tag:blogger.com,1999:blog-6973976388552824292024-03-05T12:52:02.220+08:00Ah Yes, Medical SchoolJoin me as I half-ass my way through medical school, encountering all sorts of freaks ( Patients,Nurses,Doctors, Friends, Myself etc.) along the wayN a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.comBlogger97125tag:blogger.com,1999:blog-697397638855282429.post-70080673593026375222009-07-26T13:42:00.006+08:002009-07-26T19:59:01.172+08:00Yasmin Ahmad 1958-2009<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgm0xUbNLTrBYS-asz40fUGiXH9gpRheAq-9m2uHnneRhYhgRUUix3naaW1MiNi55b5Of3Z6PVDmS6vSISxrJAYJzMjBmC82oLke3bp2SWfch4nbMcp53wpE6vsDZFnhs04YELkT5INOA/s1600-h/yh.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 200px; height: 200px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgm0xUbNLTrBYS-asz40fUGiXH9gpRheAq-9m2uHnneRhYhgRUUix3naaW1MiNi55b5Of3Z6PVDmS6vSISxrJAYJzMjBmC82oLke3bp2SWfch4nbMcp53wpE6vsDZFnhs04YELkT5INOA/s320/yh.jpg" alt="" id="BLOGGER_PHOTO_ID_5362644234345596082" border="0" /></a><br /><span style="color: rgb(204, 0, 0);"> Yasmin Ahmad<br /> 1958 - 2009<br /><br /> I feel like writing something about the demise of Yasmin Ahmad.</span> <span style="color: rgb(204, 0, 0);"> It was confirmed that Yasmin Ahmad, aged 51 years old has passed away at 11.15pm yesterday in Damansara Specialist Hospital.She was in a coma for 3 days(I think!) after suffering from a haemorrhagic stroke.3 days prior to admission, she was in a midst of a discussion with Dato Siti with her old husband wtf in TV3 HQ Bandar Utama before collapsed.</span><br /><br /> <span style="color: rgb(204, 0, 0);">To me, she was an icon legend.It came as a shocking to me becoz she was one of the few directors in Malaysia who can actually made a difference in the local entertainment scene.She was well known with her movies such as Gubra and the latest Talentime.Though I didnt watched all of them but from the outstanding reviews and the awards that were received, I am sure Malaysia is and will always be proud of her.</span> <span style="color: rgb(204, 0, 0);"><br /><br /> This prolific director has her own unique way of reaching to Malaysians heart through her tv commercials for Petronas.Some of them were witty,funny and some were of coz deadly sad.Nonetheless, all of them had special meaning to it.</span> <span style="color: rgb(204, 0, 0);"> This was a big loss for Malaysia.Great minds like these dont come very often.Let us all pray for her peace and may Allah bless her soul.Amin.</span> <span style="color: rgb(204, 0, 0);"><br /><br /> p/s I went to the gym early in the morning and work my a** out and currently energy-less .zzZZzzz...Have a nice weekend everyone! =)</span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com2tag:blogger.com,1999:blog-697397638855282429.post-46105987282237867592009-07-23T10:13:00.006+08:002009-07-23T21:17:47.924+08:00Critical appraisal<span style="color: rgb(0, 0, 153);">My groupmates and I are currently doing critical appraisal on a medical journal.The title is</span><br /><br /><span style="color: rgb(255, 0, 0);">'Effect of long-acting Nifedipine on mortality and cardiovascular morbidity in patients with stable angina requiring treatmet (ACTION trial): randomized clinical trial'</span><br /><br /><span style="color: rgb(0, 0, 153);">Doing clinical appraisal is not an easy task.Now is the time to apply all the knowledge and thats when then the problem comes.</span><br /><span style="color: rgb(0, 0, 153);">I'm tired and I juz wanna sleep.</span><br /><br /><span style="color: rgb(0, 0, 153);">edited at 9.15pm today.</span><br /><span style="color: rgb(0, 0, 153);"> </span><br /><span style="color: rgb(0, 0, 153);"> This posting is good coz one of its main objective is to ensure u on how to critically appraise a journal so that u wont be duped by a short-wearing skirt drug representative,promoting their drugs later when you work as a doctor.Sadly, there are significant numbers of doctors out there who are clueless/confused about evidence based medicine, therefore become prey for drug companies.</span><br /> <span style="color: rgb(0, 0, 153);"> I didnt know that there are a lot of types of medical journals out there .eg diagnostic,prognostic,therapeutic etc.Tomorrow is exam.byebye.</span><br /><br /><br /><br /><span style="color: rgb(0, 0, 153);">p/s: The Good Clinical Practice (GCP) certificate exam is next week.comon bebeh, nak jadi certifified medical researcher.<br /><br />p/s2: omg.so many technical terms involved<br /></span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com1tag:blogger.com,1999:blog-697397638855282429.post-76906132306895874462009-07-16T01:04:00.003+08:002009-07-16T01:09:02.503+08:00Bersosial<span style="color: rgb(51, 204, 0);">Went for workout at the gym just now.Currently having abs cramp, contracting intermittently...</span><br /><br /><span style="color: rgb(51, 204, 0);">Will be having elective proposal presentation with Prof Khairul tomorrow at 1.30pm....</span><br /><br /><span style="color: rgb(51, 204, 0);">Will be watching the NEW Harry Plotter movie at Cineleisure tomorrow with a couple of friends....</span><br /><br /><span style="color: rgb(51, 204, 0);">Will be watching Nik's band performing at the Laundry The Curve Damansara tomorrow night...</span><br /><br /><span style="color: rgb(51, 204, 0);">Who says medical students cant have social life?</span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com2tag:blogger.com,1999:blog-697397638855282429.post-6143320632799690552009-07-14T00:39:00.002+08:002009-07-14T00:54:16.213+08:00And so the NEW semester starts<span style="color: rgb(0, 0, 153);">Yes, and so the new semester starts.Will be doing a posting called 'Research and Evidence Based Medicine' or in short 'REBM'.</span><br /><span style="color: rgb(0, 0, 153);">I quote from my course handout:</span><br /><br /><span style="color: rgb(255, 0, 0); font-style: italic;">'It is crucial and indeed critical for future doctors to be trained in Evidence Based Medicine and how to apply it in daily practice.Many universities neglect this topic, some do not even teach it formally at the post graduate level.Clinical epidemiology is the basis of Evidence Based Medicine, a mantra repeated by many,understood by a few and practice by very few'.</span><br /><br /><span style="color: rgb(0, 0, 153);"> Learning on how to think (critically, laterally and creatively) are essential in a doctor's life.We wudn't want to be duped by the drugs rep when we work later.We need to be able to critically appraise medical journal which are needed to know which facts are fake, which facts are true.Critical and analytical mind plays vital role in the success in this field.</span><br /><br /><span style="color: rgb(0, 0, 153);"> This course will only be for 4 weeks, in which I will b sitting an internationally recognised exam in order to obtain 'Good Clinical Practice (GCP) certificate'.Passing this test will mean that I'll be an internationally accredited as a researcher in medicine( so I was told.I wasnt interested yet upon hearing this).I will b able to conduct experiments using humans!(Now I'm all hyped up!Conducting tests with humans, how cool is that!!!)This course are usually offered at post graduate level but I am indeed lucky to sit this test during my undergrad.It is indeed expensive to sit for this test if u r an independent candidate,probably need to pay a few thousand RM.I dont need to pay a single cent.Now how cool is that.I hope and I will try my best to pass the test.</span><br /><span style="color: rgb(0, 0, 153);"> </span><br /><span style="color: rgb(0, 0, 153);"> REBM looks challenging.</span><br /><br /><span style="color: rgb(0, 0, 153);">ps: I didnt know until about few days ago that there actually people who consistently, diligently read my blog.Looks like I have to take blogging a little bit more serious.yeah?</span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com0tag:blogger.com,1999:blog-697397638855282429.post-7841105017542029142009-06-12T02:08:00.006+08:002009-06-12T10:20:37.760+08:00And so the semester ends....<span style="color: rgb(255, 0, 0);">Alhamdulillah...</span><br /><br /><span style="color: rgb(255, 0, 0);">Maka dengan ini tamatlah pengajian perubatan saya untuk tahun ini...</span><br /><br /><span style="color: rgb(255, 0, 0);">Had my long case clinical exam last Monday.Dapat COAD case.Malangnye patient was rather a poor historian.History was rather here and there.Rasa nk menangis pun ade masa clerking.However, I still managed to get good differential diagnosis in the end.Differential diagnosis sangat penting because without them we cannot suggest relevant investigations to the examiner which carries 20 marks in exam.Discussion part was okay except kantoi sket bila ditanya pasal 'What do you know about H1N1 epidemic?Like need to know how many positive cases so far, mortality rate etc'Nampak sgt tak tekun membaca newspaper...</span><br /><br /><span style="color: rgb(255, 0, 0);">Theory paper was today.The questions looked easy but actually tricky.Quite frustrated with the Single best answer section.SAQ and EMQ were okay I guess.I seriuosly cannot forget my pre clinical basics because they will still ask them in clinical exams</span>.<span style="color: rgb(255, 0, 0);">Like how am I supposed to remember the name of the stain used for Cryptococcus neoformans.The answer is Indian stain by the way....</span><br /><br /><span style="color: rgb(255, 0, 0);">Went to help my juniors with revision later in the evening.They are about to sit for their first paper tomorrow.Professional exam babe...jgn main-main punya exam.An exam that will determine them whether they are fit,worthy and most importantly safe competent medical students to roam the wards.Good luck guys.</span><br /><br /><span style="color: rgb(255, 0, 0);">Its 2am,just got back frm 'lepaking' with my old friends around KL.Its good to update myself with their latest gossips hahaha.just kidding</span><br /><br /><span style="color: rgb(255, 0, 0);">Okla.1 month holiday.Any suggestions on how to spend the holiday?<br /><br />p/s: Finally Ronaldo is leaving Old Trafford for Bernabeu at a whooping price tag of 80million pound sterling.A warm goodbye to Ronaldo-he's been a good servant , and all parties got what they wanted.Let's leave it at that.<br /></span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com6tag:blogger.com,1999:blog-697397638855282429.post-74383488310392277082009-06-05T20:39:00.004+08:002009-06-05T22:45:29.600+08:00Air mata<span style="color: rgb(51, 204, 0);">Dear blog, u know what....I have a confession to make.<span style="font-weight: bold; color: rgb(255, 0, 0);">I cried this week</span>!</span><br /><br /><span style="color: rgb(51, 204, 0);"> It happened 2 days ago during bedside teaching with prof.I had a patient who had<span style="color: rgb(255, 0, 0);"> stroke</span> 2 days ago.She is a 43 yr old Indonesian lady, came to Malaysia about 6 months ago utk mencari rezeki yg halal,workin as babysitter.But she developed stroke and now is paralyzed on her right side.Everything went ok, but soon after I performed neuroligical examination of the lower limb on her in front of prof and my colleagues, she suddenly grab my prof's arm and start to say things like, 'Tuan dokter, tolong obati saya.Saya tak mahu jadi begini.Tolong.Tolong.Tolongg..." Allah...dats when my lacrimal gland starts to produce tears.Ok.I was like wtf, stop crying silly!(umm..I was saying silly to myself n not to d patient)Anyway,its not like tears running down the cheek.Its more like 'air mata bergenang-genang di kelopak mata"I can see that my colleagues are experiencing the same thing.We tahan.Try to look professional.But again, we are also human beings and the emotion sort of transcends right into our hearts.</span><br /><span style="color: rgb(51, 204, 0);"> Similar things happened towards another patient.It occurs the same day.She is a middle-aged Malay lady, came in with intermittent vertigo(dizziness).It was rather an interesting case because she had cerebellar signs such as nystagmus, intentional tremor,ataxia,dysdiadochokinesis etc. Again, after Hanan performed physical examination to elicit cereballar signs on her, she started to say ," Tuan dokter, ni can... can... cancer ker?"...and she started crying.I really admire the way how prof handled and tackled these emotional moments.He motivates patient.He tell them to think positive and be optimistic.By the way, we dont think its cancer because the history does not suggest that it is.Moreover, the cerebellar signs are not vivid.Even if it is a <span style="color: rgb(255, 0, 0);">CP(Cerebello-pontine) angle tumour</span>, the ENT surgeon can easily remove them.</span><br /><span style="color: rgb(51, 204, 0);"> It break our hearts to be in this situation.Its hard to be optimistic when you know that the disease such as stroke do not have a good prognosis.There is nothing much we can offer!Once kena stroke, poof... its hard to predict.The only thing to do is to motivate patient,telling them that they cannot lose hope.Patient come to us because they trust us.They hope that, with the help of Allah and to our utmost capabilities ....we can cure them.Ok.This is dilemma right there.I better stop now.Nak pegi dinner......</span><br /><br /><span style="color: rgb(51, 204, 0);">p/s: My long case clinical exam for internal medicine is on this Monday(3 hari lagi!)at 2.30pm.Doakan ye.... =)</span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com3tag:blogger.com,1999:blog-697397638855282429.post-17794614250079995032009-05-31T21:46:00.005+08:002009-05-31T22:13:58.674+08:00Paeds Surgery<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUFNSLlOnhGvNLKN8zjtxHLMINec_W6sxnEU9obKPEfGKwV-6EYyhvAMbuxSVY_26jL8vHc27RuaalTNNlMX62UBWBWMq2iUuFhH2vkdBRt1i3FxUwg7b-GfunuCj439weuSDBxy3sfBc/s1600-h/getImage.aspx.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 320px; height: 214px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUFNSLlOnhGvNLKN8zjtxHLMINec_W6sxnEU9obKPEfGKwV-6EYyhvAMbuxSVY_26jL8vHc27RuaalTNNlMX62UBWBWMq2iUuFhH2vkdBRt1i3FxUwg7b-GfunuCj439weuSDBxy3sfBc/s320/getImage.aspx.jpg" alt="" id="BLOGGER_PHOTO_ID_5341987949866491154" border="0" /></a><br /><br /><span style="color: rgb(255, 0, 0);"> Me and Hannan went to the<span style="color: rgb(51, 204, 0);"> Paeds Surgery ward in UMMC</span> 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.</span><br /><br /><span style="color: rgb(255, 0, 0);"> 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:</span><br /><br /><span style="color: rgb(255, 0, 0);">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)</span><br /><span style="color: rgb(255, 0, 0);">2.Type ( Loop or Double-barrel)</span><br /><span style="color: rgb(255, 0, 0);">3.Content of a stoma bag (feces colour, consistency etc)</span><br /><span style="color: rgb(255, 0, 0);">4.Complications ( skin excoriations, paracolostomal hernia etc if visible)</span><br /><br /><span style="color: rgb(255, 0, 0);"> We discussed about few other things la such as indication and complications of stoma.Umm malas nk type dah....</span><br /><span style="color: rgb(255, 0, 0);"> 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.</span><br /><br /><span style="color: rgb(255, 0, 0);"> Later that day, spend a few hours in the gym and later rushed to Shah Alam for Eda's sister wedding.<br /><br />ps: OMG logbook internal medicine masih agakkk kosong.Abeslaa 2 minggu lagi dh nak kena hantar<br /></span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com3tag:blogger.com,1999:blog-697397638855282429.post-83339426742026518622009-05-28T23:09:00.003+08:002009-05-28T23:18:53.840+08:00XM<span style="color: rgb(0, 0, 153);"> <span style="font-size:180%;"><span style="color: rgb(255, 0, 0); font-weight: bold;">Final exam of Internal Medicine</span></span> in 2 weeks time.I must admit that I am starting to feel a lil nervous.</span><br /><br /><span style="color: rgb(0, 0, 153);"> 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!</span><br /><br /><span style="color: rgb(0, 0, 153);">P:s What a long day.Bedside teaching sampai pukul 8pm.I'm not too sure wht I've learned juz now</span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com1tag:blogger.com,1999:blog-697397638855282429.post-89783271147284413332009-05-26T22:19:00.004+08:002009-05-26T22:58:05.265+08:00Disbelief<span style="color: rgb(0, 153, 0);">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.</span><span style="color: rgb(0, 153, 0);">Good luck Hannan!</span><br /><br /><span style="color: rgb(0, 153, 0);"> 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!</span><br /><br /><span style="color: rgb(0, 153, 0);"> 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.</span><br /><br /><span style="color: rgb(0, 153, 0);">ps:Sorry.I'm being frank here.I dont talk this stuff to anyone.I do this only in my blog.</span><br /><br /><span style="color: rgb(0, 153, 0);"> </span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com2tag:blogger.com,1999:blog-697397638855282429.post-55875492841417663832009-05-13T22:03:00.003+08:002009-05-13T22:27:01.107+08:00Altered sensorium<span style="color: rgb(0, 153, 0);">Today was a bad day la I guess.</span><br /><span style="color: rgb(0, 153, 0);"></span><br /><span style="color: rgb(0, 153, 0);"> 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?'</span><br /><span style="color: rgb(0, 153, 0);">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</span>.<br /><br /><span style="color: rgb(0, 153, 0);">At a different note...</span><br /><br /><span style="color: rgb(0, 153, 0);">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.</span><br /><br /><span style="color: rgb(0, 153, 0);">PS: Currently doing case write up( 2 long cases and 2 short cases to be submitted tomorrow).Another sleepless night...</span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com5tag:blogger.com,1999:blog-697397638855282429.post-67351565105658053022009-05-12T22:28:00.008+08:002009-05-12T23:40:28.620+08:00Think what patient's think<span style="color: rgb(255, 204, 0);"><span style="color: rgb(0, 0, 153);"> 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.</span></span> <span style="color: rgb(0, 0, 153);"></span><br /><span style="color: rgb(0, 0, 153);"><br /> Did you know that stroke or 'angin ahmar' is believed to be associated w</span><span style="color: rgb(0, 0, 153);">ith 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.</span><span style="color: rgb(0, 0, 153);">We would grade his hypertension as '<span style="color: rgb(255, 0, 0);">Stage III Hypertensive emergency</span>' 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</span><span style="color: rgb(0, 0, 153);"> penetrate his body through the heart before being disseminated thro</span><span style="color: rgb(0, 0, 153);">ughout 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.</span> <span style="color: rgb(0, 0, 153);"><br />Its interesting to think what patient's think sometimes.</span><span style="color: rgb(0, 0, 153);">Scary.</span><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEireyBqVp5M3mhiULQNn_7zb2HC6R3pNiey3hYEDWyMMr8mv_GGf_kkwt0_sYTYaZfpZ2yzAr2fXWT6RX_RuZehPAXkLUG-35cDclaYlRF7o5b-nu2ryYPWEGtSAYhvQ2L4_hVFV1xq288/s1600-h/IMAGE_972.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 240px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEireyBqVp5M3mhiULQNn_7zb2HC6R3pNiey3hYEDWyMMr8mv_GGf_kkwt0_sYTYaZfpZ2yzAr2fXWT6RX_RuZehPAXkLUG-35cDclaYlRF7o5b-nu2ryYPWEGtSAYhvQ2L4_hVFV1xq288/s320/IMAGE_972.jpg" alt="" id="BLOGGER_PHOTO_ID_5334949022964120290" border="0" /></a><span style="color: rgb(0, 0, 153);">Pic1: Pic was taken today.This is a tophi at the right elbow.This patient is having chronic tophaceous gout</span><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAXahorSbK7x8VkBc_skKHa37jJQ61I1-yg70XCBnml82T8KLfsIjTSWbvXTSRGTYyvkWAxOdst9ViD-Mj1VqWXSIe1ZvIXwCLp0oV6MpS3vGEyjXSrJwur6LSpoxwmmG-FWAY2iDPPyU/s1600-h/IMAGE_910.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 320px; height: 240px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAXahorSbK7x8VkBc_skKHa37jJQ61I1-yg70XCBnml82T8KLfsIjTSWbvXTSRGTYyvkWAxOdst9ViD-Mj1VqWXSIe1ZvIXwCLp0oV6MpS3vGEyjXSrJwur6LSpoxwmmG-FWAY2iDPPyU/s320/IMAGE_910.jpg" alt="" id="BLOGGER_PHOTO_ID_5334948588657714210" border="0" /></a><span style="color: rgb(0, 0, 153);">Pic2: This pic was taken yesterday.The chest x-ray shows 'Boot-shaped' heart.This patient has ischaemic dilated cardiomyopathy.</span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com0tag:blogger.com,1999:blog-697397638855282429.post-7722988798334302752009-05-10T19:47:00.003+08:002009-05-10T20:03:59.171+08:00Happy Mother's Day<span style="color: rgb(0, 153, 0);"> <br />Happy Mother's Day to my mother and to all mothers throughout this world.</span><br /><br /><span style="color: rgb(0, 153, 0);"> 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.</span><br /><br /><span style="color: rgb(0, 153, 0);"> 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.</span><span style="color: rgb(0, 153, 0);">Educate them with knowledge that they supposed to know.It makes things easier in the end.</span><br /><br /><span style="color: rgb(0, 153, 0);"> PS: I am curretnly back inTerendak.Will have to go to the medical ward tonight to clerk and update new patients.</span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com0tag:blogger.com,1999:blog-697397638855282429.post-16674777482681084462009-05-06T20:59:00.004+08:002009-05-06T23:56:41.615+08:00The Bashing up day<span style="color: rgb(0, 0, 153);">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.</span><br /><br /><span style="color: rgb(255, 0, 0);">If I were to stop pursuing medicine, this day would justify it</span><br /><br /><span style="color: rgb(0, 0, 153);">ps: I do not know what to think about myself right now<br /><br />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"<br /></span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com2tag:blogger.com,1999:blog-697397638855282429.post-73823909383468819222009-05-05T14:26:00.004+08:002009-05-06T01:04:59.727+08:00Internal Meddicine Week 3<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhS6cDTgsEffBKVCHnfchD96jgZx2RFJYHrvPM9UyeocDx2mZzPWWilxiBH2gOKkZoEnmr2blX4sQXZQLhZqbt45yr-ncc_vCDUR3QGCEyIZYW9paZIHNxSaSh7rdxcrA1f5AvvQdqV6BY/s1600-h/Hanan+clerking1.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 320px; height: 240px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhS6cDTgsEffBKVCHnfchD96jgZx2RFJYHrvPM9UyeocDx2mZzPWWilxiBH2gOKkZoEnmr2blX4sQXZQLhZqbt45yr-ncc_vCDUR3QGCEyIZYW9paZIHNxSaSh7rdxcrA1f5AvvQdqV6BY/s320/Hanan+clerking1.jpg" alt="" id="BLOGGER_PHOTO_ID_5332224011656884162" border="0" /></a><span style="color: rgb(51, 204, 0);">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!</span><br /><br /><span style="color: rgb(51, 204, 0);"> 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. =)</span><br /><br /><span style="color: rgb(51, 204, 0);">Ps: Internal Medicine is so tiring.But luckily it is interesting at the same time.<br /><br />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.......<br /><br />Ps: Spend 2 hours in the clinic today.Got to clerk and see cases like Asthma, Migraine and Beta Thalassaemia major.<br /><br />Ps: My patient with Unstable angina is stable.Dr Pakar are keeping him in the ward to stabilise his blood pressure<br /></span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com0tag:blogger.com,1999:blog-697397638855282429.post-80121988492748232892009-05-01T15:13:00.004+08:002009-05-01T15:23:26.419+08:00HO,MO,Specialist,Consultant<span style="color: rgb(0, 0, 153);">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.</span><br /><br /><span style="color: rgb(0, 0, 153);">According to Dr Rafizie,</span><br /><br /><span style="color: rgb(0, 0, 153);">HO = Hamba Orang</span><br /><span style="color: rgb(0, 0, 153);">MO= Makan Orang</span><br /><span style="color: rgb(0, 0, 153);">Specialist = Syphilis</span><br /><span style="color: rgb(0, 0, 153);">Consultant= Con-setan</span><br /><br /><span style="color: rgb(0, 0, 153);">LOL</span><br /><br /><span style="color: rgb(0, 0, 153);">Ps: Revision mania syndrome</span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com0tag:blogger.com,1999:blog-697397638855282429.post-81331760295769601612009-04-29T19:37:00.003+08:002009-04-29T23:48:32.526+08:00Critical vs cynical<span style="color: rgb(255, 0, 0);"> Serious hari yg penat.Went to hospital at 7am.Do necessary stuffs such as taking blood and updating patients info regarding blood test and PE.Followed the ward round with Dr Rosman.Bombarded by him with a lot of questions.Siap soalan physiology pasal Virchow's triad pun ditanya tadi sebab gatal sangat nak gune term 'laminar flow' and 'turbulence flow of blood'.</span><br /><br /><span style="color: rgb(255, 0, 0);"> Had bedside teaching with Prof Rashid just now.Hannan presented a case about bilateral leg swelling in a patient with poorly controlled DM.Again, bombarded with lots and lots of question.Dari history taking,PE,Investigation sampai la ke management of patient.</span><br /><br /><span style="color: rgb(255, 0, 0);"> Later on that day, had TBL session with yet again Prof Rashid.Tajuk 'Cough,Fever and Sputum'.Again, bombarded with questions.Siap prof ketuk ketuk meja lagi.</span><br /><br /><span style="color: rgb(255, 0, 0);"> One thing really important that I learn today is that as a doctor we should not do things blindly.We should not have this tunnel vision mind set.We should think,think and think.Do not simply do things because it is routinely done.I like all the teaching session today becoz they teach us on how to think.How to solve case.They prepare us for the real working environment as a doctor.Like prof said, teaching how to do physical examination is easy but teaching how to think is far more difficult.<br /><br />ps: Think critically not cynically<br /></span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com0tag:blogger.com,1999:blog-697397638855282429.post-89679250955654512902009-04-27T16:55:00.010+08:002009-04-27T17:37:23.495+08:00Bakti Siswa & Anak Anak Angkat program<a style="color: rgb(0, 153, 0);" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhD5oKxPMEzXXCSg4jlJjFadpQmbOewjXjE1TEKkS7OiUoEP29tDL0Wck5LmFRQkMZPi6S8iL0FKfAdrVGOsIrVApIFTGOW7yaM0Xr0PdPE9mXYSJ5gQBaq8o2GNV1iHtO_l1IBCGSjyPA/s1600-h/Bakti+siswa+PLB.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 240px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhD5oKxPMEzXXCSg4jlJjFadpQmbOewjXjE1TEKkS7OiUoEP29tDL0Wck5LmFRQkMZPi6S8iL0FKfAdrVGOsIrVApIFTGOW7yaM0Xr0PdPE9mXYSJ5gQBaq8o2GNV1iHtO_l1IBCGSjyPA/s320/Bakti+siswa+PLB.jpg" alt="" id="BLOGGER_PHOTO_ID_5329301369992277458" border="0" /></a><br /><span style="color: rgb(0, 153, 0);"> I spent 3 days and 2 nights in a kampung called <span style="color: rgb(255, 0, 0);">Kg Air Lapis Bangas in Parit Sulong,Johor</span>.I want to retract back my words in my previous post.It was worth it going there after all.The mak,abah and family angkat were super nice.We were treated as if we are their own sons and daughters.At one point, I came to think that their real sons and daughters have become their own anak tiri.For example, Nik and I was with this one family who have 2 sons and 2 daughters.Their son had to sleep on the floor when both of us happily sleeping on his bed.We were also given their cars and motorcycles.We used them as if they were ours.Therefore, there is no surprise when one of us terbabas masuk dalam kolam while learning to ride motorcycles.The food? Owh its super duper good.One of our main activities were eating and eating.We had like 3 dinners everyday.Nasi Ambang, Mee Bandung, Sup gearbox u name it, we ate it.Therefore,it comes to know surprise when I weigh myself this morning and found out that I have gained 1 kg.Gaining 1kg in a 3 days time is a lot.</span><br /><br /><span style="color: rgb(0, 153, 0);"> We had programs like membaja pokok kelapa sawit when the ahli parlimen <span style="color: rgb(255, 0, 0);">Dato Noraini Ahmad (Ex Ketua Puteri UMNO)</span> actually came to see the programme,program pemeriksaan kesihatan percuma for the penduduk kampung, program motivasi para pelajar so on and so forth.</span><br /><br /><span style="color: rgb(0, 153, 0);"> Just like in previous medical check-up activity, our Prof Latiff would surely do some clinical teachings there whenever there is an interesting sign and symptoms discovered among the patients during the event.This time, I managed to see things such as <span style="color: rgb(255, 0, 0);">chronic tophaceous gout, Marcus-Gun eye sign, Pterygium eye ,Podagra,Heberden's node as well as Bouchard's nodes of Osteoarthritis,symptomatic viral hepatitis,classical chronic uraemia signs and symptoms</span> etc</span><br /><br /><a style="color: rgb(0, 153, 0);" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7EnoPMrJqTaIOIE5hD4mr-jqMAwWSWAOHCRZY8tqJppqY7h1FDiv0BhIs9VpZYAIGcCPOPgaPTcYpPQo4CagyNDUFVrvju1kjdx0kWEApcUWvkmmfEQFJBNJAEQEqyJTMMFOFP1iip6w/s1600-h/Pterygium.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 209px; height: 159px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7EnoPMrJqTaIOIE5hD4mr-jqMAwWSWAOHCRZY8tqJppqY7h1FDiv0BhIs9VpZYAIGcCPOPgaPTcYpPQo4CagyNDUFVrvju1kjdx0kWEApcUWvkmmfEQFJBNJAEQEqyJTMMFOFP1iip6w/s320/Pterygium.jpg" alt="" id="BLOGGER_PHOTO_ID_5329298767749668450" border="0" /></a><span style="color: rgb(0, 153, 0);">Pic 1: Pterygium.One of the signs of hypercholesterolaemia</span><a style="color: rgb(0, 153, 0);" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgj9etygmFSiMduTuGYE4Eos057-y596RUCitw7gB6RyAl4TThi9HegLtrOONRSP1SlqpEGBpmKYaWVKZqtWmhXcx3BEWk-6kmnDo4qyq8Ps7V0ffLDbe0gBZAJf9S5UM2RMgK7ADIECFQ/s1600-h/Podagra.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 201px; height: 122px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgj9etygmFSiMduTuGYE4Eos057-y596RUCitw7gB6RyAl4TThi9HegLtrOONRSP1SlqpEGBpmKYaWVKZqtWmhXcx3BEWk-6kmnDo4qyq8Ps7V0ffLDbe0gBZAJf9S5UM2RMgK7ADIECFQ/s320/Podagra.jpg" alt="" id="BLOGGER_PHOTO_ID_5329298451083828658" border="0" /></a><br /><span style="color: rgb(0, 153, 0);">Pic 2: Podagra.Swelling and pain of the first metatarsophalangeal joint in Gout</span><a style="color: rgb(0, 153, 0);" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3V6Rlhxy6082AQESKUE_WuWu5ExgyjfPTQ2TNtA9Mo9GzuniOwZ4uTAebvSOYZ_Hx1sF2h4tjU84RPhL4dJZUYOv0wfp5JoErFKIvxuNJwR5V-MYLaDjg38O7e5ECU21nc7f8wbH9wSE/s1600-h/Heberden'snodes.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 215px; height: 141px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3V6Rlhxy6082AQESKUE_WuWu5ExgyjfPTQ2TNtA9Mo9GzuniOwZ4uTAebvSOYZ_Hx1sF2h4tjU84RPhL4dJZUYOv0wfp5JoErFKIvxuNJwR5V-MYLaDjg38O7e5ECU21nc7f8wbH9wSE/s320/Heberden'snodes.jpg" alt="" id="BLOGGER_PHOTO_ID_5329300177930770258" border="0" /></a><span style="color: rgb(0, 153, 0);">Pic3: Heberden's node(at distal interphalangeal -DIP join) and Bouchard's node ( at proximal interphalangeal-PIP joint) in Osteoarthritis.They are caused by formation of osteophytes(calcific spurs) of the articular cartilage</span><br /><br /><span style="color: rgb(0, 153, 0);">Note1 : I'm currently in Terendak now.3 weeks posting in Hospital Angkatan Tentera Terendak</span>.N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com4tag:blogger.com,1999:blog-697397638855282429.post-87709391671928431232009-04-23T23:13:00.003+08:002009-04-23T23:31:48.338+08:00Internal Mad-icine<span style="color: rgb(255, 102, 0);">There are so many things that I want to share regarding my experience in the medical ward so far.There are so many things that I have learnt.So many signs and symptoms that I saw and has intrigued me to do better in this field.So many interesting cases!!!!</span><br /><br /><span style="color: rgb(204, 0, 0);">Ward round</span><br /><span style="color: rgb(255, 102, 0);">I particularly love ward round.The specialists is super nice, Dr Nurain.She frequently asked questions to the HOs and also medical students.Many HOs have forgotten their basic knowledge.I DO NOT WANT to become that kind of HOs.Its a pain in the a** to forgot basic things and at the end of the day you will screw yourself becoz u need to do some serious revision for something that u knew before.God, please please prevent me from being dyslexic and receptive aphasia.</span><br /><br /><span style="color: rgb(204, 0, 0);">History taking and physical examination</span><br /><span style="color: rgb(255, 102, 0);">I managed to shortened the time taken for history taking and doing physical examination.It is important to try to time yourself.This is a good training becoz as an HO later, I need to work efficiently.Anyway, this should not compromise patient's satisfaction towards the level of care and attention that we are giving to them</span><br /><br /><span style="color: rgb(204, 0, 0);">Case presentation</span><br /><span style="color: rgb(255, 102, 0);">I am more able to organize my presentation.Presentation should be sweet and simple and interesting at the same time, without compromising the important details.I am still working on my 'negative relevants'.I still need to elaborate more on my chief complaint.Need at least 10 points before moving to associated symptoms!</span><br /><br /><span style="color: rgb(204, 0, 0);">Formulating diagnosis</span><br /><span style="color: rgb(255, 102, 0);">This is particularly a challenging part but interesting at the same time.We were taught on how to think systematically</span><br /><br /><span style="color: rgb(204, 0, 0);">Interesting case of the day</span><br /><br /><span style="color: rgb(255, 102, 0);">1.Mr Y, 56 yo, chronic alcoholism.Admitted yesterday for SOB.On PE, hepatomegaly.He had signs of right ventricular failure secondary to dilated cardiomyopathy</span><br /><br /><span style="color: rgb(255, 102, 0);">2. Mr T, 49,Central chest pain which lasts for 5 hours, occured 2 days prior to admission.ECG done had ST elevated MI with elevated cardiac enzymes</span><br /><br /><span style="color: rgb(255, 102, 0);">3.Mrs R, 60 yo, came in with diabetic ulcers secondary to chronic venous insufficiency</span><br /><br /><span style="color: rgb(255, 102, 0);">Ada byk lagi malas nk tulis...</span><br /><br /><span style="color: rgb(255, 102, 0);"><span style="color: rgb(204, 0, 0);">Quiz of the day</span>.</span><br /><span style="color: rgb(255, 102, 0);">Question 1.Give me 5 predisposing factors for the development of diabetic foot ulcers</span><br /><span style="color: rgb(255, 102, 0);">Question 2.Types of myocardial infarction (anterior,lateral and inferior),its respective coronary vessels involvement and from which ECG leads that we can see them from.</span><br /><br /><span style="color: rgb(255, 102, 0);">Answer:In next post!</span><br /><br /><span style="color: rgb(255, 102, 0);">Note: I need to pack my stuff now.We are having 3 days and 2 nights of program Bakti Siswa in Batu Pahat over this weekend.Program anak angkat and medical check-up stuff.Sigh, I am already tired with this type of programme...............................they should allow us to sleep more at home during the weekend.</span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com2tag:blogger.com,1999:blog-697397638855282429.post-76003686325193118202009-04-22T21:05:00.003+08:002009-04-22T21:10:56.874+08:00Of elective posting and research<span style="color: rgb(204, 0, 0);">Finally, I have decided to do my elective posting at the <span style="color: rgb(0, 153, 0);">National Heart Institute (IJN)</span> during this coming 1 month break somwehere in August .I am interested in <span style="color: rgb(0, 153, 0);">Interventional Cardiology</span>.U know , cardiologist who can do procedures like stenting etc. I love cardiothoracic surgery but I heard that that field is nomore in demand in the market,compared to other surgical sub-specialties.I would love to know more about the world of Cardiology....yezzaaaaa.I have also found the person who is going to be my internal supervisor, a cardiologist in IJN himself Dr Rosli.Thx Dr for accepting me =)</span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com1tag:blogger.com,1999:blog-697397638855282429.post-88544451613287903152009-04-21T21:24:00.003+08:002009-04-21T21:41:37.200+08:00IM mini homework<span style="color: rgb(51, 102, 255);">We presented our patient case today to prof Latif.Prof taught us another structured,more interesting way of presenting our case.He reminded us that the first few sentences in history presentation is important because that would determined whether we are an 'A' doctor or a 'D' doctor.He went on correcting stuffs such as by saying its wrong if we say 58 years old where in fact it should be 58 year old (minus the 'S').</span><br /><br /><span style="color: rgb(51, 102, 255);">Before ending the session, we were given a mini IM homework.Terasa macam budak darjah 1 pulak.</span><br /><br /><span style="color: rgb(51, 102, 255);">Our IM mini homework for today are to find answers for the questions below.</span><br /><br /><span style="color: rgb(51, 204, 0);">1.List 15 signs and symptoms of thyrotoxicosis</span><br /><span style="color: rgb(51, 204, 0);">2. List five macrovascular and five microvascular complications of diabetes mellitus</span><br /><span style="color: rgb(51, 204, 0);">3.Lists 5 causes of massivesplenomegaly</span><br /><span style="color: rgb(51, 204, 0);">4. Five causes of palmar erythema and five causes of finger clubbing</span><br /><span style="color: rgb(51, 204, 0);">5 List as many as you can the major differences between COPD and Asthma</span><br /><span style="color: rgb(51, 204, 0);">6. Diagnosis criteria for Acute Myocardial Infarction</span><br /><span style="color: rgb(51, 204, 0);">7. The differences between transmural,subendocardial infarct and acute angina</span><br /><span style="color: rgb(51, 204, 0);">8. The clinical features of uraemia in CRF(Chronic renal failure)</span><br /><span style="color: rgb(51, 204, 0);">9. Indication for emergency dialysis</span><br /><span style="color: rgb(51, 204, 0);">10.The five different types of stroke</span><br /><span style="color: rgb(51, 204, 0);">11. List all the features of cerebellar signs with its causes</span><br /><span style="color: rgb(51, 204, 0);">12. The clinical features of SLE(Systemic Lupus Erythematosus) and the criteria for diagnosis.</span><br /><br /><span style="color: rgb(51, 102, 255);">He says that internal medicine is so wide, that it requires doctors to specialise into certain field in th eend.But as a medical student, we have to know everything under the sun.No short cut.He also added that as physician, we need to be able 'to recognise disease pattern'.Its like getting the bits and pieces of a jigsaw puzzle together.Those who are sharp and well equipped with good background theoretical knowledge will be able to become a good physician.</span><br /><br /><span style="color: rgb(51, 102, 255);">Looks like I need to do a lot of stuff right now.My otak is so berkarat!<br /><br />p/s: Prof also reminded us the importance of study group.This is not the time to study alone!Yes you can spend 2 hours a day to have a quality time studying alone but the rest should be in a form of a discussion with your groupmates.I agree with him 100%.There is no way that we can survive medicine if we study alone.Its simply impossible to cover everything alone!<br /></span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com2tag:blogger.com,1999:blog-697397638855282429.post-1245770916607361412009-04-20T21:37:00.002+08:002009-04-20T21:51:19.383+08:00IM first day<span style="color: rgb(255, 102, 0);"> Hmm today is the first day of internal medicine.My first impression: Wowww there is a lot of things to be revised man.Most of the theories have been taught during pre clinical years.</span><br /><br /><span style="color: rgb(255, 102, 0);"> Clerked my first patient.It was a 49year old Malay gentleman from Putrajaya.Guess what is he having? Stroke! So young and yet dah dapat stroke.My impression was that this guy ada left ischaemic stroke with right hemiparesis.A known hyptertensive patient who is non compliant to drugs.He also have hyperlipidaemia.I havent seen his investigation result such as CT scan of the brain.But clinically I think he had an ischaemic stroke of the middle cerebal artery.</span><br /><span style="color: rgb(255, 102, 0);"> In IM,the challenging part would be to take a thorough history and also a thorough physical examination.A bit blur sebab dah tak masuk hospital selama 2 bulan after public health posting.I had to sit down at a corner first, trying to revise back my theory.I did Neurological examination both for motor and sensory functions for both upper and lower limb.Not forgetting the cranial nerve examination since this patient ada facial paralysis.CVS examination terlupa buat.Arghh...</span><br /><br /><span style="color: rgb(255, 102, 0);"> Each of us are in-charge of one cubicle in that ward.There will be 4 patients at one particular time in a cubicle.Each of us must know everything about those 4 patients.Tomorrow will be our first case presentation.Prof Latif will randomly pick any patient in any cubicle that he like.I didnt clerk all the patient in my cubicle because tak sempat.Hmm ntah la, the possibility to be bombed is high tomorrow.Hahaha...</span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com1tag:blogger.com,1999:blog-697397638855282429.post-79460564031238404512009-04-19T00:23:00.003+08:002009-04-19T00:33:44.655+08:00How to succeed IM(Internal Medicine)-pesanan dari Fana hey!<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2Wy0ab3sydXSvNX7ntfN0hjjCn_LoI6SZIZQpOdLUnFOSUc7tmSJsf-3SYAbgFAgCLiwaZVa5-f_1PrLUi_NevGvX8BAIJjK_EaVLYx97-TSbmIxJ5uaOGO7sMdnwMzPuH0Qs4vIqC8I/s1600-h/IMAGE_284.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 240px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2Wy0ab3sydXSvNX7ntfN0hjjCn_LoI6SZIZQpOdLUnFOSUc7tmSJsf-3SYAbgFAgCLiwaZVa5-f_1PrLUi_NevGvX8BAIJjK_EaVLYx97-TSbmIxJ5uaOGO7sMdnwMzPuH0Qs4vIqC8I/s320/IMAGE_284.jpg" alt="" id="BLOGGER_PHOTO_ID_5326069343225258034" border="0" /></a><br /><span style="color: rgb(0, 153, 0);"><br />Hmm...so nice of my friends.We r helping each other out.Dats the spirit mannn...nway, ni email yg dpt dari Fana hey.I dont edit this.Saje nk post kat blog ni.At least bleh baca slalu.Enjoy reading(to me)!</span><br /><span style="font-size:180%;"><br /></span><span style="color: rgb(255, 0, 0); font-weight: bold;font-size:180%;" >How to succeed in IM (hehe, insyaAllah)</span><span style="font-size:180%;"><span style="color: rgb(255, 0, 0); font-weight: bold;"> </span></span><span style="color: rgb(51, 51, 255);"><br /><br /><br />1. <span style="color: rgb(255, 0, 0);">Read and read n read</span><br /><br />- based on ur patient's case<br />- cth nyer kalau dia ade DM ke HPT ke then read about it and must know<br />the basic things about it (eg how to dx, what are the types, its definition<br />the classification)<br />- dont forget to refer books and old folios pls..<br />- recommended books:<br />--> oxford handbook of clinical med (a must have)<br />--> kumar n clark or davidson's<br />--> tally o'connor or hutchinson<br />--> old folios<br /><br />2. <span style="color: rgb(255, 0, 0);">Getting the history</span><br /><br />- get the history right, HOPI very important (LORD SANFARO)<br />- all the what where when why where who how<br />- the chief complaint<br />- assoc sympts n other hx<br />- after getting all the hx, karangkan n try to present to ur frens<br />- get their opinion and ask them if there is anything not complete or missing<br />or if there is a gap in ur hx<br />- dont be afraid to dig from ur patients<br />- and dont salah interpret what ur patient is trying to say (u know pening and<br />sakit kepala might mean something else to ur patients)<br /><br />3.<span style="color: rgb(255, 0, 0);"> Doing physical examination (PE)</span><br /><br />- the first day u should already know how to perform PE for every system<br />- they include :<br />>CVS (paling senang n best)<br />>respi<br />>abdomen (as in GIT)<br />>musculo (some r integrated in CNS)<br />>CNS (upper n lower limbs)<br />>cranial nerve<br />-must have:<br />>stethoscope (kalau takde bkn med student la..)<br />>pen torch<br />>tendon hammer (optional coz bole pinjam from ward, but its better to hv ur own<br />or at least share)<br />>orange stick n cotton n tongue depressor for CNS (can always get it from ward)<br />- pls jgn buat sorang2 takut nnti syok sendiri<br />- at least the other frens tgk n check anything yg tertinggal or silap<br />- this might sound cliché but practice makes perfect<br />- especially for the patients that u want to present to prof ke dr ke u MUST do ALL the<br />systems (CVS --> CNS)<br />- jgn buat short cut buat betul2 cam nak exam<br />- when ur used to it it will only take few mins (awal2 mmg la slow skit)<br /><br />4. <span style="color: rgb(255, 0, 0);">Presentation</span><br /><br />- always karangkan the hx [intro, hopi, assoc symt, past med hx, hospitalised/surgical hx,<br />drug hx, family hx, social hx(wife? anak? work? house where brape tngkat, tepi jln ke?)<br />dont forget the public health component people, also bout smoking, illicit drugs, sexual promiscuity]<br />- then followed by the summary of hx<br />- then present the physical findings (pls include BP, PR, RR, T)<br />- then PE summary<br />- finally summary of hx plus summary PE<br />- a good presentation : by the time uve finished presenting the listeners will have an idea which<br />system is the prob or at least a differential dx<br /><br />-not to be included when presenting but have to know:<br />> must know what drugs patient is having, what doc plan to do, all the investigation findings<br />must know the nilai dont just say its N or not normal (in case prof or dr wants to know)<br /><br />5. <span style="color: rgb(255, 0, 0);">Long case n short case</span><br /><br />- pls do it whole heartedly<br />- not just cincai2 lorh<br />- must have good, lengthy, informative, relevant, important, meaningful learning issues (dont<br />forget the academic n non academic learning issues)<br />- refer books n include any discussions about the patient<br /><br />6.<span style="color: rgb(255, 102, 102);"> Must have your own 'k<span style="color: rgb(255, 0, 0);">ita</span></span><span style="color: rgb(255, 0, 0);">b'</span><br /><br />- well its actually a notebook (or many notebooks) which contains important n must know knowledge<br />- knowledge from books, ward rounds, profs n drs, ur own 'michael jackson kene halau balik<br />india utara' (pneumonics) kinda thing to remember stuff<br />- the main idea is so that u dont have to refer to books many times because u can just refer to ur<br />own self made kitab<br />- u must revise every week n add any valuable new info into the books..<br />- this is also another cliché but dont study last minute<br />- prof will give u guys a registered online examination website where there are many questions for<br />revision.. so bole la practice..<br /><br />7. <span style="color: rgb(255, 0, 0);">Miscellaneous</span><br /><br />- during ward round, u guys should contribute to any new info from the history that uve taken<br />- all of u will meet 2 wonderful doctors dr shu and dr rafizi (dr shu's husband). they're really nice<br />and determined to make all of us pass our IM posting..<br />- the terendak people..dont take terendak for granted.<br />- the lack of patients should not be an excuse to be laid back. in fact u should take the opportunity<br /> to know the patients in depth.<br /><br />thats all. all the best<br /><br /></span><span style="color: rgb(51, 51, 255);"></span><br /><span style="color: rgb(51, 51, 255);">Yours truly, <----- Ok ni aku yang tambah.</span> <span style="color: rgb(51, 51, 255);"><br /><span style="font-size:130%;"><span style="color: rgb(255, 0, 0); font-weight: bold;">Fana hey<br /><br />p/s: Thx Fana~~~!<br /></span></span><br /></span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com6tag:blogger.com,1999:blog-697397638855282429.post-44064408944687606242009-04-13T00:30:00.003+08:002009-04-13T00:43:38.295+08:00Holiday<span style="color: rgb(255, 0, 0);">Yup....u heard it right mister, ITS HOLIDAY~!!! Its only a week holiday, but who cares...I need all the sleep that I can get.Plus, its going to be my last posting this semester-Internal Medicine.For that, there will b a lot of things to revise.Yes, revision honey.Preclinical stuffs!</span><br /><br /><span style="color: rgb(255, 0, 0);">Cardiovascular system</span><br /><span style="color: rgb(255, 0, 0);">Respiratory system</span><br /><span style="color: rgb(255, 0, 0);">Urinary system</span><br /><span style="color: rgb(255, 0, 0);">Gastrointestinal tract system</span><br /><span style="color: rgb(255, 0, 0);">Endocrinology</span><br /><span style="color: rgb(255, 0, 0);">Neurology</span><br /><span style="color: rgb(255, 0, 0);">Musculoskeletal system</span><br /><span style="color: rgb(255, 0, 0);">Haematology</span><br /><span style="color: rgb(255, 0, 0);">etc.</span><br /><br /><span style="color: rgb(255, 0, 0);">Im goin to concentrate only on CVS,Neuro and Urinary system for the time being inshaAllah.</span><br /><br /><span style="color: rgb(255, 0, 0);">Happy holidays everyone~~~=) =) =)<br /><br />Note1: By the way, the semester break after Internal Med will b shortened to only 1 month instead of 2 =( .We have to carry out a research paper for 1 month.Prior to that, we will b having a posting named <span style="color: rgb(51, 204, 0);">'Research and Evidence Based Medicine'</span> for 1 monthDuring this posting, we will be taught on how to do a proper research paper, journal appraisal and stuff.I'm actually excited and sad at the same time.Life is indeed confusing...<br /><br />Note2: My internal supervisor is a Paediatrician...surprise surprise! I still have about 2 weeks before submitting my research proposal.I still cant think of any interesting research topic...sigh<br /></span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com2tag:blogger.com,1999:blog-697397638855282429.post-18182385966460869992009-04-08T20:30:00.005+08:002009-04-08T21:42:59.020+08:00Viva<span style="color: rgb(0, 0, 153);"><span style="font-size:180%;"><span style="font-weight: bold;">Disclaimer</span></span><br />**This post is meant for the next public health group posting.Ni soalan compilation ni.Haha**<br /><br />Today was viva day.From what I know,viva is a method of assesment used during preclinical years for students who failed their written paper twice.Tapi tak sangka pulak ada viva masa clinical years ni.We do not use patients for public health final exam coz there is no long case exam.Instead, viva is used as part of assessment metho<span style="color: rgb(102, 0, 204);">d.</span></span><span style="color: rgb(102, 0, 204);">So layanje la</span><br /><br /><span style="color: rgb(0, 0, 153);">I was the 9th person to be called for viva.Again, only god knows how jittery and nervous I was.Two professors became the examiners.Both are public health specialists.The Viva can be divided into three components.</span><br /><br /><span style="color: rgb(255, 0, 0);">A.Public Health Journal</span><br /><span style="color: rgb(0, 0, 153);"> During the posting, we are required to read as many as public health journal that we can.In the end, we are required to list down 10 journals in our logbook.Those journals can be asked during viva.I was given the liberty to pick a journal which I am most confident with.For this purpose, I chose a journal with the title of , </span><br /><br /><span style="color: rgb(255, 0, 0);">'The short-term impact of National Smoke-free workplace legislation for passive smoking and tobacco used"</span><br /><br /><span style="color: rgb(0, 0, 153);">Questions asked were:</span><br /><span style="color: rgb(0, 0, 153);">1.About the study</span><br /><span style="color: rgb(0, 0, 153);">2.Study design ( Ans: 2 time cross sectional study, before and after legislation enforcement)</span><br /><span style="color: rgb(0, 0, 153);">3.Sampling method (Ans: They used cluster sampling method)</span><br /><span style="color: rgb(0, 0, 153);">4.Other sampling method that you know off and their differences and features.(Ans: Simple random sampling,Systematic random sampling, Stratified random sampling,Cluster sampling,Multiphase sampling and Multistage sampling)</span><br /><span style="color: rgb(0, 0, 153);">5.Statistical tests that were used</span><br /><span style="color: rgb(0, 0, 153);">For this journal, they have used various tests.Eg: Chi squared test to assess 2 categorical variables which are exposure to tobacco smoke(ETS)-"Not at all""Less than an hour","1-4 hours","more than 4 hours" and smoking prevalences among employee in various workplaces-industry,services and offices.They have also used a non-parametric test named Mann Whitney U test and test of normality for continous variables such as Kolmogorov-Smirnov,Skewness and kurtosis and histogram.</span><br /><span style="color: rgb(0, 0, 153);">6.Result and conclusion of the study.</span><br /><span style="color: rgb(0, 0, 153);">-ETS declined considerably after the legislation.Eg;Exposure was halved in 1-4 hours group.</span><br /><span style="color: rgb(0, 0, 153);">-Daily smoking prevalences among employees decreased significantly,from 30% to 25%.</span><br /><span style="color: rgb(0, 0, 153);">-etc.</span><br /><br /><span style="color: rgb(255, 0, 0);">B.Health Intervention Programme (HIP)</span><br /><span style="color: rgb(0, 0, 153);">The second part of the viva was about things regarding our HIP.Questions asked in this section were:</span><br /><span style="color: rgb(0, 0, 153);">1.Sampling method (Ans: We used Stratified Systematic random sampling.The population were stratified according to the income group, roughly by looking at their type of houses-single storey and double-storey house)</span><br /><span style="color: rgb(0, 0, 153);">2.Type of study (Ans:Again, this would be a cross sectional study)</span><br /><br /><br /><span style="color: rgb(255, 0, 0);">C.Regarding attachment to district hospital,health clinic and community clinic.</span><br /><br /><span style="color: rgb(0, 0, 153);">1.<span style="color: rgb(255, 0, 0);">Roles of Medical and Health Officer(M&HO)</span> as compared to medical officer (MO).</span><br /><span style="color: rgb(0, 0, 153);">Ans: 1. Patients-M&HO's patients consists of the population under its sub-district.Eg.If I am an M&HO in Salak, then I am responsible for the health of the whole community in Salak, and patients consists of the sick as well as the healthy ones.</span><br /><span style="color: rgb(0, 0, 153);">2.Plays role in administration and management of a health clinic</span><br /><span style="color: rgb(0, 0, 153);">3.Plays role in health prevention and health promotion.For this question I was asked the differences between 'prevention' and 'promotion'.Annoying gile...</span><br /><br /><span style="color: rgb(0, 0, 153);">2.Next, I was asked about the <span style="color: rgb(255, 0, 0);">weightage system for evaluation of food premises</span> done by the health inspector from food and quality control unit of district health office.</span><br /><span style="color: rgb(0, 0, 153);">Answer:</span><br /><span style="color: rgb(0, 0, 153);">Based on de-merit system.Deduction of marks out of 100 marks.Minimum passing mark is 50marks.Failure to achieve will result in the closure of food premise for 14 days.Can be charged under Food Act 1983</span><br /><span style="color: rgb(0, 0, 153);">Food-30%</span><br /><span style="color: rgb(0, 0, 153);">Food handlers-20%</span><br /><span style="color: rgb(0, 0, 153);">Sewerage system-10%</span><br /><span style="color: rgb(0, 0, 153);">Waste dumping-10%</span><br /><span style="color: rgb(0, 0, 153);">Food containers and utensils-10%</span><br /><span style="color: rgb(0, 0, 153);">Premise's floor-5%</span><br /><span style="color: rgb(0, 0, 153);">Toilet-5%</span><br /><span style="color: rgb(0, 0, 153);">Water source-2%</span><br /><span style="color: rgb(0, 0, 153);">Others-8%</span><br /><span style="color: rgb(0, 0, 153);">I was asked," Why do you think that the weightage for water source is only 2%?If you can answer this you can get an A+"LoL.I dont think I answer this question convincingly.It has something to do with primary prevention and primordial prevention method.Pre clinical stuff.So tak boleh ingat.</span><br /><br /><span style="color: rgb(0, 0, 153);">3.What is the required temperature for hot food in kedai mamak for example.</span><br /><span style="color: rgb(0, 0, 153);">Answer: 63 Celcius</span><br /><br /><span style="color: rgb(0, 0, 153);">The end.</span><br /><br /><span style="color: rgb(255, 0, 0);">Below are the questions asked to my friends:</span><br /><span style="color: rgb(0, 0, 153);">1.Malaysian Immunization Programme and the 'Cold Chain' system</span><br /><span style="color: rgb(0, 0, 153);">2.Program Doktor Muda-10 scopes in their module</span><br /><span style="color: rgb(0, 0, 153);">3.National Indicator Approach/District Specific Approach/Hospital Specific Approach</span><br /><span style="color: rgb(0, 0, 153);">4.Lists of communicable diseases that must be notified to authority within 24 hours and within 1 week of diagnosis</span><br /><span style="color: rgb(0, 0, 153);">5.Prevention of the spread of dengue-method,preparation before fogging,fogging mixture,equipments etc.</span><br /><span style="color: rgb(0, 0, 153);">6.Things that a community nurse do during home visits</span><br /><span style="color: rgb(0, 0, 153);">7.Recycle plastic bags-types,colour</span><br /><span style="color: rgb(0, 0, 153);">8.Steps taken in a Needle prick injury</span><br /><span style="color: rgb(0, 0, 153);">9.Expanded scope programme for health clinic</span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com2tag:blogger.com,1999:blog-697397638855282429.post-81305452314932776062009-04-07T15:28:00.003+08:002009-04-07T15:54:57.794+08:00Busy bee<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpyXAn48_-CPSzX6QmsOvZ19gdcAcUEBbqqUHtbh7ZA1AjfwxBU5ipP0CydjQdG4r0Ev2QXyyYT1geE1KY5HHgti_E_tCoxHnbN1yvThsISez_eUOzQ3xmmow_I2nWAnhsXpzXLSjTkVA/s1600-h/DSC03475.JPG"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 320px; height: 240px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpyXAn48_-CPSzX6QmsOvZ19gdcAcUEBbqqUHtbh7ZA1AjfwxBU5ipP0CydjQdG4r0Ev2QXyyYT1geE1KY5HHgti_E_tCoxHnbN1yvThsISez_eUOzQ3xmmow_I2nWAnhsXpzXLSjTkVA/s320/DSC03475.JPG" alt="" id="BLOGGER_PHOTO_ID_5321854150232361538" border="0" /></a><br /><span style="color: rgb(102, 51, 255);">Marilah tengok aktiviti saya dalam seminggu ni...</span><br /><br /> <span style="color: rgb(102, 51, 255);">1.Health Intervention Programme stuff</span> <span style="color: rgb(102, 51, 255);"> - Busy buat plan of action, jumpe orang ni, jumpe orang tu.Bak kate prof, we shud be able to MARRY the needs between penduduk taman desa vista and klinik kesihatan as well as pejabat kesihatan daerah.Proposal and plan of action dah kasi kat klinik kesihatan.Lepas ni nak konfemkan date for the programmes</span> <span style="color: rgb(102, 51, 255);"><br /><br />2. Revision for public health and community medicine posting final exam bersama rakan-rakan</span> <span style="color: rgb(102, 51, 255);">-banyak kena revise.Semua benda pasal district hospital, klinik kesihatan, klinik desa, skop tugasan, national indicator approach,SPSS(Biostatistics),occupational hazards etc etc.Dont ever make me start talking about these stuff!!!</span><br /><br /> <span style="color: rgb(102, 51, 255);">3. Gym with personal trainer</span> <span style="color: rgb(102, 51, 255);">-gluteus maximus,medius and minimus tengah sakit ni.</span> <span style="color: rgb(102, 51, 255);">-selain daripada tidur beribadat, inilah salah satu cara nak releasekan stress</span> <span style="color: rgb(102, 51, 255);">Ok.Pray for my viva(tomorrow) and written test(the day after tomorrow)</span>N a b i Lhttp://www.blogger.com/profile/16099235525655771746noreply@blogger.com0