Board Exams

Posted on Tue 24th Nov, 2020 @ 10:00pm by Makila i'Hartelhai

1,249 words; about a 6 minute read

Mission: Denouement
Location: Testing center
Timeline: MD 9 0800

Once her father was safely ensconced in the clinic Malika walked over to the testing lab. Entering the holodeck Makila licked lips gone unexpectedly dry. This was a turning point in the career that she'd chosen, the final exam for her third year. It could encompass anything that she'd learned in the past three years and she was a bit fearful of that. She would then have to approach Dr. Addams for placement with a residency. Truly she wasn't looking forward to that either.

"Computer, load program..." she looked at the PADD with the information on it. " Cadet Medical Exam 73152."

"Exam is ready to commence. Please take your seat."

Makila tucked her labcoat under her butt, and settled down into a seat.

"Enter individual testing codes in order to commence examination."

The young Romulan entered a series of 8 numbers into the computer and laid her palm on the screen so it could scan her biometrics. Of course she had to wait a time for the screen to catch up. It was difficult to manage exams in this training that she was doing, since she had to send her holographic form, and be proctored by the computer to ensure no cheating was occurring.

A trio of doctors two in Starfleet uniforms and one in a labcoat appeared on her screen, and her mouth went dry as she looked at them identifying each one in her head. Admiral Percy, Captain Andrews and Doctor Bartholomew. The racing of her heart made her ears ring with the cycling of blood, and she was forced to take a deep breath to calm her nerves. She didn't feel her nerves in her belly like most did, but in her chest. Licking dry lips yet again even though she knew that only chapped them further, she awaited the first question.

The computer voice began to speak, relaying the questioning from the trio of doctors: 'A 57-year-old male presents with fatigue and left upper quadrant heaviness. His white blood cell count is 110 x 109/L, and his hemoglobin is 8 g/dL. A bone marrow biopsy is performed, and in addition to a marked increase in neutrophils and precursors, a rare cell such as the one depicted here is present. What is this cell and what is the significance of finding one?'

On the screen was a prickly whitish blue cell.

"A Pseudo-Gaucher cell. The finding of this cell indicates some sort of hematologic disorders, such as myeloma, lymphoma, myelodysplastic syndromes, thalassemia and occasionally chronic myeloid leukemia." Malika answered with confidence, immediately recognizing the cell from pathology.

A chime sounded indicating the correct answer had been supplied. It was said that knowing the first question took the tension away from the exam and Makila found that adage to be correct. The confidence she had in her preparations took over, now that the first question had been answered correctly and she awaited the next.

A slide from a microscope filled her PADD. It was labeled gastric biopsy. "Please make an assessment of the shown tissue"

Studying it for a long moment Malika shrugged not seeing anything concerning. "Nothing of note to be seen here, this appears to be normal gut tissue."

Another chime and Malika's PADD went blank once more. The exams would do this, jumping from topic to topic.

"The patient in the previous question continues to complain of abdominal pain, and acid reflux when lying down. What is the next prudent course of action for the patient?"

"Administer a proton pump inhibitor prior to the dinner meal for 30 days. Scan esophageal tissue, and gastroesophageal sphincter tissue for any inflammation or loss of muscle tone, and culture for any abnormal bacteria such as h pylori. Concurrently I would suggest a trip to the counseling department, such symptomology can be caused by stress."

"An interesting assessment Ms Hartelhai, most people forget the psychological aspect. Well done"

"Thank you Ma'am."

'Human Infantile D-type transposition of the great arteries, diagnosis, causation and treatment? '

"This is precisely as it sounds, the great arteries are transposed. The aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle. This causes symptoms immediately upon birth of such an infant such as blue tinged skin, weak peripheral pulses, shortness of breath and a decreased blood oxygenation level despite oxygen application. Causation is uncertain, though adequate prenatal care can help to prevent such birth defects. Treatments are surgical, the arteries can be excised and placed on the correct using the Mustard or Arterial switch Procedure. "

"Can you demonstrate this technique?"

Makila chewed her lip as the idea of doing an operation on a tiny infant was a bit more than she'd signed on for. "I can" she said with only a touch of uncertainty in her voice. Were they wanting her to demonstrate the procedure for the exam? Elements she hoped not, she was not anywhere near prepared for such a thing.

"Please list the supplies needed for such a procedure."

"Pediatric specialty surgical nurse, Pediatric biobed, Micro laser scalpel and re-generator. Extracorporeal membrane oxygenation system with chilled bath. Blood- replicated to patient's blood type 4 units. Patients stem cells for replication of tissue should additional veinous or valvular tissue be necessary. Um..." She paused to think about what else she would need to prepare. "Cardiac simulator sized extra small. Isotonic Crystalloid sollution for fluid replacement."

Another chime but a different tone, and Makila smiled brightly knowing she'd gotten most of the question correct. Pediatric Cardiology was a specialty she was not interested in. To be fair, she didn't know what exact specialty she WAS interested in, but that certainly didn't interest her from the book learning.

The image of an older Andorian patient appeared in the holochamber. Immediately visible was the expression of pain and the deep blue purple spreading bruise along the side and back of his neck. Makila walked around him to see that the bruise was going down the spine on the left and appearing to initiate from the base of left antenna when she brushed the long hair aside. Dr Bartholomew watched her with an approving glance, as Michaela's eyes drifted over to the vital signs read out. While none of them were terribly outside of normal ranges, the heart rate and blood pressure were elevated possibly due to pain.

"Inital diagnosis?"

"Shearing of the Miral artery. "

"Reasoning?"

"Trauma to the antenna, especially shearing forces can cause hemorrhage without any visible trauma to the antenna itself. The bruising pattern under the hair and its origination at the base of the left antenna indicate some trauma from that location, and the speed by with it is spreading indicates to me arterial flow rather than venous. "

The Vulcan nodded in approval of her argument. "Well reasoned, your next course of treatment?"

"Pain management and slight sedation, a physical exam of the antenna in question to ensure the antenna isn't actually broken, arteriogram to find the source of the bleeding and micro-vascular repair."

Question after question followed in rapid succession. The tiny compliments she got from the test proctors was more than she expected and led Makila to feel more confident in herself. She didn't get every question correct, Each question also left her feeling more exhausted until by the end of the exam she was trembling in her seat. Sweat clung to her in a number of locations that just made her feel filthy in addition to exhausted due to the release of tension.

"Elements I need a bath."

 

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