End posting 9th term Paediatrics

Arghhh...

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.

Aminn.

 

The Boy who had Guillain-Barre Syndrome

Paediatric Posting : 8th term

yeay!

I can play with the kids again!
Well, if they are not crying or getting irritated by us...

Yep,
 Dealing with petite patients requires patience and intelligence. And of course high level of perseverence to get the bloody blood pressure, to palpate their pulses,to listen to their heart beat,to check their ocular movements, to palpate their abdomen and do all complex cranial nerves examination all in 1 and half hour.

We finished our final year theory classes at 9am. Walking or waiting for bus to get us to the hospital and reached there by 9.15am. Go to Out Patient Deparment and any concerned doctor in charge on duty to take our attendance and off we go to wards which is situated at 5th floor. Going up the stairs everyday made me thinking that i can loose some extra calories residing at the lower portion of my body. So, i simply insist and tried not to use the lift as often as i can.

We start our posting at wards by 9.30am. Put the bags down, bring two different books, a note, a red pen, a blue pen, stethoscope knee hammer,measuring tape,tuning fork and we are set to go to find any relevant cases pertaining to our level of knowledge worthy to be presented to the doctors on duty.

Me being a foreigner in this foreign land, makes it hard for me when it comes to taking the history from patients. Well, tried not to make the communication barrier as an excuse not to take cases by my self. At least, i tried to actively join the discussion and prompt my fellow Indian friends any relevant questions pertaining to patients complaint and history. It has to be done neatly, a detailed and as accurately as we can if we do not wish getting yelled by doctors.

I learned basic instruction words in local language so i can do the examination part on my own and try not to depend to much on other people. As for taking the history, i got no choice other than waiting for my friends to finish talking to patients and discuss with me what else to ask to the patients.

Kids are difficult to deal with if u do not have the basic knowledge of them. They are scared by white coats, the glasses, and strangers. They cry when we get closer to them.They sob and finds the mother's warm hug as 20 studenst in white coats approach them. If they are not in pain,comfortable and playfull, we are lucky enough to get the case complete till the examination part. With the kids crying and constantly disrupts the conversation between mother and us, we couldn't even finish the history of presenting illness. The case will only be done halfway, and haphazardly not in order. Soon, when the doctors come around and when we still did not finish our job, get ready for the yelling and heartfelt-condemning words during presentation.

I have one more weeks to go. Hopefully, i survive this time.

End of Paediatrics Posting

I will miss these kids!

She had thalasemia major with hepatospleenomegaly.

Classic clinical presentations of Nephrotic syndrome.Aged 4 years old.

In theory class.

My lovely friends trying to console this baby. ughh!


Bye-bye...See you again kids next year!!!

Paediatric: Its time to play!

With kids lah, but don't play-play. They are cute, lovely, induces mothers instinct like feeling compelled to carry them on your shoulder, wanting to cuddle them, play cikk-boooboo ,yada yada.

But, once they cry with highly shrieking voice,and demanding attitude, they aint cute or cuddly anymore.

But still have to think how to get the measurements.

The circumferences, the rates the sounds,the reflexes, the power and tones, and the developments.

These kids are sick,irritable and suspicious.

Hah! They tend to cry and hug their amma and appa upon seeing strangers.

In wards,these kids dont see us as medical guy, but rather apparent to them as ALIENS. Yes!

Aliens in white coats,with spectacles covering the eyes, with 'scary' instruments dangling around their neck and pockets, who were trying so hard at making a stable contact. To them,we are aliens trying to figure out how to communicate with them using keys,coins,phones and anything that is available in the wide wards.

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Clinical Examination in Children

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