I hav learnt a lot of things from short case with Dr. Kyin Win yesterday... uh seriusly ..i realized that so many things i dunno yet and i need to improve my knowledges as well as my clinical skill.. aduh..my end of posting exam is juz around d'corner..but i thin' it's not a big issue coz it's not contribute so many marks in our continous assessment..but i more worried about my FINAL MBBS exam which is juz a few months from now..so important 4 me to pass..uh i need to increase my momentum i thin' so..i need to strungle more ..wah2.. semangat berkobar2 ni..but kemalasan kadang2 still melanda.. Ya Allah..berilah kekuatan dan semangat buat hamba mu yg lemah ini..semoga kejayaan sentiasa bersama2 org yg sentiasa berusaha..amin..caiyuk!!
So..lets go thru' what we hav learnt in our bedside teaching (short case) yesterday~~
1st case:
A Org Asli boy..presented with malnutiron..
Kak Fatimah did the general examination.. bla2.. so during discussion, we discussed bout what are the features that we need to work out from head to toe.. wah..so many you know..i also need to practice more.. uh really scared to get this case in exam bcoz so many things the examiner tend to discuss..sumetime simple things u thing u know but surely during exam surely u can't come out with d'answer.. plzz..sy mengingatkan diri sy sendiri and mengingatkan utk kawan2 sume..plzz read up more about malnutrition bcoz it's very common problem in ward.. as we know our org asli population contributed a lot in the prevalance of malnutirion in M'sia.. so be prepared ya!!
Learning Points :
- anyone know what is 'F75'??.. uh for 1st time we learnt bout it..penat la kitorg pikir pe benda laa tu..bile dr.kyin win tunjuk input and output chart for this patient to us.. then dr. gave clue that really bluurr~~..biasa laa we always hav diffuculty to understand wat the dr said..huhu..dr.Ky clue: " u know F1 in Sepang ?? so what is F75??" wah~~ apekah?? everybody blurr.. so many answers come out.. most of us said "Fluid 75"..doc senyum2..gelak2..eay tension..die bg kitorg tertunggu jawapan sume..bukan nk bgtau..saje je suroh kitorg bg jawapan yg xrelevant n bodo2..huhu..pas2 die ckp.. i translate it laa sumthing liked " tu laa u all never observed when stay in ward..never asked..bla2.." adeh~~ yer laa tu..our fault ^_^.. finally dr. gave d' answer..baru la taw "F75 is a Formula 75".. tu pun mule2 blurr gak..owh actly F75 sumethin like formula milk prepared by dietician that contained of nutriotion needed for that patient..ermm i'm also dunno more bout that..so lets' check it out..haha..tu laa sy ckp..byk lg yg xtaw..although posting paeds da nk abes ni..adeh~~
2nd case:
a 10 years old ( if not mistaken laa)..malay..boy.. presented with bilateral loin pain..Dr.Kyin Win asked Kak Wawa to do Abdominal Examination..blaa2..
Learning point:
- for the 1st time..i saw a long tranverse scar at the suprapubic area..so what do u think of?? apekah?? so doctor explained laa all the possible scars in the abdomen..bla2 kan.. dr said mayb he had corrected ape ntah..vesicotomy rasernyer kot..owh..seriusly..mmg xtaw~ adeh..cian buat diri ini..^_^
3rd case:
My turn!! dr asked me to do examination.."u know this case?" dr. asked me.." ermm dunno".."ok do general and abdominal examination!" wah2.. 1st impression from general da agak.. look liked Thalassemia..ok..bile start wat examination tu try laa cari sign2 Thalassemia sumer.. bese laa show off laa paper yg patut..entah camne sy wat examination pun xtaw ler..huhu..bla2..
So..da abes wat examination sume..present laa kat doctor..
" Nabila.16 years 6 month old, Malay, girl, with weight is bla2..height is bla2( xingat)..i thin' is not appropriate to the age but i would liked to plot in the growth chart blaa2.."
[ then dr..gelak2 ..uh sy da konfius~~ " are u sure? what's the model weight/height?" xsure ape soklan die..waktu tu da blurr ape dr ni maksud kan?..ape yg sy salah ni?..adeh~~ blurr giler.. actly sy nk maksudkan kan thala pts besenye presented with short stature sume..dat y laa sy wat statement cam2..huhu..sumethin' goes wrong here?? ape ek?? huhu]..then i continued presentation..
"bla2..then sampai abdominal xm : on inspection..bla2..bile sy ckp there's marks around umbilicus that maybe due Desferal infusion.."
[ dr. da senyum2 lg..adeh ape lg ni?? sy da konfius lg..why i come out with this statement ni coz bese nye thala patient kan on Desferal infusion at home..so bese nye kena laa check ade x marks kat round umbilicus..uh apesal dr ni cam senyum2..ni..sumethin' also goes wrong here??]..continue lg..bla2..then kena wat urine dipstx kat bedside lg..wah2..1st time wat kat bedside ni..slalu xm je br sentuh benda Allah ni~~ pas2 ape lg glaba ah gak..sebaek laa kawan2ku membantu...nk interpret finding lak pas2 da kelam kabut.adeh~..
{ urine dipstx result: 1+ Urobilogen --> so what do u think?? the rest of result was normal..}
then sampai la nk bg summary:
"Nabilah, 16 years old, malay, girl, presented with pallor, jaundice and on examination found to have splenomegaly..i thin' the diagnosis is Thalassemia complicated with...terus xtaw nk nk cakap ape..haha..senyum2 je kat doctor~~ pas2 dr bia je sy pk lg ape problem wif this pts..but i still xphm ape yg clue dr ckp nie..
{ Dr asked: why there's 5 urine containers at bedside..die soh interpret urine color tue..actly..from 5 tu..3 contained of darked colour urine..sumthin liked hemolysis laa..} penat laa sy pkir ape laa doctor nk sy ckp problem patient ni..konfius~~ pk punyer pk..camne laaa if thalassemia ni can cause hemolysis ni...ape yg silap kat cni?? sy dgn konfident nye correct my diagnosis ckp Beta thalassemia major..then dr gelak2 lg..adeh~~ ape la yg silap lg ni?? dr ckp ape yg the only thalassemia thaat can cause Hemolysis..uh seriusly xtaw?? huhu..kantoi d'situ~~
Kak wawa tried to tell sumthin..but xdpt tangkap ..dr plak skema xbg budak2 lain jwb..still tunggu my answer..adeh~~..finally..bingje tuils kat paper..then curi2 pandang laa.." alpha thalasemia/ HbH"..ape lg..terus laa ckp~~ hah..br laa doctor puas ati..uh~~~~~ akhirnya...
Learning Point:
- 1st time jumper HbH case..so i really dunno about the manisfetation wif haemolysis liked that..so i'll remember forever bout that..haha..memalukan.. suke suki jer ckp desferal marks wat so ever..padahal HbH mane de regular blood transfusion..so diorg NOT on desferal pun~~~ adeh..malu giler..patut laa kena gelak.. so dun bluffing~~..huhu
- plzz..when u do short case xm..1st impression when u see the patient is not ur final diagnosis..so jgn terikat wif that..better u thin all the possible differential..
- plzz..better learn how to do urine dipstix at bedside..
- learn more about thalassemia plzz..must know from A-Z..thalassemia not only Beta thal..but u must thin of other types..such as Alpha-thala liked HbH..HbE also.. coz a lots of them in M'sia..so must thin' widely.. dun be liked me~~huhu
- practice more short case!! yeh..make it smooth n try to present confidently ya~~ ^-^
case 4: Nephritis
case 5: Cerebral Palsy
case 6 : Down's Synd with congenital heart problem..
MORAL of THE STORY~
Sumetime we know the theory but unable to apply it..so ape yg kite bace tu if kiter x tgk sendiri dgn mata kepala sendiri..or xkena pada btg hidung sendiri..surely xingat..so..short case is a good practice for us actly..honestly i hav learnt lots from that..books only the guidlines.the best way to learn is from patients itself... so rajin2 la tgk case kat ward..name pun student kan~~ da keje nanti lain cerita laa.. mmg sampai da xlarat nk tgk patient..
The more you see..the more you learn ..rite??
So..another short case class today with dr.Tharam..uh so hopefully..a lots of thin' i can learn before sit for my end posting exam.. wish me all d'best~~
c yaa..salamm
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