done with intmed

Alhamdulillah done with the internal medicine exams. next battle, surgery!! 

Another few steps n i'm done! ^^

Can't actually imagine how did i swallow all this for the past one week. miracle isn't it? it's medicine!!

# 13 days to my ultimate freedom!
# Day 1 of Ramadan

it's ending soon

The choices we make,
and the chances we take,
determine our destiny.

I choose to study,
and i'm taking this chance to study,
this is my destiny.

Ya Rabb, ease our way to reach jannah.
Keep moving and never give up!

I'm left with only 17 days to go to classes.
17 days is too short. make use of the remaining time wisely.
Robbuna yusahhil~

surgery and the exams

Next week genap 5 minggu posting in surgery. how time flies. i don't even get to feel relaxed and 4 weeks had gone. next week will be our first osce exam in surgery. the only thing i could say is, i'm scared! well, surgery had never been easy. as to what i had 2 years ago, surgery is a killer! i dont even remember what did i answered and how did i passed but alhamdulillah i did. and i hope i can do it once more this time.

InshaAllah i'll be taking my examination in the vascular department. but still unsure what exam are we taking. either general surgery or vascular only. but i hope it will be vascular only since we hadn't been posting in the general surgery department yet.

Since we're having our assignment on the same day, we hope and pray for the exam to be easy. or if we can postpone the assignment it would be much better. but the doctor won't allow that. he said it will be unfair to the other groups. but in my opinion either way, it is still unfair. unfair and somehow irrational for us to prepare for the exam and the assignment and take them both on the same day. but what can we do? even the doctor won't want to hear us out. i just don't know why.

Anyhow, may Allah make it easy for us for the upcoming exam and for the assignment presentation inshaAllah. All the best~!

How to prevent recurrent stye

If you tend to have a recurrence of styes, you may need to practice better lid hygiene. That means regular lid scrubs to remove excess germs and dead skin cells, which bacteria feed on.

1. Put a few drops of mild baby shampoo into a teacup of warm water and stir. Using a cotton swab or wash cloth, gently brush the soapy solution along the base of your eyelashes while keeping your lids closed.

Don't have time to mix baby shampoo?
2. Scrub your closed lids with a washcloth with baby shampoo in the shower. This shouldn't take more than 30 seconds per eye.

* Regardless of the technique, it is the mechanical rubbing that keeps the lids clear of cellular debris.

3. It is always important that you avoid contact of the eyelid with expired or contaminated cosmetics, dirty towels, or contaminated hands.

4. Pinpoint tenderness involving a few eyelashes can be an early warning sign of a stye. Frequent application of warm compresses at the first sign of an infection will speed resolution and prevent further blockage of the lid glands.

5. Recurrent styes may be associated with a chronic facial skin problem called acne rosacea. Your doctor or consulting dermatologist will be able to confirm the presence of rosacea and initiate effective medical therapy.

I have always had recurrent styes since august last year and right now i encountered them again n this time i have 2 of them in both eyes! The pain...... only God knows. Nvm dear, bear in mind it is Allah who give you pain, and He is the one who hold cures at the same time. Sakit itu penghapus dosa. Seek Him and find the cure. Semoga mata cpt sembuh. esok n lusa da nk exm. :(

Wish me luck n good luck friends!

Together we strive

In less than a year, i will become a graduate (insyaAllah). it felt like a dream. couldn't imagine how i survived 5 years in medical school. All the ups and downs, we managed to get through the obstacles... together. :')

InsyaAllah i will try my best for my final year. Lets try our best dear friends! Ya Allah, help us through. :)

physiological antidote

Lets see..... one of the important items in toxicology to be memorized are the physiological antidotes. lets just dig into some of it and start memorizing them. tomorrow will be the poison center session with Dr Laila. need to be prepared in case she ask bout them.

::PHYSIOLOGICAL ANTIDOTES::
Atropine sulphate --> ChEII, Early digitalis
1.Cyanide antidote (amyl nitrite, sodium nitrite, sodium thiosulphate) --> Cyanide
2. Digibind/ Fab fragment --> Digitalis
3. Heavy metals
- BAL (british antilewsite) --> Arsenic, Mercury
- EDTA --> Lead
- Deferroxamine/ Dasferal --> Iron, Aluminium
4. Methylene blue --> Methemoglobinemia (aniline dye, dapson, nitrites)
5. Narcotic antagonist
- Naloxone/ Narcan (short acting) --> Acute opioids
- Nalmefene (long acting)  --> Acute opioids
- Naltrexone --> Opioid addicts
6. N-acetyl cysteine/ mucomyst --> Acetaminophen/ paracetamol
7. Oximes --> ChEII
8. Physostigmine salicylate/ antilirium --> Anti-cholinergic

Fuhhh that was long. okay,,, quite long i mean. huhu.

Last but not least, sharing an oldies song to enlighten you after a torture of long antidote list. huhu --> No Surprise :)

surgical sutures

Alhamdulillah baru je tamatkn 3 sessions of BCS (basic clinical skills) and to me it was fun + beneficial for my future need. for today, i would like to share some of the types of sutures used in surgical suturing that i learned during my last session on last thursday.

we learned 6 of them, which are:-
1. simple interrupted suture
2. continuous suture
3. vertical mattress
4. horizontal mattress
5. subcutaneous suture
6. subcuticular suture

Here are pictures of how the sutures look like.....

1. simple interrupted suture

This is the most simple type and most commonly used to suture skin.

2. continuous suture

There are many types of continuous sutures but i only learned the first type.

Here another picture of it. if you look carefully the way of suturing this type of continuous suture will end up with an oblique like pattern on the surface of the wound. and continuous suture are mainly used to suture fascia where it need a tight suture with no gaps.

3. vertical mattress

Here is how to memorize the step for this type of suturing. we need to enter the needle from far and take the needle out from far too. then enter the needle from near the edge of wound and out from the edge of wound. so the spell is far-far-near-near. remember okay! ;)

4. horizontal mattress

Here is how the vertical & horizontal mattresses when look from the surface of skin.

In vertical mattress the suture line is perpendicular to the wound line while in horizontal mattress the suture line is parallel to the wound line.

5. subcutaneous suture

In this type of suture, the thread will not be visualized on the surface of the skin. it is hidden within the subcutaneous layer of the skin.

6. subcuticular suture

In this type, it is only used in a surgical wound and cannot be done on a contaminated skin wound since surgical wound has a smooth wound line while in traumatic wound the wound line is irregular.

There are a lot more suture types but those are all what we learned during our BCS session.

Here's another knowledge, you cannot simply hold a surgical needle by hand but you need a needle holder instead. here is how to hold a needle holder. one ring for the thumb, one ring for the ring finger and you have to put your index finger on the shaft of the needle holder to stabilize it. this is the correct way of holding a needle holder. 

As you can see, there are many types of surgical needle and threads. each has its own special function. 

Types of surgical needles.

Types of surgical threads.

While this is the needle and thread i used to suture during the BCS session which are the polypropylene, blue in colour and silk, black colour. the type of needle is round and cutting needles.

Last but not least..... my version of surgical suture! hehe.

Lastly, wanna show a video on how to tie a surgical knot using one hand. it is wise to know since it is the fast way of knotting a suture and usually used in the emergency unit.

Goodluck to all doctors to be :)

the baby with beautiful big eyes

The boy i met today was TOTALLY CUTE! his eyes i admired the most. so bulat woo! and the way he stares with those beautiful eyes... so innocent n cute. hehe.

Dear baby, may you live a wonderful life even though a part of you is sick. being sick doesn't make you weak. so stay strong baby! if you can lived up till now, sure you can make it to the end. don't give up on life. find miracles in it instead =)

lots of love from dukturah hans <3

tropmed

Wahhh lame gak x update sweet potato ni ye. huhu. sorry sweetie, i don't have stories to update n quite not into blogging anymore. huhu. mungkin sbb da xberapa nk bersedih-sedih kot. coz i like blogging when i feel sad. hahah :D

Btw, last semester's result already out. guess wut... i need to repeat my tropical medicine paper. i got D for that with short of 2 marks below passing grade. =( very disappointed with myself. hmmm... nk menyesal skg pon da xada guna. bende da jadi. hhhhmmmm~ nvm, myb it's time for me to wake up from my sweet dreams and start putting more efforts on facing the challenges in the world of medicine. hehe

"apakah manusia mengira bahawa mereka akan dibiarkan hanya dengan mengatakan 'Kami telah beriman,' sedang mereka tidak diuji?"

so meaning ujian Tuhan itu perlu untuk menguji hamba-hambaNya. Allah menguji kita kerana Dia syg pada kita. lagi byk ujian Allah turunkn pd kita, lagi byk rahmat serta pertolongan yg Allah dtgkn bersama-samanya utk kita. jadi usah gusah atau bimbang bila ujian Allah itu dtg menimpa kita kerana pertolonganNya juga pasti ada utk kita. maka apb kita ditimpa musibah atau kesusahan marilah ucapkan, "Alhamdulillah, Thank You Allah krn mengasihiku" :)

gudluck dear, Robbuna Yusahhil ^_~

obstetric surgery

Today we had an operative session in the O&G department.
Alhamdulillah, we got to see 2 cases..

CASE I - multiple myeloma of the uterus.. SIX! myelomata of different sizes were dissected from the patient's uterus. Poor patient. She even got a huge myeloma in the anterior wall of the uterus that seen bulging to the outside. Hopefully she can get pregnant again. she looks young. but the doctor said, she may has a familial predisposing factor due to the multiplicity of the myelomata and recurrent rate is high up to 80%. hopefully she'll be healthy always after this and that she will not get any recurrence.

CASE II - vesicular mole.. Poor patient. she got twin boys after doing ART (artificial reproductive technique) but she got molar pregnancy and was forced to terminate her pregnancy. After the doctor cuts open her uterus by C-section, two fetuses still alive! were delivered. unfortunately the babies will not survive outside at this age (16weeks of gestation). im sorry for ur lost dear mummy of the twins. myb Allah love them more. be strong! :)

two interesting cases seen today. hope to get more interesting cases next time, insyaAllah

OMG?

Finished with surgery and internal medicine. Now i'm entering the next posting. OMG ONG...
or to be exact, Obstetric & Gynecology
This means you are one step closer from being a real doctor. so scary!

Doctor: What do you think of Obstetric & Gynecology?

Student A: Bloody field
Student B: Difficult
Student C: Tough
Student D: Difficult but interesting

Doctor: INTERESTING! O&G is interesting. You can appreciate how ALLAH create human being. How HE bring them into this world.

Subhanallah..

There is noting easy in this world. But despite of that, there are still people who succeeded in life. It is not the matter of how easy or how hard is something, but how you put interest in it..

Wallahualam..

-----

Some terms to be revised and mastered: 

1. eumenorrhea - normal menstruation

2. hypomenorrhea - small amount of menstrual bleeding

3. menorrhagia - excessive menstrual bleeding

4. oligomenorrhea - infrequent but regular menstrual cycle per year

5. polymenorrhea - more frequent regular menstrual cycle per year

6. amonorrhea - no or delayed menses

7. metrorrhagia - bleeding not related to menstruation

*take note n don't get it mixed up!

aja aja fighty!

occult carcinoma

Here are the sites for occult carcinoma:

• Supraclavicular

1. External auditory canal
2. Maxillary sinus, paranasal sinus
3. Nasopharynx
4. Oropharynx (posterior third of the tongue)
5. Hypopharynx (pyriform fossa)
6. Thyroid gland (the papiilary type)

• Infraclavicular

1. Bronchogenic carcinoma
2. GIT (stomach, esophagus, colon)
3. Kidney & suprarenal gland
4. Prostate, ovary, testes

Baik kawan2, hafal ye. huhu

source: Buku Maher Zeiny part I

mind ur step!

step..step..step.. surgery on the list~

helo guys~!
One question... ... ...

Have u ever heard about the recurrent laryngeal nerve before?

this crucial nerve that lies somewhere in the area of our neck is a branch of the vagus nerve that supplies motor function and sensation to the larynx which is also known as the voice box. so frankly speaking, this nerve is important for the process of producing voice!

so why am i suddenly bringing up this topic?

This' bcoz the nerve is best known for its importance in the thyroid surgery, as it runs immediately posterior to this gland. So surgeons to be, remember diz... while performing the total thyroidectomy, pleeasee plis pliss! take care of this one crucial nerve okay guyss :)

injury to the nerve will cause trouble to ur patients..
if it happens to be a unilateral partial injury to the nerve, then ur patient will come with dyspnea (difficulty in breating) as only one side of the vocal cord is functioning, interfering with the air flow into the lung.

if the injury is bilateral partial injury to the nerve, then ur patient will suffer from chocking or stridor.. and the only way to manage is to perform a tracheostomy to allow the air flow.. if not, say bye2 to the patient!

if it is a unilateral complete injury, then the patient will suffer from dysphonia (difficulty in speaking) as only one vocal cord is intact..

and if it is a bilateral complete injury, then the patient will be in the state of aphonia! bisu oke~
as both vocal cords are in the cadaveric position ++ no vibration of the vocal cord --> meaning no voice produced!

If u accidently damage this nerve during surgery, pity on ur patients to suffer such a bad ugly outcome..

owaiz remember wut Dr Ayman said today..

primum non nocere which means DO NO HARM!

orait surgeons :)

p/s: Dr Ayman.. is it okay if i do the rehearsing by writing it on my blog rather than do the talking?? ngee :D

internal medicine in memory

fuuuhhhhhh~~~~ ALHAMDULILLAH! at last... i can finally say.. "osce is overr!! relex n enjoy!!" huhu.. but not for long.. surgery is expecting my arrival to open a new chapter in the book of medicine.. hence, making all those moments in the internal medicine as an unforgettable memories.. surely im gonna miss all those funs.. but yet hoping not to lose even a single knowledge gained!

and here comes the story behind the 'fun playful' osce:

first spot with Dr Perihan :: taking pulse
my comment: regular, 80 beats per minute, normal force & volume, no special character, unequal with slightly weak pulse on the left side, and the vessel wall is not felt. dorsalis pedis & posterior tibial are both felt. (and she went.. gud, gud) *happy2*
second task i was asked to palpate the carotid artery... ops2!! i've done it wrongly.. my hand was like dancing all over the patient's neck searching for the artery but failed! =.=" (thank god the doctor was kind to give me chance).
and the best part.. she gave me full marks! she even showed me my marks.. huhu thank u doctor for the full marks.. luv.u.doc! <3

second spot :: inspect the lower limb
the first thing i comment, there's LL edema. and the doctor goes, "okay. but u hv to inspect"
silly me, how do u know it's LL edema juz by inspection.. u shud palpate for that.. huhu
and here's another story.. after i'd finished commenting on my findings and while the doctor was busy giving marks, i noticed the patient was giving a non verbal signs telling me bout his amputated right leg.. the most important finding i shud comment on but didnt.. hahah! thank u my patient for ur help.. hope it'll improve my marks a bit ;)

third spot :: examine the thyroid
the first worse spot ever! first question from the doctor.. what is the item of examination? i answered, "inspection, palpation and auscultation." and then i started to examine the patient.. while giving the comment, the doctor asked, "how do u know it's the thyroid?" ... i answered, "by asking the patient to iblag (swallow)" ... and then the doctor asked sumtin (i can't remember wut) which made me went blurr *ting tong* and then he said, "u forget to mention about percussion" (gud hint there) but still im in blurness~~ only after the xm i noticed that he was asking me to percuss the upper part of the sternum to see if there's enlargement of the gland extending to the mediastinum.. argh~!! hate it! hate it! hate it!

fourth spot :: auscultate the mitral area
my comment: muffled S1, pansystolic murmur, radiating to the axilla. "what is ur possible diagnosis?" .. i answered, "mitral regurge" ...(doctor nod2)...  "what are the causes of systolic murmur?" actually, i didn't really get the question.. and so i juz stand there blankly staring at the doctor without answering.. i shud hv asked him to repeat the question!! and now im regreting for not answering it.. u knew, but u lost the chance to answer..huh!

fifth spot :: inspect the back
not much of a story to tell.. it went smoothly, but still worrying about the marks... nice doctor, giving points to comment on, but bad me for not mentioning all of them =(

sixth spot :: acromegalic patient, inspect the face, hand and feet
the first comment i gave, slight slanting of the forehead.. suddenly the doctor asked, "why all of u gave the same comment? there's no such a thing of slanting of the forehead.. from which medical book did u get this term?" errkkk! "i dunno doctor, but this is the knowledge we got during our preclinical year." "wut?" "yes, the doctor from our preclinical studies told us this" and the doctor when.. "hmm..." ....but actually it's true, the doctors of internal medicine never once told us this point.. it's juz us making use of previous knowledge clinically.. huhu... but still im confused~! why taught us points that not even exist?! 0_o

seventh spot :: papate the spleen
nice spot... with very direct question.. and altho my comment was not 100% completed but still the doctor gave me full marks!! yeay! alhamdulillah, thank u Dr amani~ :)

eighth spot :: inspect the abdomen
the first item to comment is the shape... but unfortunately i lost my words! there was quite a long silence with me doing some stupid movement of my hand hoping that the word im searching for will immediately pop-up into mind.. haha.. even the doctor assessing started to pray "a'uzubillah himinash syaithonirajimm".. huhu.. but alhamdulillah not for long after, i managed to find a suitible word to describe.. fuhh~ *relieved!*

ninth spot :: auscultate the chest
hate this spot! there's too many mistakes i've done.. after reading the task, i went... BLURRRR!!!
i juz stood beside the bed looking at the patient's chest but not knowing wut to do.. and then suddenly i started to palpate for his apex?! for wut??? it's not the heart u shud examine, it's the chest! haha.. after quite some time, i realized im doing the wrong examination.. i immediately started auscultating his upper, middle, and lower lung zones trying to hear for the breath sound, any wheezes or crepitations.. after i felt satisfied with my findings i went to the doctor who's face was s00ooo horror oke.. not even a little smile present.. after commenting on the breath sound and the wheezes, he asked.. "wut about the vocal resonance?" AAaa~!! i forgot about that part of examination..!! *frust2* quickly running back to the patient, and do the xm.. then went back to the doctor and said.. "increase".. haha.. actually i dunno if the answer was correct or not.. bcoz i lost my focus and cannot interpret wut i heard exactly... hmm, at that state forgetting a step in an examination do add up my nervousness!=.="

tenth and last spot of the day :: taking history of jaundice
when i looked at the assessor... Dr zed?! i was like.. im dead meat! i remembered the time he assessed me during the long case last time.. it was horror!! asking to auscultate the aortic area.. so not knowing wut i heard.. but this time, alhamdulillah.. his question was quite simple and i managed to answer it.. but still im worried of my marks coz i caught my eyes looking at the marks of my friends previously assessed by him.. not even a single person got full marks.. even worse sumone got not even half of the full marks! oho doctor, pilzz be generous to me.. plizz, plizz..

and at last... fuhh.. i managed to call it a day! =)
now, im looking forward for surgery.. those who had juz finished their surgery exams said the exams was so sO SO hard! uhuk3 takutnye! but insyaAllah i'll try my best... 
chaiyok2 my dear friendss.. let us together fight to be the best future doctors graduating from alex.. aminn~

~salam maal hijrah~