Paed's posting exam

Just wanna talk about my Paeds exam before i forgotten about it...=)







For paeds exam, we have to do a Long case and MCQ.. i was in the group for the 1st of long case..at around 9.00am







So, on the day, i went there at 8.55am..and rush into 6S (ward) and look for any familiar faces. Hmm, saw my colleagues clerking (the ones at 8.30am) ..i tried to look for someone to tell me where to wait ..so i walk to the counter and saw a Dr. in charge of our year..i asked him and he told me to go to the Department..







went there, saw my other colleague waiting as well..a few minutes later, a MO (medical officer) came and told us to follow him. We were brought to our respective patients. My colleague was just opposite of me. so we begin our clerking.







My patient was a 10 years old boy and his guardian was not around (she went to the bathroom)..so i asked the boy (patient) instead.. was asking his chief complaint = fever and abdominal pain...so i ask further details.. was clerking half way, then his guardian came back.



So i ask his guardian about the boys condition.







She told me straight away that he had Hemophilia A (a disease that causes reduction in factor VIII - had bleeding tendency) ...ohh shit.. i was first thinking of fever or other things, suddenly he came in because of swelling of the ankle (haemarthosis).. what a big difference. If i got the chief complaint wrong = sure fail lo.. so faster clerk the details on hemophilia.






while i was still clerking, i noticed that my colleague on the opposite bed had already finished...she started on physical examination(PE)...oh..i got to hurry...not much time left...after finishing with my history i moved on to PE. i was stunt at first, dunno where to begin.. so i start with the CHIEF COMPLAINT, the ankle swelling.. i just did a very very brief examination...because everything is mostly normal.. apart from the presence of excessive bruises.





Finished with my HISTORY and PE...time to arrange everything.. wat a mess, i got this problem with clerking, i wrote it everywhere..im now confused which is which..look so un professional..but nevermind , i hurry up with the opening speech.." patient was apparently well until..." times up..so i waited eagerly for my doctor to come and access me.





After waited sometime, came a Prof..luckily he was not my examiner..."lega"..=) , later came a Dr which i havent seen before for the whole posting...Dr S.. she spoke with my patient and then she told me to present.





History was a mess...but i kept on talking as if i know alot...=) luckily i wasnt stopped.. then, PE , i even forgotten to present the vital signs..the most important aspect of PE..., luckily , i wasnt stop as well...she just listen and didnt speak a word. After the PE, she asked me about the differential.. i told her Haemophilia, Septic Arthritis, Leukaemia.. she continued to investigation..





I blunderred here, because i wasnt very sure about Haemophilia . i told her that Haemophilia is a autosomal reccessive inheritance...=(.. she ask me again are u sure? then i quickly changed to Sex-linked reccesive...lol.. asked me about investigation to confirm diagnosis..i told her that we should do genetic studies..lol...what a fool..she laughed.. then, i remembered i should do the Bleeding Profile instead... Prothrombin Time and Activated Partial Thromboplastin Time..she asked me which will increase or decrease? i told her both...wrong again..=(.. actually is Aptt prolonged.. because hemophilia A affect Factor VIII of coagulation cascade.. intrinsic factor.. she told me that u are all mess up...u should study about this disease because it is quite common...





after that, she asked about what that i m going to tell the patient before we discharged him?... luckily i was told by the guardian about what he cannot do and so on..



I told the doc that, he must not involved in aggressive sports, if there is presence of swelling and bleeding, he needs to come to hospital immediately, tell others people about his condition, so he can avoid certain condition..

thats all for my clinical...i didnt do very good in my opinion..but i luckily i got a so called "benign" doctor... if not confirm fail lo..=P

Next posting is surgery..

Trip to Penang

On the 12th August, went to Penang with 5 of my friends for the convocation of 3 DOTA seniors..=)





Took bus from kelantan at around 10 pm that night and reached Penang at around 6 am... wah, 8 hours ride..and very very cold ...(i forgot to bring sweater... nearly froze to death..=( cant sleep at all.. )



Reached Penang then got to wait for car rental... which will come at around 8 am ++.. so wait at bus station. We brushed our teeth and had our breakfast at the station. Half an hour later, 1 of my friend from Penang came and he brought us all in his Satria...wah 7 people in 1 car damn packed.. he brought us to a nearby food center and we ate again..



When back to station and got our car at around 9 am because the rental guy said that office just open. After we got the car, we went to find our accomodation. I already booked a hostel (HUTTON LODGE) which was situated near Komtar. So, we scout around that area and finally found the place. But we were too early, so got to wait until 11 am till 1 pm when the occupants left.



We decided to go to INFINITY (a cyber cafe near USM campus) to play games. Later in the afternoon, we will be fetching one of our graduated senior from the airport. After fetching him, we went for lunch and then to our hostel. That night, we went to the cyber cafe again to play games.



The next day, we went for seniors convocation and also to the CONVEX. Everything was same like last year. We waited for them to come out from the GRAND HALL, and passed them with presents. We bought each of them a Soft toy ( turtle, piggy, bear).



After convo, we went to Prangin Mall to 'lepak' and have our dinner. At night, we went to cyber cafe again to play games.



3rd day, we went to QUEENS BAY MALL, we went there to buy clothes and also to watch BATMAN... the movie was nice but it was quite long i think, because i actually slept-awake cycle during the final 30-40mins. Then we went Gurney for supper and then back to hostel to sleep.



4th day, nothing much happens because most of our seniors already going back. Just left us 5 person because we bought the bus ticket a bit late so there was not much buses left so we must stay longer...=( when to Gurney Plaza and watch MEET DAVE... not bad la the movie but my friend say that it was actually meant for children..=P ..this is because the jokes are only so-so and inside the cinema, there is a lot of FAMILIES and CHILDREN.



Last day, we went to eat DIMSUM and then to the bus station for our ride back to Kelantan at around 9am. Overall, the whole trip was enjoying, we had our fun with games and movies..so, now going back to Kelantan. In 2 days time, ill be having my 1st posting exam.. dunno what to expect. Havent study at all during the trip although i did bring some books..

Advice to all, if u going for a trip, dun bring ur books coz u wont be studying.

NICU (neonate intensive care unit)

Hmmm... anyone heard of NICU before...? it is a place where very very sick babies are put into after delivery or a few days after delivery. A terrifiying story happened when i was on call at NICU a few days back.


As usual, we need to on call in the wards 5 days/once so today it was me and my partner on call. I went to NICU as usual, and today my partner was not around, i followed the doctor for ward rounds and she asked me to palpate the anterior fontanelle of one baby and comment about it.. I was also told to check the pupils of this baby. So i followed her instruction and did what i was told. Then, i followed the doctor to other babies and so on until noon where i went back for lunch.



At night, we need to on call as well, so i went to NICU but this time my partner is around. So, me and my partner just looked around in the ward. Suddenly, the doctor working there told us that there is a case of Neonatal Jaundice needing Exchange transfusion (taking the baby's blood out and replacing it with another because of the high level of bilirubin in blood). So we helped the doctor to do the task and finished at around 2.30 am.. woo, what a day..went back played a match of DOTA and slept.



The next day, one of my friend on call text me in MSN and say that he was very boring in NICU. He said that all he do there was watching a dead baby and whole family crying. I was worried whether the baby undergoing exchange transfusion died? ...he told me that the baby that i palpated and looked into the pupils died instead. Oh is it my fault... i felt that it was probably my fault so i told him the story about yesterday's on call.. He said that the baby died of SEPSIS (due to systemic infection). It scared me even more, am i the one introducing the infection? he also told me that the doctor yesterday was looking for me and she seems angry.



So, my mind went troubled... can a simple palpation and pupil inspection cause this sepsis..? i felt some difficulties in doing the pupils inspection yesterday, so i feared that i might have pressed the eyelid to hard or so...i quickly consulted a lot and ALOT of people (colleague, friends, seniors,) and asked them about this situation. I was afraid of being kicked out or even sent to jail for accidental death...

A few days later, i got a class with the doctor for a Seminar... i went to class as usual feeling guilty for the incident. During the class, nothing unusual happened. The doctor didnt talk to me, so i was puzzled... I think im being played a fool...damn, my friend lied... actually the cause of death has nothing to do with me..just that, i was unlucky to be the last guy to touch the baby..=(..

Finally it has settled. Now i can go to Penang happily for convocation of my senior.

crying over "a spoilt" milk...

hello... gonna start it with something simple.. today, i went out for dinner as usual... i felt like i wanna drink milk today so i went to the 7-eleven store situated just outside my campus. I bought a packet of chocolate milk and went of to a stall a few a hundred metres away from my campus ( me and my friends usually eat outside for dinner)- my friend bought another brand of milk as well ... i opened the drink and took a sip.. hmmm, wow the chocolate taste was so thick.. but it felt like something is wrong with the milk..(a bit soury) ..maybe is my tastebud... then i asked my friend whether chocolate is always so thick and he told yeah...ohh, so i continue drinking the milk but i just couldnt lie to myself ( i really can feel that it is different).. i told him im going back to the 7-eleven to change, so i went back and ask the staff in charge telling that my milk had gone bad..

I took another bottle of milk (this time it is the same as my friend's) .. so i opened it and drank... hmmm, nicer.. but it still felt like something is wrong..(i tell myself, maybe because the milk is fresher) nevermind, i drank and walked to the stall where my friends are waiting. There, i asked one of my friend to taste the milk, and he just 'YUCK' away... then my other friends took turns to sniff whether anything is wrong with the milk... all of them 'YUCK'...zzz, i drank nearly half the bottle already...=P.. then, we try smelling my milk and another milk of my friend's. Oh no, it really is a huge different..(my tastebud is normal) should have trusted in them.

So, after finishing my dinner, i went back to 7-eleven in hope to get another change for the milk... luckily the person in charge is friendly... i decided to get a Snicker bar instead...not another spoilt milk... hopefully the snicker is not spoilt...=)

4th week...

woops...2 more weeks for end posting exam...just read around 300+ pages of the paediatric text book...got 200 pages to go...=(... nothing much this week..been to Thalassemia day care centre in my hospital...nowadays, thalassemia is a common health problem face by Malaysian. It occurs in around 1 in 20 if not mistaken.

Anyone knows about thalassemia? it has something to do with the abnormal protein formation in the Red Blood Cells (RBC)..it causes increase RBC destruction (more fragile) and in layman terms .. means more blood loss..that is why, thalassemia patient usually need regular blood transfusion. Thalassemia is a genetic inherited problem and not an infection problem. It can happen to any of our offspring so if you wanna get marry soon, check for any thalassemia in your gene...if both u and ur partner are carrier means there are chances that ur offspring might be a carrier as well or the affected ones...

This week got KL-Selangor gathering... went to a restaurant for dinner and some introduction for the juniors... this year, there are some pretty girls and some handsome boys... not a bad gathering...get to know juniors better since im already 4th year...can act abit bossy...=)

thats all for now...see if i got the photos from the gathering...=)

a visit to YOKUK...

http://www.yokuk.org/
today, i woke up at 7.45am, prepare myself and waited for the van that brought me to YOKUK at 8.30am...

reached there after 15min of drive... i came here today because this was my first time visiting the place and wanted to help out in the 'gotong-royong' as well. At first, the place was quiet...it seems empty. Then, came a few men and women, they told us what to do...since it was still early, they decided that we tidy up the compound of the institution.

Each of us (7 people, 4 guys and 3 ladies) were given a rake. We were told to clear the leaves that were scattered all around. It was just like the 'Khidmat Negara' type of gotong-royong so there is nothing much to tell...

After finishing our work, we were given drinks and 'kuih'...later, we set up 2 tents for an occasion at the 31st of July (Birthday party for the disabled in Kelantan - around 250 disabled will be invited according to the people in charge)... here comes lunch time, we had 'nasi kukus' ...yum... after that, they sent us back to campus...

wow, did some charity work today, and in return was given free breakfast and lunch.. =) helping others and myself at the same time...hehe...

3rd week ended...

wow, 3 weeks already in the posting. The whole week was a busy one, time was spent on doing case write-up, attending tutorials and presenting cases... next week, ill be meeting my supervisor in charge for the posting. He will be assessing me and my friend for the mid posting test. Dont know what to expect. My case report was far beyond par if compared with my friend's. So i hope that the doctor wont compared our reports..but anyway, im prepare to be scolded..cuz i really think my report a bit sucky. 3 weeks more to go, hope to have a better weeks ahead.

Oh ya, i met a junior (1st year) and he is from Seri Sentosa as well.. but he was there only for Form 6..damn, he didnt know that there are 2 seniors from sentosa in USMKK, he only heard of Alex..=(.. anyway, glad to know that i got a junior ...haha...

This saturday will be going to some place to do gotong-royong...lets see how was it..=P

Unlucky situation..

today is a weird day for me... the day seems normal as usual till around 4.30pm when i clerked this patient (a 13 year old boy)... he came to hospital with complaint of chest pain associated with cough, vomiting and flu which happens for quite some time already..after the interview, i did the routine physical examination lor... was doing respiratory half way then my colleague came and guided me through the examination... all of a sudden, my patient seems to be in distress..

so i mah stop examine and ask him to sit up.. then, he seems to talk about some things (******) to his dad... after that, he became pale with respiratory distress (coughing, groaning) with pain... and i told to kid to cool down and relax...=) but he condition seem worsening. Then i saw his dad keep on shaking his head...and said something...like "what the f*** did u do to my son"... i was like OMG, did i do something wrong, press to hard? and his dad told me to use my brain la..u know his condition liao, dun la kacau him... (i was just doing my job =(... i told sorry and stood there like a stick?...then his dad yelled and tell me to get away!!

damn, with a stressful feeling, i walked to the counter and sat beside a Houseman (doctor)... i asked her how was the kid's condition, and she told me that the kid was having GERD (gastro esophageal reflux disease) ... hmmm.. doesnt seem to be a serious condition afterall...

later, the patient wanted O2 ...and i saw nurses and my other colleagues bring ECG and oximeter for the patient... wah i tot is some serious sh*t, tot that the patient will DIE!!
not sure whether is lucky or unlucky, the result of the oximeter ( O2 saturation 99%), ECG normal but not standard ( tak cantik with lots of useless waves- maybe my colleague's techniques sucks...hehe)

ask doctor again about his condition, and the doc said something bout "the patient got some PSY" what is that? ohh...psycho problem rupa-rupa... then after some recall from the history, maybe what the doctor say is true, coz he is the only son in family and his parents are all quite old (his dad look as though he is around 50++) after knowing that his condition is stable after the doctor prescribed MMT ( some kind of antacid for his gastric attack) his condition was stabilize..

wah.. what a day.. kena marah . Is it my fault? is the patient too tired from endless clerking before me ? is the patient faking the pain? nobody knows... (only god knows lo) doctor is here to serve mankind...that is our OATH... getting scolded is a normal routine...i must bear with it..and be happy...=)

introduction

start school liao...back to campus...

wah, 4th year liao, senior already, can lanzi yeah... currently doing clinical lo in Paediatric ward HUSM. 1st week nearly over, learned a bit this week, clerked some patient, go On-call till 12pm...wah all new experience..no more going to lecture listening to endless slides...

im creating this blog as a tryout to express my thought and to share some of my experience? (maybe) so for those who visited it, enjoy having fun for 6 weeks in Paeds and lots more to come... ill try to post as many interesting stories about my life as a medical student...=P

ok la..not much to comment now, enjoy visiting my blog lo..

p.s i used alot of manglish lo so hope u all dont mind...