left sided upper motor neuron facial palsy with urinary incontinence with newly diagnosed type II diabetes mellitus with resolved sensory aphasia with newly developed constipation
No abbreviations as much as possible e.g. not COPD but chronic obstructive pulmonary disease
Do not get the side wrong Specifically distinct for Gyne/Obs
Management(=investigation+ treatment)e.g. Investigations of Acute Pancreatitis
1. Diagnostic USG, CT scan, serum amylase, serum lipase, abdominal X-rays
2. Supportive Severity (for RANSON or other indices)- WBC, glucose,
LDH, AST, BUN, ABG, Ca, electrolytes etiology- LFT, USG, ERCP, PTC, PTH, Ca, Complications- CXR, CT, ECG, albumin, Hct, Comorbidity- diabetes, HTN Rule out d/d of acute abdomen a/t age sex (listed in chapter
of acute appendicitis)- Routine- Hb, urine RE/ ME
Investigation findings e.g. CXR findings of Mitral Stenosis
f/o LA enlargement-1. Mitralisation of left heart border- small aortic knuckle,
convexity d/t dilated pulm A, prominent LA appendage, left border of LV
2. Splaying of carina3. Double contour of rt heart border
f/o Pulmonary edema- upper lobe blood diversion, kerley B line, batwing appearance, cardiomegaly, pleural effusion
f/o Pulmonary HTN- peripheral pruning, dilated prox. Pulm A with tapered end, RAH, RVH
f/o calcified mitra valve
e.g. Treatment of enteric fever
Definitive: Tab cipro 500 mg PO BD for 14 days (dose details); in children chloramphenicol
Supportive: nursing; nutrition (no dietary restriction); antipyretics; fluid & electrolytes; correct anemia
Complications: hmg, perforation, etc. mgm of enteric encephalopathy high dose dexamethasone
Treatment of carrier: cipro; ampi; cholecystectomy Prevention (if time permits): 3 vaccines
TAKE
CLASSIFY
What to do at radio?
Study medicine/surgery Visit one unit a day know basics about X-rays, USG, CT especially head injury, special investigations e.g. IVU,
cholangiogram, mammogram, HSG, etc
What to do at Emergency?
Ample of opportunities Safety comes first Take few cases u can handle n follow up. not load
oneself with many cases at a time Try iv cannulation, blood drawing, NG tubing, ABG,
LP, suturing, catheterisation Carry GPA sir’s book/ oxford Take care of ur goods they may walk away e.g.
book, steth Don’t hesitate to ask ur seniors e.g. interns
OCCUPATIONAL EXPOSURE TO BLOOD –BORNE PATHOGENS IN HEALTH CARE SETTINGS
AND OUR ER?
Don’t know exactly the data…sorry But no complacency. Incidences of accidental pricks
1. Iv cannulation……one incident
2. Drawing blood sample…….one incident
3. Suturing…………..one incident
4. Injecting local anesthesia……….one incident Do u want to be a part of similar anecdote?
why are we worried?
Each exposure is an urgent health issue for the exposed person
How does it occur commonly?
Percutaneous injury, usually inflicted by a hollow-bore needle, most common mechanism
percutaneous exposure to HIV-infected blood: 0.3% (95% CI: 0.2-0.5)
mucous-membrane exposure: 0.09% (95% CI:0.006-0.5) transmission risk increased if:1. device causing the injury visibly contaminated with blood, 2. device used for insertion into a vein or artery3. the device caused a deep injury
How to prevent?
Vaccination against hepatitis B virus Universal precautions
Universal precautions
CDC: a set of precautions designed to prevent transmission of HIV, HBV, and other blood-borne pathogens when providing first aid or health care.
Applicable to:1. blood, 2. other body fluids containing visible blood, 3. semen, and vaginal secretions. 4. tissues and 5. fluids: cerebrospinal, synovial, pleural, peritoneal,
pericardial, and amniotic fluids
Not applicable to1. feces, 2. urine, 3. sweat, tears,4. nasal secretions, 5. Human breast milk,6. sputum and vomitus unless they contain visible blood. 7. saliva except when visibly contaminated with blood or
in the dental setting where blood contamination of saliva is predictable
What to do?
don gloves on. Gloves be changed after contact with each
patient. Hands and other skin surfaces should be
washed immediately if contaminated with blood or body fluids requiring universal precautions.
Wear Face masks Wear protective eyewear; so lucky people
have glasses on Wear apron Careful during procedures………..practical
tips at bedside, orientations and classes
Postexposure prophylaxis
Has finally found its place in noticeboard after accident
Dont’s: squeeze Do’s: wash with soap and running water Contact duty officer and follow instructions as
the notice in the board.
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MARATHON
After jr. internship b4 assessments
Internal assessments Enlighten urself with knowledge
Lot of time to study lots of books
Warm up for the grand finale
E.g.
Prepare materials to study in finals
20% of total marks
Theory- all except internal medicine (Prof. JPA planning from ur batch)
At basic science
Don’t cheat (strict, no adv, can ask fren) e.g.
One fren in gyne Practical- medicine, gyne, pediatrics OSCE in gyne, peda (write it down early coz
they recur in final OSCE)
Clinical examination-practice
Before assessment- medicine only
Systems- neuro, respi, GI, CVS
Get urself ready with all necessary kits
Divide topics among frens and practice in group on frens
Before finals- all subjects Standard books- macleod, hutchison’s
Most imp time- most fruitful, u think u now know a lot
Cool, a bit of apprehension is good Adequate time for study All will pass; even some fail once, reexam
very soon e.g. gyne-next day, ophthalmo- no reexam
95% ur hand Rest in
Now n then stealing beautiful moments- oranges
FINAL
DO OR DIE NO COMPROMISE OR U WILL REPENT LEAVE NO STONE UNTURNED TAKE RISKS BUT CALCULATE
BEFOREHAND
THEORY 8 papers how to prepare?
Before exam: Know probable questions- different
techniques
Time constraints Only revise important topics Be armed to the teeth e.g. knowledge, admit
card, stapler, ballpens, scale, pencils, eraser, sharpner
Exam hall- what to do now?
Read questions carefully- carefully- carefully- medicine complications?TOF; question papers prone to error so clarify
No panicking if u don’t know the answer if not heard e.g. Noonan’s syndrome
Answer orderly (examiner point of view)- can write PTO if paper not filled in the end
or Write the best answer first with diagrams n
illustrations if possible e.g.Davidson’s
Write first page slowly with good handwriting(1st impression is the last impression)
Time mgm is life mgm (80 marks in 180 minutes or 40 marks in 90 mins so divide) i.e. 2 min for a mark then 20 mins for review or if some questions left behind
Diagram if possible
practicals
12 exams 3 blocks 4 exams in each block 2-3 days gap in each block
Easier Teachers helpful Cool Follow instructions Minors don’t usually fail if u do major good Be ready with summary and comprehensive
diagnosis
Internal medicine
Long case; Short case For cases; Fully equipped e.g. neuro kit Findings ask seniors on morning note (not urself,
not admission note) Time mgm (don’t know when they turn up) Less- so imp. Hx n exam to be done More- comprehensive diagnosis n summary, few
more details, possible questions Formal clean attire No duel; “sorry” “I don’t know” “I am confused sir”
OSCE (no revision class; u l know at exam hall or outside somehow; 20 spots: xrays, ECG, ABG, cases)
Vivas- easy; same questions in a day so ask previous frens against rules
psychiatry
Long case n viva-format imp Don’t worry; residents helpful Nice experience Format Depends on teacher
dermatology
OSCE n viva Easier Revise limited imp topics Later students know cases but use what is
between ur ears e.g. leprosy and bullous pemphigoid
surgery
Long case Short cases- 4 (7mins each short time)-
challenging OSCE (15 questions, revision classes imp.,
no chance of cheating) Vivas-3
Short case e.g. inguinoscrotal swellinghernia or hydrocele
Hx- occupation; swelling- onset, progression (reducibility), duration
If hernia i.e. reducible- irreducible, pain, fever If hydrocele i.e. trauma, pain, loss of testicular sensation Examination- Inspection: site, no, shape, size, extent, skin overlying Palpation: pain, temp, no, shape, size, surface, get over swelling, expansile cough impulse; hernia: ring occlusion test after pt. reduces himself;
hydrocele: fluctuation, transillumination Supine while pt himself reduces; test on standing
position
orthopedics
OSCE- 5 questions along with surgery OSCE Case- easy
anesthesia
Only vivas Drugs, instruments Same questions for the day so later students
are lucky to know the pet questions
dental
No spotting this time n last time Only long case Instruments Easy- follow format Depends on teacher
Gyne/ Obs
Long case-
format imp. Short case OSCE- 20 questions, revision class ,no cheating,
easy vivas-2 superclassic topics e.g.FP,CS No failure; all pass Take books- read ur case until teachers turn up
pediatrics
Long case Short cases- 2 (one neonate very imp) Vivas- cool (from PRS book) No hanky panky; follow instructions strictly No need to be afraid of stern teachers PRS sir’s book n handouts is a must
eye
Long case- ward usu Short case- OPD OSCE- 5; very easy coz help available
ENT
Best exam system – very difficult to fail Long case- 30 Short cases- 10,10 OSCE- 10 Viva-40 (ear- 1Q, nose- 1Q, throat- 1Q, xray-
1Q, procedure- 1Q, instrument- 1Q) from Prof Shrivastav’s book mostly
Don’t quote Dhingra as source
Community medicine
Prepare report as soon as possible now in Jr. internship
Unscientific evaluation Don’t confront at table at individual level;
later whole batch can talk to HOD Be open tell what u know
Practical tips
Class by interns very very effective e.g.by Dr. Naresh, Nabaraj, Madan
Discussion important topics every night in small circle of frens e.g.
Very imp materials
Notes: undoubtedly Exam Format: Piryani’s Medicine review: Rumi 25th batch OSCE solved: esp for gyne peda and others Drug dosage chart Ur kits for practical exams e.g. neuro kit,
measuring tape, growth chart
e.g. books n topics
Any textbook but prepare notes in copy K & C- arrhythmias ECG made easy Neurology- stroke/ parkinsonism/ multiple sclerosis/
approaches e.g. peripheral neuropathy Harrison’s- coronary artery disease/ infective
endocarditis/ epilepsy Kundu- for revision, in beginning don’t waste much time;
short cases; very impractical theoretical points e.g. breath sounds
NTC manual- few pages
Contd..
Medicine Prof. Raut’s note Prof. Arun Sayami (if he returns to department) Surgery examination videos Growth chart Nutritive value of common food Prof. PRS handouts (respi, GI, probable questions) Forceps, and delivery videos by Rumi and Sagar.
Best of luck
At the end, rejoice
Have a blast!!!!!!!!!!!!!!!!!!!