Flawless (Well, Not Quite)

Another week of Med School ends! Though I wasn’t really that fond of the subject matter in the first place, it was pretty interesting to be a flawless dermatologist (well, not quite) for four days (recall the class suspension brought about by the inclement weather last Monday).

Side Comment – I swear, there’s something about dermatology residents and consultants! They all have super pretty complexions! I mean, is it a requirement to be so flawlessly beautiful to be in derma? Well, I guess you can’t have not pretty skin in that field… Point taken, pretty residents.

Thank God for the PAGSAMA review we gave the LU3 students that forced me to re-study the basics of Derma! I still have the primary and secondary lesions memorized as well as the basic structure of the Derma PE. Being in LU4, we were now exposed to the different skin diseases – no more simply identifying them macules and papules. No. This time, it was all about the furuncles, atopic dermatitis, skin cancers, tineas, etc. And boom! There’s also the 2nd Derma OSCE!

my cram list the night before the Derma written-kodachrome-OSCE exams :)
my cram list the night before the Derma written-kodachrome-OSCE exams :) || notice that I still have to put sleep in there, so as to remind myself about the need to do so

The written and kodachrome exams were OK, I guess. I can’t believe that solitary red patch was actually ‘tinea corporis’ -__- I so didn’t appreciate the central clearing and advancing borders. The real highlight of yesterday was the Derma OSCE!

As with every practical exam like this, the waiting time is always the hardest. There we were at the MDLs of Paz Mendoza. While those who have to live with the alphabet curse (It’s ok, Shari! :)) ) went ahead first, we, the others, had to wait for our turns at the last MDL rooms. It all went a bit faster than expected. While we uselessly crammed dermatologic information into our heads, the first of the D’s was soon called out. Oh God. Ang bilis po! “The student examiner is in cardio-respiratory distress.” PANIC. I was already tachycardic – I guess we all were! – but I was trying not to let it get to me by encouraging myself. “I am a gorgeous dermatologist for the day! I will do awesome on this exam!” 

When my turn finally came, I was directed to MDL 11, where 3 ladies awaited me – my resident examiner (pretty Dr. Castillo), the patient, and her mother. Ah. A teenager. Seeing how young my patient was, even before anything else, I started to look for any signs of the obvious and predictable condition, acne vulgaris. No such thing. Her face is clear of lesions.

I greeted them all a good morning and introduced myself. Dr. Castillo tells me to start whenever I was ready. And so, I did – not because I ready, but because I knew I was never going to be ready and that I should just get things over and done with. I turned to my patient and started taking the general info and history of present illness. (As always, all of this is withheld in this journal entry as per the patient-doctor confidentiality principle :D ) To make things short, it will suffice to say that my patient’s case was that of SCABIES. Whew. Thank God for a relatively easy one! I think I was more or less able to ask the right questions and also conduct a good PE (if a good PE meant careful inspection of the skin lesions).

Dr. Castillo opted not to make me report on the HPI and instead, told me to proceed with the PE findings, diagnosis and differentials.

Angeli the Dermatologist:
Our patient presents with multiple, small, erythematous 
papules and macules, as well as excoriations, on the dorsum  
of both hands and both upper arms. Though not inspected due 
to the limitations of the examination area, the patient 
reports to also havelesions on both legs. The lesions are 
associated with nocturnal pruritus. Similar signs and 
symptoms are reportedly manifested by the people the patient 
has close contact with, leading us to the primary working    
diagnosis of SCABIES.

As always, I struggled with the differentials. I practically babbled on that part – Contact Dermatitis? Varicella? Molluscum Contangiosum? I just kept on stressing the difference in type of primary lesion and the manifested symptoms.

And just like that it was over. Dr. Castillo gave me a bonus by uplifting my self-esteem, praising my work on the OSCE. >.< She said that she liked that I even thought of mentioning the lesions on the legs and even asking if I still had to inspect them despite the limitations of the examination area. According to her, unlike several others, I was able to identify all the types of lesions, including the excoriations. I quote her saying that, “You did very good. *gorgeous smile*” I repeatedly expressed my thanks to her, to my patient and to the patient’s mother as I made my way out.

YEEEEEY! *insert mental celebrations of joy here*

That went a lot better than I expected. For the amount of preparation I did, it was definitely such a blessing. Thank you, Lord!

Angeli the Dermatologist, ’til we see each other again~ Stay flawless!

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