Surgery 9th term: Bedside class

Today we have a class with Dr. RCP who is an excellent physician. So,they say. He has this chubby happy grandpa look-a-alike.

"You are terrific but sometimes terrible."

Sigh.

 "You read,but you don't read carefully."

Was what has been said by THE Dr AK. He was realy popular among students. I even got a lovely smack on my head with a roll of A4 paper.

Today, as i was standing beside Dr RCP, my mouth just keep spouting answers and he HAD TO STOP ME and remind me to give others the chance to answer.He was also like AK. He gave me a proper smack with his fist on my shoulder.

I think old people tend to do that. They can't help themselves. Its instinct and in nature of a parent as well as a teacher. They just care about us. At least someone do care teaching us something. Guide us where we should read. Or at least  to have an idea of what to read.

They know what we dont know and what we know. We know that they know what we dont know. Lalalala~~~


Finally,i can understand the pathogenesis of cholecystitis gall bladder and hepatomegaly.
He even taught how beautiful JAUNDICE development in many case scenario.

So, buckled up dear self.
That was your First class with him.

p/s: Dont be tempted to bunk anymore class. Even with finals exam are nearing,please spend 5 high quality hours daily on clinicals is far much better than studying alone in your room and not understanding anything.

OPERATION THEATRE : Adenocarcinoma of Colon

Patient present with severe abdominal pain.

Surgical treatment include right ascending colon removal,caecum,appendix and proximal part of ileum.

No hard questions asked.Just needed to palpate the specimen.

Must know the anatomy of colon,appendix and caecum.

Variation of appendix position.

Appendical artery.

Surgery 9th term: OPD day

It's raining heavily last night.

All my targeted topics to be read hadn't been accomplished due to a huge compulsion to sleep on the bed. I was getting rest for 10minutes and fortunately my housemate woke me up at 4am telling me
to switch off the lights. The inverter wont be able to supply enough energy to illuminate the room as she has an upcoming university BDS exam today. Luckily,i managed to finish few topics before going to sahur and Subuh prayer.

We were supposed to have OPD(Out Patient Department) today. In Malaysia it would be the clinics in the government hospital or maybe there were some like these in private hospitals.Nah,I've never been to one. So,i didn't know how private hospitals works.

It seemed that no one is willing to come outside today. Hence,we the medical students were left jobless in the demonstration room. With no one to supervise and teach some surgical knowledge, here i am updating this junk blog.

My two other unitmate was deeply immersed with Greys Anatomy season 7 on tablet. The other tried to find some kind of job or things to read.

Finally,
The one and only Dr in charge,with the minions male and female PGs and two junior interns joined him in the OPD and we final year medical student finally have something to observe from the side.

I can't forget the disappointed -hopeless face when we couldn't get the answers right. Plus, he was looking at me in the eyes.Me, the one and only Malaysian and a foreigner in the batch. I supposed he had a high expectation of me. Sigh....

I need to prove them that we somehow worthy to be here and its worthwhile to spend some time teaching us. Before he can teach us something, i need to read first.

Although,i am hugely tempted of bunking the posting for the sake of university exam which will be around the corner, i need the set my priority straight. Its not about prioritizing the schedule. Instead,its scheduling the priorities you had in you life.

As for me, 8-1pm daily is reserved for final year subjects. The rest of the day, i just have to utilise each second optimumly for my carried paper subjects.

Rabbuna Yusahhil.


Do pray for my istiqamah in studies.

Amin...
 

Surgery 101

Today we had an incisional hernia surgery observation. Most of us 9th term-ers, were excited and focused on the surgery.

Dr Rohan seemed to be immersed in teaching the new PG who recently won the seat for surgery post graduate. He seemed composed and silent. Not the bullying type of staff,hopefully.

Tonight,it rained again as usual and i had to go to OT as soon as finish drying my clothes on the rack and went off while hoping it wont be raining.

I have lots of things to read and endless topics to by heart. Not to mention about the hypochondrium pain I'm having since yesterday. I am so lazy to go and consult the doctor for this while we recently finished the gall bladder topic. It was just the cholecystitis(inflammation of the gall bladder).I know I'm intolerant to oily meals and never knew that one piece of fish fillet would make me suffer so much pain. I need to get my self together and bear the pain. Painkillers wont work for me and i have been feeling that anti-spasmodic drugs would make me hypotensive instead of relief of pain.

Had to go study now. Tata...




 

Exam Mode-.-

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OBG Posting: Aduh..peritnya si Ibu...

They giggled..., while the mother gritted her teeth trying so hard to push her first baby into this world.

It took four to five people to assist with the normal vaginal delivery of Mrs A.

One trying to poke her into the vagina, streching it as far as possible for the head.

One person to support the perineal muscles from tearing.

One person sitting kneeling over the patientt, giving a big push using her fist onto the abdomen.

One person waiting anxiously with the tray for baby on her hands.

One person waiting for the baby nearby the radiator.

20 of us students, watching with horrified-wondrous face.

It happen in a blink of an eye.

One moment the baby was out, and less than 5 minutes the placenta went out too.

and yeah.


She had a cut 'down' there. And of course without local anesthesia.

The mother can only endure the pain with a tear-less cry each time the doctor poke the hook needle into her flesh, approximating it together as soon as possible if so the vagina can be healed into its former glory.


I suddenly imagined how in the world can  one soul endure such pain?
That is only for the first child.

Y'all know my grand mothers both had like 12 t0 14 children!!!


All hail to Mothers!!!

Thank you for enduring such pain so we can see the world!

Love you Ibu.!!!!

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.

Esok medicine.

Bace tak habes lagi.

Yang dah bace belum tentu ingat.

Otoke?

Yang penting habiskan.

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Faces in Medicine

Must see post
From left to right:
1. Acromegalic facies
2. Adenoid facies
3. Amiodarone facies

4. Bell's palsy
5. Bird facies
6. Asymmetric crying facies
7. Bovine facies
8. Chipmunk facies
9. Cushingoid facies
10. Elfin facies
11. Gargoyle facies
12. Leonine facies
13. MEN-2B Syndrome
14. Parkinsonian facies
15. Flat facies
16. Mitral facies
17. Hatchet facies
18. Snarling facies
19. Thyrotoxic facies
20. Myxedematous facies

Acromegalic facies (Acromegaly)
Large supraorbital ridge and frontal
bossing, thickened lips, enlarge
tongue, lower jaw firm and square
(protruding jaw = prognathism)

Adenoid facies (Adenoid
hypertrophy)
Long, open-mouthed, dumb-looking
face of children

Amiodarone facies
Deep blue discoloration around malar
area and nose

Bell’s palsy (Facial nerve
dysfunction)
The eyelids on the paralyzed side can’t
close. The mouth is drawn to the
unparalyzed side, producing a
somewhat grotesque appearance.
Food and drink dribble from the
mouth on the paralyzed side. The eye
with the involved lid dries due to
decreased tear production.

Bird facies (Pierre Robin
Malformation)
Small lower jaw, a slit like hole in the
palate of mouth (called cleft palate)
and the tongue appear to fall into the
throat (condition called as
retroglossoptosis)

Assymeteric crying facies (Cayler
cardiofacial syndrome)
Asymmetric appearance of the oral
aperture and lips at rest, but
significant depression of one side of
the lower lip with animation (crying or
smiling)

Bovine facies (Craniofacial
Dysostosis or Crouzon syndrome)
Convex nasal profile, shortened
mandible, macroglossia

Chipmunk facies (B-Thalassemia
major, Bullimia nervosa, Parotid
swelling)
Expanded globular maxillae, with BM
hyperexpansion into facial bones,
combined with prominent epicanthal
folds

Cushingoid facies (Cushing
syndrome)
A rounded face with a double chin,
prominent flushed cheeks, and fat
deposits in the temporal fossa and
cheeks

Elfin facies (William’s Syndrome)
Sunken nasal bridge, puffiness
around eyes, epicanthal fold, blue
starry eyes, long upper lip length,
small and widely spaced teeth, small
chin

Gargoyle facies (Hurler syndrome)
Head is large and dolichocephalic,
Tywith frontal bossing and prominent
sagittal and metopic sutures, with
mid-face hypoplasia, depressed nasal
bridge, flared nares, and a prominent
lower 1⁄3 of face, thickened facies,
widely spaced teeth and attenuated
dental enamel, gingival hyperplasia

Leonine facies (Lepromatous
Leprosy)
Peculiar, deeply furrowed, lionlike
appearance of the face

MEN 2B Syndrome
Usually there are numerous
yellowish-white, sessile, painless
nodules on the lips or tongue, with
deeper lesions having normal
coloration. There may be enough
neuromas in the body of the lips to
produce enlargement and a
“blubbery lip” appearance. Similar
nodules may be seen on the sclera
and eyelids.

Parkinsonian facies (Parkinsonism)
Mask-like, tremor of head, absence of
blinking, dribbling of saliva, weakness
of upward gaze, seborrhoea and
sweatiness

Flat facies (Down syndrome)
Flat appearing face, small head, flat
bridge of the nose, smaller than
normal, low-set nose, small mouth
which causes the tongue to stick out
and to appear overly large, upward
slanting eyes, epicanthal fold,
rounded cheeks, small misshapen
ears

Mitral facies (Mitral stenosis)
Rosy, flushed cheeks and dilated
capillaries

Myotonic or Hatchet facies
(Myotonic dystrophy)
Tented, open mouth, elongated face
and blunt affect

Snarling or Myasthenic facies
(Myasthenia gravis)
Drooping of the eyelids and corners of
the mouth and weakness of the facial
muscles

Thyrotoxic facies (Grave’s disease)
Alert, startled, flushed and anxious
appearance. Protrusion of of one or
both eyes (exopthamlos) associated
with retraction of the upper eyelids
(lid lag) which results in the exposure
of white conjunctiva above the cornea
(Von-Graef’s sign)

Torpid or Myxedematous
(Myxedema)
Skin generally thickened, alopecia,
periorbital oedema, xanthelasma,
coolness and dryness of skin and hair,
thinning of scalp hair, tongue swelling.

Others:
1. Ashen gray facies (Myocardial
infarction)
2. Cockayne facies (Cockayne
syndrome)
3. Frog like facies (Intranasal disease)
4. Hepatic facies (Chronic liver disease)
5. Hippocratic or Cachectic facies (close
to death after severe and prolonged
illness like Malignancy)
6. Marshall halls facies (Hydrocephalus)
7. Monkey facies (Marasmus)
8. Mouse facies (Chronic renal failure)
9. Pagetic facies (Paget’s disease)
10. Ricketic facies (Rickets)
11. Uremic facies (Uremia)

OBG : Presentation day again

1st Day. Unit 1.

Its going to be a free-willy journey. The stafs arent so scary and arent emotinal either.

They looked 'tamed' and full of love and passion to teach. Heheh.
Maybe i wont have to be so stiff around them during viva.

I just finished copying history and examination from fellow tempe. Today,i just need to palpate and tally everything with what i have written. At least i have to see and palpate her myself when my friend had already helped me with the case writing.

Let her finish partography and within 20 minutes i can palpate her.

Will i continue to be as consistent as i am right now?

Do pray for me.

Know what? I had my MCQ Obg today evening.
Only 3 questions were given but i failed to do well.
Maybe next time. So,please get ready tomorow. Dr LM will read the most interesting answers...

(--__--)"

Q.
.
1) Define caeserean section. Mention absolute indication for caeserean section.

2)Name the layers insiced and the layers sutures according to chronological order.

3) Name the complications that can occur during c.sect. Mention the difficulties of thus procedure.

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