(Background: LMCC is the Canadian medical licensing exam. It is a 9 hour, computer-based exam. The morning consists of 200 multiple choice questions. The afternoon gives you roughly 50 cases and you write in answers based on said cases. Phew.)
The case was vague. An eleven year old boy is hiking in the woods with his family when he suddenly becomes ill. He is pale, sweaty and his heart is racing. By the time he gets to you (ER) he is unresponsive.
I read this and though, Oh! Easy, right? This kid has obviously been bitten by a poisonous snake or spider and is going into respiratory failure.
But. BUT. This exam is set in Canada. There are no poisonous snakes in Canada.
Or are there? Are rattlesnakes are part of the Canadian fauna? Surely copperheads can migrate across the border? No. But what if there is another kind of snake?
The exam board is from Ottawa, are there poisonous snakes in Ottawa (insert political reference here) or do they have ticks or other insects I'm not familiar with?
But! What else would it be? There are no signs of anaphylaxis (swelling, wheals, stridor). There are no indications that the kid has an underlying disease. It must be snake-bite.
But what snake would have bitten him?...
I went round like this for a while. Specfically, for ten minutes and thirty seconds. (You get a time breakdown of how long you spend on each question. My average was 32 seconds. This ten-minute blip was not reassuring.)
A similar thing happened during my last Canadian exam. The question was about frostbite. I sat in front of the screen blinking and mumbling to myself because in 4.5 years of Australian med school, frostbite had never come up. Blue ringed octopus stings? Sure. Lethal sunburn? Absolutely. But no frostbite.
With luck, I will have passed. If not, I'll write the damn thing again.
In the meantime, I get 6 weeks of "integration to the Canadian medical system", which will hopefully teach me the herpetological biodiversity of Canada.
I'm sure that's a priority.
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