Obstetrics and gynaecology (+ psychiatry) final exam experience

So I had obgyn final on the 18th and psych final on the 19th.

Obstetrics and gynaecology final

We got an e-mail the day before that the exam would start at 9. The examiner was Péter Gőcze. We drew four topics, two from ob and two from gyn, and sat down to prepare. I drew good topics, in my opinion. These are the questions I was asked.

10. Placenta praevia

I began by telling him everything I’d written down. He then begins asking questions.

  • Examiner: When a patient arrives outpatient clinic with a bleeding in the second half of pregnancy, not a heavy bleeding, and you perform ultrasound and diagnose placenta praevia centralis. The patient is around 30 weeks of gestation. What can you do?
  • Me: 🤷‍♂️ (What can you do? There isn’t really anything we can do to treat placenta praevia, right?)
  • M: I think we would just call the patient back later to see if it resolves spontaneously, but if it doesn’t, we should plan an elective C-section.
  • E: But the bleeding is not severe (I feel like I didn’t really understand what I said here). What can we do?
  • M: I stop and think for a moment because I have no idea. I go with a far-fetched idea.
  • M: Maybe we could give tranexamic acid to decrease the bleeding?
  • E: No, no. Something else. Sometimes contractions can cause bleeding. (What?)
  • M: Then maybe we can give something to decrease contractions, like atosiban?
  • E: That’s right. Let’s say the woman is 29 weeks of gestation, what can you give to prevent the very common problem of premature newborns?
  • M: Steroids to induce lung maturation.
  • E: That’s right. And also, you have to store blood in the institute which is compatible with the mother, because if the patient has heavy bleeding you have to perform an urgent operation, and may need transfusion. It’s very important to have blood available.
  • (It makes sense, I just thought that that was something which was always available, not that you’d have to proactively find and store it)
  • E: What do you think, what is the relatively common problem if the patient has a heavy bleeding?
  • M: So if the bleeding is severe enough it can compromise the circulation of the foetus as well, causing perinatal asphyxia.
  • E: Yeah, and?
  • M: It can also cause DIC in the mother.
  • E: That’s right. What can you do in case of the DIC?
  • M: It’s important to replace the clotting factors which are lost.
  • E: How can you do that?
  • M: It’s also a transfusion (I forgot exactly which blood product we use)
  • E: Yeah but which?
  • M: (I say the first that comes to mind) Prothrombin complex?
  • E: No.
  • M: Fresh frozen plasma?
  • E: Yes. Previously a lot of women died because of this. The problem is that we don’t know which phase DIC is in, and this is why the best way is to use fresh frozen plasma because it contains all types of factors. And blood. Fresh frozen plasma and blood, this is the best method to treat DIC.
  • E: Okay. What is your next topic?

20. Cervical incompetence; Etiology, diagnosis, therapy

Once again I begin by telling him what I’d written down.

  • E: What is very important to do before performing cerclage? What must we always do?
  • M: Once again I have no idea
  • M: We should supplement progesterone? Said in a tone of absolute doubt
  • E: No.
  • M: Thinking
  • E: If we don’t do it, we can get premature rupture of the membranes
  • M: So we have to rule out infection?
  • E: That’s right. It’s obligatory to make a culture. Only if the culture is sterile can we do a cervical cerclage.
  • E: What kind of other procedure can you do to treat cervical incompetence before pregnancy?
  • M: I’m pretty sure I’ve never heard of any such procedure. The only other thing I’ve read about which can treat cervical incompetence is progesterone supplement, so..
  • M: You can give progesterone supplement?
  • E: No, not that. There’s a surgical procedure which you can do.
  • He turns toward the other students in the room and asks them whether they’ve heard about it. No one responds. Eventually he gets up, walks toward a whiteboard in the room, and starts drawing and explaining.
  • E: So you cut out a piece of the anterior wall of the cervix, then you suture it. This forms a scar. It’s usually the anterior part of the cervix which is weak, and this strengthens it. It’s very effective but you can only do it before the pregnancy. During the pregnancy, the only option is cerclage, like you mentioned.
  • E: Okay. What is your next question?

3. Indications and methods of hysterectomy

Once again I begin by telling him what I’d written down (except the part about trachelectomy).

  • E: Do we always have to remove the cervix, or not?
  • M: Uhm…
  • E: Consider a young woman. You should know that after a total hysterectomy the vaginal prolapse can happen because of damage to the ligaments holding the vagina. And this is why we in young women often use the Chrobak operation. Have you heard about it?
  • M: No I have not.
  • Once again he asks the other students. No one responds.
  • E: Yeah, it’s when the cervix remains in place and we just remove the body of the uterus. It can be useful because the sexual function of the woman remains normal and prolapse of the vagina can be prevented.
  • Okay, so it’s just subtotal hysterectomy. Thanks for not just saying that.
  • E: Okay. Next question.

13. The criteria and potential complications of IUD

I kept this for last because I didn’t actually know that many criteria and complications. I told him what I’d written down.

  • E: Do you know the name of the IUD which contains progestins?
  • M: Well I know the name of those used in Norway, but I don’t know if they have the same name in Hungary. Mirena and Kyleena?
  • E: That’s right. What’s the indication of the Mirena? Why is it so popular? We can use not just for contraception, after all.
  • M: For endometriosis as well.
  • E: Yes, very good. And?
  • Here I kind of blank out. I knew of other indications for hormonal IUD but I just couldn’t recall any
  • E: Endometrial hyperplasia, for example. During menopause, as the progestin component. And dysmenorrhoea.
  • M: Yeah, of course.
  • E: Okay. I think it was good, but not excellent.

Finishing thoughts

So that was it. I got a 4 in the end. The exam took like 20 minutes.

I don’t think he mentioned the name of the pre-pregnancy operation for cervical incompetence, and I’ve searched for it but found nothing. We never had a lecture or seminar on cervical incompetence, so how would I know about this?

According to a helpful commenter, this is apparently “isthmorrhaphy“, which, from what I can find, is not exactly popular.

Regarding the “Chrobak operation”, from what I can find it looks like this term is almost never used (subtotal hysterectomy instead). Also, we never had a lecture or seminar on this topic either.

Regarding screening patients for infection before cerclage, this appears to be controversial, and UpToDate states that there is insufficient evidence to support that preprocedure culture improves outcomes.

So I’ve spent a lot of time and resources writing notes for this. I’ve used many sources, including lectures, UpToDate, and the Norwegian guidelines for obstetrics and gynaecology. When I spend so much time and effort studying something, and end up not being able to answer questions on the exam because certain things were never taught to us, is basically unfindable in other sources, or not evidence-based, it makes me disappointed and annoyed. But anyway, I’m glad I’m done.

Psychiatry final

We got the email from Tényi the day before the exam that we would start at 7:00. We show up, both 6th year students and 5th year students from all three programmes. Luckily, he deliberately allowed the 6th year students to have the exam first.

There’s not to much to say about the exam. During the practice you write two patient case reports. In the exam he asked me what the two diagnoses were (schizophrenia and anorexia nervosa), and he asked me to explain a bit about the anorexia case, which I did. I realise in hindsight that I spoke mostly about my impressions around the case rather than stuff directly related to psychiatry, but it was fine. He then started asking the usual rapid-fire questions, beginning with questions related to anorexia and eating disorders, before turning to other questions.

I answered all questions correctly, except that I forgot narcissistic personality disorder when listing the cluster B ones, but it was fine. I got a 5 in the end, and the exam took like maybe 5 – 10 minutes? It was a nice experience.

Next up

I begin my paediatrics practice in Pécs on Monday, which will be my only practice in Pécs (except for 1 week of internal medicince, as I could only do 7 weeks in Norway). Paeds is my next exam, but luckily that’s some weeks away still, so I can take it easier for a while.

Ob/gyn notes done

I just finished the last of the ob/gyn 1 topics. I already wrote ob/gyn 2 notes last semester, so now I’ve covered both semester’s topics. The topics in the ob/gyn final in 6th year are the same.

My ob/gyn exam is on the 18th, up until then I might still revise the notes as I read through them.

Surgery-traumatology final exam experience

I had the final exam in surgery-traumatology on the 28th of October (13:00). Me and another student waited outside the room which was written on Neptun (5th floor of 400 bed, to the right when you exit the elevator. Eventually the examiner fetches us into the seminar room (the same where trauma/surgery seminars took place). We draw topics, one from each of three envelopes, and are given time to prepare if we wanted.

There are separate examiners for the surgery part and the traumatology part. There’s no patient examination. While I had my surgery topics, the other student had her traumatology topics. The surgery examiner was Dr. András Papp. I did not catch the name of the trauma examiner.

After a few minutes of preparing, the examiner asked me whether I would like to start without preparation time to get over with it, and I was like “why not”. I believe I remember most of their questions, so here they are.

A12: Abdominal ischemia

  • Me: We can distinguish ischaemia of the large bowels and the small bowels
  • Examiner: What is the blood supply of the small bowels?
  • [damn anatomy]
  • M: The coeliac trunk, SMA, and IMA?
  • E: And the large bowel?
  • M: The IMA, and the superior rectal?
  • E: Nononono, the SMA and the IMA. What is the border between the two systems?
  • M: The ligament of Treitz?
  • E: Yeah. The median colic artery comes from the SMA but the left sided colic arteries come from the IMA. What are the symptoms if the patient has abdominal ischaemia?
  • M: Severe abdominal pain, which ..
  • E: At all time?
  • M: Not always, but if it’s acute, then ..
  • E: It’s always acute. Can you tell me the symptoms when it starts and as it’s going on, what starts to happen?
  • [I had no idea what he’s going for here]
  • M: It kind of depends on the etiology, if there is an embolism there’s a sudden, out-of-nowhere severe abdominal pain, which they say is “out of proportion to the physical findings”.
  • E: Okay. And?
  • M: They can also have haematochezia
  • E: They can, yes. Is the pain constant?
  • M: It gets more and more severe
  • E: And then?
  • M: Uhm..
  • E: And then there’s no pain. After a while it starts again, and keeps going until death.
  • M: Okay, I didn’t know that
  • E: It’s really characteristic. The pain at first is really high, and then it gets better for a few hours, and when it becomes necrotic and reaches the point of no return the pain progresses again. What can you do when there is abdominal ischaemia of the small bowel but it’s only a few cm of the jejunum involved?
  • M: You can surgically remove the necrotic part?
  • E: Yeah. And then? What is very important in this operation? Can we do the resection and the anastomosis and the patient can go home?
  • [no idea]
  • M: We should also look for the cause of the ischaemia. We can do some interventional radiological methods like thrombolysis or thrombectomy to remove it.
  • E: Thrombectomy is not radiological, it’s surgical. Yeah, we can do that also. We can also do a resection. But what I wanted was that the patient often needs a so-called “second look” operation, where we check again whether there is other necrotic parts.

That was the end of this topic. I got a 4 on it.

B34: Perianal abscesses and fistulae. Surgical management of hemorrhoids.

  • M: Okay so perianal abscess is often primary, so there’s some clogging of the perianal glands which causes a subdermic [yes I said subdermic] abscess that’s visible as a bulging out of the skin which is red and very painful, especially during defecation.
  • E: And what is the temperature of the patient?
  • M: The patient has fever as well.
  • E: Yes
  • M: And there may be an internal fistula as well, from the anal canal to the abscess
  • E: Yeah they almost always go together. We can say that an abscess is an incomplete fistula. In what kind of disease can we frequently find fistulas?
  • M: Crohn’s disease
  • E: Yes. What is Crohn’s disease?
  • [this question is made for me]
  • M: It’s one of the two inflammatory bowel diseases where we can have inflammation of the whole GI tract, most commonly the terminal ileum.
  • E: Yes. What are the surgical treatments of Crohn’s disease?
  • M: It’s mostly used for adhesions and in severe cases you might have to remove bowel which is inflamed and doesn’t respond to medical therapy.
  • E: Yes. What is the big difference between the surgical treatment of Crohn’s and ulcerative colitis?
  • M: For ulcerative colitis total colectomy is curative, but there’s no curative surgery for Crohn’s. Treatment for Crohn’s is mostly non-surgical.
  • E: Yes, and if we need it we resect only the part which is inflamed.
  • M: Yeah
  • E: Okay. Surgical treatment of haemorrhoids
  • M: So we classify internal haemorrhoids as 1, 2, 3, or 4, which …
  • E: What does the grade 4 mean?
  • M: It means that it’s not possible to retract it.
  • E: Yes, so it’s an absolute indication for surgery
  • M: Yes. So surgery is indicated for grade 4 and I think grade 3 as well
  • E: Yes.
  • M: The others are treated mostly conservatively. There are many options for surgical treatment, like sclerotherapy, banding, haemorrhoidectomy …
  • E: What is actually a haemorrhoid?
  • M: Haemorrhoids are pouches or pillows of dilated veins
  • E: Yes, so it’s actually normal, but if they cause symptoms then it’s a problem. Okay, one more question for the 5. What is the Dixon operation?
  • M: [after thinking] I don’t remember
  • E: Okay, it’s an anterior resection of the rectum with a primary anastomosis.

This was also a 4.

B7: Foot fractures and dislocations. Achilles-tendon injuries.

  • I was given some extra time to prepare for the trauma topic. After a few minutes the trauma examiner asks me if I’m ready
  • M: I think I’m okay with achilles tendon injuries, but I find foot fractures and dislocations a bit difficult, but we can start.
  • E: Actually I think the achilles tendon injuries are the most important anyway. So you can start with this
  • M: Okay. So the achilles tendon is the largest tendon and injury of it is common in sports
  • E: Which types of sport?
  • M: For example sports where you have rapid turning and acceleration, like basketball, football, sprinting, volleyball, etc.
  • E: Yes
  • M: The patient often feels like someone “kicks” them at the tendon when it snaps. And they lose the plantarflexion, which we can examine with the Thompson test.
  • E: What is the Thompson test?
  • M: It’s when you have the patient prone, you compress the calf, and you see whether the foot is plantarflexing or not. If it doesn’t, it indicates achilles tendon injury.
  • E: Yes
  • M: So it’s controversial whether it should be treated surgically or conservatively …
  • E: Actually let’s talk about diagnosis. Which modality is good?
  • M: Ultrasound, or MRI.
  • E: Yes. Usually the ultrasound is enough.
  • M: You can also palpate a gap in the tendon itself
  • E: Yes. So treatment?
  • M: So like I said, it’s kind of controversial whether surgical or conservative is the best.
  • E: What do you think, which is better?
  • [he’s a surgeon so the answer is obvious]
  • M: I think surgery
  • E: Yes
  • M: Yes, probably because the recovery is quicker. It involves repairing the tendon, sometimes you might need a graft.
  • E: If the injury is fresh then you can just suture it. What can we do after the surgery?
  • M: Proper rehabilitation is important
  • E: Yes, very important. In which position is the rehabilitation?
  • M: What do you mean by which position?
  • E: Like, which leg position.
  • [guessing time]
  • M: In plantarflexion
  • E: Yes, usually in the first 3 weeks. And after that?
  • [no idea]
  • M: Probably mobilisation and physiotherapy?
  • E: Yes, but in which position?
  • [guessing time 2]
  • M: Dorsiflexion?
  • E: Yes. And after 6 weeks?
  • [I’d run out of ankle positions so idk]
  • M: I’m not sure
  • E: After 6 weeks the patient can take off the brace and start to walk. Okay, please give me some words from the foot fractures.
  • M: Okay, so the most common is the talus and calcaneus fracture.
  • E: Okay, yeah [hesitating a bit]
  • [instant anxiety due to the examiner’s hesitation]
  • M: They can be due to high energy trauma like car accident, or falling from a height. So they can sometimes be bilateral. There is local pain, and there can be plantar ecchymosis.
  • E: What can you see if somebody has foot fractures?
  • M: You could see a deformity of the foot, and the patient cannot walk on it.
  • E: Perhaps a haematoma?
  • M: Yes, and swelling.
  • E: Okay. Diagnosis?
  • M: X-ray, maybe sometimes CT as well.
  • E: Okay. Could you tell me something about the toe fracture? I think those are more frequent fractures.
  • M: There are some named fractures, I’m trying to remember. Is Jones fracture on of them?
  • E: No, Jones is a 5th metatarsal fracture. Tell me about the toe fractures.
  • [I’d thought that toe fractures include metatarsal fractures but apparently not]
  • M: So they can be due to direct trauma. The patient will experience pain, difficulty walking …
  • E: And the treatment?
  • [idk]
  • M: I would say it probably depends on if there’s dislocation or not and how severe the fracture is. If not dislocated and not severe then we can do conservative, if not then maybe we need surgery.
  • E: Actually only when the 1st toe is dislocated is when we use the surgery. In other cases it’s conservative, no matter the dislocation.

And that was it. 4 here as well.

Done

So that was it, a 4 in total. It took probably 10 – 15 minutes excluding prep time. They both had calm, non-confrontational voices, and at no point did I feel like I was close to failing, which was nice.

I’m still annoyed, though. Most questions were simple and straightforward, but some were explained as a single sentence in a single presentation in one of the three surgery subjects we’ve had (second-look operation), hidden among a wall of text on lecture (characteristic pattern of mesenteric ischaemia), or never written in lectures at all (the position and timing of casting after achilles tendon rupture, fractures of the toes). I’m annoyed because I put so much time and effort and went through so much stress to prepare for this and write notes, only to have an exam which was relatively non-difficult but still being asked questions I could probably never be prepared for. But that’s not new here, unfortunately.

Changelog

I’ve added a changelog page, where a list of the 30 most recently added or modified topics are listed. Hopefully this makes it easier to keep up with changes.

You can find the link to the changelog in the sidebar.

End of 10th semester exam period

Here is the previous post. Unfortunately, I have bad news regarding the biyearly statistics. Sometime in March this year, the website started getting spammed, and it still is, every day. I don’t know why or how, but it happened. This luckily doesn’t cause any problems for the website, but it does skew the statistics because these spam visits are indistinguishable from visits from actual people. I’ve tried to implement measures to decrease spam visits, but they haven’t helped.

Because of these spamming bots, the visit count has increased drastically this semester, with the majority of visits now being from bots rather than actual humans. This makes it impossible to compare to previous semesters and to know the actual interest in the website. I’ll show you.

Statistics

As usual, a page “visit” refers to opening a single page on greek.doctor. A “visitor” is a unique person within that day. This graph includes the page visits from the week before the beginning of the semester until the last day of the exam period.

I’d say the numbers are valid and realistic up until the middle of March. Before the semester began there were approximately 400 daily visitors and 1300 visits. In the beginning of March, the number was approximately 500 and 1600, respectively. However, after the beginning of the spamming there are approximately 700 visitors and 16 000 visits every day. Note also the spam peak on March 9th, with 43 900 visits.

Search engine referrals are probably unaffected by the spamming. The numbers are pretty similar to last year.

These are the last 20 search words people used before ending up at greek.doctor.

This statistic is one of the stronger proofs that the website is being spammed. It is the top 10 visitors of the website today. Compare it to the top 10 visitors from before the spam.

The top 10 visitors used to mostly be from Hungary, use modern browsers, and have sensible visits (hits) per visitor.

Comments

Time for a few fun comments!

I’d mixed up “WHO” and “HIV” (I think) in the topic. From public health 4

I hope the statue turns out nicer than this. From what to study.

I hope he or she never did drag their balls anywhere. From Anaesthesiology and Intensive care exam experience

People close to me know how much I dislike this type of questions. From B5. Intersexuality, gonadal dysgenesis

Hopefully we can salvage some parts. Maybe a finger or two, and a ureter? From 70. Mechanisms and disturbances of bone remodeling. Osteoporosis, osteomalacia

Next semester

I plan to write notes for some of the subjects in 6th year. I’ll write a new post soon with which subjects I’m going to write for and when.

Until then, enjoy your summer!

My summer

In Norway, 6th year medical students can be hired to do doctor work, mostly in wards. There are very few positions available, much fewer than the number of students who are interested, so getting hired for a position is more of an exception rather than a rule.

I was extremely lucky this year and actually got a position! My position is at one of the bigger hospitals in Norway, Akershus University Hospital, which you might recognise from a certain tiktok. I’m going to be working 7 weeks in the cardiology ward, doing rounds on patients, discharging patients, doing paperwork, etc. I had my first day yesterday, but today was the first day where I was responsible for my own patients. I’ve gotten this period accepted as my 6th year internal med practice.

On this day I:

  • Wrote my first ever prescription
  • Did my first ever rounds
  • Wrote my first ever application to the state for sick leave for a patient (who had an AMI)

However, I also managed to:

  • Introduce myself as “Nikko” to one of the chief doctors
  • Say “sorry for crushing your dreams” to a nurse who asked me if she could measure NEWS less frequently, making my collegues laugh at my choice of phrasing
  • Misunderstand the computer system, making me think that blood culture on a septic patients had not taken for no good reason (while in reality they were taken)
  • Need to work 1 hour overtime to get done with all my tasks

… but it’s all good, because a nurse told me that she thinks I’m doing a good job.

Obstetrics and gynaecology 2 exam experience

So I had my gyn 2 exam on Thursday. It began at 8:00, before which we’d been waiting outside the building where ENT lectures and ob/gyn seminars took place. At 8, a woman comes and tells us to follow her to one of the seminar rooms. We were only 5 students who took the exam that day and so we were all allowed to prepare simultaneously, inside the room. Each of us drew two topics randomly, one from each pile. I drew A9: Cervical cancer, symptoms and diagnosis and B7: The most common childhood gynaecological disorders, the first of which was very good and the second which was meh. I was the fourth person to have the exam, and all exams took place in the room where we were preparing. The examiner was dr. Bálint Farkas.

A9: Cervical cancer, symptoms and diagnosis

I began with this topic as it was by far my strongest one. Dr. Farkas had the lecture on this and I’d watched that lecture, so I felt that I knew exactly what he wanted to hear. I began with an introduction of cervical cancer, with special emphasis on it being a “controllable” cancer as he’d put it himself in the lecture. I continue with the risk factors and symptoms, as I’d written it down.

I then talk about the pap smear, emphasising how it’s a cytological classification, and basically saying what I’d written down. Before I get the chance to talk about CIN, he asks me what CIN is, so I continue with that. Basically continuing with what I’d written down.

He asks me “what could be the treatment of a stage Ia1 cervical cancer?”, to which I answer “conisation”. He then says “yes, and what if the patient does not desire pregnancy?”. I answer “then we can do total hysterectomy with bilateral salpingo-oophorectomy”, to which he agreed. He had no other questions to this topic, and we continued to the next.

B7: The most common childhood gynaecological disorders

(You can tell that I didn’t really know what to talk about here. Also, I wrote the stuff about dysmenorrhoea in the middle of the paper after my exam, to remember what he told me.)

This was a much less confident topic of mine, as I don’t really know what to talk about here (which is why I’d written down so much random stuff during prep time). I began with vulvovaginitis, basically saying what I’d written down about it and nothing else. I pause for a bit as I’m pondering what to talk about next, until he interrupts my thinking with the question “what is dysmenorrhoea?”. I reply that it’s painful menstruation. He then asks what primary and secondary dysmenorrhoea is. I’d never read anything about primary and secondary types, so I didn’t really know. I guessed that endometriosis was a primary type, to which he said that that’s rather a secondary type. At that point I understood that primary probably meant idiopathic, so I said just that, which he agreed with. He starts explaining how primary dysmenorrhoea may be related to learned behaviour from family somehow. He then asks for causes of secondary dysmenorrhoea. I repeat endometriosis, and after thinking for a bit I say fibroids, to which he agrees. He then asks, “what’s it called when endometriosis invades the uterine wall?”, to which I respond “adenomyosis”, which he says is another cause.

He then says “there are two other causes as well, but you’re probably not going to guess those. They are cervical stenosis and intraabdominal adhesions”. He was right about me never going to guess those.

At this point my exam is already over. He says that this was excellent, and the co-examiner shoots with a “this should be a 5+”. Dr. Farkas tells me to “keep up the good work”, which was a nice ending to the exam period.

Finishing thoughts

I was super lucky with my A topic. I think I got off the hook easily on my B topic because I did so well on my A. In either case, he was quite nice and understanding. To be honest, when he entered the room he seemed to be in a bit of a bad mood, but it turned out that he wasn’t at all. Everyone who had the exam that day got good grades, even though all of us said some really wrong stuff (something about micropenis in Turner syndrome) and sometimes needed a lot of help to getting to the right answer.

That marks the end of my 5th year, and the end to my last ever “conventional” exam period, which I am eternally grateful to be done with.

Neurology 2 exam experience

I had my neuro 2 exam today. The exam would start at 9 according to neptun, but the day before we got an e-mail that it would start at 8 instead. The exam was at the rehabilitation clinic next to the neurology department. The examiner was my teacher in Neurology 2, the course director of the subject, prof. Endre Pál.

I was one of the last persons to go in. I draw topic 28, with obstructive sleep apnoea syndrome and Huntington disease. We got a few minutes preparation time if we wanted, during which I made this:

28A. Obstructive sleep apnoea syndrome

I mentioned what I’d written down about OSAS. He asks about two indexes which are measured during polysomnography. I guessed one of them, the apnoea index. He told me that the other one is the oxygen saturation index. I don’t think I had any other questions on this topic.

28B. Chorea, Huntington disease

I begin by defining chorea, and mentioning the most common causes. He asks me what a stroke-induced chorea looks like, and I said hemichorea, which was correct.

I then talk about Huntington, just basically what I’d written down. He asked me which diseases it’s important to rule out in case of Huntington, and he remembered he’d mentioned in the seminar that it’s important to rule out Wilson and Parkinson. He asked how we could do that, and I answered serum/urine copper and ceruloplasmin for Wilson. For Parkinson I said SPECT or PET, which he said was a possibility. He asked me what Parkinson disease patients respond to, and I answered levodopa, which was correct. He said that in ambigous cases we could give levodopa to the patient. If the symptoms improve, it’s PD, if they worsen, it’s HD.

He asked me what anticipation was, which was funnily enough something I learned in genetics two weeks ago. I explained that it means that the disease becomes worse and worse with each generation, to which he agreed. He asked me a couple of other questions as well, but I don’t remember what. In the end he gave me a 5.

Finishing thoughts

Prof. Pál is a very kind person, a good teacher, and an excellent examiner. The atmosphere of the exam was calm, he was not strict, and I’m pretty sure he passed everyone that day.

My last exam is gynaecology on Thursday.