nuffnang@10thbatch

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Financial Talk

Bismillahirrahmanirrahim, assalam 'alaikum kawan-kawan...

Pernah tak alami...?

  • Belum habis sem lagi, duit scholar dah habis...
  • Dari 1st year aim nak simpan duit untuk kahwin, tapi dah 5th year ni masih kosong lagi akaun bank tu... terpaksa tunda majlis...
  • Plan nak menabung untuk masa depan, tapi setiap kali nak menabung, duit mesti tak cukup/dah habis...

Hm.. ni nak promote, khas buat...

  • Bakal-bakal suami atau sudahpun menjadi suami
  • Bakal-bakal isteri atau sudahpun menjadi isteri
  • Bakal-bakal bapa atau sudahpun menjadi bapa
  • Bakal-bakal ibu dan sudahpun menjadi ibu
  • Anak-anak kesayangan ibu bapa yang tak lama lagi bakal bekerja
  • Bakal-bakal doctor yang tak lama lagi akan membina keluarga, membina karier...

MSC will organize...

Sister Nadia ni mmg arif bab-bab menabung dan merancang kewangan utk masa depan (pernah jumpa personally beberapa kali)


Tak lama lagi insyaAllah dah keja, lagilah kena tahu macamana nak manage kewangan kita dgn cara yang sistematik... jangan nanti dpt gaji, habis mcm air mengalir... kena juga tahu bab-bab nak buat loan, pasal marriage, & family... Dr. Suhaiza bagi talk, insyaAllah best =)

Jemput datang ramai-ramai...
Category: 1 comments

LC and SC Pro (compiled from past yr, 9th and 10th batch nye blog)

SURGERY

Urology
Bladder, renal, ureteric calculi
BPH
Vesicoureteric reflux
Polycystic kidney

General
Thyroid - diffuse, multinodular, solitary nodule
Thyroglosal cyst, pleomorphic adenoma
Lumps and bumps - lipoma, sebaceous cyst, dermoid cyst, carbuncle, abcess
Hernia - inguinal, paraumbilical, incisional
Breast - cyst, fibroadenoma, Ca
Colorectal Ca
Pancreas - pancreatitis, Ca
Liver - CLD and its Cx - esophageal varices
Cholecystitis, gallstone, acute cholangitis, T-tube

Vascular
Varicose veins
Chronic venous insufficiency and ulcer
DVT
Pulmonary embolism

PAEDIATRICS

CVS
Congenital heart dz - TOF, VSD, Eisenmenger’s syndrome
Rheumatic heart dz

Respi
Asthma
Bronchiolitis
Hyperactive airway disease
Bronchiectasis - Cystic fibrosis , Kartegener’s

CNS
Hemiplegia
Hydrocephalus
Cerebral Palsy
GBS

Nephro
Nephrotic syndrome, AGN
Steriod toxicity

Haemato
Thalassemia
Hemophilia
ITP

Endocrine
DM type 1
Cushing’s
Child with jaundice
Biliary atresia

Rheumato
JRA
SLE with lupus nephritis

Down’s syndrome
Cerebral palsy

IINTERNAL MEDICINE
DM
Hypertension

Thyroid - Graves dz

CVS
Valvular lesions - AR, MR, TR
MI - post CABG etc
Congenital heart dz
Prosthetic valve
Rheumatic heart dz
Cardiomyopathy - dilated etc
Arrythmia

Respi
Pnemonia
Pleural effusion
Lung ca
COAD
bronchietasis

CNS
Stroke
Cerebellar signs
Parkinsonism
GBS

Rheumato
Gout
Rheumatoid arthritis
Scleroderma
Psoriatic arthroathy
SLE

Nephro
Chronic renal failure
PKD

Haematology
Thalassemia
Leukemia
Jaundice
Heamolytic anemia - AIHA

Endocrine
Cushing’s dz
Acromegaly

Hepatitis - viral
Neurofribomatosis

O&G

Gynae
Ovary - benign cyst, Ca
Uterus - fibroid, Ca
Endometriois
Gestational Trophoblastic dz
Postmenopausal bleed

Obstetrics
GDM
PIH
Pre-eclampsia, eclampsia
Abnormal lie - breech, oblique, unstable
Multiple pregnancy
Rhesus
Uterus larger and smaller than date
Poly/Oligohydramnios
APH - Placenta previa, AP
PPROM, PROM

PSYCHIATRY
Schizophrenia
MDD
Bipolar mood d/0
Anxiety d/o - GAD, panic d/o
Postpartum depresion

ORTHOPEDIC

Knee - ACL, cruciate
Malunion, non-union - hypertrophic, atrophic
External fixator, Ilisarov
Diabetic foot
TB joint
Open fracture
Osteoarthritis
Osteomyelitis
Avascular necrosis
CTEV
Tumors - bone, muscle, soft tissue
Category: 4 comments

SALAM, NEW DESIGN FOR INVITATION CARD :)




NEW DESIGN ~

NAK PRINT DAH NI, PLEASE COMMENT YE IF ADE PAPE. TQVM :)
Category: 15 comments

Cara2 mengendalikan janin (bayi lahir tak cukup bulan)....

Link:

>>

http://al-fikrah.net/index.php?name=Forums&file=viewtopic&p=684661#684661




Category: 0 comments

Power of the Mind Motivational Talk


AGD 10th batch 2011- IMPORTANT NOTICE TO ALL

Assalamualaikum wbt.
This is the latest update for the AGD attendance.
PLEASE CHECK YOUR NAME.
We will order YOUR FOOD & SOUVENIRS based on this NUMBER.
WE APPRECIATE YOUR FULL COOPERATION TO CHECK YOUR NAME and contact me ASAP for any changes.TQVM.

TOTAL ( CAN ATTEND ) : 105/106
BROS: 48
SIS:57/58
TOTAL ( CANNOT ATTEND ) : 15/16
TOTAL NO OF GUESTS: 5

BROS (WHO CAN ATTEND : PLEASE CHECK YOUR NAME)

1.Anuar b. Awang Qamaruldeen ( 1 guest)-paid
2.Mohammad Haikal Bin Suhairi
3.Muhammad Hafiz Bin Mohamad
4.Muhammad 'Abdusssalaam bin Haji Jemain
5.Muhamad Farhan bin Ab Razak
6.Muhammad Nu'aim bin Ishak
7.Edre bin Mohammad Aidid
8.Hamzah bin Sukiman
9.Mohd Fakhri Hilmi bin Danial
10.Badzli Sham bin Bahdun
11.Adam bin Abdul Razak
12.Mohd Shamsudin bin Zainol Abidin
13.Ihsan bin Abdul Razak
14.Saiful Firdaus bin Mohd Samsuri
15.Mohamad Akram bin Ruslan
16.Ahmad Ghaus bin Mohd Ghouse
17.Mohd Ashrafuddin bin Ahmad Radzi
18.Faisal Amir bin Si Mirah
19.Awis Qarni bin Fadil
20.Muhammad Afiq bin Mohamad
21.Norafandi bin Mohd Noor
22.Ahmad Afifuddin bin Abdullah
23.Mohd Falihin bin Mohd Shukri
24.Wan Ikram Shah bin Hadi
25.Sariu Ali Didi
26.Farhi bin Abidin
27.Mohd Zuhairi bin Zainuddin
28.Muhammad Farhan bin Nordin
29.Ahmad Hazri bin Ilyas
30.Abdul Razak bin Mohamed Ismail
31.Muhammad Azfar bin Ruslan
32.Ahmad Faizul bin Abd Rahman Sazli
33.Noor Mohd Amin bin Moktar
34.Mohd Fadhil bin Abd Rahman
35.Khairul Shafiq bin Ahmad Bastamam
36.Mohd Nizam bin Ishak
37.Hielmi Syaiful Nizam bin Shamsuddin
38.Mohmad Aswad bin Mohmad Amin
39.Mohamed Suhaib bin Peer Pulavar
40.Mohd Hafiz bin Johari
41.Ahmad Syaify bin Berahim
42.Muhammad Sheth bin Mohamad Azmi
43.Abdul Rahman bin Mansor
44.Zaharul Azran bin Zahari
45.Muhammad Zaki bin Zainuddin
46.Mohd Azrul Hafizul bin Mustaffa
47.Syed Ajmal bin Syed Ali
48.Noor Hafis bin Md Tob


SISTERS (WHO CAN ATTEND : PLEASE CHECK YOUR NAME)

1.Wan Maihan Binti Wan Salleh
2.Nor Aliya Binti Mohamad Nor
3.Solehah binti Jeffrey
4.Adilah binti Arifin
5.Nur Fatin binti Zaidi
6.Hazwani binti Che Abdullah (1 guest) -paid
7.Nurul Ain binti Mohd Shuhari
8.Nadzirah binti Abdullah (1 guest) -paid
9.Zaeimah binti Zakaria
10.Nik Nur Liyana binti Che Hasan
11.Puteri Nurul Diyana binti Ahmad Ainuddin
12.Iman binti Jeffrey
13.Nurul Farhana binti Mohd Azman
14.Nurasmalhusna binti Hamid
15.Wan Khadijah binti Wan Mohd Saman
16.Siti Fatimah binti Abu Hussain
17.Noor Idayu binti Ibrahim
18.Syazwani binti Dzulkifli
19.Jauharatunnur binti Ishak
20.Nik Haszlina binti Nik Hashim @ Hashim
21.Siti Nurbahiah binti Haron
22.Nabilah binti Rameli
23.Rodhiyah binti Shahar

24.Azlina binti Johari

25.Nur Izzati binti Ismail
26.Siti Farhah binti Mohd Isa
27.Syazwani binti Sanusi
28.Zanaridah binti Mat Nawi
29.Siti Amirah binti Hassan
30.Siti Nadirah binti Ab Rahim
31.Nurul Hamizah binti Mhd Zaki
32.Elmizah binti Pasi
33.Noor Rahimah binti Rosli
34.Siti Rohani binti Mohd Amin @ Muhamad
35.Khaulah Karimah binti Azni
36.Farah Nadiah binti Redzuan
37.Sharifah Nur Aimi binti Syed Azhar Zawawi
38.Tasneem binti Abdul Rahman
39.Nur Al - Kamaliah binti Harun
40.Zaitul Azra binti Mohd Nasir
41.Nik Fatma Hayati binti Nik Wan
42.Nur Syazwani binti Mohd Salehuddin
43.Nor Lyana binti Hamidon
44.Intan Bazilah binti Abu Bakar
45.Sharifah Aishah Alsagoff
46.Asmaa' Hazirah binti Abdullah
47.Wadalila binti Adam
48.Norhamimah binti Mohd Noor
49.Nurul Azimah binti Azizah Ariffin (1 guest) -paid
50.Siti Syafiqah binti Md Radzi
51.Nazhiyah binti Abdul Wahab
52.Nurul Izza binti Abdul Razak
53.Nur Zila binti Md Mukhtar
54.Najwa 'Abidah binti Mohd Halim
55.Siti Nur Hafizah 'Izzaty binti Shaikh Ahmad
56.Izatul Sarah binti Zainal
57.Wan Adlina binti Mat Yusof

KIV
Maryam Al Batul binti Azizuddin
Category: 6 comments

Paeds Y5B4 questions

Here the exam questions

jersey 10thbatch v.2.2

Assalamualaikum kwn2...

1. tolong vote design mane
2. bagi name,saiz baju n no jersey
- sister bg kt aj
- bro bg kt suhaib
3. last submit name ari isnin (21/3)
4. harge..(siap ngn cop no jersey n cop batch)
- jersey kuning n merah ~50
- jersey putih ~70


---------- sepul ----------


Design 1



Design 2



Design 3



Design 4



MSC INTERBATCH TOURNAMENT 2011

Date : 26 - 27th March 2011
Venue : IMC

Games:

1. Futsal (PIC - Wan Ikram)
2. Volleball (PIC - Sepul)
3. Basketball (PIC - Hazri)
4. Badminton - single/double
5. Pingpong - single/double
6. Chess
7. Carrom
8. Batu Seremban
9. Congkak

For games 1-3, anyone (bro) interested, kindly contact the PIC, the rest of the games (4-9), contact me, for sisters, contact Rodhi

10th batch ruleszzz...Let us defend our title for the last time!!!

HO made easy




8.00am
:
Registration of participant
8.30am
:
Opening remarks and speech

9.00am
:
Workshop 1:
Housemen How to Talk
By: Dr Azura

9.45am
:
Workshop 2:
Common error in medicine prescription
By: Pharmacist

10.30am
:
Tea break

11.00am
:
Workshop 3:
Pathology request made easy
By: Dr Norzamzila

11.45am
:
Workshop 4:
Dos and Donts in ward procedures and rounds
By: Dr Azha

12.30pm
:
Lunch break and Zuhr Prayer

2.00pm
:
Group Activity

3.00pm
:
Tea break

3.30pm
:
Group Activity / Discussion / Presentation

5.30pm
:
Closing ceremony


"nak clearkan pasal interbatch.interbatch start 26/3 petang 530pm.indoor sister.Program (HO made easy) abes around 0445pm-0500pm.." (Abd Majid Ghazali, 2011)

"This is different topic daripada yg dulu punya (FYP group Cimee) ..Kali nie more on how to write request form (pathology, radiology, HPE), how to send correct specimen bottle or sample without being rejected, do's and don't about drug prescription, some tips on ward round and communication skill (referral), how to do discharge..etc...Sebelah petang, tentatively we will give a clinical scenario where you will try to fill in certain forms, try to choose the right specimen bottle, writing drug prescription...etc...In short, it will be about technical and non-technical skills of housemanship.. Insya-Allah." " oh ye, this talk will highlight the common mistakes done by houseman. So the main purpose is for all of you to be prepare and hopefully not repeating the same mistakes again...."(Dr Azura Sharena Yahaya, 2011)

Timetable Y5B5

Medical posting
Monday: Briefing w Dr Kuan 830am Sem Room 3 only. No other classes

O&G posting
Peadiatric posting
-not yet posted-

Surgical posting
-not yet posted-

Psychiatry posting

Y5B4 exam results not yet posted
TQ

MMA Pahang 1st scientific meeting

For those yg tak dpt attend.. this are just stuff i found interesting, not the whole thing cos blaja je... any corrections bgtau

1) Recent Advancement in DM control by Dr. Alexander Tan

- Hypoglycaemia increase risk of CV event (highest compared to other risk factors)
- Benefit of glycaemic control is seen longterm (>15 yrs)
- Glycaemic control depends on individual…. For example a 25 y.o we can reduce HBA1c <6.5, but if a 75 y.o with hx of stent/bypass and poor control, reduce <8… coz aggressive reduction predispose to hypoglycaemia which in turn increases risk of CV event…

Based on intensive glycaemic control in the ACCORD and ADVANCE trial…

link : http://www.nejm.org/doi/full/10.1056/NEJMe0804182 New approach= incretin (baca la sendiri ye..)

2) Battle against Obesity – Dr Adie Nuar

Just to remind revised BMI for asians
Underweight : <18.5 kg/m2
Normal :18.5- 22.4 kg/m2
Overweight:23 -27.4 kg/m2
Obese : => 27.5 kg/m2

3) Approach to joint pain – Dr. Ainon Mohd Mokhtar

Diognostic Criteria for Gout (2 or more)
a- clear hx of at least 2 attacks of acute severe joint pain with complete resolution in 2 weeks
b- clear hx of podagra
c- presence of tophus
d- rapid response to colchicines within 48 hours
Definite – crystals of monosodium urate in synovial fluid sample

Indications of hyperuricaemic drugs i.e. Allopurinol
a- Frequent and disabling attacks of gouty arthritis (3 =>attacks/yr)
b- clinical or radiographic signs of erosive gouty arthritis
c- presence of tophaceous deposits
d- urate nephropathy
e- urate nephrolithiasis
f- impending cytotoxic chemo/radiotherapy for leukaemia/lymphoma (tumour lysis syndrome)

ATTN! new criteria for RA diagnosis… yg the usual seven tu dah tak pakai sgt sebab that criteria will detect late stage RA… the new criteria is better to detect early RA… but I think for exam purposes.. remember the old but mention ada new... nak hafal mampos la.. ada score2...

ACR/EULAR rheumatoid Arthritis Classification Criteria 2010

Link : Skip to page 6 for the criteria… http://www.rheumatology.org/practice/clinical/classification/ra/2010_revised_criteria_classification_ra.pdf

4) Per-rectal bleeding – AP Dr Mohd Zailani

Perrectal bleeding- MANDATORY endoscopy
<40 yrs =" flex">40yrs = full endoscopy

Specific IX
-upper lower endoscopy
-Nuclear scan technetium 99 tagged RBC scan – sensitive but not specific.. detect bleeding of 0.1 ml/ hr (MCQ pernah kuar kan?)
-Angiography – less sensitive but specific.. detect bleeding of 0.5 ml/hr (again.. MCQ penah kuar)
-capsule endoscopy

HTAA gonna start a direct access to scope rooms for Primary care J

5) Diabetic retinopathy – Dato’ Dr Vasanth

Recap pathophysio…. Leakage + occlusion

Leakage -> macula oedema -> stretching of the nerve fibers and receptors -> ineffective impulse transfer -> scarring

Occlusion-> increase VEGF -> angiogenesis ->at disc + iris(iris rubiosis) ->bleeding ->scarring ->retinal detachment

Frequency of eye examination
<30 y.o (type I) – 1st exam 5 yrs after onset – repeated annually
>30 y.o (type II)- 1st exam at time of dx- repeated annually
DM complicating pregnancy – unsure (sapa sempat .. tak dgr la yg nie)

6) Tinnitus – Prof Din Suhaimi Sidek

Tinnitus + bleeding postnasal discharge =>rule out NPC(common gak in Msia kan)

7) Management of asthma – Prof Roslina Abd Manap

Untreated asthma causes reduce lung function long term! Caused by subepithelial fibrosis

So, ICS is important, safe to be used long term…

Treatment still ikut the one in GINA.. yg stepwise tu

Adding a LABA is better than >=2x increase of ICS..but must not be used alone, causes increase mortality.. with ICS

New treatment => combination treatment (formoterol +budesonide)..can be used for maintenance and rescue i.e. symbicort (diorg sponsor kot.. haha)

How to increase compliancy? since pt will say that they are asymptomatic and refuse to cont… instead of saying like ‘yes, I know but u still need to use it’ which is so not convincing kan?…use the asthma control scoring, afew recommended by GINA…. So say like ‘look here, yes u might feel asymptomatic but according to this score u r ?? and we need to reach ?? so u still need to cont the med’.. ok of course gentle2 la :P

8)Hep B – Dr Tee Hoi Poh

HBV carriers with increase risk of HCC
-Asia male >40 y.o, female >50 y.o
-Hx of chirrosis
-Hx of HCC
- Carrier with increase ALT or increase HBV DNA lvl > 2000 IU/L

Now ALT upper normal limit is 19 U/ml

Indication for Rx (Ada 3 study tp I only take the asia pacific…)
- ALT 2x upper normal limit and persist after 3-6 months
- HBV DNA >20 000 IU/L if HBeAg (+)
- HBV DNA >2000 IU/L if HBeAg (-)

Indication for Liver biosy
- ALT 1-2 x upper normal limit
- HBV DNA 2000-20000 IU/L
- Age >40 yrs old

Difference between =(acute hepatitis B) /(chronic hepatitis B with flare)
IgM core antibody = (+) / (-)
HBV DNA = (reduce)/(increase)
HBeAg= (reduce)/(increase)

Targets of Rx (descending pattern)
1- HBsAg Seroconversion – hard to achieve
2- HBeAg Seroconversion – the next best thing
3- HBV DNA suppression
4- Normalisation of ALT
5- Histological improvement


Rx
1) Peg-IFN alpha 2a (immune modulator ) – cannot be used in chirrotic
2) Nucleos(t)ide analogue
Category: 0 comments

MMA Pahang 1st Anual Scientific Meeting

For those yang dah register tapi tak ingat tentatif program
kindly refer below



bertempat di Zenith Hotel, Kuantan, Pahang, 12th March 2011



Category: 2 comments

AGD invitation cards

DESIGN 1
DESIGN 2



salam.kawan2 sekalian..yang ni contoh designs tuk invitation card lecturers..ade 2 designs (from ayep year1) ..sile pilih n comment ye..especially committees n mainboard AGD...need you feedback..thank you very much!!! =)
suggestions:
1)should include name of lecturer and no of guest
2)our batch logo?.....
2)any comment?
Category: 15 comments

Short Case with Prof Hamizah

Dr gave me the EDD and asked for POG… the pt’s was 35 weeks…

I was asked to examine pt generally….

Me: This is a lady in her..mid 20’s? medium built, conscious and alert. Hydrational and nutritional status fair. Not pale (no signs of anaemia sucha as angular stomatitis, atrophic glossitis)nor jaundice, no parotid, no thyroid swelling. No pedal oedema. Oh.. and the abdomen is distended…

Prof : *smiling* y do u think I bring u to this patient? What do you think I want tou to pick up?
Me: *slams my forehead* oh.. the patient has rashes found all over her face, forearms and legs *I’m so dead I thought*

Prof : remember hielmi, don’t be so caught up with the negative findings.. these rashes are obvious..
Me: Yes Prof

Prof : so describe the rashes…
Me: it is found most prominently on the face, multiple 2-5 mm, hyperpigmented, keratinized, looks healed… there are a few at the forearms and legs tho they look more healed?

Prof: what else do you want to do?
Me : I would like to check the trunk and with seeing the progression of the healing maybe can tell whether the pattern is centripetal or centri….*ak lupa dowh masa nie..prof pandang je lama plak tu*.. fugal?

Prof: good *phiuhh* what do u think is the cause?
Me: Varicella zoster?

Prof: ok, now examine the abdomen

The abdomen finding was uneventful… other than more rashes…. However halfway thru.. uterus contracts, so timing was done… prof prefers running commentary

Prof : so whats ur dx?
Me: seeing that she has contractions at 35 weeks, my dx is preterm contraction secondary to varicella zoster infection. However I need to complete my examination with VE and bishop scoring to see if she is in labour.

Prof: if I give u one chance… only one.. to ask a single question to the patient… what will it be? Do it…
Me: Puan, bila puan dapat ruam2 nie? Trimester pertama, dua, tiga?
Pt: baru je 2 minggu…

Prof: Ok, y that question?
Me: due to the complication it carries based on trimester.

Prof: elaborate..
Me: 1st trimester carries risk of teratogenicity…

Prof: but this pt got it at third so?
Me: hmmm.. the baby will be a carrier?

Prof: no… what do we worry bout? 10 days post delivery?
Me: fulminant manifestation of the dx on the baby..

Prof: elaborate..
Me: hmm… skin eruptions?

Prof: ok… skin infections.. anymore?
Me: lung infections?

Prof: ok pneumonia… one more we worry bout…
Me: *masa nie cuak.. mula pikir all the organs dalam badan…* brain?

Prof : so.. what brain? Be specific..
Me: hmm.. meningitis?

Prof: that is just the covering…
Me: owh encephalitis..

Prof: Yes… now one more chance to ask a question to patient..
Me: Puan ada makan ubat? Ubat apa? Tau nama ubat?
Pt: ada, antiviral tp tak tau nama apa.

Prof: but u know I believe… what is it?
Me: Acyclovir

Prof: how do u prescribe acyclovir for her?
Me: I’m sorry prof, I do not know.

Prof : ask the patient now, u will remember forever…
I start asking the pt and was told its 800mg 5 times a day for 5 days.. ak tak cek lagi…

Prof: will the treatment cure her?
Me: not entirely, the virus will remain dormant in the nerves ganglion and will resurface if the patient will undergo stress or immunesurpressed..

Prof: so whats the long term complication for this patient?
Me: it could resurface during next pregnancy and causes 1st trimester infxn and for the patient.. shingles..

Prof: what is shingles?
Me: the virus causes rashes along the dermatomal region it resides while remain dormant. Painful pustules.

Prof: which shingles are we afraid of?
Me: lumbar?

Prof: why? Its just the abdomen..
Me: owh, trigeminal nerve shingles… ocular complication leading to blindness?

Prof: yes… How do you think the patient get the disease?
Me: through contact with someone with the disease..

Prof: ask the patient…*basically one of her kids got it first*… what do u mean contact
Me: fomites? Touch? Clothes? Its not airborne..

Prof: what?*mata terbeliak* Are u sure its not?
Me: *ak degil ckp tak gak.. sebenarnya ya* hmm.. the virus resides in the pustules and contact with it causes spread of infxn..

Prof: hmmm… ok.. have u ever been infected?
Me: yes..

Prof: when?
Me: when I was 7

Prof: will u get infected now by her?
Me: no because one, I’m immune and secondly she is beyond her infectivity period because it has been 14 days..

Prof: so explain y she have it only now?
Me: she has never been exposed, this is her first infxn and also because she did not take the vaccination which at her time wasn’t in the immunization programme.

Prof:*asking the pt* pertama kali ked pt demam campak?
Pt: a’ah.. nie kali pertama..

Prof: you can go now
Me: thank you

Prof sgt2 baik.. tolong je… masa bincang ak atas kerusi while dia duduk atas katil..

My long case with Dr Muna

CC

A 38 y.o, Malay lady, from Felda Panching, G5 P1+3, a k/c/o PCOS with 14 yrs hx of subfertility, recurrent abortions dx with anti-phospholipid syndrome(APS) and valvular heart dx with LNMP 15/6/10 SOD, no contraception but irregular menses with benefit of early scan 10/52 confirm her EDD at 22/3/11 making current px at 37/52 presents 3 days ago for 3 days history of reduced fetal movement.

Dr: so in conclusion u have a very complicated case *smiles*
Me: Yes..huhu... but i will try my best Dr


HOPI

This is a very precious pregnancy.
Suspected when missed period, UPT done positive.
1st trimester symptoms = only breast engorgement.
No episodes of PV bleeding or abd pain during 1st trimester

Booking at 8/52 POA
-Obese = BMI 35
-normotensive, blood group cant remember, rheses +ve
-blood test = nonanaemic, VDRL, HIV. Hep B non-reactive
-urine = no glycosuria or proteinuria

Due to her dx of APS, given aspirin 75mg from 10/52-37/52. Self-administered s/c clexane given from 28/52.
Due to heart dx, visit MOPD and was told can cont with pregnancy and does not need combine care.
Due to obesity, MOGTT indicated, done 3 times @ 15, 24, 34 weeks.. all normal.

So far 13 followups(biweekly) at HTAA due to her probs, all uneventful.
Scans done on every visit – singleton, healthy, no congenital abnormality, normal growth, AFI good, placentation normal with no obvious calcification.

Quickening felt at 16/52. ATT completed.
Started on FKC at 34/52.
3 days ago, reduced fetal movement(do not complete 10 in 12 hrs), did not seek medical attention because of an upcoming followup. On followup, fetal movement returned normal but warded just to make sure.

Currently no sign and symptoms of labour, no PV bleeding, FM good.

On further questioning, denied rashes of face or anywhere else, no joint pain, no easy bleeding, no jaundice, no SOB, no calf tenderness.

Past Gyn + Obs (I decided to just combine the both to have smoother chronological flow)

Attained menarche at 12, regular till age 21 when turned irregular (every 1-3 months around 3-5 days) nor dysmenorrhea.

Was married for 14 yrs however conceived first child after 6 years of trying in which she got help of two cycles of clomiphine citrate (without any complication of OHSS) and an ovarian drilling. Dx with PCOS, other than the subfertility and irregular menses does have hirsutism(moustache), was on metformin.

Her first child was born full term 9 yrs ago with weight of 2.3 kg via elective LSCS due to oligohydramnios. On further questioning, no cause was found, she denied LL, GDM, PIH or congenital abnormality. No other cx antenat,intra,post-partum. Breast fed for only a week due to migraine.

Subsequently 3 miscarriage (2006(required D+C), 2008, 2009), investigated, dx with APS.
None of the pregnancy after the first was helped with induction.
Last papsmear 3 yrs ago – normal

Medical/surgical Hx
No significant hx

Family Hx
3/8 siblings. Both parents alive and healthy. Two other sisters have similar problems of subfertility.

No other significant drug hx. No allergy

Social Hx
Housewife, SPM holder. Live with hsband and daughter. Husband mechanic making RM1500.No high risk behavior.

PE

VS BP = 130/75 mmHg, PR=80bpm, RR=18bpm, T= 36.7oC
BMI= 42
Not pale, not jaundice, hydrational fair, No pedal oedema
Respi, thyroid normal.. denied breast examination
Heart = systolic murmur of the mitral region, radiating to the axilla, grade 3… no raised JVP.

Abd : distended due to gravid uterus. Pfannenstiel scar 20 cm, no scar tenderness, SFH 37cm, singleton, longitudinal lie, fetal back on maternal right, cephalic presentation , 4/5th palpable, adequate liquor with EFW of 2.8-3.0 kg. Can’t hear fetal heart due to thick abd.

Would like to complete with VE and bishop scoring…



Discussions

List the patients problems…

What is your concern now ?
Fetal wellbeing

How do you check for fetal well-being now?
Hx-FKC, PE-serial SFH(not relevant in this case), Ix- US and CTG.

Tell me bout FKC…

Tell me bout CTG and inteprete the pt's CTG….

What is APS? korang baca la ye sendiri pasal APS

How does it cause recurrent abortions?

What is done to this patient to maintain the px? How does it help?
Aspirin n clexane..bla2 ets

How wud u manage this patient?
-Seeing that the FM carry on till 38 weeks

Y c-sec? – very precious, dun wanna take the risk of vaginal delivery.

What risk? – untried scar, risk of rupture, no previous SVD before, so there is probability of CPD… again I stress it’s a precious pregnancy.

But is she contraindicated for SVD? No

How wud u monitor if pt keen on SVD?... S+Sx of impending rupture, prolonged active/2nd stage…

How wud you prepare this patient for C-sec: Ix : FBC, GXM, PT/APTT….Make sure anaes team comes… fasting… stop clexane on the morning of surgery.. bla2 ak goreng lagi ;P

What is the cx of the c-sec? anaes[mendelson(px)? Diff intubation(obese+px)? Difficult epidural(obese)], Hge, injury to other organs, bla2 etc….

After delivery, does she still need the anticoagulant? Yes, eventhough if the delivery is successful, she is still at risk of thromboembolism due to her obesity and APS…

So when do u wanna start? 6 hrs post-surgery..bolus 5000u and maintenance 1500u

What if tomorrow she complains of reduced FM? Put on cont CTG and if there is any sign of fetal distress EmLSCS..

thank you, u can go now

Sibuknya...


Seperti biasa, di akhir-akhir posting, biasanya medical students bertungkus lumus memenuhkan logbook i.e. mengambil darah, memasang branula, memasang CBD, etc. Lebih-lebih lagi bila FNAC tak berkesempatan nak tengok, scope pun sikit, jadi kenalah compensate dengan blood-related procedure ni.

Bagi yang jujur dan yakin setiap perkara akan dipertanggungjawabkan, mereka akan berusaha mencari procedure sendiri sehingga stay sampai malam atau weekends. Tapi bagi yang kurang peduli apa yang bakal dijawab di depan Allah esok, mereka akan menipu dengan pelbagai cara, termasuk meminta H.O. sign ‘blank cheque’ agar dia boleh isikan procedure yang sebenarnya tidak ia lakukan.

Beberapa hari terakhir posting surgeryku, aku meng-hunting procedure sampai ke wad IM. Jam menunjukkan pukul 6.40pm. Seorang H.O. sedang bertugas dan agak teruja mempersilakan aku membantunya mengambil blood C&S, FBC, VBG etc. Selesai habis procedure, aku kembali ke kaunter utk mendapatkan sign H.O. tersebut. Dengan mask yang masih melekat di muka, tiba-tiba dia bertanya kepada staff nurse di sebelahnya,

“Eh, kat wad ni boleh solat tak? Aku tak solat Asar lagi ah”

Aku melihat jam sambil berpandangan dengan temanku. 7.00pm. Tak solat Asar lagi?

Aku pun dengan rela hati menawarkan “Dr, saya boleh hantarkan specimen STAT ni semua. Saya boleh tunggu kat bawah, Dr tak solat lagi kan,”

“Oh, baiknya ko. OK, FBC ni semua takyah tunggu, ko tunggu VBG je. Thanx eh”

Aku pun bergegas ke bawah utk hantar specimen. Jam sudah pukul 7.15pm. Syukur golongan wanita Allah kurniakan MC setiap bulan, jadi aku tak risau pasal solat maghrib waktu tu. Sedang aku menunggu di lab, tiba-tiba muncul kelibat H.O. tadi, dengan cemasnya panggil lab assistant,

“Kak, boleh tolong trace tak result patient ni? Potassium dia high, 8.2 ni. Tolong checkkan balik boleh?”

Aku melihat jam. 7.20pm. Eh Dr ni dah solat Asar ke? Aku cuba berbaik sangka, mungkin tadi dia dah solat kejap sementara aku turun dan tunggu result patient. Tapi... alahai, masknya masih melekat di muka...

Aku cuba bayangkan. Nanti H.O., takkanlah takda masa langsung sampai solat 5-10 minit pun tak sempat? Seorang temanku, H.O. di Hospital Serdang nasihatkan, “Jadi H.O. ni kena selalu berwudhu’”

Rasanya bolehlah disimpulkan, hendak seribu daya... mungkin ada masa-masa emergency yang betul2 tak sempat, e.g. kalau kita tinggalkan patient utk pegi solat, patient boleh mati... Tapi itu mungkin situasi terpencil, kenalah jama’ maybe. Tapi kalau kebiasaannya, kitalah yang kena pandai curi masa. Kita kan tak tahu bila emergency tu akan terjadi, mcm tadi, tetiba potassium patient high pulak, jadi kalau ada masa yang ‘tak emergency sangat’, cepat-cepatlah tunaikan solat... Kalau dari awal dah ‘lenient’, tak set pun dalam mind masa utk solat walaupun 5 minit, kononnya sbb “Aku kan H.O., akulah yang paling sibuk dalam dunia”, jadi dengan mindsetting mcm ni, mungkin mudahlah utk seseorang tu tinggalkan solatnya...

Na’uzhubillah, semoga Allah pelihara kita... semoga kita semua menjadi hamba-hamba yang sentiasa cuba utk taat dalam menunaikan hak Tuannya, dalam situasi apapun jua...

Category: 18 comments

Interview SPA - soalan bocoq




Part 1 – perkenalkan diri

  • Sebutkan nama & IC
  • Tempat lahir ibu, tempat lahir bapa
  • Di university masuk persatuan apa, main sukan apa
  • Lulus tak exam, pernah dapat distinction tak
  • Dah kahwin belum
  • Mintak di hospital mana? Kenapa?
  • Kenapa tak minta di KK, Kuching?
  • Kalau dapat di Sabah macamana?

Part 2 – kenegaraan
  • Siapa menteri kesihatan? Address FULL JAWATAN, termasuk YANG BERHORMAT DATO’ SERI, etc
  • Siapa DG? Kenal tak rupa dia? If he comes in with slippers & jeans, would you be able to recognize & greet him?
  • Apa rukun Negara? Pilih salah satu dan kaitkan dengan profession seorang Dr

Part 3 – technical (tapi Alhamdulillah interviewer KKM tak dtg, syukur...)
  • What are the jobspecs of a house officer?
  • What are the qualities that you have to be a good Dr?
  • Hypertension & stroke, berapa reading SBP & DBP, apa Sx. Kalau low blood pressure berapa reading, apa Sx
  • You know becoming a H.O. you’ll be in a lot of stress, habis tu kenapa ramai your colleagues masih ramai yang complain? (manalah saya tahu Dato’...)
  • How do you manage stress?

Ini interview dengan Dato’ Abdul Rahman, bilik C. Sebelum tu ada yang kena soalan tentang fever & cough, how you approach. Dia baik sangat2, don’t worry.

Ada juga yang dapat dengan interviewer lain, ada soalan2 spt:
  • TB – Mx
  • Dengue – How do you Mx
  • Pernah fail exam tak sebelum ni?
  • Dah kahwin? Ada perancangan nak kahwin dalam masa terdekat? Dah tunang? Dengan orang mana
  • Maybe dia nak consider tempat/hospital yg kita mintak kot...

Sekian... Semoga Allah mempermudahkan kalian semua esok... insyaAllah, semua interviewer baik2 belaka, buat penat je takut =) Don’t worry, Allahumma yassir...

Category: 0 comments

INTERVIEW SPA-KKM (Q from senior)

kak farah rcmp
-polisi kerajaan
-isu2 semasa
-y nak jadi dr

kak ili
-posting yang paling suke.y?
-hobi
-komuniti servis

kak nazimah
-borak2 biase (cam interview main2)
-nak sambung blajar ape

kak hawa
-current issues
-NKRA (National Key Result Area)
-Key performance
-emergency (how to manage hypovolumic shock at A & E)

kak suhaili
-y u want to be a doc?
-what's your future plan?
-r u ready to be posted at any hospital?
-1 malaysia.how you apply the concept when working?

br nazhan
-HINI tgh hot time tu, so die tanye pasal tu
-disease yg common- eg dengue, tb
-pm,menteri2
-kpk,ksu
-moto, budaya kerja KKM

zaim:
-wound dressing
-ddx of unconscious child
-ambitions
-health education




~tgh tunggu jawapan dpd senior2 lain...will update soon, insyaAllah...
Category: 0 comments

Alhamdulillah ramai dah byr yuran AGD...tp ade jgk yg masih blm...ermm..

NO.

NAME

MATRIC. NO.

PAID

1

Raihan Khairani binti Rozikin

0418290

2

Anuar b. Awang Qamaruldeen

0418947

200

3

Wan Maihan Binti Wan Salleh

0512918

200

4

Mohammad Haikal Bin Suhairi

0513051

150

5

Nurwahida Binti Jamaan

0515400

6

Nor Aliya Binti Mohamad Nor

0515600

200

7

Muhammad Hafiz Bin Mohamad

0515987

200

8

Muhammad Yusuf Bin Karis

0517065

9

Mohd. Asyarie Bin Ishak

0517279

10

Fatin Nabilah binti Salehuddin

0610080

150

11

Solehah binti Jeffrey

0610108

200

12

Adilah binti Arifin

0610126

200

13

Muhammad 'Abdusssalaam bin Haji Jemain

0610397

200

14

Nur Fatin binti Zaidi

0610492

200

15

Muhamad Farhan bin Ab Razak

0610547

200

16

Hazwani binti Che Abdullah

0610680

200

17

Nurul Ain binti Mohd Shuhari

0610704

150

18

Muhammad Nu'aim bin Ishak

0610947

150

19

Nadzirah binti Abdullah

0611192

200

20

Edre bin Mohammad Aidid

0611239

200

21

Hamzah bin Sukiman

0611281

200

22

Zaeimah binti Zakaria

0611412

200

23

Mohd Fakhri Hilmi bin Danial

0611459

200

24

Nik Nur Liyana binti Che Hasan

0611562

200

25

Puteri Nurul Diyana binti Ahmad Ainuddin

0611720

200

26

Badzli Sham bin Bahdun

0611731

200

27

Iman binti Jeffrey

0611750

200

28

Adam bin Abdul Razak

0612019

200

29

Mohd Shamsudin bin Zainol Abidin

0612307

200

30

Ihsan bin Abdul Razak

0612335

200

31

Nurul Farhana binti Mohd Azman

0612598

200

32

Saiful Firdaus bin Mohd Samsuri

0612609

200

33

Mohd Hazlan bin Hamzah

0612725

34

Nurasmalhusna binti Hamid

0612780

200

35

Mohamad Akram bin Ruslan

0612955

200

36

Ahmad Ghaus bin Mohd Ghouse

0613067

200

37

Wan Khadijah binti Wan Mohd Saman

0613388

200

38

Nur Aqilah binti Shahat @ Sehat

0613434

150

39

Mohd Ashrafuddin bin Ahmad Radzi

0613589

200

40

Siti Fatimah binti Abu Hussain

0613592

200

41

Noor Idayu binti Ibrahim

0613610

200

42

Syazwani binti Dzulkifli

0613648

200

43

Faisal Amir bin Si Mirah

0613719

200

44

Jauharatunnur binti Ishak

0613752

200

45

Nik Haszlina binti Nik Hashim @ Hashim

0613838

200

46

Siti Nor Ashiah binti Johari

0613944

150

47

Awis Qarni bin Fadil

0613987

200

48

Muhammad Afiq bin Mohamad

0614001

200

49

Norafandi bin Mohd Noor

0614071

150

50

Siti Nurbahiah binti Haron

0614310

200

51

Nabilah binti Rameli

0614472

200

52

Farhanah binti Ibrahim

0614836

200

53

Rodhiyah binti Shahar

0614840

200

54

Maryam Al Batul binti Azizuddin

0614958

200

55

Azlina binti Johari

0615134

200

56

Nur Izzati binti Ismail

0615256

200

57

'Izzah binti Haji Idris

0615370

100

58

Karniza binti Khalid

0615490

150

59

Ahmad Afifuddin bin Abdullah

0615517

200

60

Siti Farhah binti Mohd Isa

0615588

200

61

Syazwani binti Sanusi

0615678

200

62

Zanaridah binti Mat Nawi

0615724

200

63

Siti Amirah binti Hassan

0615748

200

64

Siti Nadirah binti Ab Rahim

0615754

200

65

Nurul Hamizah binti Mhd Zaki

0615794

200

66

Elmizah binti Pasi

0615822

200

67

Mohd Falihin bin Mohd Shukri

0615965

200

68

Wan Ikram Shah bin Hadi

0616091

200

69

Noor Rahimah binti Rosli

0616122

200

70

Siti Rohani binti Mohd Amin @ Muhamad

0616150

200

71

Khaulah Karimah binti Azni

0616180

200

72

Farah Nadiah binti Redzuan

0616184

200

73

Sharifah Nur Aimi binti Syed Azhar Zawawi

0616236

200

74

Sariu Ali Didi

0616253

200

75

Farhi bin Abidin

0616261

200

76

Tasneem binti Abdul Rahman

0616468

200

77

Mohd Zuhairi bin Zainuddin

0616619

50

78

Nur Al - Kamaliah binti Harun

0616642

200

79

Muhammad Farhan bin Nordin

0616655

200

80

Salmina binti Md Rifin

0616686

200

81

Mohamed Suhaib bin Peer Pulavar

0616803

200

82

Mohd Hafiz bin Johari

0616849

200

83

Zaitul Azra binti Mohd Nasir

0616868

200

84

Muhammad Sheth bin Mohamad Azmi

0616901

200

85

Nik Fatma Hayati binti Nik Wan

0616980

200

86

Nur Syazwani binti Mohd Salehuddin

0616994

200

87

Ahmad Syaify bin Berahim

0617125

200

88

Nor Lyana binti Hamidon

0617128

200

89

Intan Bazilah binti Abu Bakar

0617152

200

90

Sharifah Aishah Alsagoff

0617156

91

Asmaa' Hazirah binti Abdullah

0617280

200

92

Abdul Rahman bin Mansor

0617355

200

93

Wadalila binti Adam

0617366

200

94

Norhamimah binti Mohd Noor

0617664

200

95

Nurul Husna binti Mohamed Rusdi

0617854

200

96

Tengku Ahmad Fazdwan bin Tengku Mahmood

0617927

150

97

Muhammad Zaki bin Zainuddin

0618063

200

98

Mohd Azrul Hafizul bin Mustaffa

0618261

200

99

Syed Ajmal bin Syed Ali

0618407

200

100

Noor Hafis bin Md Tob

0618435

200

101

Nurul Azimah binti Azizah Ariffin

0618458

200

102

Zaharul Azran bin Zahari

0618461

200

103

Siti Syafiqah binti Md Radzi

0618508

200

104

Nazhiyah binti Abdul Wahab

0618948

200

105

Nurul Izza binti Abdul Razak

0619172

200

106

Nurul Hafizah binti Yussoff

0619230

200

107

Mohd Nizam bin Ishak

0619337

200

108

Hielmi Syaiful Nizam bin Shamsuddin

0619387

200

109

Mohmad Aswad bin Mohmad Amin

0619533

200

110

Nur Zila binti Md Mukhtar

0619534

200

111

Muhammad Azfar bin Ruslan

0619591

200

112

Ahmad Faizul bin Abd Rahman Sazli

0619617

200

113

Noor Mohd Amin bin Moktar

0619649

200

114

Mohd Fadhil bin Abd Rahman

0619655

200

115

Khairul Shafiq bin Ahmad Bastamam

0619679

200

116

Najwa 'Abidah binti Mohd Halim

0619718

200

117

Ahmad Hazri bin Ilyas

0619737

200

118

Abdul Razak bin Mohamed Ismail

0619747

200

119

Siti Nur Hafizah 'Izzaty binti Shaikh Ahmad

0619796

200

120

Izatul Sarah binti Zainal

0619798

200

121

Wan Adlina binti Mat Yusof

0619800

200

122

Muhammad Hafiz Ishak

50

Category: 0 comments

Cloudy@10thbatch

Blogumulus by Roy Tanck and Amanda Fazani

We are ...

Name : admin@10thbatch
E-mail: admin@10thbatch.org

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E-mail: amran_hafiz@yahoo.com

Name : Nabil
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Name : Haikal
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Name : Koi
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Name : Syafiq
E-mail: blazzae@hotmail.com

Name : Pa'an Razak
E-mail: xmania_007@hotmail.com

Name : Afiq
E-mail: frosty_bluevanilla@yahoo.com

Name : Nizam
E-mail: sba_mcnizam@yahoo.com

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E-mail: aqifays_hideiki@yahoo.com

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E-mail: eastsyed@yahoo.com

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E-mail: shamsudin860401@yahoo.com.sg

Name : Sariu
E-mail: sariu2055@hotmail.com

Name : Siti Fatimah
E-mail: just_tim86@yahoo.com

Name : Nik Haszlina
E-mail: momentom100@yahoo.com

Name : Nik Nur Liyana
E-mail: nike_liyana@yahoo.com

Name : Nurul Izza
E-mail: yuyu_izzu@yahoo.com

Name : Syazwani Dzulkifli
E-mail: syazwani_dzul@yahoo.com

Name : Tasneem
E-mail: taaz4e@yahoo.com

Name : Karniza
E-mail: violinaclaudia@yahoo.co.uk

Name : Khaulah Karimah
E-mail: clint _kay@yahoo.com

Name : Hazwani
E-mail: cikadu@yahoo.com

Name : Nabilah
E-mail: colourfulife@yahoo.com

Name : Nurul Hafizah
E-mail: pinkygal_186@yahoo.com

Name : Nur Al-Kamaliah
E-mail: alkamaliah@yahoo.com

Name : Chepon
E-mail: chepon_07@yahoo.com.sg

Name : Nurul Husna
E-mail: na_guo14@yahoo.com

Name : Sharifah Nur Aimi
E-mail: saakacj@yahoo.co.uk

Name : Norhamimah
E-mail: imemyself_11@yahoo.com

Name : Noor Idayu
E-mail: e_ayu86@yahoo.com

Name : Izzati Ismail
E-mail: ceh_izzati86@yahoo.com

Name : Saiful Firdaus
E-mail: sejadahpink@yahoo.com

Name : Shakeer
E-mail: -

Name : Suhaib
E-mail: -


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