Tuesday, March 29, 2011

Dr in Action : Ortho last history taking


                                                                     ~~~~cASuALty ~~~

Yang nie Coolie`s fracture. Makcik2 selalu kena...Dr tengah buat traction.Tapi, kesian kat makcik...Dr tak kasik anaesthetics pun..


                                                                  ~~~ ward pulak~~~~

                                                                              / X D


29 Mac 2011,

Case : Wrist joint deformity

Chief complaint : Pain and swelling around wrist joint.
Atuk nih best...kelakaw... Tangan kanan ada ketumbuhan( ermm, bony irregularity..tak tahu nak kate ape)

Atuk ni tak boleh nak extend wrist dia. Tangan macam dinner fork deformity.

Seronok amek kes atuk nh. Sangat cooperative. Suruh buat banyak kali pun tak kesah. Siap gelak lagi. Agaknya seronok dapat doktor muda. Dah macam cucu pun. Atuk ni mesti tak ramai pelawat. Bila dah kena serbu ramai - ramai, pegang sana sini..sonok la dia.


                                                  (*V*)~~~~~(*V*)~~~~~~~(*V*)

30 Mac 2011,

Hari terakhir untuk ambil history patient.

30 year old male..'Anne' tu kena skin traction, tarik tullang kat sendi lutut..
A male, 30 years old with knee joint swelling.

Pain and Swelling around knee joint.
No local rise of temperature.
Bony irregularity present.
Onset : insidious.
Pain : cramp like pain,non radiating,non progressive.


Hypopigmented patches present.


No sinus, no discharge.

Kemudian, kena turun jumpa Dr JP shetty...Shetty memang sangat femes kat sini...Kena present case depan dia. Adeh, dengan bangunan sebelah under construction..Memang bising betul OPD Ortho.....





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Monday, March 28, 2011

Mitos vs Fakta : Angin dan Gas


Di suatu petang yang hening.







Ani! picit kaki mak ni... !!!

Ani pun lekas-lekas turun dari bilik menuju kerusi rotan di ruang tamu rumah rotan pusaka nenek sebelah ibu.

Kenapa mak?

Alahai...kaki aku nih sakit lagi. Bahu pun sama. Angin lagi lah nih... Kau tolong picitkan kaki aku nih. Selambe Mak Mawar .

Bila di picit-picit orang tua tu..mulalah keluar 'angin'... Kadang-kadang angin kecik dan tak banyak. Tapi bila dah picit tempat yang seakan-akan kembung, Mak Mawar pun kata, Hah, picit situ!!! Kuatlah siket Ani oiii...katanya sambil sendawa kuat. Kuat sendawa tu sampai dengar Abah kat kebun belakang...Sendawa belahak, macam naga pun ada.Macam katak kodok nak mengawan pun ada. Anak dara di larang sama sekali buat begitu. Sungguh pantanglah....Orang tua pesan tak sopan!

                                    ~~~~~~~~~~~~ Tammat ~~~~~~~~~~~~~~
(-____-)"hmmmm....


Angin nih wujud dalam masyarakat Melayu dan Cina aja. Setahu BAyu, orang India atau Mat Salleh takda pun istilah ANGIN nih... Kalau takat GAS yang datang dari perut dan dubur adalah. Takda pun ANGIN dari otot atau urat. Logiknya macam tak masuk akal. Tapi, bila dah ilmu perubatan nih... Memang susah dah nak percaya tradisi dan kepercayaan masyarakat yang dari dulu lagi diguna pakai.

Susah juga nak percaya pada jamu dan bomoh. Sedangkan kita dah ada ilmu perubatan dan ubat-ubat yang terang dan jelas apa,bagaimana dan kenapa kesan dan akibat yang berlaku.

Tapi,hidup di dunia nih penuh misteri. Kadang-kadang ada juga keajaiban yang berlaku dalam bidang perubatan yang tak dapat dijelaskan oleh akal manusia. Manusia punya HARAPAN. Misteri dan keajaiban adalah rahsia Tuhan. Cuma terpulang pada kita menilai apa yang di depan yang ada di depan mata dan menghayati pengajaran di sebalik KEAJAIBAN dan MISTERI ALAM.

P/S: Habis jugak satu entry buat mengisi masa lapang dari ward ortho.

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Friday, March 25, 2011

Dr in Action : Orthopaedic posting la pula...(-_-)



Ortho?

Apa alah ortho nih?

Ortho ialah satu cabang perubatan yang mengkhususkan tentang tulang dan tisu di sekelilingnya.

Yup, tulang. Kalau korang pernah merasa patah tulang kaki atau tangan,mesti pernah dok kat hospital untuk sebulan dua bulan.

Entri kali bukan nak citer banyak-banyak. Korang tengoklah apa yang ada kat sini.

Kami stat posting mula feb aritu. Dah tamat 3 minggu. Tinggal seminggu aje lagi.

Dari hari jumaat lagi takde kelas. Kami kena duduk lat OPD. Dr sume sibuk dengan exam nurses sampai ari nih. Adeyh...Benci betul menunggu. Rasa cam menunggu kucing bertanduk lah pulak.



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Saturday, March 5, 2011

ENT : End Posting Part 1 and 2




Just to be brief :(yelah tue..)

My end posting for 6th semester is divided into two.

I sat down and wait for the Dr to finish the inspection on patient in small cramped OPD by 11 am.


Part one ( Instruments ,X-rays and Viva)


me alone

Dr: *smiling* How do you ask the patient whether he/she have an ear pain..............in Kannada?
Me: Dumb stucked! Errmmmmmmmmmmm.............*blink-blink*
Dr: How to ask "do you have ear pain?" in Kannada? Again and again...
Me: Half geleng-geleng...Ermm Sir,i forgot sir..

A patient came to OPD. He went to check her.
I to think very hard....and.....

A moment later,

Dr: So?
Me: Ermm... Aunty, Illi (sambil tunjuk telinga) novu untha?
Dr: hahahah.....Okayh, but the right word for this(telinga) is Kivi = ear in Kannada.
     So, it is like this, "Kivi novu untha?"
Me: sengeh...

Next,

Dr: what is this?
Me: It is a laryngoscope.
Dr: mention it uses..
Me: for direct laryngoscopy in emergency cases in airway obstruction or difficulty in deglution.
Dr: Okay, Any other uses?
Me : It is also used in biopsy and sleep apnea emergencies.

Dr: Tell me what is this and mention other types of this instrument.
Me: it is a tracheostomy tube. There are other type too.For example, metal and plastic tube. The metal tube have two type.One is Jackson`s tracheostomy tube and the other one is Fuller's tube. The plastic tube are also called as Portex tracheostomy tube.
Dr: Tell me the disadvantages of this plastic tube.
Me: well, it has only one tube which makes cleaning the tube to be more difficult.In case of airway block or obstruction to the tube, it is hard to remove it.
Dr: Any other disadvantages?
Me: *blink-blink*
Dr: Well, what happen if there is massive pressure by the tracheostomy tube?
Me: it will stimulate the baroreceptor causing hypotension?*grin*
Dr: Yes, but it also can cause something else.
Me: *Blink-blink*
Dr: Well, it can also cause oesophageal mucosa necrosis due to massive pressure for  very long time.
Me: BUt, sir it wont be that hard right? ( Nada tak puas hati )
Dr: Yeah, for a period of time, high pressure on the neck can cause mucocal necrosis.
Me: Setuju ajelah..

Dr: Okay, tell me what is that?
Me: Its a plain x ray, lateral oblique view, showing the mastoid, the cervical vertebrae and the mandible.It also shows the external auditory canal.
Dr: Now, what do you see?
Me: The x-ray shows the pneumatised air cells surrounding the meatus.
Dr: Good, so how many types of of pneumatisation of the air cells.
Me: Cellular,accellular and diploic.(Diploic = both sclerosing and honeyconb air cells)

Dr: Good...Thats all, roll number?
Me: 63 sir. Saying it joyfully....

Part 2 ( presentation of case history)
Me,Miss R,Mr S


Dr: Well,present the case.
Me: A patient came to the hospital by the name Bhavya....bla..bla...
Dr: Okay,(cutting me midway)..tell me positive findings..
Me: There is mucoid discharge and small perforation in the tympanic membrane sir.The mucosa is congested.
Dr: Tell me what is he having.
Me: An ear infection.Probably chronic infection.... (Baru teringat , patutnya cakap Otitis media with effusion, OME..Cess!!!)
Dr: So, tell me what is inactive written is your report here..
Me: Erm..it means no discharge.
Dr: Yup, but is there any particular duration for dry ear with perforation?
Me: (alamak...ape nih? Ade ker dry  ear...tak pernah baca pun????)
Dr: Okay, it is in inactive stage.Tell me other stages.
Me: Huh? *blink-blink*seyes tak tahu...
Dr: Ms R, Mr. S...is there any particular duration for dry ear?
Miss R and Mr S : We dunno Sir..
                            Sambil geleng-geleng..Owh, mereka pun tak tahu.Selamat aku...(-__-)''
Me: Sengeh...dan sengeh.... atas kepala nampak bintang-bintang
Dr:  This is baddddd....How come you dont know?
Me: Ishhh..sir, tulah..mane tau mende tue...kan belajar maser 7th term..sape suruh buat maser 5th term? *blink-blink*
Dr : Tell me the management for this case.
Me: Give a local and systemic antibiotics..culture of the pus and audiogram to assess either it is a conductive type deafness or a sensorineural deafness.
Dr: Okayh, go..!! Roll number?
Me: 63, sir...Saying it reluctantly...


Arghhhhh...dah ler last posting ENT... Slack pulakkk lerr time hujung sekali..Viva and instruments dah lepas. Sekali, ini tak lepas pulak...Adoiiiiyaii....


Moral of the story, read the WHOLE text book next time. (Soryy, this is sarcastically mentioned)

Yang penting:
-semua nama instruments,uses and how to handle it.
-advantages and disadvantages.
-SOM (Suppurative Otitis Media)
-CSOM(Chronis Suppurative Otitis Media)
-OME ( Otitis Media with Effusion)
- All major surgeries like tonsillectomy,adenoidectomy,mastoidectomy,laryngoscopy..

-------------------------------------------------------------------------------------------------------------




Inactive Chronic otitis media: In this condition the middle ear mucosa is relatively healthy. The mastoid cavity also appear healthy. These patients may slip into active phase rather easily because of the existing pathology. Inactive chronic otitis media can further be subdivided into Inactive mucosal chronic otitis media and Active squamous chronic otitis media.

Inactive mucosal chronic otitis media: This condition is always associated with dry perforation of the ear drum. There is permanent perforation of the pars tensa, but the middle ear and mastoid mucosa are not inflammed. The drum remnant around the perforation is always healthy. The rim of the perforation is thickened due to proliferation of fibrous tissue. Squamous epithelial cells from the external auditory canal does not migrate into the middle ear cavity in this stage because the annulus of the ear drum is intact and it prevents this migration. These patients benefit from myringoplasty.

Inactive squamous epithelial chronic otitis media: These include retraction pockets, atelectasis and epidermization. Negative middle ear pressure can cause retraction of tympanic membrane. A retraction pocket consists of an invagination into the middle ear space of part of the ear drum. These retraction pockets may be fixed when it is adherent to structures in the middle ear or free when it can move freely medially or laterally depending on the state of inflation of the middle ear. "Epidermization" is a more advanced type of retraction and it refers to replacement of middle ear mucosa by keratinizing squamous epithelium without retention of keratin debris. The area of epidermization may involve part or all of the middle ear cavity. Epidermization often remain quiescent and does not progress to cholesteatoma or active suppuration. So epidermization per se is not an indication for surgical intervention.





































Tuesday, March 1, 2011

ENT : Dr in Action!

Pagi ni kelas surgery batal lagi.

Oleh itu, ingin saya gunakan masa yang ada ini untuk mengemas blog yang lapuk dan berhabuk....Uhuk-uhuuukk....(>_<) Ini ade sedikit gambar2 Dr BAyu in action...

This one is a post operative result from carcinoma of the buccal mucosa. The skin and unhealthy mucosa were removed and incised. The open wound is then sutured by using the other part of skin near the lip and rotated to close the wound. 
Its OPD, Out Patient Department time. We have to struggle and squeezed into this small cramped space. You are so fortunate if the Dr speaks louder, if not, you might want to consider a ear aid or something.It is noisy and crampy.
This is the unhealthy larynx infiltrated by a cancer. The larynx was removed in Total Laryngotomy Operation. Hence, due to infiltration of the cancer in the larynx which spreads into the vocal cords, the patient losses his voice. However, the oesophagus is retained to help with deglutition. 
This is the neck dissection to remove the lymph nodes infected with TB. You can see the recurrent laryngeal nerve and the constrictor muscles of the larynx. Bilateral damage to the nerve can cause stridor and unilateral damage can cause coarseness of the voice. Heheh, dapat suara macho la kira..(-__-)
This is the actual view in the OT=Operation Theatre. Kena tengok surgery from celah telinga,celah bahu. Sekarang BAyu rasa sangat bersyukur dengan ketinggian yang Tuhan bagi untuk dua mende.Pertama, dalam surgery takyah lah nak tertenjet-tenjet tengok patient atas table operation. Kedua, dalam bus, kalau anda TINNGI, anda dapat bernafas dengan baik dan dapat mengelakkan hidung anda berada di laluan angin yang membawa bau hapak ketiak-ketiak tak pakai deodorant dan bau kepala yang berminyakkan kelapa. Owhh!!! Sungguh BAyu tak mau ingat macam manalah bau tue. Hari-hari kowt kena naek bus...Hari-hari bau yang same. Bila dah hari-hari BAU, jadi alah bisa tegal biasa lah... Bak kate orang,bau hapak pun ko tak tahan, caner lah nak bau NANAH tue nanti?

P/S : Teringat satu hari tu,BAyu bau NAnAH sepanjang hari dek asyik bau NAnAh  kaki atuk yang kena Squamous cell Carcinoma ,cancerlah tue...Dalam kelas surgery sambil ambik history pakcik nih..Rupanya, kena cucuk duri sebatang je..Terus teruk macam tu. Wa cakap sama lu, Bau ayam dinner masa hari tu pun macam NAnaH aje. Tapi, Bayu bedal aje..Dah lapo,nak buat caner??? 
Bayu snap gambar kejap mase Dr buat operation... Sebab asyik tukar-rukar position,  BAyu kena berdiri kat belakang. Alah, sekarang BAyu dah pandai dah nak tolak-tolak orang kalau nak tengok patient. Tempeh =locals, mereka nih kalau nak sumtin mesti tolak-tolak,naek bus ker, nak tengok surgery ker, nak amek lunch or dinner kat dewan makan ker..Mereka nih maen tolak aje..Bukan kesah hape..Cess..!!!! Kalau dulu selalu sakit ati sebab kena tolak dengan merka nih, sekarang nih dah biasa, sebab BAyu pun dah belajar nak tolak-tolak jugak. Kalau mereka tolak jugak, BAyu buat kekuda macam silat tue. Or, bagi 'jelingan maut' kat mereka. Heheh...



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