Exam Rants

Over and done with Paper A!! Woooootttttttttttttttttttttttttt!!!!!!!!!!!!!!!!!!!!!!!
It was a 3 hour paper and I started really slowly at the beginning, making my way through less than 1/3rd after the first hour. I then realized I had to speed up and somehow managed to finish the rest of the paper within the next 45 minutes.. -_-''. I have such crap time management skills....

Just 2 more papers to go now. Below is all that I can remember of paper A.

Anesthetics (5 marks)
List down the common methods of oxygen delivery in the ward. Compare their advantage/disadvantages

So basic nasal prong, hudson mask, venturi mask question.
Also we were told by kam Cyle this would be coming out :)))


Locomotor
This was more like an ED question rather than a orthopaedic question. A young male crashes into a passenger while on his bike and suffers a fractured right femur.
1. What is your immediate management? (5 marks)
2. He starts to develop fever & hypoxia. List down 4 causes.
3. Can't remember what 3 was... Oh investigations to rule in/out your differentials.

I don't think I did very well here... dang and I spotted red flags/yellow flags which have obviously been asked too many times.


Cardiovascular (10 marks)
Yay a repeat question I read up on right before entering the hall!!!!!!!!! Thanks Shalina!!!! And one that my buddy spotted right on :))

Explain the rationale of using ACE-Inhibitors, beta-blockers and spironolactone in heart failure patients.


Opthalmology
This was a mix of very hard and very easy questions.
1. A whole paragraph for us to fill in blanks!!!!!!!!!!!!!!! WOOTTTTTTTTTTTT!!!!!!!
Cataract is a disorder of opacification of the (blank). Patients usually presents with (blank) visual loss. Surgical treatment for cataract is normally performed under (blank) anesthetic.

Yeah you get the idea... until it got to this part - The most common cause of cataract is (blank). Erm.... is it aging???? Dieded.... its either aging or.... couldn't think of anything else so I said aging... -_-''

2. Explain each of these conditions and give an example of an ocular condition that illustrates it.
Variable expressivity, genotypic heterogeneity, phenotypic heterogeneity, limited penetrance.
4 marks ??????????????????????????????????????????????????????
And who said ocular genetics doesn't get tested!!!!!!!!!!!!!!!!!!!!!!!!!!!
Another -_-''

3. A diagram of an eye is given. Mark out the cornea, lens, optic nerve etc. Woottttttttttttttt!!!!!!!!!!!!

4. Clinical examination of strabismus. Explain your findings for a child with left esotropia.
?? Gave it my best shot... Hirschprung/red reflex and swinging torch light test?


General Surgery
A couple of repeated questions from osce and past years!!!!!!!!! Wootttttttttttt!!!!!!!!!!!!!!!!!
1. A pyloric obstruction question mixed with fluids I'm sure many would remember. Something about an immigrant from Hong Kong throwing up and losing weight for the past 4-6 weeks.
List your differentials (2 marks)
Pyloric obstructions secondary to gastric cancr or large peptic ulcer.
What would be his metabolic abnormality be (2 mark)
Hypokalaemic hypochloraemic metabolic alkalosis
What fluid would you use to replace/maintain him? (1 mark)
Normal saline with 20mmol K+
How would you monitor the fluid input? (2 mark)
Urine output, JVP, blood pressure, skin turgor etc

Can't remember what the last mark question was....

2. 4 scenarios about breast disorders e.g. fibroadenoma, breast carcinoma, abscess and gynaecomastia. The last question was funny. A 21 year-old guy presents with bilateral enlargement of his breast.
1. What is the diagnosis?
2. What would you consider before treating him surgically?
Erm.... Is he fit for surgery? erm... is he on hormonal therapy....? -_-''
Still don't know what the answer is. I'm guessing they're trying to elicit if the guy wants his breasts enlarged or not. Or maybe its something about liver disease?

Next was another pseudo-ED question. A motorcycle rider slams his bike against a lamp post. He had slurred speech and was confused etc
1. What is your initial management? (4 marks)
2. Hm... can't remember what this was.... I think it was about him getting fever and deteriorating with hypoxia. List 3 possible causes.
3. He is found to have both an extradural hematoma and significant intra-abdominal haemorrhage. Which one takes surgical priority?
4. How would you assess the level of consciousness in a comatose patient? What are the components in your assessment? (3 marks)
Tricky tricky.... I initially thought it was a neuro question. So my answer went something like this:

We could assess his brain stem reflex which comprises his pupillary reaction to light, dolls eye and caloric eye reflex. (hm... doesn't sound too suited to the question -_-''.... I better add something else.....)

Or alternatively we could obtain a Glasgow Coma Scale score. The components involved are eye movements, verbal response and motor movements.

Almost ran out of space on this one....... -_-''


Rheumatology
Again it wasn't SLE :((((((((((((((( I would have hammered that down to a T. What I thought was Reiters turned out to be AS instead -_-'' + :(((((
Well at least that's what some people said.

Part A: She presents with lower back pain and some arthritis.
Part B: Explain her diarroea. !!!!! (Enteropathic Reiters!!!!!!!!)
Part C: She presents with an acute red eye. What complication has developed and how would you manage it. (SCORE!!!!!!!!!!! Conjunctivitis as part of the Reiter's triad! Manage with ? Chloramphenicol).

Well in the end it wasn't Reiters so boo.


Endocrinology
You are a GP and you diagnose somebody with Impaired Glucose Tolerance.
1. What are the appropriate figures for this? Fasting and 2 hour Glucose Tolerance Test.
SCORE!

2. Name 2 clinical and 2 laboratory findings consistent with the metabolic syndrome.
I knew this one but almost tripped up. I didn't know where to put high blood pressure and initially had it under laboratoy findings with gout under clinical features -_-''. But then I changed that to hyperlipidaemia and hyperglycaemia so it was good. Clinical features truncal obesity and hypertension?

Next was a thyroid question. Someone presents with typical symptoms of hyperthyroidism.
1.What are the 2 most common cause?
Grave's and subacute thyroiditis

2.What two test would you do to distinguish between them?
Hm... I wasn't sure what they wanted so I had
a) Thyroid Function Test
b) Thyroid Peroxidase Antibody/ Thyroid gland isotope trapping rate
LOL I hope its not cheating...

3.What 2 classes of drugs would you start management initially?
CARBIMAZOLE & PROPHYLTHIOURACIL!!

These were all hinted (not too subtly....) by Braedvedt to be in our finals :))) Thanks!!!!!!!!!!!


Lab Med
Contrast the serology for hepatitis b between:
a. Acute vs chronic infection
b. Post-infection vs post-immunization.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Isn't this a 5th year question??????? And I'm just irritated cause I skimmed through this case a couple of days ago but couldn't remember the answer. ARGH!!!!!!!!!!!!!!!! And it was frickin 4 marks -_-''

2nd question was about anaemia. Go. (4 marks)
A middle-aged woman presents with low Hb and MCV.
1. List your differentials - Fe deficiency, chronic disease, dietary insufficiency, ?pernicious
2. Appropriate investigations to rule in/out your differentials - Gastroscopy, colonoscopy, antibodies to intrinsic factor, parietal cells.


ORL
I completely left out ORL and was relieved no SAQs was asked. Alan Fraser was a bit ambiguous regarding the form of ORL questions coming out earlier. Thank God............ :)


Pyschiatry
We got an email the night before from Tony Fernando informing us of the psych questions the next day. Thanks Lydia for letting me know!!!
1. Psychosis diagnosis and management
2. Anxiety disorder diagnosis and management
3. Primary insomnia diagnosis and management
4. Dementia/delirium diagnosis and management

And everything came out just as he said!!!!! Wootttttttttttttttttt!!!!!!!!!!!!!!!
A 10 mark question on schizophrenia (very vague question - just one! A 1/4 page history followed by what additional information would you like, what test would you do and discuss your medical and non-medical intervention.)

A similar 10 mark question on panic attacks

Compare and contrast delirium/dementia

Define primary insomnia and list the non-medical management.


MCQ
HEAPPPPPPPPSSSSSSSSSSSSSSSSSSSS of repeated MCQs from past years. I only hope I can remember the answers.....

***********************DISCLAIMER*************************
The answers given are mine and I refuse to be held responsible for their accuracy.

Google Determines The Fate Of The Earth

So I wasn't with the game and managed to discover the single most amazing site on the internet just last week. For those of you equally clueless or whom has yet to designate this as only the coolest site ever (is it just me or did that sound blonde to everybody....) I present to you: Googlefight - A web service that allow users to establish which of two entities are superior to the other. Period. With its vastly complicated and advanced matrix this is a site that will resolve century-old squabbles for good. There is no reason to doubt its findings or even to question its flawless system. Everything that it says is correct and must be fully accepted. Thus the might of Googlefight.

I started off with an encounter between Googlefight and Yahoofight. The result?

It wasn't even close. Google walks all over yahoo disposing its dead body in the trash. Does this make google the new yahoo? Is google now in and yahoo out??? I formulated the next clash between google and yahoo and....

Yahoo wins round two and claws its way back in!!!! They are now tied... but round 3 is just round the corner. Who will finally be crowned as the superior seach engine??

Its unanimous!!! Google is obviously vastly superior to yahoo!!!!!!!! Everyone should stop using yahoo and switched to Google (notice how I capitalized G for Google but not y for yahoo. This is obviously meant to degrade yahoo and ridicule anyone who insist on utilizing it).

Next I determined how people around the world spend their time. Are we now at a crossroad where most people are becoming progressively more intellectual and are aware how important it really is to put aside time for boardgames? Or are most social outcasts who find their special place in sports?

Oh please help!! What freaks we have around us!!! No wonder the world is in the sorry state its in now... if only more people would hop over we would all be living in a better place.

Where do most people spend their time?

Close one. Looks like we've still got some work to do.

And names.. what about names.

Score. I've always known I was called something special. A second clash confirmed this beyond all doubt.

And the most watched tv series?

Obviously escaping from prison is far more exciting. Who wants to watch a drama about body parts?

Ah but wait a second... what about the characters themselves? Who does the public actually want to be?

The surgeon hands down. Why settle for a psychiatric engineer turn inmate when you can be the best neurosurgeon in Texas? Wait hang on... he's my guy. And he's saving his innocent brother from prison... this is all wrong!!!! Doesn't morals mean anything to anyone?

Now what about the ladies? Who is the fairest of them all?

Clearly the public disapproves of Meredith's entangled personal life. This goes to show that even in our fallen world sometimes having just one partner can be better than multiple.

Now lets move on to food.

One for the Asians. I love rice.

Hm... looks like the Italians won't take this lying down. 1-1. We need a tie-breaker.

WOWEEEE!!!!!!!!!!!! The Italians receive a hiding and its finally settled for good. Asian food rules. Good ol' chow mein.

Hm... close one. But is it really accurate? Oh wait a minute... we're not suppposed to question.

Next we try to pick out the more superior of 2 countries.

Dang. The Kiwis are one up. But fear not. Coming up we have our extremely capable capital watching our back.

This is shocking!!! Has nobody got any respect for our country?!?!?!?!? Things aren't looking good as New Zealand pulls ahead. However after a round of intense strategical discussion between the races of Malaysia we decided it was time to pull out our secret weapon. Those birds won't know what hit them!! The once tallest structure in the world versus an aged casino.

Is this country invincible???? Is nothing we have good enough???? What is this? A conspiracy??? And the tussle comes to an end as Malaysia is left licking her wounds. There's only one more thing left to do now: if you lose at least do so by a reasonable margin. And there's no time to breathe! With the score now at 3-0 and Round 4 taking place the next brawl involves the ultimate clash of civilizations. A humble drink found by the road is matched up against a franchise of beans. The Milo Ice vs Robert Harris's Coffee.

And what a match it was!!!!!!!!! The meek Milo Ice in typical Malaysia Boleh style almost wrangled victory from the hands of its posh opponent!! Alas a win is a win and Malaysia succumbs to its 4th straight defeat in a row. Can the Kiwis now complete a clean sweep over the once proud nation? Finally.... last but not least.... coming face to face with each other for the 27th time.... introducing the most notorious districts in both cities... Chow Kit vs K Road!!!!!!!!!!!

And yes... finally... the torture is over as the Kiwis walk away from a match that was theirs right from the beginning. Who was I kidding... the Malaysians never stood a chance against this small but burly nation of 4,000,000. Maybe next time... in a couple of years... we would be better prepared to face off with our Australasia neighbour. But until then New Zealand has all the right to bask in the glory of its victory, but only for 4 years before it is once again summoned to compete in the next Googlefight World Cup 2010 in Heinan, China.

Now time to do away with the circus and move on to more serious matters.

Its good that people know how to live properly.

All the fault of sitcoms the likes of Grey's Anatomy, Scrub, ER and House that glorifies medicine. Not all consultants look like Shepherd. And no interns look like Izzy.

Ha. Just wait till YOU get voted off.

Agree.

They will catch him. You just wait.

This is just wrong.

Even worse.

I wouldn't mind either.

Poster boy wins.

Yeah.

And finally I posed Googlefight the ultimate question: Can we even believe anything you say?

Global Board Game List

Most of you would have figured out by now that I like figures. I like numbers and I like handing them out to just about anything (television shows, boardgames, housemates....). Next I tend to arrange them according to the value given with the assumption that if A>B>C>D, then A>>C, B >> D and A>>>D. And then comes the fun part; I stratify all items and crunch my numbers in any way I can think of, await the final result and then come up with all sorts of presumptious theories on why the figures appear as such. Sometimes the result can be totally unexpected, and that is why I like numbers so much. Because numbers don't lie. Attaching a figure to any subject gives it an objective value that is comparable to its peers.

And this is such a list.

It is a Top 10 list (gasp!) but this time on a global scale.
1. Each game's rating is broken down to figures from individual nations.
2. The average rating from 5 countries are singled out.
3. The average from each country is totalled together with my rating for the game and an average is obtained effectively giving each country (and me....) 1/6th of a voice i.e. the 20 gamers from country X has an equal weight to the 3000 gamers from country y combined.

This eliminates all possible political/cultural/socio/economic/moral/ethnic/medical differences tipping the ratings in favour of nations with numerical superiority (I did say it was presumptuous). Naturally not all countries are considered and so a carefully selected few is chosen and assumed to represent the rest of the world. Again because I'm grandiose and like to have my say I am deemed a nation and given 1/6th of a voice.

So which other fortunate nations have been seen as being sufficiently significant to be incorporated into the 2006 Global Board Game List and why?

America
Because they are cool and rich and obliged to meddle in any and everything. Well actually its because the United States dominate Boardgamegeek, and with 52% of the ratings coming from US geeks (at least 5000 of them) the American voice is hard to ignore.

Canada
Just north of America this country with the second largest population on the geek provides 8% of the ratings data by at least 700 of them.

Germany
Germans make up the 4th largest population with 5% of the ratings data and over 300 geeks. But the more fundamental reason is that most games are produced in Germany, and with their designers dominating the annual board game awards year after year it would be clearly unwise not to consider the influential German trend.

New Zealand
Sitting at no 17th with approximately 80 geeks barely totalling 0.7% of the geek population, Kiwis are hard-pressed to create even a small ripple in the boardgame community. But their views are important because this is where I am presently and hopefully will be for the next couple of years. I love Auckland!

Malaysia
Malaysians don't currently have sufficient numbers to justify an assembly of its own and as of this moment is lumped together with other countries under 'other nations'. Hopefully the opening of a new Settlers Cafe in Mid Valley and our first convention at the similar venue last year paved the way for more geeks to jump aboard. Their views are important because this is where I was from and where I will be going back to at the end of the year.

Those interested in visiting Settlers Cafe please send me a notice. From what I understand it is a coffee place (ala starbucks or coffeebean) with heaps of boardgames within its premises that customers can play. Friendly staff are always present to assist customers in learning new games and will be more than happy to get in on a game themselves at any opportunity. Now this is one place I can work in over the summer. Maybe even for free :)

Myself
The newly established nation of me with me as its president, vice-president, treasurer, secretary.....

Anyway having explained all the hypothesis and principles that regulate this statistical list, without any further delay let us now move on to the actual basis for this post: The pilot Global Board Game List. And among the questions that our research will be waiting to answer include:

What games are indisputably adored the world over?
How will each country, now given identical weightage, influence the final order of the list?
Will there be noticeable differences in the manner each country rate their games?
Who generally rate games higher?
Who generally rate games lower?

And after years of study by our globally renown group of international researchers, we are now finally ready to answer these questions. It was a gruesome task and on many occasions we have had to claw our way out of tough challenges (e.g. lack of funding, poor numerical skills, contamination, spies), and at times we thought we would not be able to make it. It was a dangerous job but somebody's got to do it. And finally as a direct result of our hard work, we have now before us a list of the top boardgames in the world; the creme of the crop, the very few that is held with as much esteem as is each country's very own president. But patience is required as we embark on a short journey with each game, as we learn of their personality, appreciate what makes them unique, identify what makes them tick and ultimately understand what puts them at the pinnacle of the Global Board Game list. And starting right from the top, at no 1 is....

P.s. Format undertaken: country/total raters/average rating

1. Caylus - 8.43

New games are designed and published all the time - some are appaling, many are mediocre and a few are really good. But every 10 years or so one game comes along that blows away everything in its path. A game that has everything - a good theme, a wonderfully produced board with excellent bits, and brilliant mechanics that fit together flawlessly. Caylus is that game for this decade. Centred around castle-building in France and ranked 2nd in my Top 10, 3rd on the geek and top in this list Caylus was introduced last year and shot up the charts to settle at no 3 within weeks. With hardly any peers Caylus is exactly what makes me so proud to be a geek.

2. Power Grid - 8.43

Despite mounting a remarkable challenge for top place Power Grid eventually had to settle for second spot trailing Caylus by only an impressive 3/1000th of a point (8.430 vs 8.427). This was a game I fell in love with just reading the rules. An auction scheme for power plants, area control while competing to power cities on the board and a fuel market in which prices fluctuate throughout the game according to supply and demand? Checked. However despite all its strength this isn't a game for everyone. An average session last 90 minutes with plenty of tough choices throughout - and winning Power Grid the first time around is an achievement not easy to forget (I won mine one game short of my 20th game).

3. Age of Steam - 8.41

If ever there was a game that is mean, cranky and incredibly bad-tempered then this one is it - clocking in at number 3 is the notorious Age of Steam. A train game in which you compete to link-up cities and race to deliver goods across the United States sounds rather harmless. But a brutal economic system in a contest where money is everything means finances is hard to come by and in a classic 6 player game, 2 players will be eliminated via bankruptcy within the first 2 rounds. One of the most competitive games on the market and trailing the joint leaders by a mere 2/100th of a point, Age of Steam packs a punch and rounds up our Top 3.

4. Die Macher - 8.33

Sitting at no 4 is a game few as yet has had the opportunity to play - myself not included. But rave reviews have been heard from those who have. A game concerning seven political factions in different regions of Germany, players as rulers of national political parties attempt to manage limited resources to help their party to victory in the upcoming elections. And like the predecessor Die Macher is a mammoth - 3-5 players are required for the game to kick-off and each session on average runs for the next 240 minutes. Pretty impressive for a game published in 1986. And the primary reason only a handful of the more privilege gets to attach a number to this game? Its been out of print for the past 10 years. Presently the only means to get your hands on this beauty is to search for an aged copy. And although old games occasionally do get republished, I wouldn't be holding my breath.


5. Puerto Rico - 8.31

Finally the finest game on the geek makes an appearance at no 5. Masquerading as plantation owners in Puerto Rico and attempting to grow up to five different kinds of crops: corn, indigo, coffee, sugar and tobacco, this is the first of 3 games in which players compete on a common board while simultaneously managing separate individual boards out of their rival's reach. Published in 2002 Puerto Rico catapulted to the top of of the geek displacing at that time Tigris & Euphrates and raking up the crown over 3000+ other games and holding on to that position since. As you can deduce I'm probably not one of its biggest fan but unfortunately the rest of the world seem to be. So when that happens what do I do? I jump on the wagon and say 'count me in'. Because all these people can't possibly be wrong.


6. Princes of Florence - 8.30

Debuting at no 6 is the 2nd game in which players compete at least partially on individual boards and falling behind Puerto Rico by a mere 1/100th of a point - Princes of Florence. Set in the renaissance era players develop medieval cities to attract citizens of various professions (such as astronomer, painter and architects). These citizens goes to work in their respective residence producing art, map, buildings etc which help enrich their cities. Individual board represents the city and points are totalled after seven rounds. However after playing online at least 5 times I have yet to see its brilliance shine through. Nevertheless unlike Puerto Rico I never go 'mehhh' when I'm playing but again nothing spectacular jumps out at me and yell 'great game this one!'. Maybe there are some subtle attributes I have yet to discover but will with repeated playings. Or maybe I just have something going against all game with individual boards.

7. Tigris & Euphrates - 8.15

Known as part of the Knizia tile-laying trilogy and widely regarded as Reiner Knizia's best game Tigris and Euphrates holds on tight at no 7. Boasting an almost royal bloodline coming from the same designer who brought us Ra, Modern Art, Amun-Re and Through the Desert anticipation for its release reached almost fever pitch back in 1997. When it was finally published Tigris & Euphrates catapulted to the top of the charts and remained there until one faithful day 4 years ago. Set in the ancient fertile crescents of Mesopotamia players advance their civilizations through tile placements in four different categories (farming, trading, religion, and government). Leaders are employed to watch over the workers and help build up their kingdoms but with a twist - your score at the end is the number of points in your weakest category. Alas this is another game which I do not hold up with as much esteem as my fellow geeks. After multiple playings I have yet to grasp how everything fits together. However because it is ranked 2nd on the geek and because it is designed by Reiner Knizia and because my housemates seem to be such big fans Tigris & Euphrates will keep on hitting the table until the day when I comprehend and fall in love.

8. El Grande - 8.12

One of the more elegant games produced and trailing Tigris & Euphrates by 3/100th of a point stands El Grande. Set at a time of political upheaval in Spain this is a subject I have written on previously and there is in reality nothing else to add to a spectacular game. Published more than 10 years ago and settling down comfortably into 5th position on the geek El Grande has proven its worth beyond the most trusted of all denominator - time.

9. Ra - 8.11

Following close behind El Grande at 1/100th of a point Ra makes itself noticed at no 9. A pure auction game with an Egyptian theme, players as pharaohs compete to advance their individual kingdoms. Farms are irrigated to provide food, astronomers and religious leaders add culture to civilizations while constructed monuments dedicated to the sun god Ra brings eternal glory. This continues over 3 epochs with the pharaoh accomplishing the most crowned the new Prince of Egpyt. Initially produced in 1999 Ra went out of print within the year and remained so for 6 years - however a high demand and continuous calls for reprinting finally came through. Last year Ra was given a lifeline and 6000 new copies were produced dropping them into the hands of eager geeks the world over. Currently sitting pretty on the geek at no 8 Ra is one of my most played and admired game.

10. Diplomacy - 8.07

And finally rounding up the list at no 10 is my most esteemed game of all time - Diplomacy. In this classic game of pure negotiation, deception runs rife and the one frustrating question you're always asking - whom do you trust? Trust and treachery are the entertaining ingredients in this international game of intrigue as each player represents one of the great European powers prior to World War I. To gain control of Europe you must forge alliances and advance with the co-operation of your neighbours. However at the other end cunning and cleverness are required to combat the deception and betrayal that surrounds you. For ultimately to rule Europe one must stand alone. The trouble is - when do your allies become your enemies? The first time I played this with my university mates a hugefall-out occured and the group split into separate factions of 3 and 4 for lunch. This is the degree of emotions involved in playing Diplomacy and why it is the absolute perfect game in my mind. Chance plays no role as it boils down to your ability to negotiate your way out of any challenge you face - it is the art of giving people what they think they want. For the record I have never brought Diplomacy back to that same gaming group. For this is an adult's game and if you can't be old enough to differentiate a game from reality, even in the midst of being brutally back-stabbed and attacked by 4 of your closest mates, then Diplomacy is probably not the best game for you.