May 20, 2015 § 6 Comments
Yes, you read that right: I AM DONE WITH PATHOLOGY! I had made such peace with the idea that I was going to fail and it didn’t happen!
The exam is split up into 3 parts, two practical and one theoretical:
Part 1: Autopsy
When I entered the locker room, I was told, “We’re all getting Dr. X”. Dr. X is probably my favorite lecturer, but I had been dreading getting him at the exam because I’d heard that he really likes to drill the students. He told us in lecture once that at the final exam, we should be able to do things like group all the tumors by their color. He is extremely systematic, a feature I love in a teacher and fear in an examiner. Having a systematic method while studying is great, but being forced to be systematic on the spot, in the context of a final exam, can be difficult.
I was so resigned to having to retake the exam, that I didn’t feel nervous at all. “I’m going to go in there, give it my best and really learn from the experience,” I told myself, “then I’ll know how to prepare better the next time around.”. We were called into the autopsy room in groups of 5. Awaiting us was a similar sight: the autopsy examination table displaying the different organs. I was actually able to find photo of the room online. The picture is quite small, but at least you get an idea. Usually, there are two or three mobile metal tables with the cadavers on them in the middle.
We were each assigned an organ and I ended up getting the one I wanted the least: the urogenital complex. It includes the kidneys, the prostate and the rectum of the patient. We were allowed about 5 to 10 minutes to look over the organs and note any changes. I got a little nervous at one point but quickly calmed down and told myself to focus on the pathology and not the outcome. Dr. X called my name and asked if I was ready. Now or never!
I described the morphological changes and answered any follow-up questions he asked. The organ complex showed pyelonephritis, nephrosclerosis and cystic lesions on the kidney, benign prostatic hyperplasia (I had to explain how I knew it was hyperplasia and not carcinoma), with compensatory hypertrophy of the urinary bladder (trabeculated) and adenocarcinoma of the rectum. There were some things I fumbled on, like the term hydropyonephros, but other than that it went very smoothly and I ended up with a 4/5.
Part 2: Histology slides and Specimen
For this part, we moved on to the histology lab. The room was full with students and examiners, so I had to wait for a few minutes outside. We were only 11 English students being examined that day and maybe 30 Hungarian.
I was escorted to a computer and the technician helped me log in and open my slides. My heart dropped a little because I hadn’t reviewed the slides I ended up getting. Rather than letting that get me down, I reminded myself yet again to focus on the pathology and not the outcome. In our last histology practice, our adjunct professor told us, “We know how hard the histology is, trust me. Sometimes, we don’t even know the diagnosis when we first see it. It takes a lot of time and a lot of practice. What we want to see is that you know how to use proper histological terms to describe the changes and that you can use your pathology knowledge to properly diagnose the tissue sample”. We have covered 121 slides in these two semesters and get 2 at random at the exam. The only information we are given is which tissue the the slide came from.
I ended up with one from the colon (coincidentally adenocarcinoma, just like I’d had in the autopsy room) and one from the lymph node. When I felt I was ready, I raised my hand for one of the examiners. Once she had seated herself beside me, I began describing the tissues, first describing how the normal tissue should look, then describing the morphological changes and finally linking those changes to my diagnosis. I made sure to sort of guide her through my thought process while showing her the slide at the different magnification levels. (These are screenshots of the slides, with notes written by the fantastic Charlotte.)
For my specimen (we get 1 out of a possible 60 or so), I got this beauty: the hydatidiform mole. It’s a tumor of the cells of the placenta. When I saw it, I actually got quite excited because it meant that a new study trick of mine had worked. For the past several weeks, I have kept a google image search of whatever disease I am covering theoretically open on my screen. That way any time I look up, I have a visual association with the disease. I remember this one well because it is so creepy looking. It looks like a bunch of grapes! If you want to see another tumor with “bunch of grapes” appearance, check out the female genital tumor: sarcoma botyroides (be warned!).
Everything went very smoothly, save for some little fumbles, and I ended up with a 4/5 for the section.
Part 3: Theory
This is the part you have to worry about. You can fail the other sections and still pass the exam, but the theory is the big one. We ended up having to wait quite a while before we were called in to our exams. I don’t think I was called until around 12:30 (and the exam started at 8:00). During that time, I tried reviewing some topics and keeping calm. I just wanted it all to be over!
I was assigned to the same examiner I’d had for the semi-final. Her topics (each of the professors have their “topics” that they are especially adept in) are hematology and oncogenes. For the semi-final, I’d struggled with my topic on oncogenes and it ended up being the reason I’d gotten a 3. That was an experience I was hoping not to repeat at this exam.
When I pulled my cards, the smile quickly dropped from my face: (A) Autosomal Dominant Diseases, (B) Oncogenes and their role in carcinogenesis, (C) Inflammation of the Trachea and Larynx. (A) and (B) were both topics that I was not looking forward to having to answer – and (B) was a serious deja vu!
For topic (A), I talked about Huntington disease and Marfan syndrome in detail and then mentioned osteogenesis imperfecta and adult-type polycystic kidney disease. She wanted me to describe the genetic alterations, pathological consequences, clinical manifestations and treatment for each and then wanted me to mention familial hypercholesterolemia and its complications.
Topic (B) was where it went downhill. This was one of those topics that I kept telling myself I needed to commit to memory, but really only superficially covered. I’ve watched videos on it, taken notes and even have a chart hanging up in my study area. Still, my brain was coming up with very little of what I should know. I tried to recall everything I could, but she was quite picky on the topic. Had I memorized this table, it would have been perfect, because this is exactly what she wanted:
Towards the end of this topic, she seemed pretty disappointed and said, “Ok, let’s talk about lung cancer”. My teacher is the “lung” expert among the professors, so I had no problem listing out the classification of cancers of the lung. But then she asked me about the oncogene related to adenocarcinoma of the lung. When I couldn’t answer, she got a bit upset and told me that she is sure my teacher has mentioned it before and that I should know it. This is what she was referring to:
She shook her head, waved her hands in the air and told me that the 3rd topic would determine my grade. No pressure! Topic C was easy, but that was it’s problem…it was too easy! It’s one of those topics that feels so unimportant that you kind of jump over it. Luckily, I’d looked at it the day before. Unfortunately, it wasn’t a juicy enough topic to showcase my knowledge. Here is the topic I got plus another one just to show how much of a difference there is between them!
My topic above, versus another respiratory topic below. Which would you prioritize? 😉
I ended up with a 3, again. I’m a 50/50 mix of excited to be done and disappointed in myself. But I’m not going to dwell on it. I worked hard, I’ve learned a lot and I have a lot to learn. These topics will be repeated over and over again during the next three years, so I will have plenty of time to get them down.
A lot of growing and self-reflection accompanied this exam and I am stronger for it. I have some improvements to make but appreciate that I have the opportunity to do so on my own time.
Skjalg’s pathophysiology exam went well, so we celebrated with some wine down by the river.
Here are some snapshots from this past week:
Our celebratory wine and snacks by the river 😀
Bye, bye patho!!!