im clinical exams

after the exams today i felt numb. agaknye sebab anxious sangat before that.

it all ended at around 11.30am.

for my long case, i got a left deep vein thrombosis (dvt) of a 52 year old malay gentleman with underlying diabetes melitus and hypertension. his only complaint was of a painless and progressive swelling of the left calf. alhamdulillah there were no symptoms of pulmonary embolism. i've read about DVT but not actually seen any case throughout my 7-week posting. setakat baca dalam buku and pernah jumpe case dulu2. so i tried to ask for risk factors of DVT such as prolong immobilization, trauma etc but he didnt really have any risk factors. he claimed that his diabetis and hypertension was well-controlled.

waktu tengah clerk tu ada kak farah (houseman) reviewing the patient in the opposite bed so i asked her about this patient. at least i tak tengok patient's case notes which were on the table. so she told me a bit about the case.

then i had to present to Dr Hilmi who is quite nice and not scary. i said i'd give thrombolytic therapy to the patient to lyse the clot and dr was hmmming and said "really?". i degil gak nak bagi thrombolytic and anticoagulant. sebenanye tak ingat sangat management dia. tak pe i'll look it up after this.

then i had to wait for a while to be taken for my short case. maka datanglah kak nik (the same lecturer i got mase 3rd year. dulu i got a respi case and managed to diagnose it as bronchiectasis tapi presentation terabur giler).

this time she asked me to examine the abdominal system of a young girl. she was jaundiced and pale. i couldn't detect the hepatosplenomegaly. but there was ascites. i knew that all those signs were consistent with hemolytic anaemia. at that time my mind just went blank. i couldnt remember all the causes yang banyak itu including thalassaemia or even SLE. terus dr bebel2 satu wad dengar. she asked me basic questions such as examintaion techniques etc. sedih2.

i dunno how much she gave me but the total marks(SC=LC) accumulated to a pass alhamdulillah.

i will so not sia2 kan my next posting.

yay to delivering babies and meeting expectant mommies! and also the notorious anti-islamist!

post-theory exams

i'm glad the MCQs, OSCE and PMP are over.

MCQs susah macam biasa. IM kan. most of the time, its the 1st time u come across those facts.

OSCE was not that hard but u get only 2 minutes to look at a picture or an x-ray or an ECG and intrepret or describe it and then give the diagnoses. you don't have time to think. you have to answer the 1st thing that comes into the mind and put it on paper. i kinda mixed up a very obvious gouty tophi of the hands with rheumatoid arthritis. malu je kat diri sendiri.

PMP cases were "hypertensive emergency with unstable angina and underlying atrial fibrillation in failure" and "hodgkin's lymphoma". the 1st one i boleh la jawab jugak. the 2nd one, hmm bile sampai further investigation, management and complication, ternganga jugak la kat situ.

next up are the clinical exams (long case and short case) on wednesday. i'm in the 1st group, pukul 8.30am until i complete both.

i'm already thinking of all the things i wanna do after that...

sekarang kene practice short cases pulak. tak boleh dok kat meja je.

signs of impending exams

you know exams are around the corner when;

- your friend whose room is only 20 steps away would rather send an SMS rather than relay the message personally
- you would rather hold your bladder until its absolutely saturated with 600ml of urine than go to the toilet at the first urge in fear of wasting precious study time
- your meal times become irregular and you try your best to ignore the grumbling sounds of the stomach
- the library is suddenly extra full of people studying and the computer

(this list is not exhaustive. will be added when i can think of more)

my study mates

the end of IM

just now we had a revision session with Dr Ng. he's one of the non-muslim internal medicine lecturers. dia adalah sangat bagus sekali. he was also the one who gave us the introduction to this posting.

i truly want to be like him. he's organized and knowledgable, simplifies things and looks smart while doing it.

my aim for next posting.

i can hardly believe that 7 weeks of IM is already over.

k, pray that my friends and i can answer our exams well on monday and wednesday.

analogy by roomie

i took this from roomie's blog. i thot it was interesting and posted it here with her permission :)
i think some of the points are true.

RUNNING DOWNHILL

Wednesday, July 23, 2008

im making up a perumpamaan of my own today.

medical school is like going downhill, you have to keep on running or you'll trip and fall down on ur face


or it could be like going uphill. such a struggle.

or it could be like going up and down hill, lots of highs and valleys. you are so excited finishing ur first pro in second year, then comes clinical years. when u pass that stage, you stumble all the way down to being a houseman. then when ure an established medical officer, you have to sit for you masters exams or go for training. bottom of the food chain at any stage basically


yup you just have to go on with it and just keep on doing it. its like a one way ticket on a plane, you cant say to the pilot halfway through the journey "i wanna stop here and get off". unless of course u have a parachute. but then uve wasted all that time travelling and money on the fares.
gosh, im such an artist.

hey i think i can make a decent (pictorial) poem out of this for submission. the title will be medschool is like...

im trying not to complain, im trying to be grateful im doing medicine. but this is my outlet.



p.s. i've been roommates with her for about 5 years including this one. we've been thru the gadoh2 phase and now we're chums. we know each other practically in and out. people even think we look alike. mebe i'll write an entry about us once exams are over :)

Tagged by kak aliya

baru sempat nak do this tag. sebelum ni anxious with the looming exams. one day down. another to go. anyways here goes...

1) 1st time naik kapal terbang
3 years old in 1987.

2) 1st time beranak
tak pernah lagi. 2010/2011 kot...

3)1st time gi overseas
i think i was made in UK... then born in Baling Kedah and went to New Castle when i was 3

4)1st time duduk jauh drp family
mase form 1 dok asrama for 2 months then my results plummeted and ayah tak bagi dok asrama dah until matriculation.

5)1st time kerja....
tak penah lagi setakat ni. inshaAllah july next year.

6) 1st time rasa diri gemuk
tak pernah rasa diri sendiri kurus.

7)1st time bercinta?
err, next question.

8)1st time rasa diri cantik??
tak pernah kot. i think i look biasa je.

9)1st time masuk cinema
belum lagi setakat ni. my sisters and brother penah. i've never really wanted to.

10) 1st time admitted in hospital
not yet. tp hari2 gi hospital. if i masuk wad i definitely want 1st or 2nd class, hehe. coz tanak kene kaco ngan med students.

hmmm, apparently banyak bende i tak buat lagi...
suddenly feeling left behind??
naah..
everyone goes thru different expreriences when they do becoz that's best for them :)

ok, i tag: roomie, lead, and sesape yang teringin nak buat jugak.

i feel very sad rite now.

i don't think i'm prepared for next week.

L.E.K.A.

i'm supposed to be studying hehe. that's why i stayed at the library. but, i just managed to finish one clerking sheet. another 4 more to complete by tomorrow.

ok, i want to write about how LEKA i have been. i always plan out what i want to do and end up doing something else altogether that i have more interest in. the result? i don't get my work done as i have planned. astaghfirullah.

end-posting exams are in 2 weeks time.

yikes! i'm so not prepared.

what are my chances of making the examiners smile at the end of the short case or long case?

unlikely?

^sigh^

my postcard collection

from australia, courtesy of azza, kak aliya, asma'+sibah+saidat, ramzi, stacie, timah

from indonesia, courtesy of ayah and evi

yg kene paksa-rela hantar from Malaysia: kakyung, faizah amir. faiezah k, wa, azwar

Egypt postcards (half of them are kosong). 2 are from kakngah.

from other countries;
jordan (found at home), germany (k.masyitah), dubai (ayah), new zealand (asma'), myanmar (sibah amek mak dia punya) and sheffield



thank you very2 much to all of those who have indulged me in my postcard obsession.
i don't think i'll be asking for any more. but if ade orang nak hantar lagi, best je ;)

sekarang kene cari album nak simpan je.
they come in different sizes. none of the photo album can fit all of my postcards.

some info, in case u didn't know the stamp prices;
postcards within m'sia: RM0.30
postcards to our neighboring countries: RM0.50
postcards to other countries: about RM1.00

macam2

Dasar pandang rakan sebelah

It’s a term I made up for a phenomenon that I have been observing in my batch and also in previous batches.

2 or 3 years back, I never would have thought that there would be many couples amongst my female and male colleagues. Maybe one or two lah, but now there’s plenty.

The spouses of those who got married early were non meddies. Me and azza used to discuss the unlikely possibility of an intra-batch marriage. When Nazhan and Marni got married during 4^th year, everyone was surprised by the acuteness of it all. Now I know of at least 4 other couples.

I guess when you’re in 4^th year, you realize that med school is nearly over and you’re still single, so you tend to look around for available people who attract you’re attention.

Not that it’s a bad thing or anything. I’m happy for them. May their relationships progress to a blessed marriage inshaAllah.

Territorial markers

I absolutely HATE male cats who wish to mark their territories with their foul-smelling urine. If it only put other cats off then I wouldn’t mind, but, the smell is utterly horrible (like faeces). This one cat just had to mark our door and shoe closet and also the corridor. Even in my anosmic (cannot smell) state due to my nasal congestion, I can still smell it. Going in and out of the room was pure torture to the nose.

Alhamdulillah it’s been cleaned up.

If I catch the cat in action, I’d pull its tail!

Internal medicine week 4

It’s already the middle of the posting. I have another 3 weeks before the end-of-posting exams with no revision week.

The medical wards are constantly full of patients. There have been many interesting cases in the wards. Spontaneous pneumothorax. Superior vena cava obstruction secondary to brochial carcinoma. Rare murmurs like aortic stenosis etc. (I like pan-systolic murmurs. They’re the easiest to identify.) Bronchiectasis (prominent clubbing). Asymptomatic gross splenomegaly. Hepatoma. Acoustic neuroma. Lymphomas and leukemias. Pulmonary embolism following a gynae operation to remove an endometrial carcinoma. Classical and atypical acute coronary syndrome presentations. Uncontrolled diabetes and hypertension. AEBA. AECOPD. Nephro cases (banyak sgt and usually very complicated). And much more.

And plenty of lovely ECG’s. I can now read ECG’s a bit better. Dulu asyek confuse je.

The lady with acoustic neuroma ( a tumour of the 8^th cranial nerve) puzzled the doctor as she presented with chronic diarrhea and vomiting for 4 months. She didn’t tell the doctor of her condition on admission as she had defaulted follow up due to the high cost of surgery. She had persistent headaches, deafness in her left ear and also reduced vision in her right eye. She only noticed her deafness when she heard the phone rang but couldn’t hear any voice using her left ear. At first she thought it was someone playing a prank but then she put the phone to her other ear and voila, she could hear loud and clear. Hehe.

One patient developed an erythematous vesiculo-pustular rash on the face, trunk and arms in the ward and the doctor asked me to do a spot diagnosis. I was clueless. Acne?. Rupe2nya I didn’t know how varicella-zoster infection aka chicken pox looked like hehe. The last time I had it was zaman kanak2 so u cant really blame me. I just knew it theoretically.

Since the new 2-year housemanship rotations include 4 months at the emergency department (ED) aka accident and emergency (A&E), now as part of our assessment, those in the medical posting have to do on-calls at the A&E on Sundays (Saturdays are for the surgery students), morning and evening shifts.

Penat jugak 5^th year ni. Some of my friends are already stressed out.

a moment (or two) of self obsession

i'm an indian goose berry

going private

i think i want to make my blog private and accessible to selected people starting next week.

there's not really much benefit here for people who don't know me.

having people who hardly know me at all read my nonsensical entries is rather unnerving (baru sekarang la kan nak sedar)

so, please add your email address at the comment space and i'll give u the password later.

k, have a nice day :)

Unladylike

Recently, when I went to pray in the nurse’s room, the cleaner lady looked inside the room and asked if there was a guy in the room. She looked all ready to scold the terrible fellow who dared to be in a place where he wasn’t supposed to be. There wasn’t any guy. I just smiled and said that no guy was around. Feeling sheepish, she went away. It was my shoes that were outside the door.

It happened again in another prayer room. A suspicious medical attendant checked on us to make sure that no guy had entered the room. Again, I could only smile.

Some of my friends have commented on my unfeminine choice of shoes. After those two incidents, I feel that I need to justify my preference in the shoes I wear.

I have friends who love buying shoes. It’s easy from them because most of the shoes sold are tailored for slender and long feet. For those with broad and flat feet, we don’t have many choices. I love new shoes too but it’s hard for me to buy comfortable ones.

I used to wonder why my feet always hurt so much when I stood for long hours. Apparently I have pes planus (flat feet). It means that the medial and lateral arches of my feet are incapable of supporting my body while standing (berat sangat kot). Prolong standing would make my feet ache so much that stepping on them would be very, very painful afterwards. I have always bought shoes that could fit paddings inside so that they would soften the steps I take and decrease the pressure on them. I like sport shoes because they are very comfortable to walk in but I have to find one that can pass off as a formal shoe that looks smart yet doesn’t look like I just came back from a jog or a sports game.

During my electives, my canvas shoes were worn out and had holes in them. I liked them a lot because they were so comfortable. They were neither expensive nor very pretty but I cared more for comfort than looks. They went thru my wonderful year 4 postings with me.

I knew that I had better get new ones so that I won’t appear very shabby at the hospital. Before doing my attachment at HUKM, I bought a pair of moderately expensive new shoes with kak yung. Since I had a history of buying a pair of loose shoes and felt uncomfortable walking in them because pebbles kept going in and they felt like they would slip off any time, this time, I bought a pair exactly my size but rather tight.

After 2 days of wearing the shoes, they were still very tight. The long hours of standing at the hospital, following ward rounds and walking about in those shoes made my feet ache terribly and I was longing to sit down and rest. I couldn’t put any paddings in them to cushion the impact of walking as there was no extra space in the shoes.

One night, me and timah went to a nearby Tesco and I was drawn to a shoe shop. Kedai biasa je but I was intrigued to look at the shoes. I found a pair (at the guy’s section) that nearly fit my criteria and was quite cheap so I bought it on impulse and immediately wore it after that.

Although my feet still ache on prolonged standing, the impact is less and my feet feel much better.

So should I care about what other people think about my shoes?

Definitely not! I love my own feet much more.

Some more thank you’s…

To the following people who also remembered, I greatly appreciate it.

Aishah MN

Myra

Kak jan

Ili raihana

Nabihah lokman

Eza arafia aka epi

Meena CUCMS

Munirah

Shidah

Syarifah nafisah

Evi anggraini from Yogyakarta

Ramzi

Aimir

Shafiq AR

Anep Tarmidi

Naim cuz

Tan

To those who chipped in to get me my watch, my heart goes out to u. tak payah I kire pulse rate gune hp dah sementara my watch is being repaired at the shop.