Assalamualaikum dan salam sejahtera,salam ceria dan salam bahagia.
Berikut adalah artikel Dr.Norazlina Mohamed mengenai soalan beliau dalam peperiksaan akhir baru-baru ini.Dipetik daripada facebook beliau….sama-sama kita renungkan..
"This must be a lucky semester for me. 3 exam papers and my questions were asked in the form of essay in all the papers. The students either love me (if they can answer the questions well) or hate me (if they failed to answer those questions). ;)
Below are the answers to those questions (plus my comments).
Patient diagnosed with Addison’s disease. A physiologic dose of hydrocortisone was prescribed for life.
After a few months, the patient developed bacterial infection.
c. Comment on the dose of the hydrocortisone for the patient in this situation.
Answer: Patient may be stressful in that situation thus the dose of hydrocort is insufficient and need to be increased.
My comments: Almost all students failed to get this right. Most students answered that the dose should be reduced because hydrocort caused immune suppression and that’s why patient developed infection. This shouldn’t be the case if physiologic dose is given. Physiologic dose should be the dose which maintain normal body functions however, in stressful conditions such as infections, the dose need to be increased.
Refer my notes, slide no: 21
d. Besides hydrocort, name one other steroid should be given to patient.
Answer: Fludrocortisone (a mineralocorticoid)
My comments: Quite a number of students got this correct. However, some were confused of the spelling eg Flucortisone, and we still gave marks. Some gave other steroids which started with flu but are not mineralocorticoids and cannot be accepted eg fluticasone, fluprednisolone. Some were totally wrong and tak dapek nak nolong eg dexamethasone.
e. Explain the rationale of giving agent in d.
Answer: Patients with Addison’s dis also lack mineralocorticoid thus no mineralocorticoid activity such as salt-retaining activity. Even though hydrocort has salt-retaining activity, fludrocortisone must be given together.
Refer Katzung 11th edition page 687.
My comments: Most students can only answer this question partially. Only a few got full marks. Most students mentioned about the salt-retaining activity but left out about how hydrocort is not enough in terms of salt-retaining.
(Note: These questions are considered easy. Baca nota je pun dah boleh jawab.)
Patient with spontaneous premature rupture of membrane and was given oxytocin.
b. Explain the mechanism of oxytocin
Answer: binds to oxytocin receptor – cause calcium influx – leads to uterine contraction
Stimulates PG production – stimulates further uterine contraction
My comments: Most students got this correct. However, most students left out the prostaglandin part. So less mark. Some forgot to mention oxytocin receptors, some forgot to mention calcium influx, less mark lagi.
c. Describe uterine contractions caused by oxytocin.
Answer: Contraction of fundus and body, relaxation of cervix.
Increased force and frequency of contractions that are coordinated with relaxation between contractions.
My comments: Pun susah nak cari students yang dapat markah penuh. Students tend to give one info but missed the other info. Some students put the prostaglandin answer in this part. I still give some marks.
d. State one other indication for oxytocin
Answer: Prevent PPH or stimulate milk ejection or augment labor process
My comments: Most students got this correct. But some did put ‘stimulate milk production’ which is wrong. Some wrote labour induction in preeclampsia or diabetic mothers etc. But still the same indication in this patient: ie labour induction. So I had to deduct some marks. Some surprisingly did not know what indication means because you gave the answer as ‘Ergot alkaloid’ or ‘dinoprostone’. At this level, all students should know what indication means. Kalau tak tau jugak apesal la tak tanya during the exam? Kan dah hilang markah.
Patient was diagnosed with Parkinson and treated with levodopa
a) Explain the mechanism of action of levodopa.
Levodopa is dopamine precursor (1/2). Converted to dopamine in brain by dopa decarboxylase.(1) Dopamine binds to dopamine receptors in the brain and relieve symptoms of Parkinson. (1/2)
b) Patient is also prescribed with carbidopa to be taken concomitantly with levodopa. Explain the rationale of taking the combination of drugs.
Levodopa is also converted to dopamine in periphery by dopa decarboxylase but dopamine cannot cross BBB to act (1/2). Carbidopa is a dopa decarboxylase inhibitor which does not cross BBB. (1) It only inhibits dopa decarboxylase in the periphery thus prevent peripheral metabolism of levodopa.(1) Combination of levodopa and carbidopa enable more levodopa to reach the brain and enhance levodopa’s effects (1/2).
My comments: For neuroscience, I was not assigned to mark the papers. Pengsan la kalau kena mark jugak… Thus I don’t know the students’ performance.
For all papers, students may sometimes answer in a different sequence than the scheme. And we don’t penalize students for that. "