a sad truth

... rupenye, aku masak x sedap. selama ni aku masak, rupenye, dlm diam, ade yg berfikiran masakan ku biasa2 sajer. tp bila ditanye, die kata sedap aku masak. n biarpun begitu, aku bersangka baik la jugak, dan hatiku gumbira bile menerima pujian. rupa2nye, itu sekadar kata2 manis di mulut saja. bagaikan bertanam tebu di pinggir bibir.. arghhh, aku kecewa!!!


p.s: ikut suke aku la, aku nak tulis apa pun, kalo sape2 yg rasa entry ni geli, then aku x boleh nak ckp aper. aku dh penat dh tulis ikut kerenah orng. biarlah, aku tulis ape yg aku rasa. aku adalah aku.

saturday

it freezing cold out there. it is no better inside the house. winter is coming ofically in the next few days..

aiyaya

entry publish kt salah blog. sorry bout the confusion. ni yg problem managing 2 blogs ni

i'm not a mind reader. i don't know what u want. subtle hints do not work, strong hints do not work, obvious hints do not work. just say it!!. and when i asked whether something is wrong & u say nothing. i will act like nothing is wrong. i know that ur lying but it's just not worth the hassle.

great minds think alike

thank u for saying that. i'm blushed.. heheh

up for a chat.? or maybe not

why bother being online if ur gonna be in a "busy" mode. normally i wouldn't have mind, but it annoys me when most of the people in my list put up that kind of status. seriously.. people, if u know that u won't be available, then go back & hide under the invi mode. at least i know that ur not online & i wouldn't have been bothered.

a lesson learned

meningitis doesn't cause peticheal rash. i was grilled for that!!!

meningococcal septicaemia causes them. speak the rite words, then they'll be pleased.

and today i saw a couple of interesting cases such as a child with rickets. the classic bow leg appearance is there. the treatment is a lifelong supply of vitamin D.

also, there's a child presented with febrile neutropenia. he has ALL.

nervousnye.... but when i think about it, this is part & parcel of life... so, i try not to fret about it...

i hate pessimist. i hate people who cuts me short and drag me down with them. and i don't like to be around someone who thinks that they know everything. go away.. u should not be here. u should be up there with them.

piss off

life isn't a bed roses for u to fall nicely onto.

i hate pessimist. i don't deal well with problems. and with all these negativity thrown in rite to my face, i can't help to wonder.. where did i go wrong? certainly, it is impossible for me to fulfill everybody's wishes but the thing about this type of people is that they're like the human black holes which suddenly come out of nowhere and just suck the life out of u. u try to stay positive and remain strong but their negativity ends up just completely draining u, u feel so tired, so exhausted, and u just wanna leave & giving them the privilege of having the last laugh.

and on the second thought, u secretly hope that they die & burn in hell.

icy

people got me wrong when i uttered this word.. to me, icy is more or less equivalent to cold. so when i say that u appear icy, i mean that u look distant, not very approachable. that's it. no underlying meaning or hidden agenda. and i never thought that some of u consider icy as being a cold hearted bitch!!! i didn't mean that!! seriously and the fact that syafique keeps on pin pointing that back to me made me feel even worse!! babe, ur just a little reserved then, not icy.

it's just no fun anymore. it feels different now. people don't commit as much as they used to. i'm tired of running in circles.

morning coffee

it happened in the OPD. there were me, ruth H & another friend from UCD. and our consultant. dr S was there too. but he went & called the patient. within this few seconds, i just had the urge take a sip of my coffee that i brought along in the room. and i don't how it happened, but the important thing was that my coffee ended up spilling on my seat, my pants & the floor.

but of course, we managed. we cleaned it up all within seconds too. and when our consultant was back in the room, we were all demurely seated, pretending as if nothing had occured. plus, i ended up with a wet pants throughout the morning. huh...

henoch schonlein purpura (HSP)

doing paeds here is spectacular. met a girl with HOCM but her main concern at the moment is IDDM. then saw a chap with HSP.

so, here are some random facts about HSP.

• usually patients get it following a URTI
• initially present with macula papular, non blanching rash, affecting the buttock, legs, feet, but trunk sparing. but rash cann appear blotchy & with a bruised appearance too
  
• abd pain.
• joint pain typically affecting the larger joints such as the hip, knee. there may be swelling of the joints.
  
• microscopic haematuria. so if the patients comes with frank haematuria, then more likely not to be HSP
• treatment is symptomatic. have to monitor for renal function. so do a msu, 24H urine collection, spot on protein: creatinine ratio, U&E + measure BP as well. if no sequalle for the next 6 months, then renal dysfunction is unlikely.

differentials: ITP, allergic rxn, viral infection.

away

i'm sorry for the infrequent entries lately. there are so much things that i would like to share & address to u readers out there. last week have been a buys week for me. aside from the end of rotation exam, i have to do bits & pieces for my project and for the med ball as well. but starting next, i'll be away for 5 weeks doing my paeds in limerick. so gentle readers, best wishes to all of u.

end of rotation ramblings

i'm excited that i'll be finishing obs & gynae tomorrow (clap)
i'm excited to go to the ball (clap)
i'm excited to be in different hosp next week (clap)
but i'm not so excited about tomorrow's exam. i haven't done much. aiyaya.. yeah i know. suck it up quitely. huh... (sigh)

a glimpse of what i'd miss

during the family gathering...

exam is just around the corner - and i go to bed early, pump up the adrenaline with high volume music. and i eat more. this is me dealing with the pressure & intensity.

pelik kan?? considering that i don't stay up!!

mengarut

i have an exam coming up at the end of this week & it weights quite a lot too. but the thing is, i can't believe it that despite having this embedded into my mind, i just can't seem to give it my all. and i know that after the exam i'm gonna whine & bitch like no other stating that i could've done better. it is frustrating when u know that ur not utilizing ur full potential. insyaAllah, i know someday, i'll get there by any means if i have to. but i just hope that it will be sooner rather than later.

i miss my nerdy@glorious days. mom would've been upset if she knows that i'm slacking around. sigh...

tough luck

there's no one left to finger... there's no one here to blame. take the responsibility & suck it up. people hate whiners. just deal with it.

lame

one after another.. a string of soapy love ballads.. and i'm taking about the old glam hits during the big hair days of siti, ella and fauziah latiff!!! hmm.... reminiscence of the past..

case study 2

mrs. L.H, a 30 y.o presented for an obstetrics follow up, 6 weeks post miscarriage. she was 10 weeks pregnant when she had the miscarriage. she has been off work since, and complains of joint pains and extreme tiredness. she is not on any medications. notice a decrease in her appetite with slight weight loss, stiffness on her joints and difficulty to sleep and her mood has been low since the miscarriage. she also wears sun block more often now when going out.

had a hx of seizure a year ago. family hx is unremarkable.

O/E: no obvious rash noted. joint stiffness and swelling of the hands + wrist bilaterally. heart examination is normal. no murmus. chest is clear.

others: hb is low, LFTs & TFTs is normal. ESR is markedly elevated.

questions:

1. what further questions that you would like to ask in the hx?
2. what is the most likely diagnosis?
3. what are the differentials that you would consider in this case?
4. what tests would you do to confirm or outrule your diagnosis/differentials?
5. how would you manage this patient?

p.s: this is a case that i'll be presenting later this week. so, those who follow my blog will have the first view. i'll post the answers within the next few days.

i don't even know what to say

just a while ago, i was reading an interesting entry by a fellow blogger. in that entry, he specifically pin points the fact that his first crush was a very popular singer. as a matter of fact, she is too well known, that i don't think she needs any further introduction.

dude... ur declaration is one bold act. but i dig it. u've just made my day. i'm laughing my f***ing a** off here!!!.

the irony of u & me

u ask what u can do and i don't know what to say. the needy part of me wants ur constant attention, it needs ur words, thoughts & ur prsence. but i know that is not the answer. the scared part of me wants u out of my life because it would be easier. the hateful part of me wants to hurt u because it thinks u've hurt me.

i will ignore u at times, i may be rude to u. i may hide from u and wait for u to reach out to me... so i know that u care. it's not fair to do these things, but i will... i cannot ask u to put up with this, it's not fair and no matter how hard i act, i care too much to put u through this. but u 've asked,... and this is all i have to tell ...

i write this for u. for u to read & ponder. though this is for u, but u r many people. u r the people close to me now. u r the people i want to be close to even though i've kept you away. u are the friends i've pushed away in the past, the friends that i've never had the chance to tell this to. u are also the people that i will care about until once again i push u out of my life. u are the part of me that is still trying to understand who i am. u are all of these people and many more...

but above all that, i need u still. so bear with me...please.

before the labour

patient: i have three names in my head: darren, daniel and george

midwife: i like darren

ilman aiman: i think darren is good

husband: yeah, we'll go with darren...

patient: but i want it to be spelled - D.A.R.Y.N instead of darren. the latter have too much "r" in it (bare in mind that the surname have lots of letter "r" too)

everybody disagree. we like darren. it's a cool name.

patient: oohhh ok... we'll go with darren then.


u see, in the labour ward. there is a lot of waiting. and it's a plus really if u get along with the patient and the midwives. my patient is just phenomenal. and her husband cracks me up everytime he speaks!! seriously, there was a time that i really feel like singing and dancing. the radio plays amy winehouse's rehab and everybody is doing their little gestures following the rhytm. it was a fun day with a fun crowd. and of course, the birth of baby Darren is just the perfect ending to close the evening. aawwwwhh

case study 1

from now on, i've decided to put up a case every now and then for the benefit of us all. this one is taken from jimbo's blog. so credit to the owner.

This 20-year-old Nepalese presents with 1 month history of cough and low grade fever.

CXR

1) describe the CXR
2) what is the diagnosis?









answer

1)

• a PA view CXR.
  
• Sightly over-penetrated as one can see the thoracic spine behind the cardiac shadow.
  
• It is slightly rotated, so the trachea position cannot be commented on, however, it is probably not deviated.
  
• The costophrenic angles are well visualised, indicating no effusion.
  
• The right upper and middle third of the lungs are hazy with multiple cavities of varying sizes seen.
• The mediastinum is not widened.

2) In keeping with common things being common, the obvious diagnosis would be an active pulmonary tuberculosis because:

• cavities are an indication of active PTB.
• there is no evidence of fibrosis.
• the history is suggestive.

huh...

things haven't been great. and i'm still mad. but, the look on ur face when i said that.. was priceless. demmm... i hate it when i give in so easily.

CHN

went to a neurology meeting. saw and learn 2 weird & wonderful cases, congenital hypomyelinating neuropathy and a query of parkisonism. l

on the CHN,

the patient, a 7 month year old baby presented with recurrent chest infections. pregnancy was uncomplicated. good fetal movement were observed. familh hx is unremarkable.

O/E : patient is very hypotonic but with good muscle bulk (no obvious wasting), muscle is stronger distally than proximally. reflexes are absent.

inv : nerve biopsy, nerve conduction study, lumbar pucture for the CSF.

management: IV immunoglobulin & steroids.

differential : spinal muscular atrophy, congenital muscluar dystrophy

CHN is a rare form of neonatal neuropathy that should be considered in the differential diagnosis of a newborn with profound hypotonia and weakness. also known as charcoat marie tooth type 4E. little is known about the long-term outcome of neonates presenting with CHN, but the neonatal form appears to be more severe, often leading to early mortality.

monday morning

this whole week, i'll be in the labour ward. =D, no more early mornings for this week... yeay

di manakah letaknya diriku ini... sehingga ku rasa sungguh asing sekali..

i think too much. i put too much thought when doing things. i ought to loosen up & be more spontaneous. it just feels more natural that way.