Toxicology Viva

On the 24th, I had my Toxicology viva and spotting. At 9:30 we were asked to line up according to our roll numbers and after every 30 seconds the bell rang and one person would go inside a room full of toxicology specimen. There were 10 spots and we had to identify and answer the question given in 30 seconds which is literally absurd because it takes 10 seconds to reach the next spot and 10 seconds to write the answer. So in reality we actually have only 10 seconds to think about the question. The following were the spots.

1- Copper Sulphate....give its fatal dose.

2- Chillies....give its medicolegal importance ( I couldn't figure this out..hehe.....should goto the kitchen more often)

3- Poppy seeds...give its fatal dose (Poppy seeds are not fatal..darn it..I don't remember what I wrote, but it was wrong :( )

4- Define Run Amoke.

5- Nasogastric tube....give its contraindications (This too wrong :( )

6- Aconite....give its active principle.

7- Castor Oil Seeds..give its active principle.

8- Madar Leaves.....give its medicolegal importance.

9- Dhatura Seeds....Give its fatal dose.

There was another spot, but can't seem to recall it at this particular time. After my spotting, I had to go through that agonizing wait for my viva turn. At about 11:30, I was called in by the external examiner, an Associate Professor from Allama Iqbal Medical College, Lahore.

Sir:- What's EMR?

Me:- EMR sir???

Sir:- Yeah, you wrote it on your progress card. EMR Of Pakistan.

Me:- Oh! Sir, its Emb. It reads Embassy Of Pakistan. My dad works there.

Sir:- Your dad is in Cairo? Have you been there?

Me:- Yes sir. I did my 12th standard from there.

Sir:- (turns to our teacher Dr.Mateen) Note down this guy's address. He will arrange my stay there when I go there. How long is the flight?Have you seen the Pyramids and the Mummies? Egypt has one ancient history.

Me:- There is no direct flight from Pakistan. We have to fly enroute Jeddah or Dubai. Takes four hours to Jeddah and then a further 2 hours to Cairo. Yes, I have been to the Pyramids and the Museum.

Sir:- Dr.Mateen, remember Dr. so and so, he studied in Cairo. Now he has a very good clinic on GT road.

Me:- Cairo has some good medical colleges like Cairo University.

Sir:- Okz, Identify the things in front of you.

Me:- Abrus Precatarious, Tobacco, Copper Sulphate and Sir I don't know this one.

Sir:- Think about it. It's famous as the 9 D's.

Me:- Dhatura.

Sir:- Yeah, but what part of Dhatura is it?

Me:- Sir, it's the fruit.

Sir:- What's the antidote to Dhatura?

Me:- Physostigmine and Pilocarpine.

Sir:- Name poisons/drugs that affect gait.

Me:- Alchol......( and then I think a long time and my mind is empty) Sir, I can't recall anymore.

Sir:- Name myotoxic drugs.

Me:- Sea snake, Conium, Curare.

Sir:-Won't these poisons affect gait?

Me:- Yes Sir.

Sir:-What can you learn after examining the mouth of a patient with respect to
toxicology?

Me:- Corrosive Poisons stain the lips and mouth. Some poisons have a characteristic smell. Like phosphorus has a garlic like smell, kerosine has a distinct smell and DDT has a kerosine like smell.

Sir:- Why was DDT banned?

Me:- Because it concentrates while passing through the food chain.

Sir:- How do you know? And give me its scientific term.

Me:- Read it somewhere. I don't remember the term.

Sir:- It's called biomagnification. What's biotransformation?

Me:- Conversion of a drug inside the body into a more polar substance. It cane be more toxic or less toxic than the parent compound.

Sir:- What's your roll number? Dr.Mateen take his address.

Me:- 1398.

And I get to walk out.

Today I had forensic medicine viva and spotting. Stay tuned for its details because it was one hell of a day. I'm too tired of typing right now. So adios!!!!

Viva Unleashed!

9:00 Clock A.M :- We are called in for prescription writing and P drugs of two cases
1- A case of Uncomplicated UTI....prescription and P-Drug both.
2- A case of asthma.
In 20 minutes we hurridely, wrote down the P Drugs and prescriptions.It went fine.

9:20 Clock A.M to 12:00 Clock A.m:- Spent nervously walking to and fro in the corridors waiting for my turn and rushing to every person who came out to ask what was asked. Tension level past body limits. Now too tired to think about the tension. Barely able to stand.

12:00 A.M :- Finally get called in. Walk to the table. Sign my attenance and go and sit in front of the external.

Q.1- Tell me the clinical uses of Metronidazole?

Ans:- Choice of drug in C.difficle infections. Used in amoebiases, giardiases, and anaerobic infections below diaphragm.

Q.2- Which drink would you avoid while on Metronidazole?

Ans. Alchol. Gives disulfiram like reaction.

Q.3- Any other drugs you can think of that should not be taken with alchol?

Ans. 2nd and 3rd generation cephalosporins mainly cefamandole, cefperazone, moxalactam and cefotetan.

Q.4-What ring of cephaloporins contributes to this effect?

Ans- Methylthiotetrazoles.

Q.5-This ring also causes another toxicity. Related to blood I tell you.

Ans. * Stares into space* Sir I Have no idea!! You're going good kid, think about it. *Pretends to think about it but really has not a single clue what he wants to hear* It causes hypoprothrombinemia kid.

Q.6 -What will you give in Hypoprothrombinemia?

Ans- Vitamin K.

Q.7- What other conditions can you think of in which you will use Vitamin K?

Ans. Warfarin overdose.

Q.8- What will you do in Heparin overdose?

Ans. Adminster Neutral Protamine Sulphate

Q.9- What type of anatagonism is this?

Ans. Chemical antagonism

Q.10- Have you heard of INR?

Ans. *Shake my head....Aftab has no clue*

Q.11-What will you use in acute gout?

Ans. Indomethacin.

Q.12- Why not aspirin?

Ans. Because aspirin raises uric acid level below 4 grams. And above 4 grams it does have a uricosuric effect but coupled with the risk of increased sideeffects.

Q.13- When is asprin used in low doses?

Ans- Post MI and prophylactically in high risk heart patients. Has antiplatelet effect.

Q.14- Major toxicity of cyclophoshamide?

Ans- Bladder carcinomas. * Sir says no what happens before that. Aftab answer haemturia. Sir answers haemorrhagic cystitis*

Q.15- What is DOT?

Ans. Direct Observational Therapy....especially used in TB where patient compliance is low.

Q.16- When is aminophylline used?

Ans. Acute attack of asthma.

Q.17- Do you know aminophylline is made up of two compounds?

Ans- * Aftab doesn't answer....though compelled to say duh..one must be amino..the other phylline..hehe*

Q.18- Cannibis Indica gives rise to cannibinnoid derivatives that have antiemetic effects. WHat is their special use?

Ans- * Aftab stares bewildered at the examiner. *

Q.19- What is misopristol?

Ans. Prostaglanin analogue used in peptic ulcer patients taking aspirin.

Q. 20 Your rollnumber?

Ans. 1398


Now I go and sit in front of the internal.

Q.1-Uses of Metronidazole?

Ans- *Aftab says not again!!!!* Anaerobic infections.

Q.2- Indirectly acting adrenergics?

Ans. Amphetamine. Methamphetamine.

Q.3 Uses of Amphetamine?

Ans. ADHD. And abused by students for its mild altering effects.

Q.4 Toxicity of Digoxin?

Ans. GI disturbances. Yellow colour vision defect. Arrythmias.

Q.5 Treatment of toxicity?

Ans. Lidocaine, Phenytoin and Digoxin immune FABs.

Q.6-Contraindications of B- blockers?

Ans. Asthma, Av nodal block and type one diabetes.

Q.7- Uses of erthromycin?

Ans. Choice of drug in Corynebacterium Diptheria infection. Used in upper respiratory tract infections.

Q.8 - Roll Number?

Ans. 1398


And I get to walk out of the room!!!!!! Today was, I think, the longest viva I have given in my life. It went pretty ok I think and am so relieved that I'm done with Pharma VIva. It is the biggest hurdle in this years prof. Okz, me out.....have Pharma Practicals tomorrow. Thanks for each and every one of you that left a comment and remembered me in their prayers. :)

Stress Unlimited!

The viva is a few days away and already I have freakin butterflies in my stomach. I can't stand the feeling anymore. It's killing me. By the viva date, I don't think I'll even be able to stand on my feet!! And my turn for the viva is at the end of the day, so like I'll spend 3-4 hours waiting outside watching people either come out happy or crying! Either way, by the end of the day I'll definately get stress ulcers. Most of you people won't understand why all the fuss. The Prof is everything to a medical student. Failing is not an option, because if you do , you'll have to repeat the same damn procedure with written and orals. There is no way in the world I can go through this agony again. After four months of exams and exams, no way I can live through going through it again!!!!

Scared!!

My viva (oral exam) for Pharmacology is scheduled for Friday. The external examiner will most probably be Brigadier Najmi of Army Medical College (I think) and the internal examiner is o Head of Department and former Principal of our college, Rawalpindi Medical College, Dr.Shahnaz Aftab. Both are notorious for failing students and have built up a reputation for scaring the shit out of us students. And like other medical students, I too am literally peeing in my pants (sorry for the relatively foul language....But this will emphasize my feelings more accurately). Dr.Shahnaz Aftab during her tenure as Princpal stripped our Class Representative and Girl Representative of their offices because they asked permission for a class function. She said that she thought this was a "bahana" for taking girls out on a date. Anyways, this is a long story and I"ll get to it on some other post. She also wants all the boys to dress up in ties, comb their hair nicely, brush their teeth, shave their beards, and polish their shoes before entering her office. She said boys smell so bad that she has to turn her face to the other side before proceeding with the viva.
And if I wasn't scared enough, I just learnt yesterday that the external of Pathology will be General Hannan. And the Head of Department himself is scared of what might transpire. He is running around telling us students to prepare Microbiology very well. General Hannan is a very experienced and reputed teacher of Microbiology and also taught our Head Of Department Dr.Abbas Hayat.
So I have some real studying to do, and I don't know where to start where to end. This is going to be one tough month :(. I hope Allah Helps me get through this in once piece. Ameen.

Hmm

Eid was pretty good I guess. Considering that last year it was raining and real cold, and we had to wait till midnight before we were free from all sacrfices we had to make. This time, on the contrary, the weather was pleasant and we were free from all the hectic sacrfice rituals by 12 noon :) So, Alhamdolillah, everything went great. And my cousin was also here to celebrate Eid with us this time, so I didn't get bored either. Since, I didn't get bored, I have nothing to complain about. And since, I have nothing to complain about, I have nothing to write about . So adios for now till I have something to complain about :)

Eid Mubarak

Eid Mubarak everybody!! Sorry didn't update for a while. Shifted my house, so didn't have a phone connection. I still run on dialup :( My Pathology exam was a disaster :( Going through a real tough phase right now...Exams,Shifting, Eid, etc. Oral exams and practicals will start on the 20th. And this is the most dreaded part of the Prof Season. So need all your prayers.

Forensic Medicine Gone

Alhamdolillah, two down:) Forensic went pretty well, though the MCQS were tough. But all in all, it was a pretty ok exam. Now looking ahead to Pathology on the 5th. Hope it goes well. Only 2 days and loads to do :( Khair, soon they will be "Going Going Gone" and I'll be enjoying life like the rest of you people out there!!!!

Happy New Year

Happy New Year everybody! Hope you all have a blast. InshaAllah,this year will bring more joys and less sorrows then 2005.