Saturday, November 29, 2008
Written exam is on the Thursday.I dont know what to say.Buat je laa...
Tuesday, November 25, 2008
Monday, November 24, 2008
This baby have many trisomy18 features- hypotelorism, triangular shape face, prominent occiput, overlapping of fingers, clinodactyly etc.This baby is also having ASD and PDA with continuous murmur best heard at the left infraclavicular region grade 4.
Monkey-ing around is certainly another way to help them
Tengokla tu, ada aktiviti menconteng tangan dan muka budak-budak
As usual, like in any other health project a medical check up booth is a must.I 'happily' volunteered myself to man the physical examination booth.Tak check ape pun, just practice on my physical examination skills je, patient kan ramai :P
Friday, November 21, 2008
I am in the middle of completing my last long case write up for Paeds when I decided to update this blog.Today I would like to show you some of the pictures that I have taken today.
Above is the classical rash in dengue fever.It is described as 'generalized erythematous rash with areas of hypopigmentation in between'.OR 'White islands in the sea of red'.This is due to plasma leakage.Smal,multiple non-blanching petechial rash can also be seen.Petechial rash on the other hand is due to small capillary burst.You'll get more petechial rash if Hess test is positive( which I did on this patient)
Above are what we called 'ecchymoses'.This 4 year old child came in today with multiple bruises over the upper on lower limbs as well as the trunk of 7 days duration.He has no history of trauma or fall.No lymphadenopathy or hepatomegaly.He had history of URTI about a month ago.Therefore he was diagnosed with Immune Thrombocytopenic Purpura(ITP) and not Acute Leukaemia coz Leukaemia must be one of the differentials.
We had another new Kawasaki's Diseases today.Admitted just before I went back from the hospital.We also had a patient with blisters and looks like its going to progress to Scalded skin syndrome.I'm going to take the pictures tomorrow.
I do feel sorry for the patients, but for the sake of studying we as medical student need to take pictures so that we can use it in our presentation later.Thats what I've been told by the specialist ' Take picture,take picture and include this in your case presentation later!You should be taking pictures and videos as long as you gain permission from your patients and that pics or videos will not degrade your patients later by circulating it around in Youtube!' I do feel a little bit awkward when taking pictures of the legs and bodies instead of the faces.
A group presented a TBL on Paediatric Emergency today.Lucky for us that Dr H the Paediatrician did not bebel us too much today.My subgroup will be having a bedside teaching by Dr Faizah tomorrow at 10 am.I'll be volunteering myself to present 2 cases tomorrow.Bioethics class with Dr Musa at 2.30pm.I'll be on-calling tomorrow night but before that I am going to Hospital Putrajaya to the Medical Ward.A colleague told me that they have a patient with Steven-Johnson syndrome.That is like super duper rare, 1 case in 1 million patients!
Wednesday, November 19, 2008
Paediatric Ward 5 B
Tuesday, November 18, 2008
Soft toy.I have a mickey mouse as my mate.He helps me when I'm trying to build a good rappot with my patients.A child will open up to you easily after you have played with them.They become more cooperative and it helps when doing physical examination.
Tendon hammer.Is used to check for reflexes.The tip is used when trying to elicit the Babinski reflex
Saturday, November 15, 2008
I really think that the ward round is too long.Average is 4 hours everyday.Not to mention thenumber of hours that we need to be in the hospital everyday.Usually I came at 7.30am and go back at 6pm.Sometimes, it can go up to 11pm.
At last, Adik A my dengue patient was discharged yesterday.He requested for my autograph and my phone number as well as my email.He said he want to keep in touch with me, telling me about his progress in school.So cute.These are the things that money could not buy.The satisfaction.I felt great.
Presented my long case today to the head department of paediatrics.I got 7/10.Alhamdulillah.Never thought that I would get that kind of mark.You see, Paediatric history taking is so detail.All of the specialists in the hospital expect us to be able to clerk as well as present a good history.90 percent of the diagnosis were made from history taking.What a loong day today.Had TBL about approach to respiratory distress, then later after Friday prayer we had Bioethics class.
I spent the whole day yesterday in the Damansara Specialist Hospital Dr Musa's bedside teaching.In the morning, we were in the nursery where all the newborns were kept.He asked us to examine a few neonates and tell him our findings.The babies are so fragile.We had todophysical examination of the newborn from top to the bottom
Its not that hard really.The only annoying part is when they start to cry.We then spend the rest of the day in his clinic.
Monday, November 10, 2008
Sunday, November 9, 2008
Sometimes I made myself scared to death, especially when I think that I have woken up late.This morning my kakak woke me up at 5.45am because I need to be in DSH (Damansara specialist hospital) at 7 am for my bedside teaching with Dr Musa Nordin the Neonatologist.Anyway, to cut the story short, I woke up late this morning.It was 6.20 am.Yes I tertidur balik after that.Mind you, its Sunday morning and thats the best time to sleep.No need to worry about anything during the weekends.And so I managed to get ready within 10 minutes time(mandi pun tak basah sgt kut) and Super Subuh, and after having a sip of tea and a karipap I'm off to D'sara.I was lucky that the traffic was smooth and I have arrived on time.Dr Musa arrived at 7.10am.Yeay!
A Radiologist came to us and ask us to review this CT scan.He said 'This is a good CT scan finding coz they usually ask you during your exam, so plz see ar".Anyway, this CT scan shows Multiple brain lesions over the frontal and parietal region with vasogenic oedema.Its a secondary metastases of a lung cancer.
Interesting cases throughout the week
- a boy in the ICU showing signs of upper motor neurone lesion such as hypertonia and hyperreflexia.
2.Complex febrile convulsion - seizure unresolved by rectal diazepam and midazolam.Patient
eventually had to be intubated.All happened right in front of my very own eyes
3.Pyrexia of unknown origin
4.Another case of Kawasaki's disease - I'm starting to think that this disease is not rare after all.The child has all of the diagnostic criteria
- we went to the cardiac high dependency unit to see the boy.He has 3/5 of the major criteria in the revised Jones criteria of Rheumatic fever
6. Arteriovenous malformation
7. Haemolytic-Uraemic syndrome
Tomorrow ( as in Sunday morning at 7 am), I have a bedside teaching with Dr Musa Nordin the Neonatologist in Damansara Specialist Hospital.God knows what case is he going to give us tomorrow.No complicated case please!
Wednesday, November 5, 2008
Again, ward rounds was tiring.It lasted for 4 hours.Penat and nk patak kaki dah.However, manage to assist the specialist in doing physical examination.I ausculated many chest today, but sadly all of my findings did not tally with the specialists.Guess that I need to listen more attentively.
My group presented a TBL topic today with Dr Faizah supervising.It went well.
I really need to prepare for my case write up and my MIDPOSTING EXAM which is scheduled this coming Thursday.
Monday, November 3, 2008
1. 3 hours of ward rounds.Nak patah kaki
2.Clerking and examining patients
4. Clerk and examining newly admitted cases
Some interesting cases today
4. Ventricular septal defect with Patent ductus arteriosus
What do I need to do tonight
1. Complete my powerpoint for TBL presentation tomorrow
2.Write my case write up.
3.Need to finish reading the Failure to Thrived articles
-Kawasaki's dzs - criteria for diagnsosis, complications, investigations, treatment
5.Types of rash
6.Malaysian Immunization Programme- use Paediatric protocols of Malaysian hospitals
7. Finishing my Hutchisons