(",) Bukit Panorama & Sg.Panching

Ya Allah rindunya nak tulis blog..

Jom kali ni aku story pasal "Tafakkur Alam Part 1" pulak...Nape Part 1 ??? sbb Part 2 InsyAllah nanti aku update pasal trip kami ke Taman Negara yg mana kami akan pergi hujung minggu ni.

Ini kali ke-2 aku conquer Bukit panorama yg mana terletak di Sg.Lembing dan Sg.Panching aku dh xingat entah kali ke berapa dah aku p...Ni pun last minute plan, mlm tu plan mlm tu jgk gerak...usha punya usha, 6 org je nk join..daripada 6, 3 orng belum pergi lagi, jd ni kali pertama tuk diorang la..

Syasya, Adib, Piji Bro, Che Nap, Capik n aku

Kami mula gerak kul 5.00 pg dan sampai sana lbih kurang kul 5.45 pg..Singgah solat subuh jap pastu baru start naek Bukit Panorama (masa naik tu gelap lg)..Masa tuk daki lbih kurang 30-45min bergantung kepada tahap kesihatan la.. xde pun yg berubah masih sama macam dulu...dan Alhamdulillah, untuk kali ni xde la letih dan getaq lutut mcm masa 1st time dulu. Sampai je puncak, ambik2 gambar menghargai kebesaran ciptaan Allah, posing2...snap2..then lbih kurang 40 min duk kat puncak kami pun turun tuk ke next destination --> Sg.Panching. Tp sebelum tu singgah dulu alas perut kat food court area Sg.Lembing (sedap dan murah je mknn dia)

Jom kita roll---> keindahan2 alam ciptaan Allah (rasa sejuk dan tenang klu dpt tgk real depan mata)

Ni masa dah half-way daki..kabus masih lagi tebal

Lagi gambar kabus dari trek pendakian

SubhanAllah cantiknya

Silap haribulan nampak Son Goku melompat atas awan ni (jgn terkezut pulak)

Sinaran mentari menyinari ~ ~ ~ la la la

Ada sape2 mau "Honeymoon" atas awan ni

Kalau dapat tgk tiap2 hari, mesti hidup ceria je setiap hari

Some kabus dah cuba larikk...

Wow, Gojes dan cantik !!!

Best klu dpt wat pre-wed pictures kat cni

Jom Sayang, I bawak U jalan2 cni

Snap dulu buat kenangan

Matahari masih malu2 kucing

Farewell for kabus, takut ngan matahari gamaknya

Hebatnya Allah S.W.T !!!

Buat apa nak p jauh2, kat Malaysia pun banyak tempat lawa

Bye-Bye Panorama

Meditasi dulu kat puncak

Capik with his pose

Jom kita ke Sg.Panching pulak ---> Nek kereta lbih kurang 20 min perjalanan akhirnya sampai kat Sg.Panching area Kg.Pandan... klu masa BMS dulu, best dtg cni sbb air terjun dia bersih, cantik dan dalam...tapi sekarang dah xmcm dulu.. sebab diorang tambak pasir, mungkin sbb byk kes kematian kut... Tapi masih mengekalkan kebersihannya. Aliran air masih lagi laju...sejuk dowh ( dpt bawa wifey mandi manda lg best)... Gambar kat air terjun byk, tp diorang sume mandi xpkai bju except aku la... so xbole nk upload, hanya tuk kami2 jek....Let's roll pics

Amboi jauh termenung capik, ingat org rumah ker

Jom mandi dengan saya !!!

Meditasi kat panching pulak

Hensem/Macho/Comel mana satu nih?? haishh

Panorama view for the whole waterfall

Snap dulu buat kenangan

Antara gambar-gambar orang kuat yg menjayakan misi pen'conquer'an Panorama dan Panching :

Capik the Burmese !!!

Syasya the Mongoloid !!!

Adib the javanese !!!

Syasya, Piji Bro n Capik

Dan telah kami jadikan di bumi ini gunung-gunung yang kukuh supaya bumi itu tidak bergoncang bersama mereka, dan telah kami jadikan di bumi itu jalan-jalan yang luas agar mereka mendapat petunjuk (Surah Al-Anbiya' ; 31)

Pilih-pilih single tp some of them are not available..hahaha

Last pose sebelum balik....Smile guys!!!

SURGERY finale 'runaway' 2012

Long Case (Prof.Saufi)

Mdm.N.S/59yo/M/Lady/Housewife/Jerantut/kco treated Rt renal stones 4yrs ago/presented with abdominal pain for 3d and postprandial vomitting for 2d prior to admission

i) Abdominal pain -S=flank
                             O=sudden
                             C=dull ache
                             R=sometimes radiated to back
                             A=associated with mild fever
                             T=continuous
                             E=not aggravated by movement and relieved by vomiting
                             S=5/10

ii) Vomitting - postprandial = 2-3 min after eating or drinking
                   - contained mucus + food particles
                   - no sore throat, hemoptysis or coughing

Both symptoms preceded by urinary incontinence associated with, frequency, urgency, dysuria, dribbling and so on. The patient noticed to have mass at Lt side of flank.
 
O/E - Ballotable Lt kidney

Questions

1) Analyze symptoms and what do you think the system involved?
2) what is your working diagnosis? why?
3) In this patient where is the level of obstruction?
4) Causes of unilateral and bilateral urine retention??
5) If caused by colon, where?? what are the parts of colon?
6) Investigations?Why and components to look at??
7) Compare between abdominal x-ray and KUB?? and how do you prepare for both (NBM, clean bowel etc)
8) what do you look in ultrasound??
9) If the patient has renal stone, what is your choice of treatment?? (nephrostomy, ESWL, antibiotics, etc)

Short Case (Mr.Zailani)

Examine the abdomen (pt of invasive breast ca with mets to pubic bone and femur)

1) Your positive findings??(mass at pelvic region) describe it?
2) what do you think the mass is that? why?
3) other causes??
4) Relevant imaging?? what to look for?? (u/sound, AXR. CXR, etc.)

Lesson for today:
- learn more about investigations (blood, urine, imaging) in detailed.
- don't merely send it if we don't know what to look for

Ya Allah..berikanlah aku PASS..ameenn
tiba masa tuk fokus kat ramadhan and mak ayah pulak
(apa pun rezeki yg tertulis untuk aku, aku terima seadanya).. Good luck kawan2 yg nk exam esok !!!

ALLAH knows best !!!!

(",) I LOVE SURGERY !!!

Bismillahirrahamnairrahim...

Alhamdullillah and praise to Allah for giving me another ideas to write another chapter in my e-book so called WONDERFUL-LIFE-MAYBE and hopefully it will be a great masterpiece someday. I wish it would be benefit not only to others but at least going to be a lullaby story for my little caliphs in the future. I love my life a lots. Sometimes i felt like experimenting with what myself need to go through, seeing a great person's doing their great noble job would make me think where am i standing at,what have i been through and who really i am. For sure meeting this legendary creature will inspire you for what you are going to do as the time flies.

My best time in OT (HOSHAS)

Talking about the determination will never be lasted until your body is buried and returned for good. Life is not only to be inspired but it is more to be an inspiration to others. Once you have reached that level, then you will really know and think about what is one's life supposed to be. I am still in the process of learning and of course it will never stop me until I really appreciate how much the people surround me are meant to.

Currently, I'm in 4th posting which is the last posting for year 3 before moving to the next phase,year 4. Alhamdulillah, i have done with Internal Medicine, Obstetric&Gynaecology and Paeditarics (where we have to get PASS at least 3 postings to move to year 4). Now, time to boost myself for surgical posting which i guess, the best posting among all. I know it is not an easy posting but at least i can put some enjoyment for me to learn and prevail it. For this moment, i want to say that I do love SURGERY !!!


P/s: Alhamdulillah, i got a chance to assist the doctor in OT since the HO was not around...
       [ i have a shaky hands, i need to do something if i want to continue with surgery in the future :(( ]

PAED finale 'runaway' 2012

LONG CASE (Dr. ABG Nagi)

My patient adik AS/3 years old/Malay/girl presented to HTAA with complaint of 1 episode of seizure prior to admission.

• witnessed by her mother
• sudden in onset (during sleeping)
• generalized and lasted about 10 minutes
• occur once only within 24 hours
• associated with uprolling of eyes, stiffness of limbs and vomiting of milk
• no post-ictal complications 

preceded by fever, runny nose and diarrhea

• fever was 38 degree celcius noted at home
• diarrhea occured 3 times with no foul smelling
• in contact with sick people at home

P/E: noted only febrile (38) and tachycardia (148 bpm)

provisional diagnosis : Simple febrile seizure secondary to viral fever/AGE

Questioned ask by Dr.ABG Nagi :

1. Definition of high grade fever
2. Cut point for tachycardia and tachyponea in this age
3. Prognosis of simple febrile seizure
4. Why did you mention viral fever not bacterial?
5. Signs of meningeal irritation
6. Definition of Kernig's and Brudzinki's signs?
7. Classification of seizures (maybe yg ni Dr nak based on ILAE)
8. Definition of simple and complex febrile seizure
9. Comparison of management between simple and complex febrile seizure (yg ni aku ckp xthu)
10. Complication of complex febrile seizure
11. If patient presented with complex seizure what are the investigations you would like to send
12. Management of status epilepticus
13. Examples of anti-convulsant (diazepam, phenytoin, phenobarbitone...etc)
14. If patient with seizure was given all types of anti-convulsant but the seizures still occur, what you want to do (inducing coma)
15. etc..

SHORT CASE (Dr.Aye Aye)

Adik SNF/ 6years old/ facial puffiness

Please inspect this patient, DON'T TOUCH

Questioned asked by Dr.Aye Aye:

1. Is this moon face? Why? (prolonged used of steroid)
2. Examples of diseases that treated with steroids?
3. What are steroid toxicities?
4. What do you think the disease that the patient had? NS
5. Patient has already performed renal biopsy, what are the indications for renal biopsy?
6. What are the types of nephrotic syndrome? and what do you think about this patient?
7. What is the prognosis of focal segmental glomerulosclerosis (FSGS)?

p/s:

- Dgn yaqeennye duk present dalam bilik ber-aircond sempat pulak Dr. ABG Nagi tidur dgr presentation aku....hampehhhh

- Masa session CP ngan Dr.ABG Nagi aku present kes sama simple febrile seizure, alhamdulillah dpt jgk idea mcm mn nk buat ayat dan prepare soalan yang bakal Dr tanya...tp balik2 dia p pusing soalan laen...mak aihh

- Patient nephrotic tu aku dh clerk last week, so nsb bek la ad jgk idea nk present...

aku bermonolog sendirian sebelum keluar pergi exam:

[Allah dah tetapkan rezeki aku, walau apa pun terjadi jgn sedikit pun pertikaikan rezeki Allah]

Muka2 DR kesayangan (termasuk yg xde dalam gambar, Dr.Nargis, Dr.Taufiq & Dr.Fadzillah)
haha..gambar aku pun masuk!!!

InsyAllah mudah-mudahan apa yang aku usahakan hari ini menjadi bukti untuk hari yang akan datang.. Doa dan tawakal kepada Allah semoga ilmu yang diperolehi mendapat keredhaan-NYA.

Semoga mendapat PASS untuk paed posting..ameen

(',) Me, Myself and My Life

Assalamualaikum..

           Alhamdulillah masih diberi rezeki oleh Allah untuk bernafas walaupun terasa diri ini begitu jauh dari Sang Pencipta dan bukan semua rezeki itu mampu dilihat dengan mata yang terlalu kerdil ini kerana segala apa yang diberikan oleh Allah adalah tersirat biarpun ia sekadar ingatan yang tidak langsung.

           Akhir-akhir ini, diri ini amatlah sibuk dengan hanya 1 minggu lagi yang masih berbaki sebelum memberi laluan untuk peperiksaan akhir untuk posting ke-3. Walaupun dah hampir penghujungnya, masih terasa hanya secebis sahaja ilmu yang ada untuk dibawa, InsyAllah masih belum terlambat selagi ada usaha dan tawakal yang sentiasa istiqamah diabdikan untuk Si Dia.

           Penghujung minggu lepas berkesempatan menghadirkan diri untuk 1 program BAKTISISWA anjuran batch kami, 13th Legacy dengan kolaborasi Felda Chini Pahang. Alhamdulillah, tidak menghampakan sebab dapat belajar banyak benda yang bukan sahaja tersurat malah pengajaran yang tersirat yang saya rasa cukuplah untuk membuat saya duduk termenung memikirkan apa suratan disebalik penciptaan diri yang serba kekurangan ini. It changes my life a lots..~~

Beberapa gambar yang sempat di-snapkan:

Tahniah kepada pemenang cabaran tembikai hantaran dan xlupa kepada Miss Daily Dose dan temannya yang cukup kreatif menyiapkan gubahan. (walupun mata meliar tengok gubahan sebelah..haha)

Menunggu untuk menaiki van aka mini-lori menuju ke Tasek Chini.

 Siapa itu?? hehe..inilah 'artis' batch kami Mr. Syahmi Fikri mengambil peluang bergambar di Pusat Jualan Tenun Felda Chini

Menyelongkar keindahan dan misteri tersimpan di Tasek Chini.

           Sepanjang meng-k.i.a.s.u-kan diri di Wad Melur 2, HOSHAS selama 8 minggu, wad kanak-kanak ini banyak menginsafkan diri mensyukuri keupayaan diri yang boleh dikatakan sempurna untuk dibandingkan dengan adik-adik yang lebih tabah dari apa yang dapat dilihat dari mata kasar. Hati tersentuh melihat ibu-ibu begitu gigih menjaga anak-anak yang terpilih ini. Pada minggu terakhir ini, membawa hati yang sedih pulang dari Chini ke Temerloh sambil memikirkan masa depan dan kelemahan diri yang perlukan sokongan. Tapi dengan kehadiran adik-adik yang begitu ceria walaupun sakit dan juga group-mate yang supportive sekurang-kurangnya mampu mengukirkan senyuman dan tuntaskan perkataan syukur kepada Allah.

           Masa jalan kaki di depan kiosk hospital, hati tersentuh melihat satu naskhah buku yang saya rasa tajuknya begitu masyuk dengan situasi yang saya alami, tanpa berfikir sejenak..terus buku itu dimiliki untuk men-semangatkan diri yang mana semangatnya kian pudar. Apa yang dapat dicoretkan, diri ini cuba berubah untuk jadi insan yang lebih baik, mudah-mudahan Allah permudahkan jalan..ameen

"Visi untuk hati yang terluka"

p/s: Biarlah apa orang nak cakap sekalipun, they will never feel it unless they are in our shoes.
      Kepada Adik Taufiq (pt CP kat HOSHAS), mudah-mudahan Allah bagi kekuatan kepada kamu ye adikku dan tabahkanlah ibunya melayari hari-hari yang mendatang..ameen

          Groupmate yang D'bomb... haha, berseri2 semua!!

O&G finale 'runaway' 2012

LONG CASE

- Mdm.Z./ 27 years old/ G1P0/ 37 POA/ EDD = 8-3-12
- k/c/o Bronchial asthma for 20 years on MDI last attack was October last year
- p/w signs and symptoms of labour.
- o/e cervical os was open 3cm and the leakage during admission was not liquor.

Questions asked by Dr. Kamarul Bahyah ( korang cari sendiri la ye !!)

1. Type of asthma treatment that the patient used, what are medications used for asthma that you know?
2. Do you think the leakage is liquor?? i said no.. Your differential diagnosis ?? LL, urinary incontinence, ... etc
3. How to confirm it is liquor?? (aku bagi tau semua test untuk confirm liquor, pastu doktor perli aku balik, semua sekali ke awak nk buat?? then doctor asked me, in our center (HTAA) what is the test used? )
4. If patient came with PPROM (don't use short form masa present ye!!), what do you worry about??
5. How do you monitor patient with leaking liquor in the ward?? --> Pad chart
6. What are components that you monitored in pad chart?? colour, quantity, ... etc
7. Induction of labour ?
8. Methods of IOL?
9. What are complications of oxytocin? UHS, uterine rupture
10. If patient with PPROM, what are vital signs that you will monitor? (dr suruh guna medical term, dr xnk guna eg: temperature --> increased, high or elevated.. cakap je febrile/tachy/...etc)
11. If liquor is continuously leaking, what do you worry about?? what is your plan??
12. Continuous leaking + blood pressure drop, what do you think?? hypotensive shock
13. For this patient, when do you want to deliver her?? within 24 hr
14. etc...

" Okay Afizul, you go back and read regarding PgE, Oxytocin ...etc, because you'll be seeing this again in year 5... unless Nauzubillahuminzalik, if you repeat this again "... then Dr said, ok dah bleh tarik nafas dah.. 

Hahaha..nak berair mata cheq na.. Satu ward dengar suara Dr !!

Actually, i did one case presentation with Dr.Kamarul Bahyah in her room during 2nd week of the posting.  and during the presentation she bombarded me with a lot of questions.. Sampai satu tahap tu, i shed my tears.. pastu Dr cakap, xpe biar depressed sekarang, this is how you learn.. Banyak sangat Dr bg semangat masa tu, sampai je bilik terus nangis (mahalnya harga sebuah air mata, ingat senang ke aku nk nangis) .... InsyAllah, mudah2an I'll be a good and safe Dr..ameenn..

SHORT CASE ( Prof. Hamizah)

- EDD = 8/2/2012, so 

- Please examine this patient 

Pastu aku buat la satu2 sampai habis...Yaqeen giler aku wat (sebab dh banyak practice palpation kat pregnant mother..haha)

Pastu Prof cakap, Afizul, how do you improve your technique of measuring fundus height clinically, can you show me once again?? --> Alhamdulillah, banyak teknik yang Prof refine (but i'm worried because, our SC exam for 3rd yr is assessed from the technique not the findings)

1. POA = 41w (hari xm 15/2/12) --> Postdate
2. If patient came with postdate, what are the signs that you want to look for?? signs and symptoms of labour
3. What do you want to do?? Bishop Score assessment
4. Components of Bishop Score and Total score??
5. Then, Prof gave me the table of Bishop score and she asked me to calculate. I got 5/13 and i said it is not favourable.
6. What is your plan?? Induction of labour
7. Methods of IOL?

Okay, tq..you may go now..

p/s : kalau bleh masa session dgn Mentor, jgn suruh dia evaluate ap yg kite buat tp suruh dia observe btul2, btul ke teknik yg kite buat tu.. kdg2 kite dh rasa yaqeen..laen Dr laen diorang punya teknik and evaluation kan?? so, prepare more is better than less..

InsyAllah, mudah2an..apa yg aku belajar hari ini jd satu semangat untuk aku usaha pada hari2 akan datang.. ameen.. Ya Allah, aku dh usaha sebaik mungkin, segala apa yg akn berlaku, aku redha dgn rezeki-Mu Ya Allah..