Paeds Surgery

Me and Hannan went to the Paeds Surgery ward in UMMC for the second time(and yes during the Sunday).Today we followed the morning ward round, headed by Dr Syariz Izri the Paeds surgeon MO (he is my cousin by the way).Managed to see a few cases such as pancreatic pseudo cyst, cystic hygroma, Hirschprung's disease, imperforated anus etc.

Later, we discussed about the topic regarding stoma, since that it can come out in our short case surgery exam.Stoma literally 'mouth' in Greek or Latin.The other name for stoma is colostomy or ileostomy.Depends on where the stoma bag is.There are many types of stoma but the popular ones are loop-type and double-barrel type.We also discussed about the important points that we need to mention during the short case exam.They are:

1.Sitting of a stoma (as a rule of thumb, stoma must be placed away from bony prominences such as the ASIS and away from the umbilicus)
2.Type ( Loop or Double-barrel)
3.Content of a stoma bag (feces colour, consistency etc)
4.Complications ( skin excoriations, paracolostomal hernia etc if visible)

We discussed about few other things la such as indication and complications of stoma.Umm malas nk type dah....
We pinjam-ed a baby who has Hirschprung's disease.Did rectal examination and boy there was a sudden gushed of feces coming out just right after removing our finger out from the anal canal.A sudden gushed of feces is a pathognomonic feature of a Hirschprung's by the way.

Later that day, spend a few hours in the gym and later rushed to Shah Alam for Eda's sister wedding.

ps: OMG logbook internal medicine masih agakkk kosong.Abeslaa 2 minggu lagi dh nak kena hantar

XM

Final exam of Internal Medicine in 2 weeks time.I must admit that I am starting to feel a lil nervous.

My patient, the 15 year old boy who has hypokalaemic periodic paralysis dh discharge petang tadi.I hope he will achieve his dream of becoming an architect.Rajin.Bile dtg kat katil mesti tgk dia tengah buat soalan latihan.Pastu cepat-cepat sorokkan buku tu.Malu.Haha.Remember dik, poverty should not become your 'batu penghalang' in achieving your dreams.I shall pray for your success!

P:s What a long day.Bedside teaching sampai pukul 8pm.I'm not too sure wht I've learned juz now

Disbelief

Dear blog, sorry for not updating u for quite some time.It has been a busy weekdays and weekends.Yes, I have to come to the hospital even on Saturdays and Sundays.Saturday in HPJ.Sunday in UMMC at Paeds Surgery department.It's all becoz I am teman-ing my groupmate Hannan who will be doing her elective in Paeds surgery in the UK next month in the prestigious,world-famous Paeds surgery hospital, the Great Ormond Street Hospital.Its good for her to get some early exposure before going there.Good luck Hannan!

I am surprised and totally taken aback by the lack of history taking as well as presentation skills among houseman(HO).Particularly who graduated from that country.I tried not to be prejudiced.But so far I've met 1,2 and 3 HOs graduated from that country who shows similar trait.Tell me, how can you diagnosed a patient without knowing on how to take a proper history.As we all know, 90% of the diagnosis is made thru history taking alone.The rest are confirmatory.Izzit due to the lack of clinical exposure during clinical years?Are they not trained to take history?Lack of practice? Lack of patient access in the wards?Lackadaisical attitude of their lecturers?Easy passing mark during exams?or simply unmotivated during clinical years?Enlightened me.How can you make a diagnosis of chronic liver disease when you cant name any signs of chronic liver disease- palmar erythema, Dupuytren's contracture,spider naevi,caput medusae,gynacomastia and testicular atrophy-to support your diagnosis?I thought these are basic stuff that should have been taught during meds school.These are a must know knowledge!

Consequently,who will suffer the most?Yes,its none other than the patient.It serves as a reminder to myself.I hope that I could improve on my history taking as well as presentation skills.As for now, I tend to jump to the associated symptoms before even giving a good elaboration to the chief complaint.I pray to Allah in every step that I make.

ps:Sorry.I'm being frank here.I dont talk this stuff to anyone.I do this only in my blog.

Altered sensorium

Today was a bad day la I guess.

Went to the female medical ward early in the morning before the ward round starts.As usual, went to the nurses counter.The usual question came out ,"A'kum dan selamat pagi.Staff nurse, ada brape patient baru admit ke ward petang semalam?" I was a bit unlucky becoz the Sister(Ketua Jururawat) was moody.'Staff nurse, buat ape u layan sgt medical student ni?Jgn layan sgt.Kalau kite layan kerja kita takkan siap.U medical student dh buat orientasi kan?Haa tak faham lagi ka?'
I swear to God that I almost take the BP set and throw at her fat face.Wasnt she listening?My question was simple.'How many new patients admitted to the ward yesterday?'I need to know becoz I have to freakin go and clerk and do physical examination to those new patients.Preparing b4 the ward rounds becoz the Specialist would surely to either ask us to present the case or give the case summary to them.It's not that I am asking that staff nurse to bring me and show me every single new patients one by one!I'm sure that big fat old hippopotamus with that st*pid looking white hat sticking on her freakin hair has sensorineural deafness.Pardon me.Yes,I was pissed.I admit and rela dimarahi if I've done something wrong.But I got irritated if I was freely being lectured for some unknown,unjustified reasons.I dont know.Some nurses and sisters are downright cocky to the core.

At a different note...

Multiple sclerosis,Lung ca with secondary metastases to the brain as well as iatrogenic Cushing's secondary to exogenous steroid-are some of the new cases admitted to the ward yesterday.

PS: Currently doing case write up( 2 long cases and 2 short cases to be submitted tomorrow).Another sleepless night...

Think what patient's think

So many things have been happening for the past 2 days.On Monday, we witnessed the launching of 'Minggu Kesihatan Angkatan Tentera' bersempena dengan ulang tahun Kor Kesihatan Angkatan Tentera Malaysia yang ke ...... .Ntah, saya pun tak tahu.Will post the video perbarisan once I copied it from a friend of mine.

Did you know that stroke or 'angin ahmar' is believed to be associated with serangan syaitan?That's what some of the Malays thought.I've heard this notion before but had never ever thought that I would come across a patient who believe this so soon.One of my assigned patient suffers from right sided limb weakness associated with facial assymmetry 4 hours prior to admission.He was admitted 4 days ago.He is a known case of uncontrolled hypertension as a result of non compliant to medication.His systolic BP upon admission was unrecordable,while his diastolic blood pressure was 150 mmHg.Thats super duper high.We would grade his hypertension as 'Stage III Hypertensive emergency' under the new CPG guideline.Anyway,during history taking that patient started to tell his own version regarding the 'pathophysiolgy' of stroke.According to him, he believed that a devil would penetrate his body through the heart before being disseminated throughout the body.The most vulnerable part of the body will eventually manifest as limb weakness.He believes that stroke is curable especially when treated by powerful shamans or 'bomohs'.He even suggested me to learn from a few bomohs and that he could recommend me to them if I am interested.
Its interesting to think what patient's think sometimes.Scary.

Pic1: Pic was taken today.This is a tophi at the right elbow.This patient is having chronic tophaceous gout

Pic2: This pic was taken yesterday.The chest x-ray shows 'Boot-shaped' heart.This patient has ischaemic dilated cardiomyopathy.

Happy Mother's Day

Happy Mother's Day to my mother and to all mothers throughout this world.

Woke up at 8.30am this morning.Its Sunday, I was lazy indeed.However, we had to carry out a medical check-up in Bandar Tun Razak.Waqi contacted me yesterday saying that they need some men to run the booth.The medical check up is part of the activities being held during the Mother's Day celebration anjuran Puteri UMNO bahagian Bandar Tun Razak.Kak Sha was the contact person.

Arrived late, around 9.30am.Sesat.The signboard for Taman Tenaga was nowhere to be seen.We opened the booth as soon as all of arrived at the scene.Once the registration booth were opened, a hoard of people menyerbu.My god.I manned the Blood Pressure taking booth.Bayangkan orang beratur mcm nk mengundi je.Line panjang.I was taking the BP for almost 2 hours straight without getting a rest!Nobody was kind enuff to give me at least a mineral water.Anyway, had a little bit of fun when I get to practice my 'counselling' skill to makcik and pakcik.PLease take care of your diet,stop smoking,exercise more etc etc.Yes.Its important.Doctors ( or future doctor as in my context ) should play roles as a teacher to patients.Educate them with knowledge that they supposed to know.It makes things easier in the end.

PS: I am curretnly back inTerendak.Will have to go to the medical ward tonight to clerk and update new patients.

The Bashing up day

Today was a bashing up day by prof.From bedside teaching to our TBL session.Extremely tired.The day starts at 8am and finished at 7pm.Extremely tiring, physically,mentally and emotionally.We have the knowledge but the problem is that is how to apply it in a real situation-ie translate it into our working environment such as using those knowledge during history taking so that we could ask relevant questions,looking for focused,relevant physical signs,ordering for relevant investigations etc.

If I were to stop pursuing medicine, this day would justify it

ps: I do not know what to think about myself right now

ps:Patient case presentation for today was about 1) Unstable angina 2) Acute exacerbation of asthma secondary to rhinosinusitis 3)Beta Thalassaemia major.TBL was on "Approach to DM and Dyslipidaemia"

Internal Meddicine Week 3

Another reason why I dislike Paeds.Sometimes while clerking patients (a.k.a kids) will b busy doing somethingelse.This pic was taken yesterday when adik H was admitted due to Poorly controlled asthma (classification based on the latest Asthma classification-the GINA classification).My friend Hanan was so into clerking his history while he , on the other hand was busy playing with Gameboy.She had to come to the ward at night to clerk his history.And at the end, this is what she gets!

No lar, I'm not making a big fuss out of it.What is more interesting is the chest x-ray findings.His chest x-ray shows tramline and ring shadows which is consistent with the diagnosis of bronchiectasis.We r doing CT Scan tomorrow morning to confirm the diagnosis.Will try to take the chest x-ray pic and paste it here. =)

Ps: Internal Medicine is so tiring.But luckily it is interesting at the same time.

Ps: Had 2 TBL today- 'Lethargy' and 'Cough n Wheezing'.The second TBL was done with Dr Rosman.We have to change to our sports gear and went to a place near the sea shore and had our discussion there in the late afternoon.Dpt tengok sunset skali.......

Ps: Spend 2 hours in the clinic today.Got to clerk and see cases like Asthma, Migraine and Beta Thalassaemia major.

Ps: My patient with Unstable angina is stable.Dr Pakar are keeping him in the ward to stabilise his blood pressure

HO,MO,Specialist,Consultant

Its labour day.Still, no holiday.Drove from Terendak and reached KL yesterday evening.Attended 2 teaching sessions by Dr Rafizie and Dr Shuhaila this morning in Hospital Putrajaya.Did I mention that they are married together?Hehe.They are so motivated in teaching us.May Allah bless the couple.Seriously, they are both good and nice.

According to Dr Rafizie,

HO = Hamba Orang
MO= Makan Orang
Specialist = Syphilis
Consultant= Con-setan

LOL

Ps: Revision mania syndrome