Wisdom 1

Treat your patients as if they are your family members. Give the best care to them. Be humble. Hope you can make a difference.

Don't take by heart in whatever I've done / said to you. I just want you to learn.

Prof. Dr. Nasser Amjad (1/6/2010)

We, doctors - cure sometimes and comfort always. Even you know that your patient does not have hope anymore, please be by their side. Everything is in hand of Allah.

If you have any interesting cases, write it down and publish it. It's not for showing off, but for sharing of knowledge.

Dr Harris Ngow Abdullah (1/6/2010)

For My Juniors...

I don't have much to share about my final professional exam. But, I hope this might be useful especially to my juniors.

Happy reading! =)

25200 Kuantan

Final Professional Clinical Examination

My long case exam (Mr Shukrimi, Dr Husin Imam, Prof Zalina, Dr Ramli, Prof How):

A case of 13-year-old Malay boy from Pekan, in his day 42 admission; presented with painful and erythematous swelling at the distal third of right leg for 4 days prior to admission which later progressively spread to the proximal third of the same knee and the patient was unable to mobilize. It was associated with high grade fever without UTI or URTI symptoms. There were constitutional symptoms and the patient were brought to hospital due to shortness of breath.

Debridements were done twice on him due to unsettling infection. He was treated with IV cloxacillin 1g QID.

He has no history of trauma, insect bite, diabetes mellitus type 1 or other chronic diseases.

On examination, there was wasting of the right quadriceps muscle and the right leg looked swollen. There were multiple clean incisional wounds over the medial part of the right leg. There was no bony tenderness or bone discontinuity noted. The power was 5/5 with intact sensation. The peripheral pulses were present.

DDx : osteomyelitis, osteosarcoma, DVT with pulmonary embolism

The discussion were mainly about the investigation and management of osteomyelitis.

- FBC, RP, se albumin, RBS, ESR, Blood C&S
- CXR, XR of right leg including the knee and ankle joint in AP and lateral view

- debridement
- IV antiobiotic
- prevention of fracture : splint, crutches

Alhamdulillah~

My short cases examination (Prof Hamizah, Prof Kyaw, Dr Marzuki, Dr Aye Aye, an external):

1. CVS (Paediatrics)

A young Malay boy with mitral regurgitation and not in failure. No other discussion~

Alhamdullilah.

2. OnG (Uterus larger than date)

A young Malay lady, G3PO+2 at her 34 weeks POA with uterus larger than of 48cm SFH and difficulty if palpate the fetal part and positive fluid thrill.

We discussed about MOGTT, ultrasound findings in polyhydromios and expected fetal anomalies in GDM mothers.

Alhamdulillah.

3. Respiratory examination (Medical)

An elderly and obese Malay lady with grade 1 clubbing and reduction on chest expansion as well as coarse crepitation at the left lung field.

Causes of bronchiectasis : recurrent pneumonia, pulmonary tuberculosis, pertussis

Alhamdulillah

=))

Thank you examiners for your trust to me. Most importantly, I have to work hard to strengthen my knowledge and skills.

25200 Kuantan

Be Calm

Today, the Final Professional Exam result will be released in the afternoon.

So, now I'm still in palpitation and tawakal mode.

The key of this exam especially the clinical exam is to be calm and get ourselves relax on the day of examination.

I really meant it.

Take a deep breath before the exam and relax. Smile. Smile. Smile =)

Be prepared to face any case.

Clerk the case as our usual routine during posting and end-block exam. I did not really feel the difference while clerking the case. The difference was only felt when I presented the case to 5 examiners.

The examiners were so different than during the end-block exam (provided we presented the case satisfactorily).

They were trying their best to help and guide us to the right way.

If they said something that contradict with our statement, they were usually right and they just wanted us to say it so and be agreed with it. A lot of hints and guidance throughout the presentation. Thank you Allah for this nikmat.

I was so touched when the my examiner in short cases, Prof Hamizah offered herself to prop up the bed for me for respiratory and cardiovascular examination. Thank you very much Prof. ;) I learned another lesson; be humble in any situation even to your own student!

I thank Allah for giving me such a kind examiners.

Thank you Prof and Dr, for not making my way difficult and always said to me throughout the exam to just be calm and relax. Thank you very much. It is only Allah can give the best reward to all of you.

I am waiting patiently for the result and I'm hoping for a good news =) Insya Allah.

25200 Kuantan

Note : My examiners were Mr. Shukrimi, Dr Hussin Imam, Prof Zalina, Dr Ramli and Prof How (long case), Dr Marzuki, Dr Aye Aye, Prof Hamizah, Prof Kyaw and an external examiner (short case).

My Final Posting Examination

I just discovered Pediatric is interesting after I left the ward after examination yesterday.

Pediatric was once down in the list of my interested topics =p

Whatever it is, I'm done with examination. Thanks to Allah for everything.

For my long case, I got a very typical and common case; a 5-month-old Malay girl in her 35th day of admission (with 1 month stay in PICU) who presented with mild grade fever, shortness of breath and cyanosis for 1 day prior to admission. No history of cough, foreign bodies ingestion and congenital heart disease. No history of intubation or assissted ventilation during admission to PICU. The mother had history of GDM during the pregnancy with controlled blood sugar level and she was born full term via emergency LSCS due to poor progress and fetal distress. On examination, the OFC was between 55th and 95th centile but the weight and length was below 3rd centile. She was active, not in respiratory distress with occasional rhonchi heard in all the lung fields. Other system examinations were unremarkable.

For my short case, I also got a typical case of spastic quadriplegic cerebral palsy in which I was asked to perfom motor system examination. A 5-year-old malay boy with microcephaly and nasogastric tube in situ was lying comfortable with abnormal posture; extension of both wrist and fisting of both hands as well as slight extension of the hip and dorsiflexion of the feet. The patient had muscle atrophy (most probably disuse atrophy) with hypertonia and hyperreflexia. However, there was no clonus and there was downgoing toes upon plantar reflexes stimulation (huhu..it should be present to indicate that there was an UMNL, but when the examiner reconfirmed it, the finding was the same as mine). There was no scissoring, but there was loss of head control and presence of trunchal hypotonia.

Alhamdulillah, everything went well.

Now, I'm looking forward for my Final Professional Examination.

25200 Kuantan

My Last Week of Posting

This week will be the last week of our posting after 7 years of journey in medical school.

I want to enjoy it until the last day.

Thanks Allah for all the strength that you gave me to reach until this stage.

The very next step is to pass the Final Professional Examination (as well as the Paediatric posting).

Note : I don't want to receive any 'mangkuk' in this week. =p

25200 Kuantan

23 days to Final Professional Examination

My Great Teacher

I have a great teacher.

Initially I thought, it was only me who acknowledge him as a great teacher.

But, when chatting with other friends, everybody seemed to be in the same line with me.

Why he was so great, despite of his long lectures?

It was truly long. He could deliver his lecture in 4 hours without break!

The problems are always from us who could not stand it.

We will bring along food and drink during his lecture when hypoglycaemia set in.

Why were we so 'struggling' to stay awake during his lecture?

Just simply because of the precious knowledge from him.

He made us understand things easier.

Things that were so difficult before seemed so easy after his explanation.

Who is he?

I personally do not know him much.

I did know where he came from. I did know where is he working. I did not know his age.

I assumed he is from KL as his car plate number was WLS XXXX.

I assumed he has his own clinic (or maybe hospital) as he always told stories about his patients (which seemed different from government hospital setting).

For all I know, he is our visiting lecturer since our senior's time.

He is a great pediatrician who attained his first degree in UKM and had MRCP qualification.

He has taught many students including some of our lecturers.

He is the only lecturer who is still using OHP in the class and very kind in giving notes to us.

I've tried to Google his name, but nothing much information obtained (it was actually none!)
So, once again, I wondered, who is he?



By the way, I would like to thank this great teacher, Dr Mohd Zain bin Zainal Abidin for his patience and enthusiasm in giving us the knowledge.

You are not only teaching about medicine, but in most of the time you inspired us to become a good and safe doctor like you. (Great teacher inspires!)

We pray for you to be at the best health, so that you will be continuing spreading the knowledge and inspiring our juniors. We also pray for you to be always blessed by Allah in the world and hereafter.

25200 Kuantan

Note :

1. Credit for Tini for the photograph. (I was not in this group. Our group did not have pictures with him. So pre occupied with the SPA interview)

2. There were a lot of 'funny' quotations from him. I'll try to put it in my blog later. It was very meaningful to us.

Don't be Selfish

"If the patient was ill-looking, don't disturb him. Don't be selfish."

Thank you Dr Aye Aye for the reminder.

"It's good for us to learn but it was no good at all for the patient."

I was relieved to listen to her advice just now. We have to be empathy. Just use our common sense!

What's painful to the patient is always an amazing thing to medical students. By the way, that's how we learn.

Thousands of thanks for all patients. Only Allah can give you the rewards.

25200 Kuantan

Note :

This ill-looking patient had passed away 2 days after that. She was a cute 4-year-old little girl with Down's syndrome who were suffering from atrioventricular defect which was complicated by pulmonary hypertension for the past 1 year. The parents were so nice to us and she had involved in our university final professional exams for few times. May you rest in peace there my dear. Thank you for everything. ~

Coagulation cascade

Remember this until the end of life.

It has been more than 100 times the lecturer asked us about this pathway, but still we could not answer it satisfactorily.

Important points:

Components of intrinsic pathway
Components of extrinsic pathway
Vitamin K dependent clotting factors

Really hope this will be at my finger tips after this.

25200 Kuantan

Basic Suturing Workshop 2010

Basic Suturing Workshop (27 March 2010) by Department of Surgery and J & J.
Thanks to Prof Azmi, Mr Zailani, Mr Jun, Mr Khairussaleh and Mr Nazli.

I've attended 3 workshops in basic suturing. Those were during my 3rd year (Department of O&G), 4th year (Department of Orthopedics, Traumatology and Rehabilitation) and 5th year (Department of Surgery).

I like suturing. But it is only to the extend of doing T&S, episiotomy repair, simple procedures in ward and other required procedures during housemanship. It is not more than that =p

I never imagine myself doing operation (or even entering operation theater) during my MO period later. But we'll see what will happen in the future.

Anyway, a million thanks to all my lecturers for the exposure and the basic knowledge.

Note: Credit for Nadhir for the photo

25200 Kuantan

Developmental Assessment

I found it difficult to carry out development assessment in the infants and children. Definitely, it needs a lot of practices.

Prof Zabidi from USM came to IIUM last Wednesday as visiting lecturer. He taught us this pneumonic:

C - Cognitive
O - Optic
M - Motor; gross and fine
E - Emotional and Social
L - Hearing and Speech

He also demonstrated on how to carry it out.

And now I knew, developmental assessment is not that difficult! =)

I'm looking forward to do developmental assessment to all the stable infants in the ward =)

Note : We had a very good session with Prof Zabidi. I will always remember him as a good teacher. I want to be a teacher like him; teaching and inspiring =)

25200 Kuantan

My Introduction

Medicine is truly a blend of sciences and arts.

There are fine arts in applying the science of medicine.

But, not all arts in life can be explained by scientific reason.



I never considered medicine for study until after I got my SPM result.

It was a tough decision for me who never had any dream of it before.

I just followed my instinct at that time.

I built up the interest bit by bit throughout the 7 years (5 years in medical school plus 2 years in matriculation center) of journey.

Now, I know that I do not want to lose this very special field in life.



This blog is meant for me to jot down my experience in this field for sharing purpose.

It will be more towards exam-oriented (I guess), but we'll see how will I do about it.

I am only an ordinary student; going to hospital everyday-clerking the patients, presenting cases to the lecturers, discussing with friends, preparing my case reports and summaries, unable to recall facts that much and most frequently being scolded by specialist when unanswerable to 'simple' questions.

Despite the feeling of inadequacy, I'm fighting with time to fulfill my addiction in other activities, and, consequently I'll be feeling very tired and sleeping as early as 9.00pm. ~sigh~

(for the readers for not to expect much from my blog)

May this effort benefits me and you =)

Insya Allah

Happy reading!

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