Bismillahirahmanirahim........
Hari ni hari jumaat.. 11st sept 2015...
Semalam maka dengan ini berakhirlah peperiksaan yg menentukan kami ini layak atau tidak menjadi seorang doktor... alright let's begin how to things happen..
1st Sept
Theory paper MEQ & SEQ (MEDICAL based)
Posting medicine,paediatric (MEQ)
Q1 crohn disease
Q2 bronchopneumonia
POSTING primary care and emergency (SEQ )
Q1 emergency hypertensive & START triage
Q2 list 5: dementia vs delirium
EVERYTHING depends on Dr... sbb medical based ni include medicine, paeds,em, community medicine,public health, primary care, psychiatric
2nd Sept
Theory paper MEQ & SEQ (surgical based )
Posting surgery,obstetric &gynaecology (MEQ)
Q1 colorectal Ca (rectal Ca )
Q2 cervical Ca
Posting ent and orthopedic (SEQ )
Q1 acute sinusitis or rhinitis (xingat tulis apa )
Q2 non union bone and bone healing
Sama gak... depends on Dr nak bg posting apa soalan apa..
Sbb surgical based in including surgery, obg, orthopedic, ent, opthal,
3rd Sept
OSCE
this what they talk about... station to station... fuh!! 20station..
Abis je osce aritu blk tu g mkn dgn shela n kak fira kat ani sup utara.. blk tu... dh start rasa nak demam... pening kepala.. but manage tak mkn ubat.. heheehe.. as usual ubat dgn i mmg xngam.. (mcmne nk nasihatkan org utk mkn ubat ek??) Hahaha..
I more prefer organic product.. minum halia jwbnya.. sbb perut dh sebu sbb osce kitaorg start lepas morning station abis.. dlm kul 12msk quarantine room.. tapi station kul 2lbh mcmtu.. abis OSCE dh asar.... dpt la berjemaah solat asar.. tapi zohor slps tu.. haih!!! Bkn lepas solat blk.. sembang plk psl osce tu dgn yg lain2.. I can see ramai muka stress.. same goes to me... betullah apa yg kak ayu ckp.. believe in ur first instinct... sllnya betul...
Tulah... tukar jwpan lg.. trimethroprim dh betul... potong lg... uwaaaa... kalo tak dpt la markah FREE....
4th MCQ
600 question?? Rasanya surgery byk membantu... sbb masa revisions soalan sama dikeluarkan.. terima kasih Dr Adel
5&6 relax sebentar...
7th sept - 10th sept
Clinical examination
grp A,B,C,D,E,F
Saya grp F...
Pagitu g HSB tak rasa gemuruh pn.. sbb tgh pening kepala lg.. stress headache dari mlm sblm tu.. yelah kitaorg qiamulail kat surau.. tido kul 3pagi.. bangun kul 5... anin dgn ain la.. g amik wudhu.. pastu berjumpa lah dgn family lipas2.. org siang hari kuar... mlm muncul plk.. mcm buat party plk dia dlm toilet ni..
Tido kat lantai surau berlapikkan karpet.. sakit gak badan.. tapi takpe.. ada kwn2 rasa mcm best plk.. sbb we can what we are.. diaorg jer tau otak gile2 org.. hahaha... tambah2 study psy.. =P
OK back to topic.. smlm kitaorg bertolak g hsb kul 6.30.. sampai kul 7lbh... lalu jalan byk traffic light tu.. mmg sll ikut situ pn.. entah.. dh serasi agaknya.. kak fira yg bwk.. so... sampai hospital baru teringat toys tertinggal bwh katil kat umah.. so.. mcm?? Harap2 xdpt case paeds la... OK.. Time to cabut undi.. kul8 tu... ya Allah.. baca bismillah byk kali.... orait no. Bertuah anin aritu = 34... what?? Last no. 43.. safwan la... so,geng terakhir ni ialah.. lawrence, afiq, saya, laila,farahzahida,zaty shazni,azizu...
Round 1... round 2.... round 3.... round 4... barulah kami.. round 5...
Rumours.. no. Genap surgery.. no.ganjil medicine .
Rupanya Doctor tukar... so... anin 34.. dpt medical based..
Long case paediatric... ya Allah.. memang rezeki Mu itu luas...
What i like i got... lepas clerk.. dpt plk tau.. this kids msk sbb sob and cough... hehehee.... AEBA 2° URTI.. dgn Dr Foo and Dr Achamma...
Short case surgery thyroid ca... em acute appendicitis.. obg VBAc
Long case:
Masa nk msk bilik tu.. duduk la kat luar.. so,Dr Julie yg jaga kami.. dan serahkan pada penjaga masa utk set time... maka bermulalah.. why took sooooo long dlm tu?? Nmpk Dr luthfor kuar.. paediatric?? Where my toys?? Alamak!! I call " Dr julie.. saya tertinggal toys.." "awak xbwk ke?? " " aah... saya pinjam ili... (selamba je aku ini.. Ya Allah.. yelah arini byk brg Org lain kena bwk plk.. brg sendiri tertinggal - hahha ingat surgical based tu yg xgubra ) Dr Julie kata.. takpe2.. awak mula je.. saya pegi pinjam... (hahah... adnin berani kau minta kat Dr mcmtu.. i know her... she love me.. tu yg i penah fail primary care dulu.. siap call me adnin sampai skrg.. ) nak saya pinjam dari ain..
Back to this case.. I clerk his mother.. this 4y/o malay boy, I call he zabidi.. came to hsptl today due to cough and SOB for 1day...
Dengar je mother mention dia ada asthma.. Ya Allah lagi last EOP I also got asthma new diagnose la.. (again?? Allah.. he answer my call.. ) bersinar la mataku masa tu... mx all in my fingertips.. hahah.. OK, he is moderately controlled asthma.. sbb pas attack last month.. august visit ed to take nebulizer.. but not admited..
past medical illness
Bronchial asthma diagnose at 3y/o..
On regular follow up at klinik ihzam (private clinic )
Every 6month..
Now on MDI ventolin (SABA )
&.MDI fluticasone (corticosteroid )she only mention orange in colour
Cough small amount, clear colour,no foul blood,+post tussive vomiting and no sick contact, no barking cough, no
SOB sudden in onset start yesterday night..
No orthopnea, no PND, +wheezing, using of accessory muscle (mother noted chest indrawn )
No fever
on examination
child playful on bed.. active, comfortable not in respiratory distress with RR 20breath per minute (susah nk kira sbnrnya.. sbb bdk ni xduduk diam) tapi bagus dia xnangis.. cuma manja.. No nasal prung or oxygen mask.. last nebulizer at 8am..
this is the child yg kitaorg nampak masa dia naik lift g level 9 tadi..
Anin pn tak sangka.. mak ni nmpk mcm xmesra.. tapi,bila anin abis bertanya dan examine.. dia cerita yg previous student kena tny 1.kat mana nak check eczema? 2.as a doctor how do u manage this pt? Techniques using inhaler... yer ke puan.. apa lagi dia tny?? Rupanya.. bila kita baik dgn dia.. all the story will come out spontaneously.. dia nasihatkan juga.. biasalah kita tau.. bila exam kita gelabah.. jadi lupa.. puan tu mmg supportive.. she live in damansara damai.. hahha.. i know that place.. yelah my playground time foundation kan..
Dr Foo (HSB ), Dr Achamma (MSU )
On history dia tak tny byk pn... tapi my history xde la complete sangat.. sbb review of system xtulis.. ingat dlm kepala je..
Q: Please do general examination
Q: anthropometry
Head circumference 48cm
Height 96 (10-25centile)
Weight 15kg (10 centile )
Q: you mention there is intercostal recession, please show me .
Please tell me the positive finding and negative finding on chest inspection
There is intercostal recession, no pectus carinatum, no pectus excavatum ,no harrison's sulcus,
Auscultation: there is equal air entry, vesicular breath sound, there is generalized rhonci
Q: inspiratory or expiratory??
On expiratory phase.. (knp lah xsebut lengkap tadi )
Q: where do you check for eczema?
On forearm fold, behind popliteal,
On neck where is is more.. front or back?
Errmmmm.... (ada beza ke ??haaha ) front?
Q: how do you deliver the medication?
Inhaler? Yes.. by using aerochamber.. since he is still child.. OK
Q: now you in emergency department.. and this child come with tachypnea, u check SpO2, generalized ronchi.. please proceed how do you manage him..
I would check the SpO2, if less than 95%,I would supply O2.. (actually dlm nebulizer dh ada oxygen pun skali.. hahaha )
Give short acting beta2 agonist, such as salbutamol.. or terbutaline.. if patient have heart problem.. Dr Foo gelak.. is it make any different?? Errmmm.. cause salbutamol can cause palpitation more.. (dlm hati.. Dr manan yg ckp.. terbutaline for pt with heart problem -tak sampai hati nak naikkan nama doktor )
Then? Give ipratopium bromide.. (penjaga masa kata lagi 2minute)
Then? Aminophylline and theophylline (but have narrow therapeutic index (btw therapeutic and toxicity ))
Then?? Intravenously? Owhhh... IV hydrocortisone.. Ha!!! That most important!! then doktor senyum dan mereka pun beredar.. Ya Allah... baru rasa Fuhhh!!!
Bersembang lah dengan puan or kakak tu... student sblm ni lagi teruk kena dik... yer ke kak?? (Dah xprofessional dh.. )dia tanya macam2.. nak nangis budak tu... hohoho.... saya kenal kwn saya tu.. soalan sama je... tulah kak.. lega sikit dh abis .. ada lagi 3 short case plk pasni... TERIMA KASIH banyak2 puan... anak dia xmau pulangkan mainan.. (kalo mainan saya.. sy bg terus je kak.. tapi ni mainan kwn saya.. )-sll pas abis eop time year 3,4,5 sll bwk mainan bg bdk2.. my anak2 saudara yg baik hati lah ckp "aunty... amik la mainan2 ni... abg long dh besar... xmain dh... bagi je bdk2 kat ward tu... " sbnrnya tersentuh hati masa tu... yelah.. masa dia kecik2 dulu... asthma dia teruk jugak.. xblh kena aircond.. teringat tengah2 mlm.. dia semput.. bergegas kitaorg g ED PPUM.. sbb dia lupa bwk inhaler.. tertinggal kat Ipoh.. (masa tu dia darjah 4 xsilap.. g kl naik ktm dr ipoh dgn mak bapak ,kak nani mak dia xikut skali... sbb kerja )anin masih ingat.. dia xblh tido kot.. chest dia teruk in drawn.. anin rasa nak nangis masa tu.. sbb takut jadi apa2..
(Sadness took my memory awayyyyy.... )
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OK back to topic...
Lepas tu... kuar bilik.. Dr Than da oo (radiologists ) pegang bahu anin... r u finish.. yes.. where is ur examiner ??already came out just now... owhh... ok... please bring her to the room... (sbnrnya... masa Dr than da pandang tu.. she look really pleasent.. rasa mcm dia seorg ibu yg sedang menenangkan anaknya... hahaha... but actually anin xrasa pape pun lepas sembang dgn mak adik tu... -saje kuar lmbt dr bilik tu je... )
Back to quarantine room...
At last meet them back... heheeee... let's discuss about next short case.. walaupun xtau kes apa... I want corneal ulcer, psychiatric (sbb dh hafal ubat ), and obstructive jaundice... hahaha.. sukahati je mintak....
They ask me?? Case apa?? Sama dgn ili.. pt sama.. sembang la dgn ili... hhahaha... discuss on ortho la..myotome,dematome,branchial plexus injury, diabetic retinopathy.. semualah... mcm2.. lompat2...
Nak g toilet pun kena kawal.. nk g surau utk solat zohor pn kena jaga dgn Dr Julie... sbb takut bdk. Surgical based jmp medical based... haahah.. jmp Dr Zakiah kat surau.. Ili tny.. Dr buat apa.. saje jln2.. lawak la Dr ni... good luck yer korg... tq Dr.. mula2 ili sebut nama Dr za.... org ingat zahilah... rupanya Zakiah...
Short case
OG 1
Q(HOD ong HSB Dr Azah )
Please examine this patient abdomen...
Dlm hati.. anin buat betul2... tutup screen... wash hand.. greet pt, introduce and consent..
Dr Azah: owhh... dh hafal step...
(Sempat lagi Dr berkata2.. )obstetric kot... for patient modesty and privacy.. (padahal dlm hati.. dupdapdupdap... tarik curtain menyediakan anin berfikir psl step sbnrnya..
General? No need... abdomen only... (melayu rupanya doctor ni.. ingat cina.. cerah.. putih... )
Ok this is G2P1, 36pog..ect.. xingat pn.. please do abdominal examination..
OK.. blh puan tarik sikit baju ni??
Ideally I will expose from nipple line up to mid tight.. however for pt modesty.. I'm only expose from xiphysternum to symphysis pubic..
On inspection.. abdomen is distended up to gravid uterus with evidence of striae gravidarum.. no striae albican.. no linea nigra.. umbilicus is centrally located and flat.. I would check for scar for previous pregnancy.. owhhh... (nasib baik check.. mmg ada... )
There is transverse scar.. measuring about 10cm in lenght.. well heal by primary attention.. no hypertrophy, no kelloid, no discharge, no infection (apa aku ckp ni -ini scar lama lah.. oppss...)tapi Dr diam je... i would check for incisional hernia.. as pt to cough.. -of course lah xde.. kalo ada pt xde kat sini.. hohoho..
Next.. puan ada sakit kat mana2 tak... masa nk start palpate ni.. Dr Azah tu dh duduk.. Dr Myo yg berdiri depan anin waktu ni.. sblm tu Dr Myo duk blkg.. so.. tgh palpate.. rasa mcm polyhyramnious... Ya Allah... rasa air lagi byk dari rasa fetal part... fundal grip... lateral grip.. pelvic grip.. I won't do pawlick maneuver becoz it cause pain to pt..
