Wednesday, August 21, 2013

2nd sessional Final Year Mbbs

I have to stay strong.

I have to.


Oh, you should.

Life is short.

Aim high dear,
Aim to shoot the moon,
At least,
When you fall,
You'll land among the stars...

Tuesday, August 13, 2013

Surgery Note

  • Herniotomy 
  • Herniorhaphy-approximate the inferior border inguinal ligament 
  • Hernioplasty 
  • Incisional hernia  
  • Children inguinal hernia-rx:herniotomy, coz no post wall 
  • Must know-anatomy of inguinal ligament. 
  • Pure tissue repair 
  • Mesh,sutures used 

Varicose vein  
  • Tests 
  • Hemorrhage  
  • Complications  
  • Investigation 
  • Treatments 

Carcinoma of stomach 

  • Left iliac fossa pain radiating to right aggravated on hip flexion n adduction 

Gall Bladder palpable  
  • Troisiers law, in jundiced pt, any palpable gallbladder is not due to stones. 

  • Obstructive jaundice 
  • Achylorius jaundice 
  • Typhoid Mary : enteric fever 
  • Back pressure 
  • Surgical jaundice 
  • Congenital hyperbilirubinemia 
  • Splenectomy 
  • ERCP 
  • Charcot's Law:  
  •  itching 
  • Parts of CHD : supra,retro.inferior,intra 

Umbilical hernia 
  • Infant: no surgery,self limiting 
  • Linea alba,  
  • Vertical vs transverse incision  
  • Induce hernia, child n adult. Cough n cry baby 

  • Choletectomy 
  • Choletotomy 
  • Valvulos colon 
  • Haustra 
  • Sigmoid colon,maize 
  • Congenital mega colon 
  • Hiershsprung disease,ganglia... 

Epigastric Hernia 
  • Many multiple defect 
  • Weakness over the fascia 
  • Linea alba is further defect 
  • Mesh sutured around,the defect 
  • Below or above the umbilicus 
  • Paraumbilical vs umbilical hernia 

Sunday, August 11, 2013

End posting 9th term Paediatrics


This time i didn't do well. I was told to read more. This is not enough. Yeah, i didn't come prepared. Not 100% prepared.

I left my notes and books at home.I shouldn't do that next time.
Geram geram geram....
Geram sebab kes ni dah banyak kali aku present. Pastu, still tak confident nak jawab apa cikgu tanya.

I've repeated my answer soo many times and yet she didn't understand. Maybe i spoke too soft? Too slow?Mumbled? My accent? Okey, i admit it was my fault... *sigh*

My patient this time is super cooperative and playfull but i screw things up. I knew it was my fault...

There is no next time. Because next time it would be real. I hope i will be better next time.

Viva Questions
  • What is nephrotic syndrome? Give proper definition.
  • What is remission? What is relapse?
  • Treatment for first time episode of nephrotic syndrome.
  • Rx for relapse?
  • Rx for remission
  • Rx for steroid dependance?
  • Method of assessing organomegaly in presence of ascites.
  • Child draw a stick man. Give the age of the child.
  • Development - motor,fine,social,personal of 7 year old.

Actually i realised that this kid had supraclavicular pulsations and elevated JVP of which i didn't say because it is too risky and way beyond my expertise. So, i stated only the OBVIOUS and most common findings in nephrotic syndrome.

He has fast breathing >30cycles/min, tense, distended abdomen, positive fluid thrill, positive shifting dullness. Just not confident enough to mention that the kid had signs of hydrothorax. No hydrocoele. There is puffiness of the eyes, abdomen distention and pedal edema of pitting type. No organomegaly. No hematuria. No fever. No artralgia. Nails have white bands, pale palm. He had history of hypertension and maybe that's why he had elevated JVP.(well it looks like it)...(-__-)" im not sure....

Next time, be sure.Be confident. You will get this right next time.


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