WEEK 8 - LONG CASE INTERNAL MEDICINE , A FLOP!

Tuesday, supposedly i start at 8am sharp...but had to wait for my patient to be available... the first 1 patient had ESWL procedure.. So had to change patient from AGE to Diabetic case..

So the case

62 year old Malay lady... have loss of conscious (LOC ) with shortness of breath...with underlying HPTN and DM

Well the flop is... LOC came for ICU then later developed SOB soon after warded to the general ward after  the ICU...

Silly me i put SOB for the chief complaint..because i forgot to change to LOC because the main main complaint why she came was LOC.. but i clerked SOB then later after digging more, the complaint was LOC...super silly didn't change it...hamagad..

When you fail your chief complaint... you fail everything...

So... again.. another flop...my diet history for the DM underlying patient was detailed...... had to know breakfast lunch and dinner what the patient had...

In what particular.. well the sugar intake...and did she inject her insulin before or after food?...
as she have loss of conscious probably due to inadequate energy... daaa....means the mediation was not correctly follow...

Another clue is that this patient had multiple addmission for diabetic problem...silly me again i DIDNT ask further on this under Past Medical History!!! hamagaddd how silly...

From here, i have to keep reminding my self... FULL HISTORY IS ALWAYS THE BEST...

Well.. thats that .. thats my long case issue with this one... its going to be a hard ball to save this one.... my theory have to be tip top

Physical Examination ( PE )

Positive Findings

• Swelling of right dorsum of hand with puritus
• Reduce Vocal Fremitus & Vocal Resonance
• Bronchial Breathing 
• Reduce Breath sound both side on lower zone of lung
• Bibasal Crepitations lower zone best head anterior chest
• Corse Crepitation

DDx ( differential diagnosis )

1. Hypoglycemic Shock

2. TIA <24 hours Transient Ischemic Shock

3. Stroke - Ischemic Stroke

4. CVA - Cerebro Vascular Accident

Management :

1. ABC - Maintain Airway, Assist breathing , Check Circulation

• Chest Physiotheryapy
• Oxygen Therapy
• IV Access for Fluid Resusscitation

2. FBC

3. Blood sugar profile - Glucometer

4. Lipid Profile

5. ABG - Pulse oximetry & Blood drawing

6. ECG

7. Chest X-Ray - Pleural Effusion, Pulomary Edema, Pneumothorax

8. CT/MRI - Stroke

9.RFT - Creatinine & Urea

10. LFT - ALP

11. Angiography

12. Spirometry? 

Stroke Mx

• Confrim by ECG , BNA, ECG , CT
• TpA fibrinolytics
• Aspirin 300mg
• Admit to stroke unit

Further,

Reperfusion Stratergy - Fibrinolytics & PCI

Pace Maker / Heart Transplant

WEEK 5 - INTERNAL MEDICINE ( New Shoes )

Heyya folks..

Sunday the day to start with ..
Its raining heavily till evening..

Got my self a new shoe on Friday from Bata thou... imma wearing it this mornin.. really naissss

Well today me and my group of 5 went on for a morning ward round for 5 hours...
Well my legs are killin me yo..

Todays cases was mostly on Pneumonia, COPD and TB's.. and one case was PUO ( Pyrexia of Unknown origin )... suspected tb and cellulitis at perianal region was seen at stage 2...was nasty

Anyways! ... i got to do lung examination and my friend thought me on how to listen differentiate between vascular and bronchial breath sound. It was splendid!

Btw, i got to present a case to this doctor who asked me for a fast summary. Nois. Not perfect but was praised to be good.

Anyways! Andddd at 2pm or so... we are done so later i went to Aeon for lunch. I had  Ayam penyet sambal belado hijau.

And  got back home...now feeling feverish...gosh.. everyday to the hospital who wouldn't  get an infection ey? Especially TB!!

Sooo..yeah .. need to start studyin...time flies i keep on telling myself... peace out skillet need to bounce!

1st Day Internal Medicine - 5th Year Medical Student

Hey Internal Medicine!

8 Weeks of Deep Medical Theories & General challenging cases to solve!

Hope ill do good in this posting since as for now , 5th year is technically every posting could be my last posting until HO. So should give my all on every posting! Yes i will!

21st October! Last day of my deepavali holiday week!

Well my university gave me a 1 Week break

And to day is my last day of my 5th year first season holiday!
Next would be on 21st of December 2017.... 2 months from now.

Still in KL... just waiting for my 9:05pm flight to KB, flying with Air Asia since.

Now at home, waiting to play badminton and my laundry...

Well lets make the best of today because tomorrow is class day...oiveyy

1st day on 5th Year

Salam

The last chapter out of 5 chapters of my journey being a  medical student...

Time is short. Life moved so fast.

I remembered ... just not to long ago that i asked myself whats like being a final year medical student.

And now here i am... 5th year bebeh!
Cant believe it!!

But syukur Alhamdulillah i made it this far.

12months from now to become a doctor.

AMIIN

Staying in Shah Alam for 4 days 3 nights with Brother

Today marks the 4th day,

it has been 3 nights , sleeping on the carpet with a thin mattress-like bed,  well time flies so fast and the clock is ticking fast!  towards  5th year.

 10 days that is ....to 5th Year. gulp


Well, feeling right now of wanting to learn but to sleep at the same time.

Tomorrow is Wednesday, gotta use it productively InsyaAllah

🎆 31st August 2017 - Merdeka Merdeka Passing my 4th Year! Alhamdulillah! 🎆

Its official , it's 31st August , didn't get any call from the University.

Meaning , i passed!!! 😆

Alhamdulillah!

31st August - Thursday 

Night before Hari Raya Haji - Buka puasa with family

30th August where i took off to KL , gotten a warm welcome from my dad and brother

Drove back and had a pleasant night and sleep snuggly in bed with a smile where InsyaAllah Tawakkal by tomorrow 31st all ok. and Alhamdulillah its official.


It has been a journey to get this far, and another year to  go InsyaAllah i will perform better this time!

Going to put my effort to push even further,

InsyaAllah Amiin.

Just done with my PE3 Medical Exam !!!

Well, to be honest , Alhamdulillah for what posting i got for this long case,

Internal Medicine, - Dengue Case

My exam started at 1:25pm

Patient with no underlying disease.

It was an easy case, but ... had some problems on answering it and presenting it.

A day to remember that learning in depth has its value.

Don't feel it waste of time, but do take up the necessary points.

What i fail today is , that i have to think  before i say.

For example , in the HOPI, is already said dengue, so technically i have to still put that under my diffrential diagnosis... wasnt thinking that time... because i gave another diffrential.. something  lungs related knowlingly dengue has no link or the patient does not complained of SOB , so not  Pneumonia, not COPD,....

For example, ABG .. is not indicated if the person can breath , or even nasal prong is not needed if the  person is okay too..

all in all dengue is just treating with hydration and monitor any changes of vital signs...

InsyaAllah my Long Case is a pass...

Currently in my 3rd Professional Exam - 4th Year Medical Student

2 Exam Week

1st week , Theory & OSCE week

Monday - Surgery ( 7 Postings )
Wednesday - Medicine ( 7 Postings )

Thursday - OSCE Surgery
Wednesday - OSCE Medicine


Well 1st week of PE was crazy , cramping 14 postings in 1 study week

Sleepless nights , intense headache and red eyes.

Today is 3 days before my Long Case.

Bismillah . Wish me luck! Amin!

End of my 4th Year Internal Medicine Posting🤓

Hi there ,

This posting have given me a breather from what is going to happen when I become a doctor one day , Insya Allah. Because Internal Medicine its the core of medicine, hence the name internal lol!

Just wanted to let you know , in 5th year Final Year,  2months is apply for this posting! whereas in 4th year is 1 month, it shows how much its needed before graduating. yikes! and 1 month in 4th year is too rushing to squeeze, but examiners dont ask management in detail because still 4th year students, so kinda fair.

So far , internal medicine covers all systems basically. thats the hard part, it covers from ECG readings, xray readings, fundoscopy ,and relatively all the small small numbers and units, and formulas, and plus all the diseaes known to human. From CNS to Bone Marrow.

So , for my long case i gotten :
Dengue with underlying heart disease ,

and i scored for the first time 88% !! what a breakthrough to be honest, basically i just got lucky for this one because my case was pretty dang common , my other colleagues gotten a much harder cases , from hepatic encephalopathy to ataxia , TIA and many more weird unread topics that i missed to read , that basically could have gotten me an F.


So then again, with this awesome gift from Allah , 88 % now its time for me to get an A for the first time in 4th year, Truthfully , me in 4th year its been hard , because somehow the things we learned from 3rd year is not the complete version * theroy wise , because 3rd year is just a warm up. 4th year when they did 1 month posting, its hell to cover a 2 months worth of knowledge. Thats the challenge and plus , examiners are much stricker , and 4th year students have to know how to manage and elicit in moderate detail of the disease pathophysiology and types, and management 2-4 will do with reasons why compared to square pants 3rd year.



OK! so today just want to blog because i just done with my Theory papers! and it was pretty challenging , i need more side reading when im free , because most of the time i watch online movies and going out with friends instead of studying 6 hours minimum.


well , the Theory paper was divided in to 12 Questions MCQ , 3 Short Assays and 3 OSCE.

12 Questions MCQ : Was moderate


3 SAQ :
Chronic Liver Disease
God i dont remember....


3 OSCE :
X-ray : TB with cavities and lost of weight findings
ECG : Atrial Fibrillation , i answered Ventricular Tachy Cardia
Picture of Pressure Sores : I answered horrendously weird


Anyways i hope it pans out!

4th Year Internal Medicine

Hi , just blogging 2:30am  6th March ,


Currently i'm in my 4th year studying medicine,
Current posting  : Internal Medicine.
1 week, 1st day , Kelantan KB , HRPZII ,Tomorrow morning is our 2nd day.


Today , discussed in class :

-Pneumonia Case , that leads to Plueral Effusion.

-Respiratory Acidoses Co2 , decompensation by HC03 Carbonate

-ECG , R to R , PQRST





Note :

- Hypoperfusion to Renal can lead to increase in lactate.

- Renal Function test can check for Urea levels.


Current Personal Feeling : 

Still somehow getting the hang of medicine , clerking is my biggest fear still. Still cannot make up words and do on physical examination on time.

Given 1 hour , somehow having trouble still. Hope what i bought today was a  test pad book for  long cases , to make sure i'll be more productive and confident on what i'm doing.


Preparation to PE is in 167 days in counting!