Kicking off with Orthopaedics~

I half expect that i would be posted here even before YM tell me. What would it be like? Frankly I have no idea at all,so lets start everything all over again!

I've set my eyes on Paediatrics because I think its interesting. But seeing the reaction of some of my colleagues who knew that they are posted to Pediatrics make me doubt my opinion? Is it really that bad? What can be worst than O&G?

Therefore, now I will enjoy the last of my holidays. I will decide what's interesting and what's terrifying later this year :P

Muahaha............orthopaedics, here comes me~~

Neurology 1- Review of the Common diseases

Meningitis
Explain the layers of the meninges
Common etiology, and mode of infection.
What is meant by the term Meningism?
What signs can be elicited in a patient with meningitis? Is the sign positive for any other conditions? How sensitive of specific is it for meningitis?
How do you differentiate a viral,bacterial and fungal cause of meningitis?
How do you do a lumbar puncture? What is the contraindications and how to make sure there are no contraindications?
What are the complications of meningitis?
Principles of management.

Cerebrovascular accident
Stroke, stroke in evolution, Transient ischaemic attack and minor stroke.....Define
How many types of stroke? How to differentiate?
What are the typical presentations of stroke?
Will the Babinski reflex be positive in the right foot of a patient with a stroke of the right side of the brain?
What is the most common site affected if a branch of the middle cerebral artery is involved? What would be the signs? What happens if the trunk of the MCA is thrombosed?

A 61 year old man who is a known case of hypercholesterolaemia presents to the A&E department with vomiting, dizziness and numbness on the left side of the face for the past 1 day. On examination,left sided partial ptosis and myosis,diminished gag reflex, dysdiadakokinesia. and past pointing. Based on this information, what do you think the problem is? What other signs would you look for?

How would you manage an emergency case of stroke?

Thats all for now~more complex neurological problem coming soon:D

Rheumatology

Please make sure you know how to examine the hands for rheumatological problems.

Questions
What is the difference between arthralgia,arthritis and arthropathy?
Causes of arthralgia

Rheumatoid Arthritis
Explain the pathogenesis of Rheumatoid arthritis(RA)
Who is more prone to develope RA?Why?
How is RA different from other types of arthritis e.g. osteoarthritis?
Explain something on Still's disease(Juvenile RA)
Differential diagnosis for symmetrical arthritis? What investigations would you do to confirm?
What are the criterias used to diagnose RA?
How do you define morning stiffness?
What complications can arise from RA?
How to manage RA?

Gouty Arthritis
What is the cause? Briefly describe the pathogenesis.
What are the risk factors?
Why is it that the most common site for crystal deposition is the 1st metatarsophalangeal joint?
Describe the pattern of joint involvement.
How can you classify the attacks?
Define pseudogout. How do you differentiate it from gouty arthritis.
How would diagnosis be confirmed?
What is a tophy? Does it happen in every gout case? If not, when does it happen?
What are the complications of prolonged hyperuricaemia?
How would you treat an acute attack of gouty arthritis?
What advice would you give the patient to reduce attack rates.

Systemic Lupus Erythematosus
What is it?
What are the causes?
If there are joints involvement, what would be the pattern?
What criteria is used currently to diagnose SLE?Explain
What blood test should be done to confirm SLE?
Are there any correlation between complement level and disease activity? Explain.
Explain the complications of lupus.
Prognosis. Patient usually die of?
Management & advice to the patient

Systemic Sclerosis a.k.a Scleroderma
Epidemiology
A bit of pathogenesis
Types of scleroderma, how to differentiate them in PE.
What is CREST syndrome?
How do you differentiate a rheumatoid nodule, a calcinosis and a gouty arthritis clinically?
Which complication of scleroderma is the most common?
What are the autoantibodies looked for to confirm scleroderma? Can they be used to differentiate between the types? How?
Prognosis? What is the most common cause of death?
Management.


Psoriasis
What is it?Briefly describe the pathogenesis.
Explain the possible pattern of skin lesions. Which one is most common?
Explain the types of joint involvements of psoriasis.
How to differentiate RA and psoriatic arthropathy?
Management

Seronegative spondylytis(SS)
Explain what is meant by this term.
Give examples of SS and explain.

Surgery-An overview

Nobody wrote about surgery a.........aiz...

Surgery is one of the more "free" posting especially if you have been posted to Medicine before. The lecturers are fun and sporting.

Surgery department is located on the 8th floor (2 floors above the Medicine wards). You won't miss it, there's a big Jabatan Surgeri sign to tell you where it is. And their Lecture hall and tutorial room have special names, i.e. Stargate and Seagate respectively. Canggih kan :P

During my time, each group consist of 8 students with 4 supervisors. Each supervisor will supervise 2 students. They will grade your long case and PPD as well as continuous assessment. However you can ask for teaching from any 4 of the lecturers.

In surgery department, the specialists and consultants are called "Mr" or "Miss" instead of Dr.(except if they are Prof or Prof Madya,where you call them Prof). Example, Dr Saladina and Dr Lee are called Miss Saladina and Mr Lee respectively.

In Surgery, you will have to learn all the subspecialties, from General Surgery to Urosurgery. basically there are around 8 or more subspecialties(1 week each) and you have to learn them all.

There are only 4 surgical wards, only 2 of which is frequented by 3rd year medical students, Ward 1 and ward 2. This is because ward 3 and ward 4 are Urology and Neurosurgery ward which is too specialised to be appreciated by 3rd years. However you are allowed to go and have a look and clerk patients if you find 1 concious.

Going to the wards in surgery is less enjoyable because generally all the patients are either unconcious or grumpy due to the operation which have been or will be conducted on them. This is where you have to use whatever nonsense you have learnt in PPD. I would advice going to wards at night or on weekends where there are less Medical students and more new patients which is more willing to cooperate.

You do exactly the same thing you did in Medicine in the wards. However most of the PE is new. Respiratory,neurology and cardiology examination will rarely be used here. Only GI examination is used. Other PEs to be learnt in Surgery includes hernia, thyroid, breast, venous system of lower limb etc. It is not in Tally's so you must pester your supervisors to teach you.

Going to the Operation Theatre may sound glamorous but seriously, you cannot learn anything if you don't read beforehand. even if you have read you will realise that theory and practical are 2 very different things. There is not much thing that can be learnt in the OT, so just go to fill up what;s required in the logbook, and spend more times in the ward hunting patients.

Clinics MUST be attended because you can learn so much here. Differnet days are clinics for differnt subspecialties so you are adviced to go everyday to cover all subspecialties. Clerk new patients and present to the lecturer; you will be sneered at here and there but you will really learn a lot. Palpate and examine as many patients as possible in the clinic.

You must go and observe procedures like Endoscopic Retrograde Cholangiopancreatography(ERCP), fluoroscopy etc. Read beforehand and clarify all your doubts with the lecturers.

Out of interest you can also go to the Stoma care clinic, and Daycare surgery.

You must also ask your supervisors to teach you about Instruments. The box is usually in the tutorial room in the Male wards(1 or 2, i forget). This is important because one of the instruments will definitely be asked in OSCE.

There will be 1 workshop (we have suggested at least 3) on sutures and insertion of certain instrument such as venous cathether and Ryle's tube. Pay good attention to this as it may be asked in the exams. My exam, they ask us to insert urinary catheter and venous catheter.(on the mannequin of course)

you have a lot to read. I read Forsythe and In a Page but i find Forsythe confusing. Therefore i would not really recommend it.

Have fun in Surgery! It is the Direct opposite of O&G, i would say :)

Siapa barking????

They dare to oppose the teaching of math and science in english when they don't even know the meaning of a simple English idiom....idiots.....
I know the meaning of this idiom in Std 2...........for heaven's sake...their level of english is less than a std 2 kid!!!!!

Popular English idiom touches a nerve
The use of the popular idiom ‘Barking up the wrong tree’ touched a raw nerve with an Umno assemblyman who thought that the idiom referred to a person as an animal that barked.
Shabudin Yahaya (BN – Permatang Berangan) exchanged barbs with state executive councillor Phee Boon Poh, who had earlier used the term when explaining statistics on hardcore poor families to Jasmin Mohamad (BN — Sungai Dua).
“Barking denotes an animal. I disagree to you using this idiom when speaking to the Sungai Dua assemblyman,” said Shabudin while interjecting during Jasmin’s debate on the motion of thanks on the Yang di-Pertua Negri’s opening speech yesterday.
Phee retorted that Shabu- din, who is also state Isla- mic Religious Council chair- man, did not understand the idiom.
“You (Shabudin) are barking up the wrong tree with your accusations now.
“If you do not know the meaning of this idiom, how can you serve as a YB (elected representative)?” asked Phee.
Shabudin argued that Phee was the one who was barking in the hall.
Later, outside the hall, Phee told reporters that he did not think it was derogatory to use this idiom when speaking to someone, including a Muslim.
He stressed that the literal meaning of idioms should not be taken.



BN is trying to change what it stands for......Barisan Nasional want change to Be Nak(malay word benak, meaning "slow mentality")

Revision on Common Infectious Disease

Seems like nobody wanted to revise on Gastroenterology, so lets play my favourite topic : Infectious Disease~



1) Classification of Fever

2) Causes of Fever



Respiratory tract infections

What is the most common etiologic agent?

What are the difference between influenza and common cold? Are there any difference in terms of treatment?

How often are influenza vaccines given?Any reasons?

What is pneumonia?Classifications based on anatomy?Common etiology? What are the signs and symptoms? How to manage?
Causes of cough
Causes of bronchiectasis
What are the symptoms of bronchiectasis? Complications?
Explain what is meant by empyema.

Neurological Infections
Define meningitis,meningism, encephalitis and encephalopathy.
Route of infection of meningitis
Common etiology?
SYmptoms of meningitis
How to differentiate viral and bacterial meningitis?
What signs indicatate meningism? How to do it?
Treatment for bacterial meningitis? How would you select the antibiotics?
What is post infectious encephalopathy/polyradiculopathy? What etiology?
What are 2 infectious causes of 7th nerve palsy? WHat syndrome do they cause? How to manage?

^^ play la.easy only

Medical Schools

This article is interesting
Culling for Quality

Booklist for 3rd Year

*all books are recommended by myself. As usual, different seniors will recommend different books, so the best thing is borrow the books from your senior, see whether it suits u before buying.

Internal Medicine
Buy Original
1) Pocket Essentials of Clinical Medicine, Kumar and Clark (a.k.a Baby K&C)
2) Nicholas Talley's A Guide to Clinical Medicine
3) Chest X ray made easy (NOT the unipress one)
4) Heart sounds made easy

Can be Photostated(or order from Kak Ros)
1) ECG made easy
2) all Clinical Practice Guidelines

Download
1) clinical practice guidelines for STEMI, Stroke, DM,Hypertension, Dengue, and all relevant diseases ( Download here)


Surgery
Textbooks(Buy 1 is enough)
1) Lecture Notes on General Surgery (I find this better than Forsythe)
2) Bailey and Love (bagus, but tebal dan mahal)
4) The small Handbook(i dunno whats the name)
3) Forsythe (ermm......please borrow from senior to read first....personally i find it quite confusing)

Photostat
1) In a Page: Surgery


Obstetrics and Gynaecology
Textbooks(Photostat)
1) Ten Teachers
2) Illustrated

Buy(from UM,RM 2 only)
1) Prof Kulentheran Arumugam's book (a.k.a Dumex)

Borrow(unless the O&G Department make it compulsary to buy, RM 30)
1) A handbook of Labour room Practice (Dr Lim Yun Hsuen)

My supervisor keep telling us that Ten Teachers is for midwives. He recommends Fundamentals in Obstetrics and Gynaecology by Oats,Abraham and Llewellyn-Jones......... I dunno, i never see this book before

Do not rush in buying books....see which is most suitable for u b4 buying.

Standard Setter Set Aside

A UNIVERSITI Sains Islam Malaysia lecturer who passed only four out of 157 of her law students claims she was forced to resign so that the university could protect its reputation, Kosmo! reported.
Nor (not her real name) said the reason she left was because she could not stand the pressure from the university management on her to give “sympathy marks.”
“How am I to give extra marks if the marks they got is what they should be getting?” she said, adding that her downfall started when she received a show-cause letter on why so many students had failed.
She was then criticised by her superiors, who also wanted her to add marks based on attendance so as to reduce the number of failures.
“I stood my ground. How could I give them marks for that when it is their responsibility to show up for classes?” she added.
The university declined to comment.


My comment: How will the USIM protect its reputation when it produces lawyers that is incompetent and worse of all, one who "speaking England" instead of speaks English?
Maybe this lecturer is a bit like prof Adeeb, but standard is only maintained as long as such lecturers are around.

KHIRja TOYOl hanya untuk carik pasal

SHAH ALAM: The Selangor government’s decision to retain Elizabeth Wong as a state executive council member and Bukit Lanjan state assemblyman reflects the state government’s inconsistency in making decisions, says the state opposition leader.
Datuk Seri Dr Mohd Khir Toyo questioned why former Bukit Selambau state assemblyman V. Arumugam’s resignation was accepted but not Wong’s.
Wong had offered to resign from her posts as assemblyman and chairman of the permanent committee on tourism, consumer affairs and the environment on Feb 17 after revealing photographs of her were posted on the Internet but Mentri Besar Tan Sri Abdul Khalid Ibrahim had advised her to go on leave.
“I knew this would happen,” said Dr Khir, who is Sungai Panjang state assem­blyman.
He said the decision would be an advantage to Barisan Nasional as it showed the inconsistency of the state government in its administration and that it had set aside noble values in society. — Bernama


My comment : What inconsistency? The MB Selangor have been firm in his decision, he won't accept Wong's resignation.
I hope Toyol will not try to divert the public attention. Maybe he should think of what good reasons to give for his spending "to study Disneyland" with his wife and children and maid.

Being the Opposition doesn't mean you have to oppose everything~

The more i read in the internet, in opposition MPs blogs, in whatever supposedly "independent" online news portal, the more i think that the Opposition is becoming the very thing they opposed.

Najib recently introduced his idea 1Malaysia,People first, Performance now. This idea have been the topic the opposition have been playing about. Opposition nothing better to do is it? Whenever government come out with ideas, whether bad or good, sure oppose one. But when opposition come out with their ideas that is the same as what the government introduce, all opposition parties laud it!

Please be a constructive opposition. 1Malaysia is a very good concept if implemented well. We must be able to see that this is a long term concept, how can you judge that it is useless la, menangkan melayu la, what la when its not even been 1 month since its introduced?

LIM KIT SIANG blogpost

Talking about tuntutan yang melampau, this is one of the melampau things that can be very dangerous to our ultra-multi-racial society.

Bidayuh upset over exclusion

That day,when the list for Cabinet Ministers is announce, Opposition say that the cabinet size is still big. Now, if they "berjuang" for bidayuh people for a post in cabinet, i swear that they will not get my vote next election. Why? If they berjuang for Bidayuh, surely they must berjuang for dozens of other orang asli's race for the cabinet post! There are the Jakuns,Sakais,Kelabit,Orang Bukit, etc! And I want a cabinet post for the Baba and Chitty community oso! Only that can reflect Malaysia, a multi racial ultra big 90 man cabinet!

My point being, it is really impossible for each and every tribe in the country to be appointed to the cabinet. If that is done, our cabinet will have over 60 man. Which country in the world have over 60 ministry!

If the Bidayuh felt excluded, we Baba and Nyonya community felt lagi excluded! Tan Cheng Lock is a Baba, yet after his demise Baba community bayang pun tak nampak dalam government! So, kita pun kena exclude tau walaupun kita cakap melayu kat rumah. Tapi kita tak gila kuasa, siapa mo tu power power amik la.....Bukan kata kalu Melayu jadi MP nanti dia bunuh kita orang....ingat ni taliban ka. ok sorry sorry tertype Baba mia language pulak..

If racial things like this is played, until Judgement Day pun Malaysia people takkan bersatu. Bukankah dulu dulu kita mia nenek moyang semua boleh bersatu? Nijam pulak mo representative from each tribe dalam kabinet...lu orang ingat tu kabinet playground? Entah bongok ka apa lu orang ni...

Dont buat demand yang bukan bukan la...tolongla pakai otak....


People say, after the 2004 election, that the government is too powerful that it can make any decision it wants. But after 2008, i think that the Opposition now is too powerful ady...Maybe next election let opposition win and see if they can built a cabinet with Jakuns, Kelabits, Negrito, Baba, Chitty etc......Itulah Kuasa Rakyat! Makkal Sakti!!!!

Just for laughs

If this really happen in the court, i must really salute lawyers. Looks like medical students are not the only one memorising scripts :P

ATTORNEY: Do you recall the time that you examined the body?
WITNESS: The autopsy started around 8:30 p.m.
ATTORNEY: And Mr. Denton was dead at the time?
WITNESS: No, he was sitting on the table wondering whyI was doing an autopsy on him!


ATTORNEY: Doctor, how many of your autopsies have youperformed on dead people?WITNESS: All my autopsies are performed on deadpeople. Would you like to rephrase that?

ATTORNEY: How was your first marriage terminated?
WITNESS: By death.
ATTORNEY: And by whose death was it terminated?
WITNESS: Now whose death do you suppose terminated it?


ATTORNEY: She had three children, right?
WITNESS: Yes.
ATTORNEY: How many were boys?
WITNESS: None.
ATTORNEY: Were there any girls! ?
WITNESS: Are you sh****n' me? Your Honor, I think Ineed a different attorney. Can I get a new attorney?

ATTORNEY: So the date of conception (of the baby) was August 8th?
WITNESS: Yes.
ATTORNEY: And what were you doing at that time?
WITNESS: Uh.... I was getting laid!

ATTORNEY: Now doctor, isn't it true that when a persondies in his sleep, he doesn't know about it until thenext morning?
WITNESS: Did you actually pass the bar exam?


ATTORNEY: Doctor, before you performed the autopsy,did you check for a pulse?
WITNESS: No.
ATTORNEY: Did you check for blood pressure?
WITNESS: No.
ATTORNEY: Did you check for breathing?
WITNESS: No.
ATTORNEY: So, then it is possible that the patient wasalive when you began the autopsy?WITNESS: No.
ATTORNEY: How can you be so sure, ! Doctor?
WITNESS: Because his brain was sitting on my desk in a jar.
ATTORNEY: I see, but could the patient have still beenalive, nevertheless?
WITNESS: Yes, it is possible that he could have been alive and practicing law

Haha..........wit beyond measure is man's greatest treasure.. special thanx to kohging for this post

Of impatience and insolence

Today at the Melaka Central bus station i saw something......that makes me angry, and sad, and murderous at the same time.

This young man, around my age with his girlfriend busy walking leaving his mum tagging behind dragging their bag. Then he turn around, shouted "Ah ma, jou kuai dian la, mei ci dou jiang man!" very rudely. His gf i is a nice lady, she chided him for being so rude and waited to help the poor old lady with the baggage.

This attitude shock the hell out of me.... there are still people like this around. I feel like going to the man and beat the hell out of him~

I know its none of my business but i simply couldn't tolerate insolence especially to your own mother.

These people take for granted that their mother or father will be around all the time. Never think that one day when mother gone father gone how you will regret.

That makes me reflect, human beings only appreciate things when that thing is no longer with them. To put it in Baba lingo, " dah mati baru la buat meratap"

For example, most working people think that a Housewife have the most wonderful job in the world. Try becoming a Housewife for 1 month and see what you think. Is it enjoyable or not. Think, your mother out of love for you and the family, is doing all that less enjoyable job.

Young people......when your parents is around you ignore them. They wait for your phone call till couldn't wait they call you. You speak with them for 10 minutes at most. Tapi if speak with gf/bf can speak for 2 hours! See.....
But 1 day, people will pass away...... You wait and wait for their call, wont come one. You want to call, how you want to call?
Masa ini barulah buat sedih kan...kesian...........aiz...human

Talk about this today because I want people to treasure, cherish your parents. Don't wait till one day when they are gone forever, then regret..

I am thankful that when my mum is around my siblings and I never do anything of that sort to her. We will always let her walk in front so that we are sure she's ok.
Did I expect my mum will suddenly pass away? Who would expect a jejunal adenocarcinoma to manifest itself in her? In the world less than 100 people have disease~
Although I did not treat her like crap i still feel bad upon her passing. Imagine if i have treated her like the young man above, how will i feel now?

Cukuplah.....to the young man, i hope u open up ur heart fill with some compassion and filial piety la.......at least your bitch have some~

Marah betul suddenly....................dunno why....aiz.....

Revision on Gastroenterology

Enough of politic rubbish which is able to make my blood pressure shoot up. Now lets revise on gastroenterology

Common symptoms
abdominal pain or discomfort
Bloating
Nausea and Vomiting
Diarrhea


There are hundreds cause of abdominal pain from abdominal trauma to carcinoma of the innards. It is easier to group together the site of the pain to point to the problematic organ. Therefore, there are upper,mid and lower abdomninal pain. Upper abdominal pain mostly is due to problem in the stomach, liver, bile duct,duodenum or pancreas. Mid abdominal pain often due to small intestine and lower abdominal pain is due to large intestines or the reproductive organs.

Question
How to differentiate between a visceral pain and a musculoskeletal pain(abdominal wall pain) in the abdomen clinically(From physical examination)? Not from Hx, not radiologically and not from any investigation.
I will provide the answers only if anyone care to know or try answering... :)
Lau hia, zhen hsiung, i tell u all before, faster answer hahaha :D

Bloating of the abdomen can be due to massive ascites and overproduction of gas by the intestinal flora.
Easy question : How to differentiate by physical examination?

What makes overproduction of gas happen? Food (lactose intolerant individual) and overgrowth of intestinal flora due to stasis of the intestine can cause it.

Question
Sometimes patient complain of feeling bloated in the abdomen when there are no overproduction of gas or ascites. what do you think makes them feel that way? Hint : hypersensitive?

Nausea and vomiting- again there are so many causes. so just classify them into GI and non GI cause. GI causes : Infection,obstruction, inflammation Non GI cause : Neurological e.g. motion sickness, increased ICP, Drug induced e.g. alcohol,opiates,digoxin, hepatobiliary disease, UTI, pregnancy.

So when asking bout vomiting ask for the timing, the volume, the content of the vomitus.

Question
Name 2 infectious agent that cause vomiting but no diarrhea

Diarrhea.......bermacam diarrhea.
Secretory diarrhea- too much excretion of fluid into bowel. Caused by infection, neoplasm,endocrine cause e.g. carcinoid and Z-E syndrome)

Osmotic diarrhea-the more you eat, the more the diarhea is. If you fast it disappear.
Question: What's the most common cause?

Exudative diarrhea occur if there is inflammation of large bowel. Small amount but frequent and may be bloody or mucoid. Common cause is infection(Shigellosis and amoebiasis), IBD and Malignancy

other special types such as fatty stool (Steatorrhea...correct spelling rite?) may be cause by bile deficiency due to obstrution or terminal ileum damage or drugs.

Question : Why is there diarrhea alternating with constipation in patient with colon cancer?
What is peptic ulcer disease? What cause it? Presenting symptoms?
What is the triple therapy for peptic ulcer disease caused by the bacteria?

How do you manage hepatitis B and hepatitis C patients?

What are the complications of hepatitis?

Differences between Crohn's and UC?

Complications of IBD

What is functional dyspepsia and how to manage?

sounds fun hor....look it out la if free nothing to do..

Police and Politicians

This post not so nice to read la, sure got a lot ppl disagree with me one. So anggap saja baca suka suka ok jangan simpan dalam hati :)


Do you ever wonder why the crime rate seems ever rising instead of dropping? Despite many upgrading of the police force? Its because of the damn politicians!

Petty petty things, report police. I think in one day the police receive more petty reports than more pressing matters in the country : Mat rempit menace, snatch theft and rape cases.

Another reason is i think that those in the police force have no motivation at all to work. Why? Any mishap happen, whole Malaysia go againts them. Remember A.Kugan the car theft suspect? And when they solve any big crime, catch the head of a Mat rempit gang, nobody commented on that. Like that who got motivation to work?

Politicians(i dont like to say this, but mostly Opposition politicians) like to make noise, police no good la, not fair la, but i see they only know how to complain. A. Kugan died in custody, macam macam ceramah was made, i think 2 forensic pathologist gave their opinion on how he died, but still ppl wont belief ! People belief what they want to belief ; that A. Kugan was beaten to death. Their ear is closed to other explainations, even by experts!

Now want find australia expert to see, for heaven's sake, ask la kuasa luar help you. I see its only a matter of time before some politician ask the help of Mongolian Prime minister to declare him the TRUE Prime Minister of Malaysia. Last time, gila kuasa people ask help from British, Portugal etc, now change a bit la rite. Peredaran zaman, kita mesti berani berubah!! Macam ni lagi baik scrap saja mata pelajaran Sejarah. Waste time learning Sejarah if it keeps repeating itself.

The newest, the Anwar Mansor story. Again, mesti politician come out become hero! Some politician yang berjuang utk bangsanya will say Mr Anwar here is forced to drink thinner!

Whenever any suspect die the police become suspect. Wait many politician will come out "INI TAK PATUT BERLAKU!""INI POLIS SANGAT KEJAM" Whenever any suspect convicted or caught red handed nobody pat their shoulder saying Good job. Siapa mau kerja utk you all macam ni aiz~~

Police used to be kawan rakyat, now they are lawan rakyat. Siapa punya pasal? Politicians la.......dalam rancangan menghantukan polis. For once, Gomen and Opposition bekerjasama hantukan polis. GOmen forced polis to catch opposition, opposition retaliate by telling people how evil polis is. Siapa paling rugi in the end?
Some people say, "why the polis can be forced by the gomen one a?Fight back la!" Kalau itu polis fight back opposition pun mati lo...bcum like thailand dy.
Opposition shouldn't "mendevilkan" polis. Its really not their fault. Its the Gomen's fault

Police now is the pelanduk: Government is the gajah no 1, Opposition Gajah no 2. Rakyat gajah no 3. Mat rempit, peragut etc is the spectator.

Gajah 1 sama [gajah 2 dan gajah 3] berjuang,
pelanduk tersepit tengah tengah.
spectator ketawa terdekah dekah.

Politicians(Gomen or Opposition) please leave the police force alone. Let them do their job, praise where praise is due. Jangan hanya tau complain ini complain itu la k..........

Politicians sucks.....biggest sampah wrapped in beautiful wrapper. Even my ludah is more mulia than them. i will write some pantun for them next time to give them a piece of my mind~
(of course, not all la...only those who make a lot noise to get support but do nothing)

Introduction to Clinical 3rd year

One junior asked me"what is it like in clinical years? What to do? Why need go walk around ward?

So for the benefit of the juniors i will try my best to give an overview of what to expect in 3rd year.

in 3rd year, Students are divided into 4 equal groups. One each for Internal Medicine, Medicine and Society, Surgery and Obstetrics and Gynaecology(O&G) posting.

Before you are posted, all of you will attend a PPD camp. Almost the same like the one you have in 1st year, only thing is the location is different. In my year, its held in Ulu Kenas, Kuala Kangsar,Perak.

Generally, all postings require reading and understanding. The difference with 2nd year is that there is no lecture notes in 3rd year, you have to read book or make your own notes. No more memorising powerpoint slides.
My advice, read and try to get what is the book trying to tell you, and you won't forget the concept. Attempt to memorise word by word will drive you crazy.
There is a saying : Learning medicine only by going to ward is like going to the sea without a map, but learning medicine by reading without going to the ward is like not going to the sea at all.

Therefore, students must go to the wards. What do you do in the wards? Practice for your long case exams:) what in the blue hell is long case? Read here

Going to the wards is not for fun, especially in internal medicine and O&G. Make the ward your learning centre, touch as many patients as you can(appropriately of course)

Next, i'm going through the postings one by one briefly.

Medicine and society--> READ HERE

Internal medicine- my favourite posting. learn a lot from here. Here is where we learn all disease that doesnt require operation (Surgery).

lEssentials of 3rd year Internal Medicine
1)Basic medical knowledge, especially anatomy, pharmacology, physiology and pathology
2) Ward bed side learning--> learning how to take a complete full history, do physical examination the right way and stimulating the brain to think critically.
3) Group study-> conducted IN the ward, not at night in the cafe. Exchange patients, prepare for short cases and prepare for any question that is posed to you by ur colleague, as well as prepare relevant common questions for your colleague.
4) Learn and read at night. Night is a time for self study, not group study. Only when you self study the night before can you contribute to group study the following day. If not, you will be a "blur parasite", not even knowing what you are learning in the group.
5)Do not compare compare yourself to others. If they have different method, let them be. Knowledge should be complete, not used to compete.
6) In approaching a patient, if the patient doesn't entertain you, make an appointment with them. After you have succesfully clerk and examine them, don;t stop there. Visit them regularly and be friends. This way, they will not feel they are being used by you

Surgery--> one of the more relaxed posting. Much to read but not much to do

O&G--> the most feared posting in most medical student's life. So many things to understand, different lecturers have different views, so many things to do, you have to be on call to conduct delivery, dealing with mid-wives in the labour room(who is thankfully nice to male students), getting scolded in front of the patient in ward rounds, the extremely high failure rates in exams etc etc............shortly, i dont like it at all. But you will learn many things here compared to surgery.


To my juniors, if you want guidance in examination, history taking etc, do not feel ashamed to approach your seniors. True, some seniors may not be that enthusiastic, so find those who can bring you to the wards and guide you. If cannot find anyone find me la, dont be shy i wont scold you all one ok :) If i am free sure i will follow u all to wards and teach :) if not free we arrange time......time management haha :P

Enjoy your 3rd year! This is what the rest of your life will be.......so learn to enjoy!(except perhaps in OnG,i still shiver when i hear the name of certain lecturers) XP

Teachers and their Thoughts

I went back to my alma mater yesterday. Its good to be back. I met a few of my teachers and catch up with the school's updates

I went to MHS 1st with Qing Ci.

The first teacher we walked into is none other than my Biology teacher, Mrs Leong. With over 30 years of experience in teaching the subject, she can proudly claim that she have "disected more white rats and produce more doctors than your fingers and toes can count"(this is to put it in her own words). But alas, she's retiring this year, a great loss to the school and to the students. Mrs Leong is a teacher who not only emphasize on performance but also on manners and discipline. When you enter her class, you must wish her, otherwise, she will tell u "WISH me!". In her class, we have to keep quiet or else, stand outside. Beneath her stern look is a kind and gentle teacher who is really willing to share her knowledge. Ask her questions, she will never disappoint you.

Then we met my Math master Mr Khoo. Evergreen is the word to describe him. Still as chatty as before, he updated us on all that is happening in school from the day we step out. He even updated us on our seniors, how our seniors who are MO all around malaysia is doing etc. We spend 1 and a half hour chatting with him.He told us that the performance of MHS have been on the decline. Decline? Nobody scored 4 flat? i thought to myself. He told us " only 14 got 4 flat last year" -_-".....ok, in my year there are 21 of us, but 14 is not badla~~still 2nd in malaysia ma....

Then we meet the Chemistry and Pengajian am teachers, Miss Lim and Tan and again we chatted for 1 hour. Its incredible that after so many years, they remember each and every student's name. its equally incredible they remembered their places of birth(which i have forgotten).

Mdm Teo, the applied math teacher have retired. Sad to say, but hopefully her successor will have the same passion for teaching like she have.

Then i walked across to my older alma mater, St Francis Institution. Entering the gates Is so nostalgic, nothing much have changed since i left in 2003. Even the guard is the same old kakak. I can see Prefects on duty(i used to hate them) and the PBSM(or scouts? i simply cannot tell anymore) marching in the quard angle.The same noise from the school military band is also there. First thing i do, i went to look at the teaching staff. Ok, OCW is still the principal.......mrs goh,mr lee,mr chong,mr yong,bro mike still there, but all other teachers are sooo unfamiliar. aizz...luck is certainly by my side because i bumped into,non other than my old class teacher Mr Lee himself..hahaha but unfortunately he is busy bcuz tomorrow is the Sports day, and we didn't chat much. Mrs Goh is not around bcuz she accompany a group of students to Sunway, while Bro Mike have gone for a retreat. Aizzz...so i just walk around, go to canteen eat the famous Mee Ta(its still delicious~~)and go back home...


All in all,its good being back at school.....everything seems so relaxed~~:)

Typical.........

KUALA LUMPUR: A three-month-old baby boy left in the care of a babysitter by his parents, who had gone overseas on holiday less than 48 hours earlier, was found dead.

Chan Kai Yee was found motionless when the 40-year-old babysitter tried to wake him up to feed him at her home in Kampung Bukit Tinggi, Bentong, at 8am yesterday.

Kai Yee’s parents had left for Hong Kong for a month’s holiday on Monday night.

The babysitter alerted Kai Yee’s family members, who lived nearby, and they rushed him to the Kuala Lumpur Hospital (KLH), where he was pro­­­nounced dead.

Dang Wangi OCPD Asst Comm Zulkarnain Abdul Rahman said the family members, suspecting something amiss, lodged a report at the KLH police beat base.

“A post-mortem will be conducted to verify the cause of death,” he said.

A family member, who declined to be named, said that when they arrived at the babysitter’s home they saw the baby’s mouth had turned purple and black.

It is learnt that the initial post-mortem result showed that the caused of death was believed to be due to chest infection.



Not being cruel or judgemental, but i think it is really irresponsible of the parent to dump their baby (3 month old) to a babysitter and they themself go for a holiday. If its a business trip or something urgent than MAYBE its justified, but they went for a Holiday! and for 1 month duration~
I dont know what makes them do that, perhaps they find being a parent isn't easy and think they deserve a break?
And they leave the baby in the hands of a babysitter when their relatives live in the same area as the babysitter...i find this weird too...

Now, who is it to blame? Want to sue the babysitter? Who ask you go for a holiday? Can't your Hong Kong trip be posponed later? Hong Kong won't run away, i'm sure~

I dunno la...i'm not a parent yet, but for me, I will not leave my child who is only 3 month old in the hands of a babysitter to go for a HOLIDAY~...it's just ridiculous.. the baby is not a puppy you know....

of Voltaren and Voren

today i went to 2 pharmacies to look for Diclofenac gel (Voltaren or Voren) for my sprained ankle

in the 1st pharmacy
me: Excuse me, do you have voltaren gel?
Storekeeper: ooo u mean for asthma one? got got
Me: no, not for asthma, for painkiller one. Diclofenac...
Storekeeper: o....pharmacist not here, don't know

So imagine, they can cell asthma inhaler but cannot sell topical Voltaren

In the 2nd pharmacy just beside the 1st one

Me: excuse me, do you have topical diclofenac
PHARMACIST: Huh, diclofenac? how many miligram u want?
Me: oh no...i want topical one....are there any gel preparation avaiable?
PHARMACIST: Huh...diclofenac we don't have topical one...no gel only pill
Me: Got la, i use before...
Pharmacist: Let me check.......we only have Voren,Voltaren and counterpain. WHere got diclofenac?
Me: -_-"

For those of u who did not understand, Voren(or Voltaren) IS diclofenac! Voren/voltaren is the brand name for Diclofenac.

I dont blame her if she's a lay person, but she is a Pharmacist...dunno graduate from where one.

Madness-->Sex Ed--> Hitting the G spot?

From the STar

THE G-spot is probably the most talked-about aspect of sexual relations as it is believed to be able to produce very powerful female orgasms. Yet, it remains elusive to many.
For many women (and men), finding the G-spot is practically a lifetime endeavour. Some may never find it ... but half the fun is in the finding!
Does it exist?
Is the G-spot real, or just an idea cooked up by a woman to make things more challenging for men? Well, conventional wisdom indicates that it does exist in some women but not in others, and that the sensitivity varies for every woman.
The G-spot is an area located about one to two inches inside the vagina on the front wall (the “front” wall is the wall of the vagina on the same side as the belly button). The area consists of the bean-shaped spongy tissue of the paraurethral gland – it is to women what the prostate is to men.
When a woman is not sexually aroused, the actual area is no bigger than a pea, but once she is aroused, it increases to the size of a small coin. This is because the G-spot is composed of erectile tissue and swells up when blood rushes to it.
It feels rougher to the touch than the surrounding tissue, rather like a walnut compared to the smooth, silky wall of the vagina.
It was named after a gynaecologist called Dr Ernst Gräfenberg, who first described the G-spot in the 1940s.
Finding it
So how does one find this mysterious spot? The most commonly recommended method is to insert the forefinger and crook it into a “come here” motion towards the front vaginal wall, sliding your fingertip along the top of the vagina until you find an area that is rougher than the rest of that vaginal wall.
Foreplay is important because a woman will be more sensitive if she is already sexually aroused. Experiment with the pressure and length of the stroke to find out what feels best.
Some women do not enjoy manual stimulation of the G-spot, but may enjoy penile stimulation during intercourse. It helps if the man’s penis has a natural upward bend and is able to make contact with the G-spot, but different positions may also work, such as the “woman on top” or the posterior position, or raising the woman’s pelvis.
It’s quite likely that you will not be able to find the G-spot on your first try. Women should not be shy to tell their partners what they are feeling during stimulation, and what feels particularly sensitive.
Gee, what does it feel like?
Different women have described different sensations with stimulation of the G-spot. Some women say that the first sensation is similar to the need to urinate – this is possibly because the G-spot is on the front wall, therefore pushing against the bladder.
However, when you become comfortable with it, you may be fortunate enough to experience a powerful orgasm, or even multiple orgasms if the G-spot is stimulated repetitively.
Some women even claim to ejaculate when their G-spot is stimulated. Research shows that approximately 10% of women release between 9ml and 900ml of fluid from the urethra during such an orgasm.
G-spotless?
Despite all the hype built up around the G-spot, we have to face the fact that not all women are G-spot-sensitive. Some women actually find G-spot stimulation to be uncomfortable or simply produce no sensation at all.
It is believed that women can intensify their ability to have G-spot orgasms by doing Kegel exercises to strengthen their pelvic floor muscles.
Age may also make a difference in the type of orgasms women achieve. For most young women under 30, their relatively high oestrogen levels lead to thicker vaginal walls. Hence, it is more difficult to directly stimulate their G-spot area.
After their 30s, however, women’s oestrogen levels begin to decline, causing the vaginal lining to become thinner and the G-spot to become more accessible. So you may find G-spot orgasms more likely during your early to mid-30s.
Nonetheless, you don’t have to build your entire sex life around that little area known as the G-spot. If you and your partner take it too seriously, it may even end up ruining your enjoyment of sex.
If you don’t have a sensitive G-spot, just accept it. The clitoris and urethra are other erogenous zones that can be stimulated to provide pleasure. So experiment and explore other ways to improve your sex life.



n Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). For further information, visit www.primanora.com. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.


For more information, see Wikipedia

Should have looked for the G spot in the labour room or in the cadaver,eh?:P

Education

Now, MCA want to organize a Physics and AddMaths workshop for students and teachers. I dont know why or whats the need for such workshops, because as far as I know, in Melaka, most tuition centres offer tutorials in this subject.

But none offer tutorials for subjects like STPM biology.

Perhaps we should consider a Biology for STPM workshop 1 day?

Education -> is the cane necessary?

Look at this comment by some readers regarding caning in school

Stop caning
CHINESE primry school pupils are caned for minor mistakes like forgetting to bring books n low marks in spelling. Pupils are terrified! Edu Dept, pls ban caning in chinese schools, not necessary.
STOP caning school kids 4 not doing homework. Don’t presume child was lazy. Ill health may b one cause.
SON age 9 was caned for answering maths question wrongly. Now traumatised n stressed in chinese pri school, afraid 2 make mistakes. How can kids learn? JY

I don't know la....but maybe parents today pamper their child too much.

"stop touching my brat! or i will report u to the MCA! if MCA never do anything i will go to DAP! if not i will write petition to the King to have a royal commission to investigate why u hit my child!" -_-"

Caning with reasonable intention is the most effective method to discipline a child. It can be explained physiologically. In the brain there are areas called reward and punishment centres. It is essential in learning. If a kid do something bad and get a punishment which is painful, he will learn that doing that thing will cause pain and not do it again! Similarly, if he do something good,and gets a reward, he will try to do the same thing over and over again.

All other punishment proposed by parents of pampered children are preposterous. They want counselling la,talk properly la etc. For God's sake, these are children. You talk properly to them,they will say they understand although they dont and do it again! Than he gets counselling again and again until 1 day, he felt bored and desensitized to those words coming through his ear. He then sleep in counselling session. So how? Counsel him that it is wrong to sleep in counselling session?

Kids not doing their homework must be punished or else this habit will carry on till their adult life. Caning is an effective method. Of course the one who cane the children must know his/her limit. Do not cane too hard as children's skin are delicate. Just deliver a message to them that not doing homework is a wrong thing and deserve punishment. Cane them parts that will not hurt that much e.g. palm, buttocks . DO NOT cane at the back of the hands, face, body, legs etc.

Agreed that some kids did not do their homework due to ill health. But isn't it the job of the parents to explain to the teachers about this? Can't they even write a simple letter explaining the situation to the teacher? The teacher will surely understand and excuse the child! But no...as usual, parents expect teachers to know everything about their child! Even if their child is sick at HOME, they expect the teachers to know. Easy ma...just COMPLAIN to MCA or DAP if the child kena cane.

The inappropriate reason for caning is when a child did not do well in exam. Children are prone to make mistakes and should be given chance to rectify their mistake. It is not a big crime deserving caning. However, if a child repeatedly do the same mistake over and over again despite adequate explaination, some form of punishment must be given to ensure the mistakes are not repeated.

However, i heard that in chinese schools, students are caned for not scoring perfect in exams. That means, you must score 100 marks. If not, you will be caned. Even 98 marks is no good, you must have 100. Well, the school may have good intention, wanting to be perfect, but isn't it absurd to cane a student just because he/she make a mistake or two? This is inappropriate...its exactly the life that will put students into a depression. The school must realise that nothing is perfect,not all children have equal ability. However, whatever we said, the caning of children for "low" exam grades are still rampant in chinese-medium schools today.

In my school life, i did not memorise my times table until standard 4! Haha....why did it happen? because in std 1,2 and 3 teachers are too kind to me. In std 4, there come this big "Terminator" who will really hentam anyone who doesn't know his times table. This terminator scare me into memorising! So you see, without Mr Terminator, i would not be what I am today.
I have been caned for various offences in school which I am not proud to disclose, but all those caning, looking back now, makes me a better person.

Therefore, my point is, when you cane a child, he may hate you in short term, he will not do the mistakes he is caned for. But when he grow up, he will remember and grateful to those who punish him! He will not hold grudges if the caning is reasonable.

Reasonable caning? Ok, let me give you one example of UNreasonable one. In my form 3 days i have one hell of a Living skills teacher by the name of Zainuddin. This fella enjoys caning for no reason like i enjoy eating Baskin Robbins ice cream. Without any reason, he will cane and laugh. I remember him...and still wonder why he caned me in almost all Living skill classes. Mind you...his caning really hurts, he's an ex army officer you know.

that's all la......caning appropriate or not, up to you to ponder on.

Senarai Penginapan Tahun 4 09/10

is out! Check it out at KTDI website

Relation between hot beverages and oesophageal Ca

this is a study done in Paris showing the link between piping hot beverages and oesophageal cancer. According to Chandrasoma and Taylor in Concise Pathology 3rd edition, Oesophageal Ca is more common in the far east, notably China. Why is this so? This is because Chinese people love to have hot meals, hot tea and hot soup. This risk factor is not proven untill recently. So, if you want to drink soup or tea, there's no need for it to be piping hot. The nutritional value will not change if you cool it down a little. :)


An endoscopic photo of an adenocarcinoma at the lower esophagus. There are multiple polypoidal growths at the 6,11 and 12 o clock position. The growth is may obstruct the lumen causing dysphagia to solids initially and progress to both solid and liquid.

PARIS (AFP) - - People who drink their tea piping hot run a higher risk of throat cancer than counterparts who prefer a cooler cuppa, according to an investigation published Friday by the British Medical Journal.



Cancer of the oesophagus is linked especially to smoking and alcohol abuse but hot beverages have also been considered a risk factor, possibly because of damage to throat tissue.
Interested in finding out more, Iranian researchers went to Golestan province, which has one of the highest rates of oesophageal cancer in the world.
Inhabitants there sip large quantities of hot black tea -- typically drinking more than a litre (1.8 pints) per day per person -- but also have a low incidence of tobacco and alcohol use.
A team led by Reza Malekzadeh of the Digestive Disease Research Centre at Tehran University of Medical Sciences looked at 300 people who had been diagnosed with a throat tumour and a matched group of 571 healthy people who lived in the same area.
Those who drank hot tea (between 65-69 degrees Celsius, 149-156 degrees Fahrenheit) were twice as likely to develop throat cancer compared with those who drank warm or lukewarm tea, whose temperature was 65 C (149 F) or less.
Drinking very hot tea (at least 70 C, 158 F) was associated with an eightfold increased risk compared with warm or lukewarm tea.
In an editorial, The Lancet said the study backed evidence that scorching fluids may cause damage to the throat's epithelial lining and lead to cancer, although exactly how this happens remains unclear.
But it also said that there was no cause for panic, as most people tend to drink tea at a warm temperature. Previous studies in Britain have reported an average temperature preference of 56-60 C (133-140 F).
It recommended that tea junkies wait at least four minutes before drinking from a freshly boiled cup.
The study said there was no association between the amount of tea that was consumed and the risk of cancer.
Its scope did not include an assessment of risk for coffee and other hot beverages.





For further knowledge on this issue read Chandrasoma and Taylor's Concise Pathology 3rd edition page 568.

Kerja Toyol

Kerja kerja Toyol
Diagnosed by Jeffrey On 9:42 AM
Toyol is a mystic creature in the Malay folkfore. It's actually a dead fetus which is have been revived by dark magic by a bomoh. The toyol will do its master's bidding, most toyols are used for stealing money.

A Toyol

But in the Selangor previous government, a bigger toyol have emerged. And believe it, this toyol is not a fetus, it's an adult complete with misai and janggut! And it is extremely powerful as it is able to steal money right under the Governmen's nose! read the news below

SHAH ALAM: Permodalan Negri Selangor Bhd (PNSB) spent almost RM1mil for a trip to France and Morocco taken by former Selangor Mentri Besar Datuk Seri Dr Mohd Khir Toyo and his entourage in 2004.The entourage included his wife Datin Seri Zaharah Kechik, their three children and Indonesian maid.PNSB chief executive officer Datin Khairiyah Abu Hassan re-vealed this at the Special Select Committee on Competence, Accountability and Transparency (Selcat) inquiry yesterday.She said that among others, RM81,723 was spent on Dr Khir, RM366,000 on a recce team which went earlier to prepare for the trip and RM2,300 for an economy class ticket for the maid.PNSB also paid an additional RM9,000 for Dr Khir and his family’s accommodation during a four-day transit in Dubai.The inquiry heard that PNSB paid RM750,000 for Dr Khir’s trip to the United Stated in December 2007, which included tickets to Orlando Disneyland.An additional RM110,000 was spent on Dr Khir’s seven-night stay at a hotel suite in Honolulu, Hawaii.Dr Khir and his family also flew first class, said Khairiyah, adding that the entourage visited Miami Beach, Los Angeles and the Kennedy Space Center.On why the trips were conducted during the school holidays, Khairiyah said Dr Khir, then PNSB chairman, had fixed the dates.Selcat chairman Teng Chang Khim said a police report may be lodged against Dr Khir and Zaharah for failing to attend the inquiry.Zaharah was the head of the now defunct Wives of Selangor State Assemblymen and MPs Charity and Welfare Organisation (Balkis), which is being investigated for various financial discrepancies.As far as the Contempt of House Act 2008 is concerned, Teng said anyone violating the Act could be prosecuted with the Attorney-General’s consent.He added that Dr Khir may be referred to the State Assembly’s Privileges Committee for further action.
from The Star

Considering this news comes from a mainstream media, I suspect the amount spent was diminished to make this toyol look "better". If diminished means rm1 million plus, the real amount must be really big. I want to own this toyol!!!:P