osce 2016

1. A&E
An elderly lady collapsed at the hospital parking. The guard calls you for help.
There was a mannequin on the floor, wearing jacket.
– BLS 2010
– must open the jacket!
– Pt unresponsive, no pulse. Proceed.
– Show me how you give rescue breaths.
– Until when do you do the 30:2 compressions? When help arrives, when aed arrives and when pt has pulse.
– How often to you feel for pulse? 2 minutes, ie after 5×30:2
– If pt has pulse what do you do? Check for breathing, no breathing, give rescue breath every 5-6s.
– Do you know how to use the AED? Tell me.
– If the rhythm is shockable, what do u do next? Ensure pt is clear, deliver shock dan cont compressions.
– If the rhythm unshockable what do u do next? Just immediately cont compressions.
– Tell me the criteria of good chest compressions (mention the five from bls protocol).
Branula insertion on mannequin
– Which vein would you like to insert? Dorsal metacarpal vein, but in this mannequin, i would take the cephalic vein.
– Proceed with insertion and give me a running commentary.
3. EYE
Visual acuity assesment. Room is 3m, with floor markings 1m, 2m, 3m. Mirror at 3m. Snellen chart at 0m.
– tricky bit, where to stand the pt. At 0m!
– right eye 6/6. Left 5/60 (6/18 pinhole)
En Ahmad had MVA. Assess the GCS. (standardised patient lying on bed)
– Only open eye with verbal stimulus. E3
– Confused, said his name differently, etc. V4
– Able to obey command. M6
Gcs 13.
– This is a trauma pt, what xray would you like to order?
– Would u do CT and why?
CXR – Tension pneumothorax
– Give 3 abnormal findings
– Diagnosis
– What is your immediate mx to save the pt?
– Describe how u do the procedure
This pt, u/l DM. Came in with SOB. Dx with pneumonia.
pH normal but on higher side
PaO2 low
PaCO2 low
Hco3 normal
BE normal
– comment on the ABG
– what immediate mx
7. EYE
Fundus photo. Pt dx with DM.
– 3 parts labelled, name it.
– What is your dx. Proliferative Diabetic retinopathy
– Give 3 eye threatening cx from this condition.
– Give 2 ocular mx for the condition.
8. ENT
Exhibit 1: Picture of tympanic membrane with multiple vesicles.
Boy, hearing loss 3 days.
– Describe the findings.
– What can cause it? Give 2
– How would you treat (non-surgical)
Exhibit 2
2 y/o with flat watch battery stuck in one of the nostrils.
Xray of the head.
– How would they normally present.
– Give 2 complications of the condition.
VIDEO: Baby 4 mnth cough non stop. Barking cough.
– What is your dx
– What vaccine prevent this from happening
– 4 mths old, how many doses of vaccination that he should have received?
10. PCM
Pt dx with bronchial asthma. Prescribed with mdi salbutamol. Teach him inhaler technique.
X-ray shoulder dislocation.
– what is your dx?
– do neurovascular exam
– what specific nerve do you need to test. Axillary nerve
– how do u test axillary nerve. Sensory on deltoid muscle.
– how would u mx the pt? Consent, sedate, analgesia, cmr, redo x-ray to confirm placement.
12. PCM
Pt previously healthy. 1 week cough with sputum. Bronchial breathing on right upper zone. Not tachypnoiec or tachycardic.

Communicate about his cxr findings and answer his questions.

– cxr Right upper zone opacity.
– pt: do i need to take meds?

13. ENT
Weber and rinne test.
– tell me your findings.
– what objective hearing test can u do
14. A&E?
Pt dengue fever. Symptoms described on question paper. slightly low bp, tachycardic. Hb 11, wbc low, plt low, hct high.
Pt needs admission. Convince her to admit.
– pt refuse.
– got children at home
– husband not around
– drive to hosp
– etc
15. PSY
Pt on tx for epileptic psychosis. She has been talking to herself.Ask her about hallucination sx.
16. O&G
Teach the pt how to use fetal kick chart.
–  this fetal kick chart is different from the usual pink book one.
–  must mention when to seek for medical attention.
Pt is 34 week pregnant. Reduced fetal movement. Keep asking why my baby not moving. Is it normal. What are the causes?



Thank you

Dear UM MBBS final year students,

Its exam months again,

My blog received huge traffic lately and Im grateful that it serves its purpose.

I hope those who are sitting the exam ,can control your nervousness and answer the question calmly.

I am also delighted to received feedback from some of you who actually would like to help contributing to this blog.I appreciated your help and kindness.May Allah rewards your kindness.

I have to say that the exam question this  and last year did not change much from my time.Some of the questions are still repeated.If you dont believe me,do the statistic on your own…you can find the past years question in my blog!


the Unlucky Student

Sharing : Circular on career advancement through parallel pathway.

Dear juniors and House Officers, if you are interested in pursuing a career in Internal Medicine, please allow me to share some of my experience.
I’d decided to pursue a career in Internal Medicine since the first year of medical school. The students’ book vouchers during 4th and final year were used to acquire books needed for the preparation of MRCP(UK) exam namely
1. Essential Revision Notes for MRCP by Philip A. Kalra
2. Oxford Specialty Training – Clinical Medicine for The MRCP PACES Volume 1 & 2
(Should have also bought Rapid Review of Clinical Medicine for MRCP Part 2 by Sanjay Sharma)
We passed MBBS final exam in early April, leaving us with about 2.5 months of final freedom before working life (housemanship training). After spending 1 month on farewells & vacations, I had 1 month of free time to go through those books without much pressure, underlining and picking up the points.
My first posting of housemanship training was Internal Medicine, busy and with steep learning curve but it served as a great stepping stone for the adventure ahead. Second was Obs & Gyn, chasing days and nights for the compulsory performed procedures (LSCS, ERPOC, vacuum). Thank God that I was able to make time to go through another round of Essential Revision Notes and Oxford Handbook as well for the Nth time.
My third posting was Surgery, requested, arranged and approved. It turned out to be a relatively friendly posting to concentrate on Part 1 preparation (day and night of answering PasTest past year questions and reading Oxford Handbook & Essential Revision Notes again) throughout the posting.
Fourth posting was Orthopaedics, the easiest with the least stress, again requested, arranged and approved. Stepping up the intensity of final phase of preparation, I spent the first 2 months of posting answering PasTest past year questions, reading Oxford Handbook and referring to Medscape, whether at work or at home.
The 4 months of PasTest subscription allowed me to answer the whole question bank of 5100+ questions for 3 times – first round by question number, second round by specialties and third round by past year papers, with the rate of minimum 175 questions per day, at times up to 300+ questions per day. While going from question to question, I was blessed to have the access to Oxford Handbook and Medscape for me to referred to repeatedly.
I sat for Part 1 exam in September 2014 and results was released in October 2014. I spent the last month of fourth posting going through Rapid Review of Clinical Medicine for MRCP Part 2, a book with 400+ scenarios covering most important major topics with excellent explanation.
My 5th posting was Paediatrics. I was blessed to be able to complete all exams, assessments and compulsory performed procedures (intubations, LPs, UVC) within the first half of the posting, leaving me with 2 months to concentrate on Part 2 exam preparation. The preparation was almost similar, going through the Rapid Review and Oxford Handbook few times, Medscape PRN, PasTest questions, CPGs, published trials and studies, google images on CT, MRI, ultrasonography, ECG, echo, dermatological conditions and so on. By the end of 5th posting I had submitted the form and updated MOH on passing Part 1 exam.
Final posting was Emergency & Trauma. The final phase of intensive preparation continued. Application for transfer was submitted early in the posting as well, where I coupled the application forms with Part 1 results to increase the odds of being assigned to tertiary centre and start Internal Medicine training & subspecialties rotation as a Medical Officer.
I sat for my Part 2 exam in July 2015 and the results was released before my transfer, upon completion of the 2 years housemanship training.
In short, my suggestion is to start early. Get the books ready once you pass final exam. You are eligible to sit for the Part 1 exam after 1 year from the date on the certificate of passing final exam or completion of course. Take a short break and graduation trip, then start preparing for Part 1 exam, especially when the waiting time to be given a post in housemanship is getting longer currently. Go through Oxford Handbook of Clinical Medicine and Essential Revision Notes for MRCP at least 2-3 times, subsequently by the 2nd / 3rd posting you can start subscribing for online past year questions bank / package, about 4 months before the exam. Go through the whole collection of question 2-3 times and revise along the way. Once eligible (3rd / 4th posting depending on your waiting time to start housemanship), you will be prepared to pass the Part 1 exam, subsequently update MOH on passing it through this form coupled with the certified copy of exam results, as soon as possible. Start preparing for Part 2 exam, repeat the whole routine again – going through Oxford and Rapid Review of Clinical Medicine for MRCP Part 2 few times, the whole question bank 2-3 times over the 4 months subscription, Medscape, CPGs and Google Image PRN. By 5th or 6th posting you are ready to pass Part 2 exam. Subsequently you can start training as Medical Officer and prepare for PACES exam from day 1 itself.
However, passing exam is not everything. Have faith, enjoy the beauty of life and the presence of our loved ones. Cheers

from FB Raphael Schee Jie Ping

Random notes..credits to Raphael Schee Jie Ping

Oral Antihypertensive, Dyslipidaemic & Antidiabetic agents
Brand names – Generic names :

Adalat – Nifedipine

Norvasc – Amlodipine

Coversyl – Perindopril

Cozaar – Losartan

Diovan – Valsartan

Micardis – Telmisartan

Micardis Plus – Telmisartan/Hydrochlorothiazide

Cozaar XQ – Amlodipine/Losartan

Hyzaar – Losartan/Hydrochlorothiazide

Exforge – Amlodipine/Valsartan

Twynsta – Telmisartan/Amlodipine

Co-diovan – Valsartan/Hydrochlorothiazide

Caduet – Aorvastatin/Amlodipine

Zocor – Simvastatin

Lipitor – Atorvastatin

Crestor – Rosuvastatin

Lipanthyl Penta – Fenofibrate

Actos – Pioglitazone

Glucobay – Acarbose

Diamicron – Gliclazide

Riomet – Metformin

Januvia – Sitagliptin

Galvus – Vildagliptin

Trajenta – Linagliptin

Onglyza – Saxagliptin

Forxiga – Dapagliflozin

Victoza – Liraglutide

Janumet – Sitagliptin/Metformin

GalvusMet – Vildagliptin/Metformin

Trajenta Duo – Linagliptin/Metformin

Kombiglyze XR – Saxagliptin/Metformin HCl extended‐release

Whenever I see / clerk new cases and plan management for patients, this is the basic general template that I employ :

    -Intubate or not ?
    -NBM or not ?
    -Target SpO2 (British Thoracic Society guideline)
    -Target BP
    -Target MAP
    -Target CVP (Surviving Sepsis Campaign guideline)
    -IVD regime
    -Pulse rate
    -Temperature trend
    -ABG (pH, PaO2, PaCO2)
    -VBG (pH, HCO3)
    -Serum ketone
    -Serum lactate
    -As necessary
    -eGFR & dose adjustment
    -Include DVT prophylaxis
    -Include stress ulcer prophylaxis
    -Chest physio
    -Limb physio
    -Incentive spirometry
    -TED stockings
    -Bedsore prevention
    -Occupational therapy
    -Speech therapy swallowing assessment
    -Imaging / Radiology
    -Bedside real time – ECG, echo, IVC, US ± Doppler
  8. Scoring system/criteria for risk stratification & prognostication
    -SIRS criteria
    -TIMI risk score
    -ABCD2 score
    -CHA2DS2-VASc score
    -Ranson / Glasgow scoring
    -Wells scoring for DVT & PE



Cefobid – Cefoperazone
Fortum – Ceftazidime
Rocephin – Ceftriaxone
Keplex / Ceporex – Cefalexin
Zinacef / Zinnat – Cefuroxime
Zinforo – Ceftaroline
Maxipime – Cefepime
Claforan – Cefotaxime
Zerbaxa – Ceftolozane + Tazobactam
Sulperazone – Sulbactam + Cefoperazone
Standacillin – Ampicillin
Beamoxy / Betamox / Ospamox – Amoxycillin
Unasyn – Sultamicillin : Sulbactam + Ampicillin
Tazocin / Tazpen / Tazrobida – Piperacillin + Tazobactam
Augmentin / Curam – Co-Amoxiclav : Amoxycillin + Clavulanic acid
Invanz – Ertapenem
Tienam – Imipenem + Cilastatin
Meraparon / Meronem / Monem – Meropenem
Klacid – Clarithromycin
Zithromax / Zmax – Azithromycin
Avelox – Moxifloxacin
Ciprobay / Ciprox – Ciprofloxacin
Dalacin – Clindamycin
Zyvox – Linezolid
Flagyl – Metronidazole
Trimexazole – Co-trimoxazole : Sulfamethoxazole + Trimethoprim
Combivir – Lamivudin + Zidovudine
Kaletra – Lopinavir + Ritonavir

Adalat – Nifedipine
Norvasc – Amlodipine
Coversyl – Perindopril
Cozaar – Losartan
Diovan – Valsartan
Micardis – Telmisartan
Micardis Plus – Telmisartan + Hydrochlorothiazide
Cozaar XQ – Amlodipine + Losartan
Hyzaar – Losartan + Hydrochlorothiazide
Exforge – Amlodipine + Valsartan
Twynsta – Telmisartan + Amlodipine
Co-diovan – Valsartan + Hydrochlorothiazide
Caduet – Aorvastatin + Amlodipine

Zocor – Simvastatin
Lipitor – Atorvastatin
Crestor – Rosuvastatin
Lipanthyl Penta – Fenofibrate

Actos – Pioglitazone
Glucobay – Acarbose
Diamicron – Gliclazide
Januvia – Sitagliptin
Galvus – Vildagliptin
Trajenta – Linagliptin
Onglyza – Saxagliptin
Forxiga – Dapagliflozin
Victoza – Liraglutide
Riomet / Glucophage – Metformin
Janumet – Sitagliptin + Metformin
GalvusMet – Vildagliptin + Metformin
Trajenta Duo – Linagliptin + Metformin
Kombiglyze XR – Saxagliptin + Metformin HCl extended‐release
Humalog – Lispro
Lantus – Glargine
Levemir – Detemir
Novorapid – Insulin aspart

Calcijex / Rocaltrol- Calcitriol
Bonviva – Ibandronate
Fosamax Plus – Alendronate + Cholecalciferol


I need feedback from final year repeat MBBS UM

Its been a long time since my last post.

My blog’s visitors increase from time to time…especially in this month where final year mbbs UM repeaters drop by to look for infos and guide.

I wish all of you pass your exam in next attempt.To moslem,remember your prayers,no one can help you except Allah.He will do His magic and wonders if you ask from him.No other way.

Consistently study and work smart.Lastly just pray and asked from Allah for the best outcome.

p/s: i need my juniors to contribute something to my blog…i know there are many silent readers out there,but if you do contribute and share infos about the exam,inshaallah …please write to me tsatellitec640@gmail.com

To those who aspire to be physician…the key is to always be humble..

Personal testimony :

I was a mediocre C-graded pre-clinical medical student and an average B-graded clinical student in Faculty of Medicine, University of Malaya. I had never won any Dean’s list award or book prize. I was never in the top 10% of my batch. Still I was blessed to pass the final exam, blessed to complete the course on time for a MBBS degree.

The very first posting of my Housemanship in Kota Kinabalu was Medical posting in Queen Elizabeth Hospital 1. It was a rough start where I practised to insert IV branulas, central venous catheters (PICCs, IJCs), lumbar punctures, pleural & abdominal paracentesis, intubation and so on. It was a posting which I could have at most 2 proper meals per day, started working by 5.30am and punched out after 10.30pm (if not past midnight into the next day). It was also a posting which I scored less than 60% in the end-of-posting written exam and had to go through viva exam to pass the overall assessment. Survived it at the end. It was challenging, yet fruitful; steep learning curve, yet enabled exponential growth.

Second posting was Obs & Gyn in Likas Hospital (SWACH), where we had to conduct 10 SVDs, performed 5 episiotomies, assisted 3 LSCS & 1 Gynaecological procedure and pass the end-of-tagging viva assessment within 14 days in order to pass tagging. Subsequently we had to perform at least 1 LSCS, 2 vacuum deliveries and 2 ERPOCs to fulfil logbook requirement and to avoid being extended in the posting. Yet still, I was (and few other friends) marked as failing the end-of-posting written exam by a MO-in-charge and thus a potential 3-month extension in the posting. However God always works wonders in various miraculously ways. The graceful Specialist-in-charge decided to gave us a second chance with 70% passing mark. It was a fair exam with fair questions, therefore most of us passed. Survived the posting at the end.

Third posting was Surgery in Queen Elizabeth Hospital 2. I enjoyed the whole package that the posting offered : ward duties, outpatient clinics, visiting trip to other district hospital, workshops and seminars. We were not too stressed about the logbook requirement as we only needed to performed 1 compulsory open appendicectomy. The end-of-posting written exam was an open book exam that lasted 8 hours of which all of us passed. However my viva exam was a shameful + hilarious experience. I was given 5 minutes for relevant history-taking, 5 more minutes for bedside physical examination, followed by a 30-40 minutes discussion with assessor. I managed to get by the physiology, biochemistry, pathology, microbiology, investigations and basic managements part but totally made myself a joke in the Anatomy part where I couldn’t even sketch a basic hepatobiliary system. Still God granted me a graceful specialist as examiner and I was allowed to survived another posting again. The second half of this third posting was also the time when I took the leap of faith, registered for MRCP(UK) Part 1 exam even though I was nowhere near ready for it, subsequently subscribed PasTest online revision package and started serious preparation for the exam.

Fourth posting was Orthopaedics in Queen Elizabeth Hospital 2. Memory of the first 2 months of posting was kind of blurred as all that I could remember was 100% focused, day-and-night exam preparation. I was in Green (Foot & Ankle) team, the team with the most patients but least HOs. Still thank God we only need to take care of 10-15 patients each daily with other routine ward works and procedures that we were already familiar with. By the beginning of the third month of posting, I sat for the Part 1 exam after 3+ months of serious preparation. I wasn’t nearly as prepared as I expected myself to be and the first attempt was a horrible experience. Still, God works wonders in various miraculous ways and I survived that attempt even though I still have no idea how. The results was released within the same posting. The end-of-posting written exam was almost a walk in the garden thanks to the circulated past year questions. All in all it was a relatively easier posting without much obstacles.

Fifth posting was Paediatrics in Likas Hospital again. After passing Part 1 exam, I was on cloud nine, at times full of myself, forgot how low I had started and how hard God had pulled me through. I even got ahead of myself, planning to start serious preparation for Part 2 exam to secure a safer pass while simply get by the Paediatrics posting from day 1 onward. Pride comes before the fall, sure enough. I failed my end-of-tagging assessment with subsequent 1 week tagging extension. It was a massive hit that brought me down to earth again, rearranged my focus at that moment and started paying attention to the posting. From there on, with God’s guidance, the remaining of the posting was a smooth sailing. I managed to pass tagging reassessment, NRP theory and megacode exam, end-of-posting written exam and clinical exam smoothly while completing all logbook requirements of 3 successful neonatal intubation, 3 successful lumbar puncture & 1 successful UVC insertion, all by the first 2.5 months of posting. This enabled me to spend the last 1.5 months of the posting on Part 2 exam preparation with 100% focus at full speed.

Sixth and the last posting was Emergency in Queen Elizabeth 1 & 2. It was a busy, stressful yet fruitful posting where we could apply our head knowledge in daily practice. The whole posting was also spent on Part 2 exam preparation while fighting fatigue and escalating stress level. Still the end-of-posting exams were quite a challenge – written exam with 70% passing mark and Moulage on ACLS + ATLS. Thank God that I managed to survive both exams without much preparation. Again, thanks to God’s blessings and guidance, I managed to get myself ready in time and sat for the Part 2 exam in the last month of the posting, the last month of my Housemanship. The results was released within 4 weeks and God had granted me a safer pass.

Just a simple sharing on my journey through 2 years of Housemanship and MRCP(UK) Part 1 & 2 exam. Dear friends, colleagues and juniors, I was and am never nearly as good as I ever wanted to be, yet. I’m not better or smarter than you or other colleagues. I’m just average like many others. In fact, there are always medical students, HOs and MOs out there who are far more superior than me. Yet with hard work, self-discipline, dedication and proper preparation, it is possible, step by step we can accomplish. I’m still not good enough, I’m still learning as well, I’m still working my ass off to improve myself day in, day out. Thankfully, His grace is sufficient for us, for His strength is made perfect in our weaknesses.It is not about what we can achieve but what He can accomplish in us and through us. At times, we just have to take that leap of faith, give our very best, and God will take care of the rest.

God is good, all the times;
All the times, God is good.


Copied from FB Raphael Schee Jie Ping

For Future Doctors: How Much Do Doctor’s earn……………..?

Pagalavan's Avatar

One of the common questions I get asked via email and this blog from SPM/STPM leavers is as above. Just recently I had an SPM leaver asking me how much do a heart surgeon earn? From the random survey that I have done looking at these questions, I can only say one thing: majority are only interested in medicine for “good money, good future and good life”, a general misconception. And the reason why many want to become Neurosurgeons and Cardiothoracic Surgeons is also for the same reason: they feel that these are the highest earners in medical field!! Despite explaining many times in this blog, I still get these questions asked to me on a daily basis.

Thus, I thought of writing a separate “thesis” on this topic. Someone asked me a few days ago, how much do I earn as a Rheumatologist? Frankly if I were…

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