Pulmonology, Infectiology, Medical Genetics, and Endocrinology exam experience

The exam dates for these four exams this semester lined up perfectly the first exam week to allow for taking all of them in one week. They’re all written exams, so there’s no dignity to be lost in case of a fail, and I’d learned a bit during the semester, so there was a reasonable chance of passing, and I knew I’d probably never need a C chance for them, so the idea was that I had nothing to lose and everything to gain by trying. My plan was to try all of them.

I don’t have much to say about each of them, though.

Pulmonology was the first, at 14:00 on Tuesday. The questions were mostly mediocre, as is standard in POTE written exam. We got the grade at 12 on Thursday. I got a 4 somehow.

Infectology was the second, on Wednesday. Like pulmo, the questions were mostly mediocre, but I somehow got a 4 again. They’d told us that the rules regarding written exams is that the tests have to “quarantine” for 24 hours before correction can start, which is why we’d get our grades in 48 hours. They stayed true to their words, and we got the grade at 12 on Friday.

Medical genetics was the worst of the bunch. It was at 8 on Thursday. Questions about stuff I’d never heard of before, questions I had literally no idea about. I was pretty sure I’d failed, but I somehow got a 3. Funnily enough, the department of genetics didn’t know about the “rule” infecto talked about, and so we got our grades later the same day, Thursday at 12.

The last of these were Endocrinology, which was at 12 on Thursday as well. This was, in my opinion, the least bad of the four. I walked out of there with a pretty good feeling, and got a 4. We got our endo grades at 15:00 on Friday. The head of endocrinology, Emese Mezősi, was present and she made some funny comments and had a relaxed attitude, which is unusual for teachers in higher positions. After reading the rules of the exam out loud, she said “don’t worry guys, the exam is easy”.

All in all it went well grade-wise, but it was very tiring to have to study hard every day with no rest in-between. I know at least four people who followed the same plan (except having public health final on Monday instead of psych, which is an even bigger achievement). It went well but I don’t think I’d recommend this to others.

Psychiatry 2 exam experience

Psych 2 was my first exam of this semester (excluding family med on Friday week 14, which was easy), and it was the first in a line of 6(!) exams in the first exam week. I’d studied for it with the Anki throughout the whole semester, and I’d reviewed all of it in the 2 days before, so I was pretty well prepared.

It was raining, and I was super nervous ahead of the exam, as before all oral exams (especially the first of the semester). The sound of pouring rain woke me up at 7 and I couldn’t fall back asleep.

I met the other international students and a bunch of Hungarian students under the roof outside the entrance to the Psychiatry department a little before 9. A while after 9, a Hungarian-only speaking secretary comes out and gives us some information (which the Hungarian students there had to translate for us). She then shoots our foreheads with the temperature-gun (which showed 34 degrees for me).

After a while we’re allowed to enter the corridor, and we wait in front of the library of the psychiatry department, where we’re supposed to have our exam. At some point prof. Tenyi arrives and basically repeats the information the secretary gave, and tells us that the exam will be short questions and answers like last semester.

At around 9:45, 45 minutes late, he starts taking in the first students. There were to be two students in the room at the same time, the one who is to be examined and the one next in line. The other student sat inside and waited their turn, and was allowed an opportunity to answer questions the “main” students couldn’t answer.

The Hungarians were the ones to line up first, partly because the information was given in Hungarian first, so the international students were examined after the Hungarians were done.

I was the third international student in line, so I was in the library listening to the second international student’s exam. There was one question they couldn’t answer completely, which was “Which are the two diagnostic criteria for schizo-affective psychosis?”. They couldn’t answer the question, so Tenyi asked me if I knew the answer, but I didn’t. That student got approx 8 – 10 questions, missed only that one question and got a 4.

My turn. Short questions and answers, as usual. I answer all of them well, until he asks one question I was not prepared for. “What’s the name of the self-help group for alcoholics?” My immediate first thought was “Alcoholics anonymous”, which was the correct answer. He then asks “how many steps are there in their program?”, which I had no idea about. Apparently this is something many had learned from TV and stuff, but I didn’t know. I answered that I didn’t know.

He continued asking me questions, all of which I could answer well. I’m pretty sure I got more than 10 questions, more than the previous student, which I thought was because he wanted to give me an opportunity to climb up to the 5. However, after something like 15 questions, he tells me that it’s a 4.

A bit disappointed, seeing as how I was well prepared and that there was only one question which I couldn’t answer, I asked him if we could continue for a 5. He agrees, continues asking 4 – 5 questions, all of which I answer correctly. In the end he gives me the 5.

All in all a nice exam experience, although the stress and anxiety level was high beforeheand. The experience was the same as for psych 1.

Internal medicine

I’ve been in a bit of a pickle lately. There are a few topics in the four internal medicine subjects we have this semester which I want to write notes for, but I don’t have time to write all topics in all those subjects, and I don’t want to upload a subject to the website if I’ve only written a few of the topics (looking at you haematology). Haematology really bothers me.

I’ve decided the best way to do this is to jumpstart the notes for internal medicine final in 6th year, seeing as that subject contains the most important topics from all internal medicine sub-specialties. For now, only the pneumonia topic is there, but I plan to write a few more topics in endo, infecto, pulmo, and/or nephro as well. The topics are based on this semester’s lectures, so they should be relevant both for the internal medicine exams this semester as well as for the final on 6th year.

This semester’s notes and Anki

This is the link to this semester’s notes and Anki. The only notes there are neuro 2, and I probably won’t write for any other subjects. The neuro 2 notes are getting close to finished. When they’re almost finished, I’ll upload them to the website like normally, and do the last edits directly on greek.doctor.

For the first time, I’m making Anki flashcards. I’ve made flashcards in these subjects:

  • Nephrology – based on lectures and seminars
  • Neurology 2 – based on my notes
  • Paediatrics 2 – based on questions
  • Infectology – based on lectures and seminars
  • Psychiatry (same questions as last semester)

You’re welcome to use them if you want. Every time I add new cards I create a new file in the folder. Download the file and import it, and the new cards will be added to your Anki.

April 1st fun

I didn’t do any pranks for april 1st this year, but I wanted to do something fun anyway. Every day greek.doctor receives many spam comments, mostly phishing ones which try to trick you to click a link in the comment. I thought it’d be fun to reply to those comments as if they were real.

Many of the spam comments are obviously targeted for personal blogs and politically motivated ones, which greek.doctor are not, which makes for some funny situations where the comments are very unrelated from the topic they’re commenting on. Some comments are very generic and could fit virtually any personal blog, some try to push medications or vaping, and some push explicit services.

I’ve edited out the phishing information from the comments by replacing them with XXXXX. The topic they’ve commented on is at the top of each picture.

That’s all for now. Until next time!

End of 9th semester exam period

This is the moment at least two of you have been waiting for for almost a year! See also the previous post if you’d like to compare.

Page visits

As usual, a page “visit” refers to opening a single page on greek.doctor. A “visitor” is a unique person within that day.

These are the page visits for this semester, which began at September 7th, and a few days preceding it. Not surprisingly, the numbers are lower in the days preceding the semester, at around 200 visitors and 800 visits per day. Then, the semester began at September 7th, after which visitors numbers and visits suddenly increase to around 400 visitors and 2000 visits.

There is a very nice sinusoidal pattern in the first weeks of the semester, with much higher visitor numbers and visits on Monday – Wednesday, with numbers dropping off the rest of the week until the next Monday.

Visitors and visits remain relatively stable in the first 7 weeks, as people are generally on low gear in the first half. Classically, people start panicking around the 7 week mark, after which a higher gear is assumed.

There is a small peak at November 12th, but I don’t know why. I don’t have good insight into which pages were actively used during that day, but I think pathophys pages were most active. Could it be the day before pathophys 1 midterm? Was there even a midterm this semester?

Page visits peaked during this period on December 13th, at 7701 visits, the day before the beginning of the exam period. I’m certain that more cramming of information occurs on this day than on any other day of the exam period or semester. And then, in the afternoon hours of December 14th, most of the information was probably forgotten.

Page visitors peaked on January 12th, for reasons I don’t know. There were 1204 visitors that day.

Numbers were low at December 31st and January 1st, at 3000 visits and 500 visitors.

Since last post, we’ve passed 1 000 000 page visits, and we’re already over half way to 2 million!

I think it’s safe to say that the notes for third year subjects are the most popular. These numbers only account for the visit to the parent pages of each subject, not the child pages of each subject. The results are kind of messed up because I moved all subjects to their respective years sometime during the summer (I think?), which is why you see both /pathology-1/ and /third-year/pathology-1/ in this list, even though they’re the same page.

Looking at the number of page visits from search engines is fun, because there’s a much smaller correlation between them and the semester at POTE than there is for other metrics. I assume this is because most POTE students don’t use a search engine to find greek.doctor. Most search engine referrals are from people searching for medical terms and ending up here.

There are the last 20 search words people used before ending up at greek.doctor. This is one of my favourite metrics; I love looking at what people are looking for before ending up here. I hope they find what they’re looking for.

These are the countries from where the last 10 visitors were from. There is a bit of variety, which is cool!

This list shows the number of visitors from each country during the semester.

This list shows the number of visitors from each country during the exam period. It’s very interesting to see the large variety, although it’s no shocker to see that Hungary is at the top by a large margin. Hungary would probably have won by an even larger margin if most of us didn’t travel home to have our online exams from home.

Comments

It’s time for a few comments! There are now 1362 comments, of which 600 are mine, leaving 762 comments for others.

Grammar > correctness. From here
Everything sucks, but everything is also amazing. From here
Appreciate your local cobras. From here
“Bro, can you spend hours and hours writing notes for me in a subject you hate?” “Bro, no”. From here
This was very sweet! I love getting comments from non-POTE students as well. From here.
It’s not every day you get to explain pathology to one of the world’s most famous wrestlers. From here
I love this. From here
When a topic gets too personal. From here
The week 12 fatigue sets in early. From here
This term would probably confuse a german Karotte as well. From here
The flascard will remain unupdated. From here
Probably the most frequently asked question at POTE. From here.
Sorry, David. From here
welc. From here
Important discussions in the comment section. From here
Fun fact: I initially wanted to study in Germany, for which you need to pass a B2 level German exam. I learnt German but in the end only passed 1/4 language exams, causing me to end up in Hungary. Damn you past me for not studying German enough! From here
I don’t think many people have heard of the Marvel super hero Ball Fondler. The name is unlucky but when his first comic was released in 1986 testicle fondling wasn’t invented yet so the term referred to fondling of golf balls. True story! From here
Maybe they thought I’d hear their comment better? From here

Results of maintainance

Maintainance went pretty smoothly. Some technical jargon ahead:

The server was running ubuntu 16.04, which was EOL soon (April?). It’s now upgraded to 20.04, which is supported for 4 more years. I’ve also hardened the server a bit. I was planning to make a good automatic backup solution during the maintainance, but there wasn’t enough time for me to finish it. That shouldn’t require downtime, though.

Next semester

I don’t know which subjects I’ll write notes for this semester yet. I’ll let you know, though.

Planned downtime for maintenance

I need to do some maintenance work on greek.doctor. However, unlike Neptun, I’ll try to do it when the website is not in heavy use. So, I’m scheduling maintenance for:

Friday 5th of February at 17:00 to Sunday 7th of February at 23:59

That’s at the end of the extra exam week, so no one should need greek during those days.

This is the first time I do this, so I have no idea how long it will take, but I don’t think it will actually take that long.

I’ll wait with the statistics until after the maintenance, in case anything interesting to write about occurs during the downtime.

Paediatrics 1 exam experience

So I had paeds 1 yesterday. The day before, at around 9:00, everyone who were to have the exam got an email stating the examiner and the time of everyone’s exam. Our examiner was to be Dr. András Tárnok, and my time was 9:10. According to the email, we were to call the examiner at our designated time. There were 20 minutes between each student’s time, so we knew upfront that each exam would last maximum 20 minutes.

So 9:10 yesterday, I called him on Teams, and he answered. He asks my ID, which of my names to use and whether I’m in Hungary.

He holds up the cards with the neonatology topics in a fan-shape. He asks me where to pick from. I tell him to pick somewhere in the middle, and out comes the first topic: “Persistant pulmonary hypertension of the newborn. Patent ductus arteriosus.” He asks me if it’s alright, to which I reply that it is.

  • Examiner: Can you start with the second part? Patent ductus arteriosus?
  • Me: Okay, so the ductus arteriosus is an embryonic structure which connects the truncus arteriosus with the aortic arch, so it allows blood to avoid the lungs in embryonic life. Persistant ductus arteriosus is when it doesn’t close early after birth.
  • *During these sentences he was writing something down, so he didn’t notice, or at least react to, my mistake regarding truncus arteriosus.*
  • E: So is it good or bad?
  • M: It’s not good, because, if it’s very small it might be asymptomatic, but if it’s large it may cause symptoms.
  • E: What symptoms?
  • M: For example, uhm, dyspnoea, or tachycardia.
  • E: Okay.. Please tell me, where is this little blood vessel? What does it connect to?
  • M: It connects the truncus arteriosus to the aortic arch.
  • E: Truncus arteriosus?
  • M: No, no, the pulmonary trunk, sorry.
  • E: So there’s a connection between the pulmonary artery and the aorta. Now think about it, if you have a connection between the systemic and the pulmonary circulation by this little thing, what is going to happen?
  • M: The pressure is higher in the aorta, so it’s like a left-to-right shunt.
  • E: Okay, so what’s going to happen with the lungs then?
  • M: They will experience more blood than they normally do
  • E: So then what is going to happen?
  • M: Pulmonary hypertension.
  • E: Good. Do I need to ask questions or would you like to make sentences yourself?
  • M: Well, I can try to make sentences but I appreciate some help if I need it.
  • E: You’ve already received help. *we laugh*
  • M: Yeah, so this is not a good thing, pulmonary hypertension is not a good thing. Uhm, where should I continue. It can be closed either pharmacologically or by percutaneous procedure. Pharmacologically you would use an NSAID like indomethacin or ibuprofen.
  • E: Okay. Why do we indomethacin?
  • M: It works because prostaglandins are what keep the ductus arteriosus open
  • E: It’s much nicer to have it explained like that, so if you now it, just say it so. It’s so easy. Prostaglandins are what keep it open, so if I give something which inhibits prostaglandin synthesis, it will close. If that doesn’t help, we have the surgical option. If not percutaneous we must perform a thoracotomy and put a clip on there. Good. Clinically, what do you see apart from tachypnoea, or whatever. Is there anything else on physical exam?
  • M: Uhm, they may experience respiratory distress.
  • E: Is it the cause or the consequence?
  • M: The consequence.. Uhm, on physical exam there is a murmur.
  • E: Okay, we’re approaching. Tell me the characteristics of that murmur.
  • M: I can’t recall actually..
  • E: When do you hear it?
  • M: After systole, I would suppose…
  • E: Where does this murmur generate?
  • M: Where? Oh, uhm, I would guess the turbulence in the pulmonary trunk?
  • E: Ehm, we’re going down to basics, to year three now. So if we do auscultation at the heart, you know that different sounds are produced in different cycles of the heart-beat. In this scenario, what do you think?
  • M: Second heard sound?
  • E: What is the problem [of the PDA]? Nikolas, tell me. Where is the problem?
  • M: The problem is the pulmonary hypertension.
  • E: No, the problem is the connection between the two circulations by this tiny little blood vessel. This is the problem, this is the PDA, yeah? And where is this?
  • M: Between the aortic arch and the pulmonary trunk.
  • E: Is it outside or inside the heart?
  • M: Outside.
  • E: Okay. Does it have any connection to the valves?
  • M: Uhm, no, not directly.
  • E: Okay. So if it’s outside the heart, and it’s not connected to the valves, then what is the characteristics of this murmur? Because, in the heart, if we have a systolic murmur, or a diastolic murmur, it is connected to the phase where the heart is beating. And because the valves are open and then closing, this is going to give you the first and the second heart sounds, yeah?
  • M: Yeah
  • E: Now, this tiny blood vessel has no valves in it at all. So, how would you characterise it?
  • M: Uhm..
  • E: Does it have any relation to the heart cycle?
  • M: Oh, uhm.. no, I would suppose not.
  • E: No. So, what is the charactisterics of this murmur?
  • M: So it’s constant throughout the heart cycle.
  • E: It’s continuous. Because it is going to happen all the time, from the high-pressure area to the low-pressure area, and you will hear this sound because it’s a thin connection, therefore, when the blood is flowing through a narrow part, it is going to produce the sound. Where do you hear this? Is there a typical site where you can hear this?
  • *Somehow it just occured to me*
  • M: In the left infraclavicular region.
  • E: Exactly, exactly. So if you suspect it you put your stethoscope there, and you try to hear. It’s called a continuous type of murmur. It doesn’t have an end, because there’s no valve to put an end to it, where the blood flow is stopped. Okay?
  • M: Yeah.
  • E: Okay, so now that I’ve explained you this topic, we need to move on to the second one, I don’t want you to get in trouble with the persistent pulmonary hypertension, okay? I do not wish to explain more of that. So all-together this is a 3 at the moment.

Not a great performance by me thus far, but he’d been very nice about it. We were around 11 minutes into the exam. He hold up the topics for general paediatrics and asks me where to draw from. I ask him for a card from the middle again, and he draws out the second topic, “diabetes mellitus”. “Is it better?”, he asks. “That is better”, I reply.

  • E: Now. No interruptions, nice sentences, brief summary.
  • M: Okay, so. In childhood, still diabetes type 1 is the most common, but of course type 2 is becoming more and more common, but I’ll focus on type 1. So type 1 is mostly an autoimmune phenomenon, where there’s autoimmune destruction of the beta cells causing them to have insulin deficiency. There are many antibodies involved in this, like anti-insular cell, anti-… Oh, well I guess I just remember that one. Glutamic acid something, there’s an enzyme, GAD or something. Okay, anyway. So a child may present with typical symptoms of diabetes type 1, or they can present with ketoacidosis. The typical symptoms of diabetes type 1 are weight loss, polydipsia, polyuria.
  • *He hold up three fingers*
  • E: Another “p”. [Like, another symptom on “p”]
  • M: Uhm..
  • E: They eat a lot.
  • M: Sorry? [I couldn’t hear what he said]
  • E: They eat a lot.
  • M: Polyphagia.
  • E: Exactly.
  • M: Yeah, they have to make up for the lost glucose. And weight loss, even though they eat a lot. Or maybe they wouldn’t gain as much weight as their eating habits should’ve made them.
  • *He nods*
  • M: Okay, where was I? Symptoms, uhm.. So, the diagnosis can be made in multiple ways. Fasting plasma glucose, HbA1c, OGTT, random plasma glucose.
  • E: Okay.
  • M: So if the HbA1c is above 6,5%, or the fasting is above 7 mM, or the random is above 11,1 mM, or the OGTT is above 11,1 mM, all of those are diagnostic for diabetes.
  • E: How do you determine that there’s no insulin?
  • M: You look at the C-peptide level.
  • E: What is that?
  • M: Sorry?
  • E: What is the C-peptide?
  • M: The C-peptide is the peptide which is released simulatenously as insulin from the beta-cells.
  • E: How? *slightly dissatisfied face*
  • M: No, it’s actually a part of the prepeptide of insulin, which is cleaved off to make the C-peptide and the insulin.
  • E: Exactly. Good. *very satisfied face* Treatment?
  • M: The treatment is insulin injections.
  • E: How? Once a life I give an injection and it’s done?
  • M: Sorry?
  • E: Is it like a jab? I give it once a life and it’s done?
  • M: No, it’s daily. There are multiple regimens to do this. They often use once or twice a day a long-lasting insulin, and before meals that can take some short-acting insulin.
  • E: Where do you give it?
  • M: You give it in the abdominal fat.
  • E: So how is it administered?
  • M: With, uh…
  • E: Or *where*?
  • M: Oh, subcutaneous.
  • E: Yes, okay. Why don’t we give IV?
  • M: Well it’s because it’s much easier for the patient to inject themselves subcutaneous than IV.
  • E: And, also? What is going to happen if you inject IV?
  • M: Everything is immediately into the blood stream, so it won’t be released gradually from the subcutaneous fat.
  • E: Okay. What is the prognosis of this medical condition? Are they going to be cured, ever?
  • M: No, they’ll never be cured. They have to do this life-long. And the exact prognosis depends on how strict they are with maintaining normoglycaemia to the best of their ability. Most of them will develop some diabetic complications, microvascular or macrovascular. Diabetic retinopathy, neuropathy, nephropathy.
  • E: Have you ever seen a type 1 diabetic patient?
  • M: I have some friends who are, but I’ve never seen it in a patient, no.
  • E: And your friends, just a personal question. Are they all right?
  • M: Yes, they are.
  • E: So they’re functioning well?
  • M: Yeah.
  • E: And that is the aim of the treatment. To have a normal life, kind of. What about restrictions in this medical problem?
  • M: So they should try to eat almost a constant amount of carbohydrates, because the amount of carbohydrates they eat must be balanced out with the insulin they take.
  • E: Okay. Have you heard of insulin that is somehow acting differently than the normal? That has an advantage nowadays in diabetic patients.
  • M: Are you talking about like a pump?
  • E: Pump is okay, yes, but anything else you have heard? Because you said, it has to be given the short-acting before the meal, yeah? What if I don’t feel like eating? I’m not hungry. And the insulin is already in my body. What’s going to happen?
  • M: You would get hypoglycaemia.
  • E: Can you give me any ideas what it can cause?
  • M: In the worst case it could cause a coma, but in …
  • E: And death.
  • M: And death, yeah.
  • E: So you lose consciousness, you’re going to have seizures. And you lose contact with the environment. Now, have you heard about so-called insulin analogues?
  • M: Yeah.
  • E: Insulin analogues are good because you can give them after the meal, because they’re much faster. So it can be paired with the carbohydrate input. So if you don’t know, because you have a bit of tummy pain or sickness-feeling, and you don’t feel like eating that much, you can balance it to the amount you have eaten. And it’s not going to disturb your blood sugar level that much. Okay. All right. Nikolas. That was 5. I’m happy. So all together, it’s a 4. Okay?
  • M: Okay, yeah, I think that’s deserved.
  • [I meant to say that that’s more than I deserved but I was so nervous and said the wrong thing]
  • E: Okay, Nikolas, please look at those neonatal stuff, because we can lose patients with persistent pulmonary hypertension, or not discovered PDA can cause long-term problems. It’s a significant question which you’re going to fail at the final if you have big gaps, okay?

I said thank you, we wished each other a good day, and with that I was done with this exam period.

He was very nice and compassionate, and was smiling and nodding along during the whole exam. I’m glad I had him as my examiner, although I’ve heard that all examiners in paeds are very nice.

I had an amazing idea before this exam. I’d start an exercise session on my smartwatch so I could monitor my heart rate during the exam. I had to choose the type of exercise. I chose “gardening”, because “having exam” was not an option for some reason. Here are the results!

“Du gjorde litt ekstra!” means “You did a little extra!”, which is nice.

My “gardening session” started 08:56, 14 minutes before my exam started, so the exam started 14 minutes into the gardning. At that point, my heart rate peaked at a comfortable 155 bpm. I suppose the sudden drop was because of how calming the examiner was. I don’t know what happened toward 24 minutes; the HR sensor probably dysfunctioned. At around 25 minutes I drew my second topic. At around 33 minutes my exam was done. Fun stuff!

Now that I’m done with my exams I’ll upload my neuro and paeds 1 notes to the website as usual. At the end of exam period I’ll return with the fan-favourite: statistics (I promise!).

Good luck to those who aren’t finished yet, and congratulations to those who are finished!

Obstetrics and gynaecology 1 exam experience

So I had obgyn 1 yesterday. The day before me and the other 14 students who had the exam were added to a new team on teams. There, the secretary Dora Szigeti wrote a message that at 8:00, we would receive our topics, and when it was our turn, the examiner would call us. Another student asked her who our examiner would be, and she answered “Dr. Bálint Farkas”.

At 8:00 the next day, we all joined the meeting. There, the secretary gave us some more information, about how all students will at least get 30 minutes preparation time. She then drew one A topic and one B topic for each of us, in alphabetical order by last name. I was the eighth student to draw topics, so I knew I would be the eighth student to have the exam as well.

My topics were: A7 – Prolapse of the foetal cord and limb, and B3 – Placenta accreta, increta, percreta.

She told us that while we prepare we must leave our cameras on but microphones off, and we could leave the room and eat and drink as we wanted, no need to ask for permission.

Because I knew the alphatical order, I could tell when my turn was coming up, which was nice. I was the eighth student, so my exam began at 10:40 when Dr. Bálint Farkas called me. He began asking for ID, and then left me to explaining my topics. I began with my A topic.

I began by telling him everything I’d written about umbilical cord prolapse (except the differentials). After I’d mentioned perinatal asphyxia, right before I was going to mention the management, he asks “What would you do about it if you diagnosed this on the labour ward. What would be the management?”. I continued with what I’ve written about management. He said “OK”, so I continued on with what I’d written about foetal limb prolapse. He said “OK, next topic”. So there were no questions to this. I continued on with my B topic.

I’d written the pelvic diameters in the corner because I’d heard that someone else was asked about that before me.

I tell him everything I’d written. He had no questions to this topic either, but began asking me general questions, where my performance wasn’t exactly excellent.

  • Examiner: Can you tell me other causes of postpartum bleeding?
  • Me: Uterine atony, is the most important cause.
  • *I couldn’t recall any other causes*
  • E: What does “cotyledon retention” mean?
  • M: It means that one or more cotyledons have been retained in the placenta (I meant to say uterus), so that not all of the placenta has been expulsed in the third stage
  • E: What is uterine inversion?
  • M: It is when the uterus sort of prolapses out of the cervix
  • E: Can you tell me a reason for that?
  • M: I don’t know a reason for that.
  • E: It can be artificial if you pull the cord without the placenta detached, so it brings the uterus with it, or if the cord is too short, so it pulls the uterus with it. It’s very painful and causes very heavy bleeding.
  • E: What is the so-called Crede manouevre?
  • *He actually sent me the word “crede” on message because I couldn’t understand the word*
  • M: Is it the one where they return the inversed uterus?
  • E: No.
  • M: Then I don’t know.
  • E: It’s a maneouvre to fascilitate the detachement of the placenta through the abdominal wall. You squeeze it out like a plum.
  • M: Okay.
  • E: Do you know what the Ritgen maneouvre is?
  • *Once again he sent me the word “Ritgen” on message*
  • M: No, I don’t recognize that name either
  • E: So you’re not really a maneouvre guy, are you?
  • *We laugh*
  • E: Okay. It’s when you grab a sterile towel and hold the perineum when the head is deflexed to protect the perineum.
  • M: Okay, I had heard of that, I just didn’t know the name.
  • E: What is an episiotomy by the way?
  • M: It is when you cut the perineum to increase the opening of the birth canal, either midline or slightly oblique.
  • E: Yeah. How many stages of layer do you know?
  • M: Four.
  • E: How many movements does the foetal head do during normal labour?
  • M: So it begins with descent, …
  • E: No
  • M: Engagement, descent, and flexion at the same time?
  • E: Flexion, okay.
  • M: Yeah flexion, and then internal rotation, and then the head extends out of the birth canal, and then the external rotation back, and then the anterior shoulder and then the posterior shoulder.
  • E: Yeah, okay. What is shoulder dystocia?
  • M: It is what occurs if the shoulder has not been born, so to say, in the same contraction or the contraction after the contraction where the head was born. So it’s a form of mechanically obstructed labour.
  • E: What can you do about it?
  • M: Operative delivery, so foreceps or vacuum
  • E: No, the head is already out.
  • M: Oh no, yeah of course. You do the, uhm.. I don’t remember the name of this maneouvre either, but you pull the legs of the mother, and put pressure on the pelvis somewhere, to try to help the shoulder out.
  • E: So where would you put the pressure on the pelvis?
  • M: On the symphysis
  • *I was only half-sure that symphysis was the right answer, which is why I didn’t specifiy where to put pressure initially
  • E: On the symphysis, yeah? To remove the stuck shoulder. The manouevre is called McRoberts. What if that doesn’t work?
  • M: I remember there’s a list of possible managements. I don’t think.. You can also cut the clavicle or the symphysis of the mother, but I don’t think that’s the next stage..
  • E: Those are drastic movements …
  • M: Yeah, there is another movement you would rather do before that.
  • E: Cutting the symphysis of the mother, wow. Cutting the whole urethra and bladder and everything. That’s a bloodbath, man.
  • M: Yeah..
  • E: I mean, one of my collegues who retired like 20 years ago told me about how they used to do that in the 1970s, but I haven’t seen it before.
  • M: I’m glad. I just remember that it was mentioned on the lecture. Uhm.. I’m drawing a blank. I remember there’s a different maneouvre but as we established I’m not good on manouvres.
  • *We laugh*
  • E: Yeah. I’ll give you a 4, okay?
  • M: Yeah, I’m happy with a 4.
  • E: It wasn’t bad, but it wasn’t excellent, yeah?

Completely deserved, although it’s annoying that they mention procedures on the lecture which apparently haven’t been used for 50 years.

My whole exam lasted 10 minutes. I spent almost exactly 5 minutes with my topics, and the remaining 5 minutes were used to uncover how little I knew about manouvres.

Either way it was a pleasant experience. He can sometimes seem a little intimidating but I was much less nervous during the exam than I was while waiting for it.

My last exam is paeds 1, on Friday. Looking forward to being done!