PACES(Chennai) Diet 1/2014 (Personal Experiences) ================================ I had a chance to try for my second attempt in Chennai, the largest city of Southern India in March,2014. On usual traffic morning of Chennai, I arrived at 10AM to MMM hospital.(The actual time for exam is 11:35AM.) There were alltogether five candidates, two from Myanmar,one from Bangaladesh and the rest two from India.After filling requiring documents and being taken a potrait photo, I had some time to chit-chat with other candidates. Dr R,in his 40s, saying that his daughter was also sitting for GCE’O level exam, while her dad was also sitting for PACES. Like us, Indian doctors seen to be faced with difficulty in terms of finicial constraints for PACES. This was his 2nd attempt. Dr L, in her 30s, came from Dheli, doing her Ophthalmology training, was also 2nd timer. Both indian doctors got over 140 scoring in their first attempt. Dr B, 30 plus, was from Bangaladash. This was his very first attempt. All these fellow asked me why I came to Chennai for exam even though we are opening Myanmar centre for PACES.I replied we had no enough seats in our land. In MMM hospital where PACES exam was held, I found out that most of Consultants were not MRCP diploma holders.I asked indian collegues why ther were trying to get this Diploma in spite of having their own post Graduate training in India. They replied that for the sake of psychologic safety, they have to sit for MRCP. I was wondering that that answer was fit-in for me too. I started with Station 3(CVS & Neuro), straight forward MS,MR with TR, discussion went to MVR. CNS was also simple Left hemiparesis( frankly the patient also got some bilateral peripheral neuropathy), but examiners kindly went to discussion of stroke uptill antithrombolytic agents. My communication section was to persuade newly diagnosed SLE(28 years lady)patient to get a kidney biopsy.The patient already had known her diagnosis but not details. Never heard of SLE before. So need to explain some facts on SLE, just 2-3 lines. Also need to explain procedure of renal biopsy. I could find out that patient was to start a family and get a baby soon(but patient was not married and even didn’t have a boyfriend. I think it will be an arranged marriage.Indian tradition!!) Finally she never agreed for biopsy. Time’s up!! (At least I could summarize about discussion.) In the 5 minutes discussion, examiner asked how to proceed to persuade patient for biopsy. As you all know ,let her meet with Consultant for second opinium. Next question was what I would do if patient did not agree for biopsy at the end of the day. Simply, this was her autonomy and we have to respect it.Finally the last & difficult question came.If we went to biopsy which was complicated by haemorrhage & had to do Em nephrectomy, what will I do? Would I defend myself at court if patient sued me? After a pause, I answered I would defend. I got all the written documents of informed consent given by patient. Why not? The bell rung. Station 5( 1st case) was young lady with episodic palpitation. I thought of differentials. Thyrotoxicosis, SVTs, Coffee induced and Anxiety. The answer was thyrotoxicosis. She, surrogate, had significant wight loss. I checked PR and thyroid. All were normal. Examiners wanted thyrotoxicosis and anxiety. Station 5(2nd case) was elderly lady with DM and progressive visual loss. Simply again. I thought of DM retinopathy,CRVO,RP. Slow onset,progressive,bilateral,never appeared at DM clinic, no eye check-up, I knew she should have DM retinopathy in the first few minutes. Examiners only allowed me to do visual acuity & fundoscope exam(actually they were very kind). When I started to hold my fundoscope, examiner switched off the light, comfirming that I was going into right path. Right eye-pre-proliferative, Left eye having cataract, I got the diagnosis and lucky enough to solve the pt’s concern. Station 1 was bilateral polycystic kidneys, going smoothly, asked routine simple questions. My respiratory case was disaster. I failed to find sputum cup(actually I could not find out), which was a green one and I thought it was a coffee cup!! I could not get a diagnosis. Maybe bronchiatasis or fibrocavitory lesion. Station 2 was young man with 3 episodes of right arm weakness (longest time- 8 hours). I could fine out he also had dysarthria during attack. Hypertension 170/90 ,Bad family history of CVDs, 5 packed years of smoking, wife expired one year ago. I thought this young guy( actually surrogate one) should have young hypertension leading to TIA. I could persuade him to stop smoking, solve his concern(he worried he got a brain tumour) and explain management plan. Examiners wanted TIA,Hemiplegic migrain(he gave some history of tension headache) ,demylination and cardioembolic thromboses. Unfortunately my first diagnosis given to examiners was Conn’s!!! TIA was only my 2nd differential. But examiners seemed to be pleased. I met that surrogate after exam in the lift, and he said it was TIA!!! Whether feeling good or bad, fortunate or unfortunate, pass or fail, depressed or quite stablized, the exam was went over. Whatever passed or failed, the exam result will not change my life. If failed, I will try for my third attempt.If passed,I will continue walking in cancer ward. Best of luck for all candidates!! Any questions, just drop some lines in my message box.Thanks you all.
Posted on: Sun, 09 Mar 2014 11:03:01 +0000
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