Dr: I want you to examine the pulse of this patient and tell me your findings
Me: 76 beats per minute, irregular rhythm, normal character
Dr: What type of irregular rhythm? Irregularly irregular or regularly irregular?
Me: Irregularly irregular
Dr: What do you mean normal character?
Me: There is no bounding pulse,...
Dr: (muka berkerut) You said irregular irregular rhythm, how can it be normal in character?
Me: Oh, abnormal character.
Dr: What about the volume?
Me: Sometimes low, sometimes high volume.
Dr: Ha, so, inconsistent volume means NOT normal character right. What do you think the patient has?
Dr: What else do you want to look for in this patient?
Me: Pulse deficit
Dr: OK what else?
Dr: What else??? What happens to the a wave of JVP? Absent or present?
Me: (hentam) Absent a wave
Dr: OK. You can proceed by examining the heart sounds. Auscultate only.
Me: On auscultation, 1st and 2nd heart sounds were heard, with a mid-diastolic murmur loudest heard at the mitral area, getting louder on expiration. There is no radiation and the grade is 3.
Dr: 3 over what? 10?
Dr: Are sure? How many gradings are there for a diastolic murmur?
Dr: Are you sure?
Me: Errr..(dalam hati: salah ke?) not sure
Dr: Then why you answer 6? There is actually 4 gradings of diastolic murmur. 6 is for systolic murmurs
Me: Ohh, (Dlm hati: Ye ke? Tak pernah terbaca pun)
Dr: So what murmur does the patient have?
Me: Mitral stenosis
Dr: What do you think may be the cause?
Me: Congenital (sebab patient mcm muda lagi je)
Dr: (berkerut – tanda tidak setuju dgn jawapanku). You say it’s congenital. I say it’s not. What else may be the cause?
Me: Rheumatic heart disease, infective endocardotis
Dr: Ok, what else?
Me: (Em, apa lagi ek cause MS?) Err...
Dr: What else can cause this condition?
Me: Oh, the cause of AF ke? Thyrotoxicosis.
Dr: Do you think this patient has thyrotoxicosis?
Me: Not really.
Dr: What else?
Me: (sebut jelah semua – ada yg Dr setuju, ada yg Dr tak berapa setuju sbb unlikely in the patient, but sebut jelah semua yg tau...) MI, HPT, pneumonia, etc...
Sekian... Harap bermanfaat..