Musim berganti

Bismillahhirahmanirahim........

Panas... panas...  memang panas...
Skrg kalo minum air sehari 2liter pn xcukup nih... dari tidur xberkipas...  skrg 24/7 pasang kipas...  even kat dapur...  nk baking sll kalo malam boleh tahan je oven tu panas..  skrg x... nk kena jugak pasang kipas...  it's sooooooo hot.....

Nasiblah sebahagian  rumah ni pakai batu marmar.. sejuk jugaklah lantai nya..  nk dibandingkan dgn lantai simen..

Semalam memanjat bumbung dgn bapak..  betulkan atap umah.. ada yg pecah... dh lama xpanjat survey kawasan... mula2 panjat masa form 2kot.... hahhahha... xingat lah..  tp,yg pasti salah pijak..  hampir jatuh lah... terkapai2 pegang tiang kayu..  sejak dr tu bapak xbg naik dh...  daddy little princess actually sukakan cabaran...  tapi, terbatas bila mummy ratu kebaya masuk campur..  girls don't do That!!!!! :(

Muhammad Jazlaan....  budak kecik yg mencuri tumpuan kami sekeluarga dlm rumah ni...  ada aje telatah dia yg buat org ketawa...  hari ni buat lg...  baru blk dr jln2 dgn kak nani..  sampai rumah...  "makkkk.... saya balik...  " ehhh.... sape budak ni.... (sampuk aku ) dgn muka xbersalah....  "ni sayalah...  MUHAMMAD JAZLAAN.... " (HAHHAHAH....  siap bagi nama penuh lg....  apa yg dihappykan sangat tu?) Dia msk...  menghampiri maknya sambil menunjukkan mainan yg baru dibeli oleh aunty nani kesayangannya.... sedang aku menoleh ke phone...  dia dtg menghampiri...  "anin.....  nah amik ni...  " ?? Nk buat apa ni jazlaan??  Mainlah........

 (hahhha..  bertuah betul bdk ni....  suka kongsi mainan... mmg diajar..  ingat lg masa kat kelantan..  dia lihat mainan warna-warni jual kat wakaf che yeh....  dia tengok...  dia pegang...  tapi, bila mak dia kata letak balik...  xnk beli....  dia xmerenggek.. dia ltk balil..  dia just xckp...  "kenapa xboleh mak??" -easiest way to teach children by telling the reason....  why can... why cannot... bdk2 blh berfikir  ) panjang plk throwbacknya...

Thank sis for reading my blog...  hahaha...  emoticon xhidup plk kat sini....  :P

Anin interview 17/3/2016 ni.....  uwaaaaa....... dlm grp mcm2 soalan kuar...  hahhahaha mcm soalan PRO 3 pn ada...

Soalan harini..panel 8. 1 doctor 1 spa

Nama siapa 
Dulu belajar dimana
Siapa datuk nor hisham-ak kata director general,director general tu ap,...krik2....
Akta siapa gubal
Parliment ad 2 dewan...dewan ap
-brape populasi msia
-brape doc-patient ratio
-kenapa kkm buat peringkat2 mcm ad tmpt ni ad KK je..ad tmpt ni ad 1msia klinik je,ad tmpt ni ad hospital besar
-nak jadi specialist ap

Soklan doc
-how many stage of labour
-how many phase of 1st stage labour
-when u call latent,when is active
-what is true labour
-stage 3 apa
-if 10minute stage 3..what u shud do
-what r sign of placnta separation
-since u said globular uterine during palpation,why it is globular
-what is the reason for sudden gush of blood
-what do u call when there is no sign n symptom of placnta separation
-cause retain placenta
-why fibroid cause placenta to retain or remain
-list what u can see on partogram
-normal fetal heart rate brape
-what is ctg
-what component u see on ctg
-on fetal component,what u need to see
-what is baseline
-what is deceleration
-when u call decel
-what is type 1 ,2 n 3 decel
-pathophysio each

Hahhaa.... kann...  ni belum soalan terkumpul yg lain...  simpan dulu lah....  buat seramm je rasa nk g interview...  seminggu sblm ni relax lg ni...  tinggal brp hari je... 3hari?? Ya Allah permudahkanlah hambaMu ini dan rakan2nya menghadapi hari temuduga nanti...

Gaya penduduk kampung  semarah padi tenangkan diri...
1) tarik nafas.........
2)angkatkan kedua belah tangan... goyangkan...
3)sambil  SENYUM.....
Haahaha...  that's all... sayonara....  ;) :D

what's going on??

assalamualaikum...

cutiiiii... oh cutiii.....
benda yg anin terokai semasa cuti ialah craft...

menarik betullah brooch keeper ni... sejak masuk grp "geng jahit beg" macm2 hasil seni yg diaorg hasilkan...

lagi anin cuti lagi mcm2 anin nk cuba... pasal masak malaslah nk citer SEMUA anin nk buat.. tapi kalo xpandai suh kakak lah buat kan... hehhehe ..

jahit beg ni mmg kena sabar sikit bagi org baru mcm anin ni...
step by step kena ikut.. kena kemas kalo tak kak janna rotan.. hehehe
satu lagi anin dh join kelab peminat rose jepun/japanese rose/moss rose/portulaca grandiflora

anin juga nk citer anin dh msk group "geng mak nenek" - dari last year lagi lah..
macam2 kitaorg sembang.. bkn takat tu.. bila kepala msk air ni.. byklah benda yg merepek2 dibincangkan... tapi, takdelah menyentuh sensitiviti sejagat.. cukuplah menceriakan hari anda..
anin kenal start dari twitter dgn sorg ni. nama shazwani.. panggil cik kiah /sha/wani...
dia yg mula add anin dlm whatsapp... dlm instagram.. dlm weechat.. dlm facebook..

orgnya happy go lucky.. suka mengusik org.. dia dulu kerja kat singapore.. skrg sambung architect balik.. stay kat melaka.. sll gak dia citer dia busy sangat skrg ni.. pandai main biola.. entah bila dia nk bt kelas utk kitaorg ni..dia berangan nk main biola lagu mohabbataein masa kenduri dia.. rare kn?? dia jugak ada bkk kedai Dpavillion (physical store) kat melaka gak.. anin lupa nama tempat tu..


anin simpan sikitlah citer kami geng mak nenek di sini dululah..

dlm grp tu ada Nadia,huda,fiqah dan wani.. yg lain2 anin xkenai sangat.. sbbnya diaorg pun kenalkan diri dgn anin... hurrrrmmmm.... jadi kami2 jelah yg byk berbicara..



oklah sambung later ek.. sbb nk g masak bahulu dgn donut.. nk MAKAN...

=)

jom belajar sama2..

CASE WRITE UP..

should be kena tulis by handwriting... but, disebabkan tulisan cantik sangat... anin nak kena taip lah dulu... later anin tulis ek... =P


Thank you for seeing this patient..(ayat yg anin selalu jmp time praktikal kt IPR dulu...)

This patient 16 y/o Malay student with no know medical illness previously. she came to emergency department accompany by her parents due to chief complain of cough for 2 week associated with yellowish sputum. There is no Hx of pleuritic pain and no haemoptysis. She present of Hx of exertional dyspnea and palpitation. She also has fever for 1 week duration, on & off with chills and rigors. She does not have night sweat, loss of weight or loss of appetite. She has a hx of contact with her uncle with pulmonary tuberculosis but the contact was not prolonged and her uncle already completed his TB medication of 6 month. she does not have altered bowel habits and no family hx of malignancy.

on clinical examination, she was no tachypnea, BP 123/56 mmHg, Pulse rate 108 beat/min,regular,good volume, afebrile SpO2 97% under room air. Respiratory system revealed trachea deviated to left, stony dullness on percussion and reduce air entery on left lower zone. On auscultation, normal S2 and S2 heard without any murmur. Her abdomen was soft and non tender.

A pleural biopsy and pleural tap under aseptic technique was performed on day 2 of admission. Aspirate was around 100ml pus, foul smelling and not blood stained. Chest tube was inserted on left on day 6 of admission. Howerever, the was no drainage. The chest tube was subsequently removed.

She was treated as left lung empyema for further investigation. She was started on Augmentin 1.2g TDS for 5 day and complete T.Azithromycin  500mg OD for 3 days. She is currently on IV Rocephine 2g OD (5 days)and IV Flagy 500 mg TDS (5 day)

Radiology investigation
Chest radiography
left sided homogenous opacity

Ultrasound of left hemithorax
revealed marked elevates left hemidiaphragm with remarked displacement of spleen and left kidney suggestion of left lung collapse. No significant pleural effusion identified on ultrasound.

CT Thorax
was performed on day of admission and the CT scan showed reduced left volume with trachea and mediastinal shift to the left. Cystic bronchiectasis change of whole left lung. Thick wall collection in the anterior segment  of upper hemithorax, measuring 4.5 (AP) X2.2 (W) X 4.9 (CC) cm with air fluid leve;. No calcification noted in the left hemithorax. The chest tube tip is in th epleural space at left middle thoracic region. the left superior mediastinal nodes are enlarged and matted. the largest measuring 2.0 X 2.3 with central necrosis. Nodes also seen in the carinal region. Subcentimeter nodes in both axillary region. No enlarged nodes in lower cervical and superclavicular region. Minimal left pleural effusion.

compensatory hyperinflation of upper and lower right lung. Cystic bronchiectasis of the right middle lobe, no right pleural effusion. The visualized upper abdominal angle appear normal. No upper abdominal lymphadenopathy.Vesicual bones are normal.

Impression:
 the lung empyema with matted left superior mediastinal lymphadenopathy in the background of cystic bronchiectasis. Reactivation of PTB need to consider.
TRO Bronchigenic carcinoma associated obstructive pneumonia.

Biochemical Investigation:

FBC (19/10/2012) Hb : 11
                              WBC : 14.26 (on admission) , currently 8.12 (19/10/2012)
                              Hematocrit : 34.4
                              Platelet : 550

Renal profile : Urea: 4.8
   (19/10)               Sodium : 137
                     Potassium : 5.3
                     Chloride : 103
                     Creatinine : 55
Liver function test :
Total protein  : 55
Albumin : 30
Globulin : 58
ALP : 103
ALT : 20
Total Bilirubin: 3.3

CRP                      96.1
ESR                     114
Ca125                  55.6 (0-35)
Ca 19-9               11.1 (0-27)
CEA                      1.2
Blood C&S          No organic isolated
Mantoux               negative
Sputum AFBX 3   negative


Pleural Fluid Investigation

Plaural fluid gram stain - Aspirate appeared pussy & no organism isolated
Pleural FEME              >1000 cells/mm3, predominantly ,neutrophils
Pleural fluid for AFB        negative
Plaural Biopsy               no granuloma or malignancy

this patient is referred to seek your expert clinical evaluation and subsequently needful management.

on 23/10/20012

patient are alert, conscious, cooperative, to time,places and people.
B/P : 118/71
PR : 72 (rate/rhythm/volume)
T  : 37'C
SpO2 : 100 % under room air

Plan :
1) continue respiratory plan
2) to ask patient to bring letter from Serdang Hospital (kept by mom)

24/10/2012

B/P: 109/91
PR : 71
T: 37'C
SpO2 : 100 % under room air

plan :
1) continue abx X 2/52
2) continue medication
3)SpO2 monitor
4)confirm empyema
5) Hypoplastic left lung secondary congenital

continue:
Azitromycin/ Augmentin
reduce IV Rocephine 2g OD
Hagly 500mg TDS
TROMAL 50mg 3OD




p/s: this is only a STORY about how doctor make the decision during ward round... and what they plan for the real patient... please don't make anything conclusion before you can really understand what the patient being going thru... kasihanlah pada mereka.. jika, kita berada dalam kedudukan mereka.. barulah kita benar2 faham apa erti nikmat kesihatan.. saat berserah diri pada Allah.. Allah uji lagi kita dengan perkara yang tak kita jangka... percayalah... Allah sangat-sangat-SANGAT menyayangi KAMU......

insya-allah...

cerita tentang kisah adik ini belum berakhir lagi.....

my CASE WRITE UP tak siap lagi.... hehhehehe...

handwritinglah kena check betul2.......................... bkn boleh edit... so, bila dah tenang nnati anin tulis balik ek... kat kertas... sekarang masanya untk makan daging korban....

Bismillahirammanirrahim.................................

emergency!!!!!!!!!!!!!

morning people....

yesterday recap

etopic pregnancy- send to ot after blood transfusion

alleged MVA- back bone rupture? 6 pack of FFB and plasma-cryp?

?femur fracture



tolong!! tolong !!! anin tak tau nak buat apa... then, dr aka BOSS for emergency department tu ask me??

1 scene :
"medical student from MSU??- why u late?? " -specialist

me?? hahhaha... (dlm hati- did anyone come here before this??) my opportunity to learn something....

 "help me to take off the ECG lead.... - sambil tu amik la kesempatan tny patient what happen actually..
hyperthyroiodism suggested due to tachycardia-BP high-irregular menstrual.. mother also on medication..... but she don't know which one.. hypo or hyper....


2 scene:
pakcik.. saya nak masukkan tiub nanti.. nak intubate... so, pakcik banyak2kan mengucap ya....
perlu ke nak ckp mcm tu... "menakutkan anin je...... "

long day at A&E- from 4 pm till 11pm.... kalo masuk ot pn org dah balik dah...

arini klas kat MSU- dari kul 10..

kalo takde klas, boleh la msk OT uncle semalam..- kul 7.30 pagi tadi.. -ampullary carcinoma-under Dato Nordin -major surgeon...



hujan... hujan... balik tu lepas makan malam kat luar... hujan... - me alone
should i say........... thanks to whom they may concern....

Pro III examination

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..

Keep it here.. maybe future i need it.. =)

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