Case write up disorder

Bila meja penuh dengan kertas.. itu tandanya case write up sedang dalam progression.......

handwriting?? bila tengok balik tulisan sendiri-asyik mengutuk diri sendiri je... kalau huruf BESAR boleh la tahan kemas... bila tulisan kecik2.... mula lah macam2 bentuk.. hehehehe.....

let's prepared ourselves.. internet-unifi dah mula active balik... lepas makan ubat, should be kena tidur lah kan.. sabar adnin... semua ini ada hikmahnya...

chief complaint(C/C) :SYMPTOM

running nose for 2 week(duration)

Hx of presenting illness(HOPI):

• occur at close space area or only on exertion, sudden onset,episodic, worsen during evening.
• aggravating by dust, direct fan, air-cond, cold condition, when prostration or drinking ice. relieving by blow breath, avoid cold drink, away from direct fan and air-conditioner. 
• associated with nasal congestion (? sinusitis ? allergen), sometime bounding of the heart present without chest pain or any other symptom 
• (based on cerita- apa yg patient complain-itu adalah SYMPTOM)

review of system (ROS):

general : ( ask about)

weight loss? appetite?thirst?lethargy/weakness?Fever? sleep? itchiness?

respiratory: (ask about)

cough?haemoptysis? sputum colour?dyspnoea? wheezing? decrease effort tolerance?

CVS : (ask about)

palpitation(if mention xperlu la nak ulang lagi)orthopnea?PND? dyspnea?exertional dyspnoea?chest pain? ankle oedema?

GIT: (ask about)

etc.........

MSS:

CNS:

O&G:

 

Skin:

Urinary :

sexual/genital:

psychiatry:

 

-DETAIL lah............ kena tny sebab afraid patient xmention atau tak ingat mereka alaminya... just bg mereka FULL image of their condition-severity dll...

kalau tiada.... just mention

On review of system.. there is no other special or significant symptom related to patient condition..

then, baru masuk

Past medical hx (PMH):

- cari penyakit yang ada kaitan dengan symptom yang patient beri...-

find idea- asthma? heart disease?

Differential diagnosis??

surgical Hx:

Family Hx:

------------------------------------------------------------------------------

mother: 66, alive and well.

father :71,Diabetes since 2011,Hypertension -relapse case on 2011 -all are control under medication prescript by doctor at hospital raja permaisuri bainun, ipoh. under follow up and treatment. 

other family member are well and healthy- insya-allah.... heheehehe  =)

all are not smoker or not alcohol drinker.

social & occupational Hx:

single, student, stay with few friends in double storey house at bayu perdana,klang,

not smoking, do not take any alcohol

Drug Hx;

NKDA-no known drug allergy

physical examination: SIGN

general examination:

B/P: ??

Pulse rate : 92, regular rhythm, good volume and afebrile 

respiratory rate :13/ min

temperature :??

body weight : heehe... 50kg

height : 152cm

nails and hands: no abnormality

eyes: rabunlah...

mouth and tongue: jom gosok gigi.... nanti doktor gigi nk dtg sekolah.... =P

neck:

respiratory system examination

inspection

palpitation-vocal fremitus/ vocal resonant guna stethoscope '99' or "one,one,one"-ask examiner to hear it- more clearly sebenarnya guna stethoscope...

percussion-resonant?hyper-resonant-pneumothorax?dull-consolidation?stony-dull-pleural effusion? 

CVs examination

abdominal examination

limb examination

Neurological examination

Provisional diagnosis:

Differential Diagnosis

Medical summary:

patient 24 y/o come to haospital due to symptom of running nose ect

  

Gadget

For your information... what i found on internet... hahaha.. semalam ada CME kat performing art theatre about HPV-so... as we duduk row paling depan atas sekali...  semua yang duduk dibawah kelihatan jelaslah.. ada yang tido,main phone,messaging.. dalam pada tu nmpklah beberapa orang student yang pegang I-pad,galaxy Tab etc.. 

Anin rasa ramai yang mempunyai tablet menggunakannya untuk melayari internet. Ada juga yang menjadikan tablet sebagai telefon pintar bagi tablet yang menyokong rangkaian 3G. Namun jika dibandingkan dengan Netbook mana yang hebat? Dari segi perkakas jauh Netbook lebih hebat.. yer ke??

so, anin found this article..

Antara perkara yang menyebabkan anda menyesal membeli tablet.

1) Kapasti penyimpanan yang terhad.
Ada tablet yang hanya mempunyai memori dalaman sahaja dengan kapasiti 16GB/32GB. Ia tidak boleh ditingkatkan. Ada juga tablet yang didatangkan khas dengan memori kad, tapi hanya menyokong hingga 64GB.

2) RAM yang terhad
Walaupun sistem operasi yang berasaskan Linux mengunakan RAM yang rendah, namun jika hanya mempunyai RAM 1GB memang tidak cukup. Bayangkan jika anda membuka banyak aplikasi dalam masa yang sama. Susah tentu tablet anda akan jadi pelahan.RAM juga tidak boleh dipertingkatkan.

3) Kelajuan pemprosesan.
Jika Netbook yang mengunakan Intel Atom mempunyai kelajuan pemprosesan 1.6Ghz, tapi tidak bagi Tablet. Paling laju pun 1.5Ghz.

4) Perisian Office
Di dalam Tablet yang berasaskan Android, tiada Office yang setanding Microsoft Office ataupun Open Office. Office yang disediakan hanyalah peralatan yang asas sahaja.

5) Papan kekunci.
Semasa anda membeli tablet, ia tidak didatangkan dengan papan kekunci. Anda perlu membelinya secara berasingan.

6) Harga
Biasanya tablet berharga RM1600 hingga 1900. Bayangkan jika anda membeli tablet dengan harga RM1900, secara automatik anda akan terfikir jika andabeli netbook, anda akan dapat dua netbook.

7) Sistem Operasi
Seperti yang kita tahuu, jarang ada tablet yang boleh menyokong lebih dari 1 sistem operasi. Jika netbook, anda boleh memasang windows dan Linux (OpenSUSE, Android, Ubuntu, Linux Mint)

8) Port yang terhad
Biasanya jarang tablet yang mempunyai port USB seperti pada komputer. Jadi macam mana anda nak pindahkan fail ke pendrive atau nak print dokumen?

9) Bateri
Memang bateri tablet tahan. Tapi bagaimana jika rosak? Bateri tablet tidak boleh dicabut-cabut seperti laptop. Jika rosak, terpaksa claim waranti sebab tak ada jual kedai biasa.

hurm... that make me think again... my netbook also need to find battery... ~uwaaa.................. (anak kecik mencari ibunya...)

that's it until we meet again next time..

UPDATE student log book warna BIRU... 

real people at real time

Jom membaca... article taken from http://www.jacknaimsnotes.com/2012/09/the-gray-area-of-making-diagnosis.html

let's digging into it..

In treating a patient, we are relying on clinical assessment supported by laboratory, diagnostic instrument and imaging test. We need a diagnosis before diving more deeper into it. All of this step will aid a doctor to provide management based on available evidence based medicine. 

However, there are time when thing did not work as we plan. The diagnosis is in vain and the resources are limited for us to proceed. Moreover, the symptoms and signs are mixed and further compromise our ability to determine the primary insult. 

This is the gray area of medicine and it will delay the treatment. The longer we are in this period then the prognosis will be bad.

Medicine is about logic based on the integrated knowledge of the anatomy, physiology and biochemistry of the body function. For every things that happen, there must be a connection  behind it.

When the signs and symptoms sounds did not correlate with the patient’s condition, then we need to look more into it.  It means that there are a missing puzzle that fails us from identifying the connection on what is happening to the patient.

The missing puzzle could be from the inadequate history, lab errors, hidden genetic predisposing factor, lack of knowledge from the healthcare provider in identifying the problems, faulty reasoning and logic and often contributed by a famous quotation “All Patients LIE.”

Therefore, we need to step backward and starts the whole process again and make sure that we did not left any pieces of the puzzle. In between that, it is essential to meet the basic requirement in maintaining patient’s survivability.

They are places that practice defensive medicine. It often scare them to initiate any treatment before knowing the diagnosis. In one aspect, i do agree as it might be not working or worsens the patient’s condition. But in another aspect, i believe that a doctor should be firm in making decision to treat a patient based on the best interest for patient. At least, we should be able to identify what is killing the patient at that particular moment and try to intervene. I also strongly believe that when the diagnosis is in vain, it is not a sin to treat as the most likely diagnosis based on the epidemiology, the most likely condition that can give the presenting symptoms. After all, most of the disease have an overlap pathogenesis. The gray area will always exist and it should not clouded our mind as well.

so, in other way... sebagai student in clinical year... we do need to read more,relate the anatomy,physiology,biochemistry to the patient condition and diagnose the disease based on overall start from clerking patient,P/E,biochem-haemot- and so on... apa yang pasti clear view of the condition can make we get the correct diagnosis..



tadi siang BST dengan Dr Law (m/o from HTAR) , nice gentlemen =))
P/E on respiratory and cardio- really lah increase my confidence later bila nak do full p/E to patient... sebelum ni haih!! jgn ckplah.... tak yakin sangat which location? inspection,palpation,percussion( kena cari alat music) heheheh =P and auscultation.... gain more experiences after dia yer ADNiN.... =)

senyumlah selalu.. biarpun orang tak senyum pada kita... yang penting we HaPPY by OUR own.... i really want to PLEASE everyone.. but then, ppl will start to make different attitude toward us.. belum sempat nak cakap, dah kena potong... belum sempat nak habis cakap... orang dah "FaHAM lain"...

till then, we meet again next time... =P

Ana perlu lebih berhati-hati semasa bertutur- intonasi,bahasa,kedudukan..

Alteration alternator...

what should i write... kenapa tajuk ni?? -sebab bunyinya macam rapping.. yeah- hiphop time..

6.49pm- things happen for a reason..

pass this week and last week.. anin rasa macam xboleh nak adapt dengan situasi ini... but, i have too..
Allah tak akan membebankan hamba-Nya melebihi kemampuan hamba-Nya.. so, i should be motivated!!!

HEy GIG.... my left upper limbs, on both knee ada bruise- due to smalllllllllll accident dengan Lagenda yamaha.. hehehee.... kini tinggal kesan yang masih berbekas.. tulah- ur parents dah bgtau jgn bawak motor... but, keDEGILAN yang ketara merasuk dalam diri... motor orang pulak tu yang dibawa.. sib baik xde pape.. kak soleha kata.... "risau dengan Jan.. sebab rasa macam ada tak kena je... sebab Jan xbawak phone pulak tu.."

careless of ME!!.. tulah pasal.. lainkali kalau rasa nak keluar rumah think-think-think!... ni pegi charge phone kan dah tertinggal.. sib baik xde yang injured teruk... first time ON CALL till 9 pm- tetttttttttt.....

posting kat Medicine ni need to learn more...

tadi, first time Bedside teaching-i present but, not fully by my own lah.. Dr Maghdi yang banyak membantu.. what to do next... what her chief complain.. past medical history,family hx,social hx, ect...
Dr cakap... now u should do the physical examination- by system CVS,R/S,GI,CNS siap ada homework lagi...-INR? gastroentestinal? ulceration?   hehehehe =)


tadi pusing2 kat Klang.. mencari kedai spare part for ganti cermin sisi motor kak soleha.... nmpk gayanya anin bagi duit jelah kat kak soleha utk bayar ganti rugi... 1/2 time ponteng today.... ~LOL adnin... dengan rasa xbersalahnya present case (-_____-)

so long.... tata...... farewell???

one things, i should say.... family support in this time is very important.... create the bonding between patient and doctor can create the world a better place.... =)