Tuesday, September 23, 2008

23rd Septembr 2008

What did I do today

1) Bed-side teaching by Mr Al-Amin, the Hepatobiliary surgeon.I presented a case of an anterior neck swelling.This patient is having a rare thyroid pathology known as Hashimoto's thyroiditis, which is an autoimmune disease where there is an infiltration of T-lympocytes, leading to follicular cells destruction.This patient is a textbook patient.During the acute phase of attack, this patient had transient hyperthyroidism symptoms, also known as 'Hashitoxicosis'.During this period of time, she experienced palpitations, sweating,agitation, loss of weight despite good appetite and anxiety.After a significant number of thyroid's follicular cells( cells that produces the thyroxine and Triiodothyronine) destruction, the patient slowly progresses to hypothyroid state.On neck examination, there is a visible, diffuse neck swelling only on swallowing and not on tongue potrusion.The mass is diffuse, soft in consistency with ill-defined margin.

2) Went to the Emergency department for orientation by an MO

3) Went to the Surgery clinic.Assist Mr Hisham in inserting Foley's catheter for Continuous Bladder Drainage (CBD) to a patient known to have BPH (Benign Prostatic Hypertrophy).Did some venepuncture, not by looking but by palpating the veins at the cubital fossa.Patient to berkulit gelap okay and tak nampak veins!Luckily, my first attempt of withdrawing blood from this patient was successful.

4)Had another bed-side teaching by Miss Sarinah, the Breast and Endocrine surgeon.I presented a new case of 4th degree Haemorrhoid.Did physical examination on him but unfortunately the patient refused to be PR-ed! However, on inspection, there appears to be a single mass at the anal opening which is ulcerated and and thrombosed.Will try to request for PR from him again tomorrow =)

Currently listening to Raya songs while writing my case write up

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