They Hated Me in My First Life, But Now I Have the Love System Chapter 640: Candidate, Present Your Case

She straightened up, her mind racing through possibilities.

---

The observation room was lit up.

Linda leaned forward. "She’s missing sothing, she hasn’t asked about previous cardiac interventions."

"Give her ti," George countered, watching intently. "She’s pacing her flow."

Carl, expression unreadable, quietly tapped a pen against the desk. "She’s already seen it," he murmured.

"What?" asked one of the examiners beside him.

"The pattern. She’s connecting the pulmonary findings to left ventricular failure."

@dNation: Is she gonna say it?

@StudentDocZ: She’s definitely thinking congestive heart failure secondary to long standing hypertension.

@FutureDrK: If she nails this viva, she’s not just passing, she’s making history.

---

After completing her physical exam, Nnenna stepped back and wrote a few quick notes before turning to the patient again.

"Mrs. Tasha," she said softly, "I believe your symptoms may be related to your heart. Possibly a condition called heart failure caused by your high blood pressure and maybe a rhythm problem. But don’t worry, we’ll confirm with further tests to be sure. You’re in good hands."

The woman looked at her in quiet disbelief before nodding slowly. "You sound like you actually care," she said. "Most people just write and leave."

Nnenna smiled. "Because you’re not just a case, ma’am, you’re a person. And people deserve care."

---

Back in the observation room

The room was silent for a full ten seconds.

Then one of the senior examiners let out a breath. "Brilliant."

George grinned from ear to ear. "Nicely done."

Linda’s jaw tightened. "Let’s see if she can handle the viva questions. Diagnosis is just the beginning."

Carl’s lips curved ever so slightly.

Online, the viewers exploded.

@dNation: She’s unreal.

@OmnioraObserver: This girl’s making the toughest case look easy.

@DocReview: Professional. Empathic. Accurate. Textbook 5th MBBS level.

Nnenna finished her examination calmly and stepped aside to record her findings. Her tablet glowed faintly as she wrote with steady hands:

Provisional Diagnosis:

Congestive Heart Failure (CHF) secondary to Hypertensive Heart Disease.

Differential Diagnoses:

1. Ischemic heart disease with left ventricular dysfunction.

2. Valvular heart disease (possibly aortic stenosis).

3. Arrhythmia related cardiomyopathy.

Her handwriting, clean, sharp, deliberate, reflected her composure.

---

In the observation room, examiners were blown off by Nnenna’s performance so far.

"Whoa," one of the examiners muttered, glancing at her notes on the shared monitor. "That’s an impressive differential for a student."

Linda scoffed under her breath. "Anyone can write fancy terms. Let’s see if she can defend it."

George, still watching closely, couldn’t stop smiling. "She’s analyzing patterns like a resident. That’s not luck."

@dWatch: Her differentials are solid.

@FutureDrK: She’s covering all the right bases.

@ExaminerFeed: This is how a final year candidate should think.

Carl said nothing, but the soft lift of his brow betrayed his approval. He knew her style, precise, never rushed.

---

Back in the room, Nnenna tapped on her tablet and turned to the nurse assigned to assist her.

"Please, can we get the following investigations?" she said gently, her tone firm but courteous. "An ECG, chest X ray, full blood count, serum electrolytes, urea and creatinine, and echocardiography. We’ll also check her fasting blood sugar and lipid profile."

The nurse hesitated. "That’s a long list, dear. Are you sure?"

"Yes, ma’am," Nnenna replied politely. "The goal is to identify both the cause and the complications. Missing any of these could cost her stability."

The nurse gave her a strange look, part doubt, part respect, before nodding. "Alright, doctor."

Mrs. Tasha frowned, her arms crossed again. "Why all these tests? Are you people trying to turn into an experint?"

Nnenna smiled gently. "Not at all, ma’am. We just need to understand what’s happening to your heart so we can treat you properly."

"Hmph. You’re just saying that because they’re watching," the woman said, eyeing the caras.

Nnenna leaned slightly closer, her voice soft. "Even if no one was watching, I would still care the sa way."

That silenced her.

---

Back in the observation room

"Very good," one examiner whispered, almost forgetting himself. "She disard her again. That patient has broken more students than I can count."

Linda rolled her eyes. "She’s performing. She’s just good at pretending empathy."

George turned sharply to her. "Or maybe she actually has it. You should try it soti."

Linda glared daggers at him, but before she could snap back, the head examiner announced, "Ti for presentation."

---

In a few minutes, Nnenna was ready to present.

She stood in the center of the room, facing the panel of examiners seated in a semicircle, five of them in total. Carl sat at the far right, calm and unreadable.

"Candidate, present your case," the chief examiner said.

"Yes, sir."

Nnenna began clearly, her voice confident but calm. "Mrs. Tasha is a 57 year old woman who presented with a two week history of progressive chest pain, shortness of breath, and leg swelling..."

Her rhythm was smooth, chronological, logical, human. She highlighted key findings: the radiation of the chest pain, the hypertension history, the cessation of dication, and the signs of fluid overload.

Then ca the interpretation, fluid retention, pulmonary congestion, reduced cardiac output. She concluded

"My provisional diagnosis is Congestive Heart Failure secondary to Hypertensive Heart Disease. Differential diagnoses include ischemic heart disease, valvular heart disease, and arrhythmia related cardiomyopathy."

The hall was silent for a mont.

"Excellent presentation," the chief examiner said, tapping his pen. "Now, let’s begin the viva."

The questioning began shortly after.

"Candidate," one examiner started, "how would you confirm your diagnosis?"

"I would use echocardiography to assess the ejection fraction, look for wall motion abnormalities, and evaluate chamber sizes and valvular function," Nnenna replied instantly.

"Good. What’s the normal ejection fraction?"

"Between 55% and 70%, sir."

"Correct. What are the common causes of heart failure in hypertensive patients?"

"Chronic pressure overload leading to left ventricular hypertrophy, ischemic heart disease, and poor drug compliance, sir."

The examiners nodded. The flow continued.

"Treatnt plan?" another asked.

"Lifestyle modification, dietary salt restriction, and pharmacologic therapy including ACE inhibitors, beta blockers, and diuretics. Depending on the ECG findings, anticoagulants or antiarrhythmics might also be needed."

One of the female examiners smiled faintly. "She’s good."

Still in the observation room, students who still hadn’t began their exam continued to observe.

George, at this mont was practically glowing with pride. "That’s how it’s done!" he whispered.

Linda folded her arms tightly, jaw set. "She’s just lucky they haven’t asked her about pathophysiology."

"I think you’re wrong Linda." Another student finally spoke up seeing how the situation was turning in Nnenna’s favour. "She’s killing it."

"That’s true." Soone chid in along with acknowledgents and awe from almost everyone present there.

"Hmf." Linda finally scoffed out of embarrassnt.

Online, almost everyone also agreed.

@dNation: I’m learning a lot. Thank you Omniora Academy!

@DocTalkLive: This is one of the cleanest presentations I’ve seen.

@OmnioraObserver: Prince Carl hasn’t spoken yet... wonder what he’ll ask.

And then, he did.

---

Carl’s calm voice broke the rhythm of the room. "Candidate White," he said softly.

Nnenna turned toward him. Her expression was respectful but steady.

"Yes, sir."

Carl’s tone was gentle, but his question was precise, surgical. "You ntioned diuretics. In a patient with long standing hypertension and possible kidney involvent, how would you balance diuretic therapy to avoid precipitating renal failure?"

The room went still.

Even the chief examiner glanced at him, it was a brilliant question, the kind that could break an unprepared student.

---

Nnenna didn’t blink. She took a slow breath and answered.

"Sir, in such a patient, I would start with low dose loop diuretics while carefully monitoring urine output, serum electrolytes, and renal function. If the patient shows signs of pre renal azotemia or worsening creatinine, I would reduce the dose or hold it temporarily while optimizing perfusion with ACE inhibitors and ensuring adequate hydration. The goal is to relieve congestion without compromising renal perfusion."

Her tone was calm, asured, confident.

Carl’s gaze lingered on her for a few seconds before he nodded slightly. "Good."

---

Students in the observation room were taking notes as well.

George exhaled, grinning like he had just won a bet as he wrote it down. "She handled that like a pro."

Linda bit her lip, looking furious. "Of course he gave her an easy nod. It’s his sister."

Another examiner in the room turned to her. "That wasn’t an easy question. Half our registrars fumble it."

@dNation: That question was brutal.

@ExaminerFeed: She nailed the renal balance explanation.

@OmnioraObserver: Even her brother tried to test her, she didn’t flinch.

---

The questioning went on for several more minutes. Nnenna fielded every one with quiet assurance, distinguishing left from right heart failure, explaining ECG interpretations, discussing prognostic indicators.

When it ended, the chief examiner smiled faintly. "Thank you, Candidate White. You may return to your seat."

Nnenna bowed slightly, collected her notes, and stepped out gracefully.

---

Monts Later

The panel mbers exchanged glances.

"She’s exceptional, the best so far." one said.

"No hesitation, no overconfidence," another added. "Balanced."

Carl remained silent, but his faint smile spoke volus.