hari ni, keluar 7.20, naik bas 7.25 pegi town. then sbb awal lagi, ingatkan nak cucuk duit jap, so, tak kisah la bas no. 10 dh pegi pun... tengah jalan2 nak ke S.I, nampak bas no.10A... tgk kat depan mcm pegi mahon point. so cun la ni.

naik jap, dlm hati mcm takut2 kalo die ikut route lain.. then lepas gerak, lalu gardai building tu, dlm hati lega skit. benti jap kt traffic light. then tgk2 instead of pegi terus, die pusing masuk selekoh kiri...

dlm hati dh nyumpah2 dh, so budget turun next stop.. rupenye next stop die jauh giler ok!!! masuk highway mana tah... so terpaksa jalan kaki all the way and turn to the corner yg nak pegi S.I. 15 minit ok jalan! sakit hati betul. dari budget awal terus jadi lambat..

seb baik tutorial worth it la. buat practice role play short cases: byk gak kaver,
- expressive dysphasia
- myasthenia gravis
- ataxia
- thyroid eye disease
- leg ulcer
- parkinsonian features
- ankylosing spondylitis
- DVT

then gi amik hx haematmesis. hx die menarik tapi patient tu mcm a bit deaf. so die x dgr sgt aper yg kitorang tanya. but all in all, rasa mcm banyak blaja hari ni biarpun insiden pagi tadi sgt menyusahkan diri!!!

n ohh, my bas pass mcm dh nak expire dh... x best nye, x leh nak naik bas sesuka hati lagi.. dush2..

a picture that paints a thousand words

and i want it for all the wrong reasons. where's the sense in that?

hari ni sgt best. initally mcm x nak dtg, then yesterday, bernard ckp nak buat tutorial. so dtgla jugak. alih2 lepas grand rounds, cancel pulak.. x dpt nak book room.

sbb still awal lagi, dlm pukul 8 lebih, then pegi la staff canteen, breakfast jap. kat situ, jumpe kak wan dgn haizlin. borak2 pasal nak final, then tanye pasal interview, tanye ok x kalo jadi intern kat sini next year, pasal gaji, pros and cons sumer...

then, jumpe fadri, mintak patients. amik hx pasal PE. seriously, hx taking ni la antara yg best, bukan sbb dpt elicit byk points, tapi sbb asyik gelak jer sepanjang amik hx tu. pakcik tu mmg cool!

then pegi cari patient yg ade chest signs. case pleural effusion, dgr crackles, wheezez in 2 patients. then pegi jumpe patient lain, die dtg sbb angina attack tapi skrng dh stable skit. so buat praktis la mcm2 exam kat die. buat CVS, respiratory, and peripheral nervous system. pakcik tu pun best.

all in all, hari ni mmg sgt best. cume balik tu penat skit n xde mood nak masak.

cinta

Cinta - Nikki

i like this song. it's a simple, uncomplicated song without the typical melancholy of a soapy love ballad. plus, it is soothing to the ears. this song is certainly growing on me.

siti

baca paper, nampak pic siti ni..

honestly, i'm not in any way supporting the way she wears her head scarf but in this pic i think she looks adorable. like a korean actress...

the new ESB bill is up the roof !!! how on earth are we going to pay for it???

seriously!!

did quite a few things today. first up, took a history, the patient has prostate cancer but now present with an epigastric mass & diffuse abdominal pain. initially, we thought, it is a metastatic liver condition but turns out that the homogenous mass covers a lot of the liver area when we looked at the CT scan. so most probably it is a primary hepatocellular carcinoma.

then, another interesting patient who has wegner's granulomatosis. he has a bilateral sensorineural hearing loss. he is in his late 30s and now use hearing aids on both ears. usually WG affects the respiratory tract and renal function. he is admitted following acute abd pain and had a hx of perforated bowel before.

then, with bernard, i was instructed to examine a parkinsonian features. kelam kabut la jugak walaupun penah buat. the whole group bursts out laughing because i made a few embarrassing mistakes during the examination.. heheh

then, some of my fellow classmates complimented on the pictures that we took on saturday. u guys look cool !!!

i could write a whole lot more, expressing issues that i think is worth while.... but i choose not to. i could've done so much more but i choose not to. or i could bitch, whine and complain like no other but i choose not to...

sabar sabar ilman aiman.

shuffle

the new 3rd generation ipod shuffle with a capacity of 4GB is now on sale for RM 304 !!
yeay !!!

i've just watched the latest episode of grey's anatomy. it's a bit sad to see izzie leaving the show. i think the producer just wants her out immediately. if not, then why on earth was she scripted to have a 5% survival rate with a stage 4 malignant melanoma that has mets to the liver & brain?

and oh talking about melanomas, i haven't really seen one up close. not in my rotation anyway. maybe there are some in the hospital but unfortunately, there are under different consultant that i'm not attached to.. but in the surgical wards? hmmmm

bernard is away atm.. so i didn't do much. saw a patient, talk a bit, didn't even take a full hx.. huhuh, and i left during lunch time. apparently today is the last session for dr Bennet's tutorial... what will i do now on Thursday evening?? i'm gonna miss the radiology part the most.

went to the gym today. tunggu bas number 8. haih, lama pulak, dkt half an hour!! because i played diablo 2 yesterday n didn't study much, i felt the urge to do a little bit of reading today. so, in between my workout, i spend a good few minutes reading the oxford handbook, hahaha!! rasa sedap sikit la hati sbb study...=P

n my presentation still x siap lagi. stuck a bit dkt the result section. x sure nak regurgitate everything ker, nak put up only some information n said the rest during the presentation itself?... hmmm

lagi satu, internet xde the whole afternoon!!.. so balik pegi tido sat, bangun still xde!!! dkt pukul 8.40 mlm baru ade n this is practically the first thing i do. i blog, =)

yesterday was tiring. got home, slept for 2 hours and i played diablo 2 for the rest of the night!!! anyway, mikail baked blueberry muffins and gave us some yesterday. the muffins look like the picture above and they were seriously good!! nyum nyum.... they were supposed to be for sarah's birthday but turns out her bday is next week. lol

presentation

after 3 weeks of hiatus, it's a bit difficult to start on my power point. i have to reread back my printed fyp since i'm having a bit of trouble recalling the important bits of my project.. tsk tsk

unwell

i just feel like lying in bed doing nothing..... but i have back to back surgery tutorials this morning... arghhh!!

thursday evening

i went to dr B tutorial just now. of course, the radiology was brilliant as usual but the most entertaining part was during prof presentation. he talked about stem cell and how it would be useful in diabetic patients. and during the end of his speech, there was a heated debate between himself, dr B and some of my outspoken colleagues. as u would have know, stem cell research is a controversial issue and the arguement to and againts the research are not without their limitations. but the funny thing is that everybody was very firmed with their opinions and none of them want to back off!!! they are old indeed, highly educated with a lot of experience in their pockets but the common denominator is that all of them are stubborn!. their ego practically fills up the room!!

and hands down, watching them argue againts each other is by far my favourite part of the tutorial. they can just argue and not teach for the whole two hours and i'm not gonna complain. and as a matter of fact, they'll have my full attention. i'm all eyes and al ears for that!

this is an excellent revision book for both medicine & surgery. i have it for months but only recently started to read up on it. the basics are well covered with a little bit of extra bits for brownie points. highly recommended especially if ur not into thick text books.

words from the wise - strong as an ox but twice as intelligent... are apparently what u need to become an orthopaedic surgeon.


huahuahuahua

case study: status epilepticus

56-year-old man presents with status epilepticus. According to the family members, he was diagnosed 6 years ago with epilepsy when he presented with the first episode of seizure. He was subsequently prescribed anti-epiletics but continued to have episodic seizures despite being adherent to his medications. Like many similar patients, no EEG was ordered nor a CT scan of the brain done for him. There is no family history of seizures nor does he takes any drugs, alcohol or traditional medications.

When he was more lucid, other than being of slow mentation, there were no other focal neurological signs.

questions:

1) comment on the CT scan
2) what is the next course of of action?





answers

1) There is gross hydrocephalus, suggested by the dilated lateral ventricles as well as the 3rd ventricle. The fact that the latter is dilated as well suggests a block in the connecting duct between it and the 4th ventricle (the aqueduct of sylvius) or a generalised hydrocephalus. There is also an irregular lesion in the right frontal lobe, with density between that of brain matter (grey) and CSF (black). This might suggests a tumor.


2) The immediate action to take is to alleviate the raised intracranial pressure. A neurosurgical referral should be made for a VP shunt to be inserted. Later on, investigations should be done to identify the cause of the hydrocephalus, which in this case is most likely due to a brain tumor.


*credit to jimbo*

knee exam

buat knee examination, jadi the chosen one to do it first, isk isk... hbs la terkontang kanting, x reti buat... but bernard corrected me. so in the end, insyaAllah dh tau skit cmner nak buat knee examination.

dgr citer, knee examination is important in surgery utk final med. nak assess ligament yg injured itu. this is especially important for sports medicine. a few interns ckp diorang dh kene n bernard pun asyik remind supaya practice and make it look like u've done it before..

basically, the knee examination is more or less similar to the one demonstrated in this video. and at least for exam purpose, please read up on ur knee ligaments!!!

not ready to make nice

Not Ready To Make Nice - Dixie Chicks

I'm Not Ready To Make Nice
I'm not ready to back down
I'm still mad as hell and
I don't have time to go round and round and round
It's too late to make it right
I probably wouldn't if I could
Cause I'm mad as hell
Can't bring myself to do what it is you think I should

mock xm

i had my mock exam just now. ingatkan kene next week, but then sarah bg tau that bernard wanna do it today. so i was caught a bit off guard la. and i went in unprepared... okla, sempatla tgk certain chapters yg i think penting...

n the exam went ok. dpt case appendicitis. bernard will always give good feedback. i adore him for that. he will try his best to keep u motivated. but what i like the most was when the patient backed me up. he said that i know a little bit of everything and i will be a good doctor~~ heheh, terharu jap especially the part where my patient intentionally help me to answer some of the questions. since bernard was looking towards me for answers, the patient at the back gave out many signs and gestures indicating what he thought was the correct answer.. sweet kan.. hahah

and of course bernard loves the fact that i bonded well with the patient!!!

i'm not feeling well actually today. initially, i feel like skipping the whole Thursday and stay in bed sleeping but yesterday, Bernard said that he's going to talk about murmurs today since two person were missing yesterday. he wants everybody to be there.

and oohh, i saw her. after all these months, i still hate her. she's evil!!! she made my 2nd rotation a misery!

things to do before i turn 25

since i'm turning 25 next month then what the hell..

1. i would love to be debt free. u see, i spend a lot and buy a lot of things that i seldom use. i use my cards like almost every time i go out. damn those impulse purchasing!!
2. i hope i can get better grades. if i get grades like this when i was in high school, i'll probably shoot myself and die. it is embarrassing. but knowing that i'm in final med and at least a third of the class is getting more or else the same grade, then it's a bit comforting.
3. i honestly feel that i need to learn how to play at least an instrument. in my eyes, musicians are sexy!! my brothers play the drum and the guitar. my sister is a good pianist. and me, unfortunately i'm not musically talented.
   
4. i really need to be in love, like seriously dangerously to die for in love. get dumped. and fall in love again with a better girl who is going to be my future wife. it's all about the right timing. past encounters are of no use. i walked away too early
5. i know Liverpool has a slim to nil chance of winning the premier league. but i hope MU will not win it either. it's so annoying seeing them taking it all. i know i'm going againts the odds here. even if they do win the league, i hope they'll lose on other encounters.
   
6. i need to brush up on my presentation skill. i'm amazed at some of my peers who are very fluid in their delivery. sometimes, it doesn't really matter what u say but how u say it is more important. me... i talk too fast when i'm nervous. that is not good.
   
7. i wish i can just go out there, take the next plane and go to somewhere exotic. but surely, in the right state of mind, this isn't possible.
   

having said all of these, i know, when i turn 25, most probably i'll ended up not doing the things that i've mentioned above. so, why bother jotting it down then? just for the fun of it i guess plus to fill up some empty gaps in between my next entry. :)

snow

setelah sekian kalinya, snow dgn begitu lebat melanda bumi cork!!!

pagi before keluar, jenguk2 window... fuh... byknya snow! habis all the grass dkt halaman kene cover with snow, and the cars, the top part & bonet pun diliputi salji.

then, on the way nak pegi bas station depan rumah, budget nak naik bas 7.25 pagi, tapi kuar dlm 7.20.... dlm hati rasa mcm bas dh lepas jer... huhuh. before sempat sampai tempat tunggu bas tu, ade kereta pull over, tanye, nak ker S.I ker?.. heheh, angguk, n die ckp masukla.. =), oh itu kereta dr syuk ya.., dlm kete pun masing2 sembang pasal snow. everybody was excited about it.

then, masa dkt S.I, keluar jap, nak pegi town.. biasela.. gap between tutorial lama, so apa lagi... then on the way jalan tu, a heavy snow turun!!! rasa mcm best giler. like a wark in the park when i was in Amsterdam ( sbb pegi time2 bulan mac jugak!). it was snowing for a good 20-30 minutes jugakla... rasa mcm nak amik gamba. tapi jalan sorang2 la pulak. malu pun ade..

oh, before i forget, yesterday, when i did my hx taking with this one patient.. he looked out the window, it was raining a bit and he said to me & yopit.. i think it's gonna snow tomorrow!!. and tup2, mmg snow pun hari ni... then, i saw him again today at the corridor. i said, u were right mr. it is snowing!!! die pun ckp.. i told u, didn't i!! heheh, and somewhere close to the main entrance, nampak pulak dr hewitt dgn his former spr (norin). ape yg diorang buat dkt S.I ek??

kene tegur dgn landlady lagi semalam.. sigh

asal la aku yg rajin bukak pintu.

die ckp nak hire orng clean the walls, or possibly repaint them. huhuh

anyway, this week is my anest week. but i went to the theater for only an hour. couldn't find the consultant. stuck with the reg i think, and he left me after 20 minutes. so aper lagi...

isn't it funny that we always have the answer to other people's questions but not our own...