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

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..

(",) All about "Pocket reference for ECG made easy"

Assalamualaikum...(kaifa Halukum??)

        As i promise to you before in the previous entry ECG made easy, actually this is just my own review about the book and either you like it or not it's up to you. I'd like rate this book..ermm 3 and half stars . The book is really good because it is handy, easy-to-carry and it highlights the important point to understand the basic knowledge of ECG. The book comprises of 9 chapters :

• Chap 1 : Anatomy and physiology (revision from our previous BMS)
• Chap 2 : Basic Electrophysiology (very important chapter)
• Chap 3 : Sinus mechanisms
• Chap 4 : Atrial rhythms
• Chap 5 : Junctional rhythms
• Chap 6 : Ventricular rhythms
• Chap 7 : Atrioventricular blocks
• Chap 8 : Pacemaker rhythms
• Chap 9 : Introduction to the 12-Lead ECG

Actually, i'm not finishing it yet (ye la kan...this is not a novel, mag. or what)..which i think, don't need to rush finishing it because it is a story of 3 years next (i mean clinical years) just afraid of "cepat habis, cepat plak lupa"..but so far, it is a good production...the book is written based on the various reference textbooks. It provides us of how the waveforms are drawn and why each waveforms are shaped like that. Besides, it tells us how to analyze the ECG strip and the methods to assess or measure the rate of the rhythm. The most important is, it compares the normal and the abnormal ECG strip in each rhythms with a brief description.

Alright, i think this review is more than enough to talk about the book, so i hope it will be beneficial and give you a simple description about it. If you want to get more information just "GOOGLE" it and honestly, there are many other books which are better to give a detailed explanation about ECG.. 

P/s: I'm just a mediocre student and it is my pleasure to give something from my little knowledge and of course I'm so glad to share about it .