Jeffrey's Lair

Pengajaran & Pembelajaran Sains dan Matematik dalam Bahasa Inggeris

2009-07-09T00:52:00.000-07:00

So in the year 2012 Sains dan Matematik will be taught in BM.

Frankly, I oppose this decision. But for a different reason.

The Government seems to have forgotten the purpose of teaching Science and Math in English. They seem to think that teaching science and math in english is to
1) improve level of english in primary school children
2)improve the result of Sains dan Matematik in UPSR

To tell you the truth,Malaysia is the first country in the whole universe to use Science and math to improve english. Nobody have done this before ^^

"Muhyiddin said studies carried out by local universities found that students’ mastery level of English during the entire policy was around 3% while the level among rural students was low.
“Based on these observations, the Government is confident that Mathematics and Science should be taught in languages understood by students, which is Bahasa Malaysia in national schools, and Chinese and Tamil in the respective vernacular schools,” he said."- The Star

The reason Tun Dr Mahathir introduce PPSMI is for the future generation. How can the government gauge the success of PPSMI after only 6 years??? Most children who is under PPSMI is only in Form 1 now!!

Let me reiiterate the purpose of PPSMI: To make sure students are competent and familiar in the Scientific english when they are in the University and outside world

How can you use the declining UPSR results as a "strong-point" to discontinue PPSMI??

Imagine what will happen to the form 1 students now. They had learn Science and Math in English for 7 years. They will continue learning in English up to PMR level. Then in form 4, suddenly constant become pemalar, hypothesis become hipotesis, Newton's Law of Motion become Hukum Gerakan Newton (Thank goodness its not Niuten). And they will learn all this till form 5. Then, in form 6 they will learn back all these terminologies in English!
Then we will produce Rojak graduates. Not proficient in BM or BI.

Memang dah sah gomen ni stupid. Even if you want to revert the policy, wait till the pioneer batch of students under the PPSMI students to enter higher education. Assess their level of english then. If they have mastered english successfully by then, it means that PPSMI is a success. If there is no difference or worse, then by all means scrap it if you want! This is how the success of PPSMI should be assessed, not based on UPSR results! (Of course, pakcik muhydin will say "cis...budak ni tau sikit sikit, sudah trying to teach me what to do")

You scrap it in 2 years, what good will it do? We will not even see 1 Malaysia University student who have Science and Math taugh fully in English in school. We will get rojak students!

We are going down. Keep digging our grave, dear government, but don't take us along with you.

Starting Paediatrics!!

2009-07-05T04:45:00.000-07:00

Starting Paediatrics tomorrow! Yay!

Hopefully i won't be "yay"ing for only 1 day. Some said Paediatrics is like Internal medicine...well, doesn't sound too bad.

Some said Paediatrics is like O&G.......OMG.....its going to be hell~~

Look at Yi Hui, Paediatrics seems to be more like Surgery......relax only..can go marathon somemore~~:D

But cannot compare myself to a Super Medical Student la...

So I assume Paediatric is like O&G&IntMed....so much to learn yet so little time. Wait a minute...isn't all posting like that?

Arrrgghh...no need think ady la.......just go and play with small kids tomorrow. Scared oso no use rite?

2009-07-03T18:44:00.000-07:00

Cheers replace tears for SPM top achiever

Luckily, being rejected by the JPA doesn't make me cry and stop my meals back then. If i did that last time, no politician of any sort will be coming to my aid. :P

I hope this girl here realise what's in store for her for the rest of her life. And i certainly hope to see her "serving the country" without complain next time. That's her vow, isn't it? All the best~

From Calcium to Bone

2009-07-01T01:49:00.000-07:00

Orthopaedic posting is over......it's been a very very nice posting bcuz there's so many new things that is learnt throughout this posting

Before coming to orthopaedics i am worried i will suffer because of my poor basic in Musculoskeletal anatomy. Now that orthopaedics is over, i understood why i despised Musculoskeletal in the past : its because in the past i dont see the purpose of memorising lengthy muscle names. It seems so silly. Now that i've completed orthopaedics i finally realise that it is fun to know about muscles and tendons and ligaments.

Special thanks to my 1st week "supervisors", Prof Amara, Dr Rashidah, Dr Musfirah, Dr Masri, Dr Kartina and all others in the Rehabilitation team for igniting my interest in Orthopaedics during the first 2 weeks. If i am not interested i will end up like in O&G walking around pointlessly in the ward.

Going on to Paediatrics....If i take Yi Hui as the standard, looks like Paediatrics is not so busy also..hahaha but I will be prepared for anything which awaits me in Paediatrics~~~
Here comes the Paedophile~~~~~~~~~ :P

The return of TB

2009-06-22T07:44:00.000-07:00

Due to our government's generousity in accepting foreign workers without proper screening, TB has returned to Malaysia! Welcome back, old friend(or foe?)

Return of disease linked to foreign workers

Because i foresee that our government will continue to be generous for many years to come, I think its essential for us to equip ourself with the knowledge about our old friend here.

As usual, basic sciences are essential
1) What is Tuberculosis
2) Describe the etiologic agent
3) Clinical features
4) How is it transmitted
5) What investigations need to be done
6) What other organism or disease that can mimic tuberculosis
7) Complications of tuberculosis
8) Pott's paraplegia-what is it?
9) What are the regimens for anti TB drug? how long it should be given? Based on what do we decide the exact duration?

Nodules of the limbs

2009-06-16T22:41:00.000-07:00

Foot

Elbow joint

An easy one here.

A 73 year old man who is known to have chronic renal disease presented to PPUKM with multiple painful nodules on the upper and lower limbs for 1 year duration.

1) Describe the nodules(sorry for the bad image quality, my Hp camera only 2 megapixel)

2) What are your differentials? What do you think is the most likely diagnosis? What makes you say so?

3) What investigation do you want to do? What to expect?

4) The best way to diagnose this condition is clinically. How do you do that?

4) How do you manage this patient?

The power of Blogging?

2009-06-12T06:58:00.000-07:00

Could it be coincidence, or had someone actually saw my previous post and took action?

The sink in the previous post is now this.

Very neat and clean, isn't it? Hope it can be maintained like that:)

This proves YM wrong...its NOT a SSM project of growing aspergillus

Next time I saw anything dirty i will blog...it will become clean in a matter of hours:)

Blogs works wonders :D

Medical Students are survivors

2009-06-12T00:42:00.000-07:00

You know, i am sometimes quite amazed at the perseverance and strength of medical students in life. They can survive anything and can live in any adverse conditions.

Medical students, i think, are trained to practice "hygienic medicine" but not hygiene itself. I don't like to do this at all, but below is a picture of a washing basin from one medical student's quarters.(identity dirahsiakan)

Note the growth of fungi (presumbly, Aspergillus. niger?). I have noticed this for weeks and am observing for some actions. Medical students can live in this condition! Who said medical students cannot survive adverse conditions?

Full proof of 2 things

1) Medical students are survivors(Salute!)

2)I am not a survivor because i will kill all those aspergillus niger when I cannot tahan the sight of it anymore.

Vote for Kuan Yew!

2009-06-05T17:36:00.001-07:00

Our friend Kuan yew is running for the President post.......oops salah. :P
ACtually he is contesting in a Postcard competition and he needs all the votes you can give.

Vote for his beautiful photo! You won't regret.

KUan yew rocks:D

CEPAT!!!

PPD-Approaching a Difficult Patient

2009-06-05T17:36:00.000-07:00

Usually a patient refuses to be clerked for one(or more) of the reasons stated below

1) Too many medical students clerked them before you

2) Bad experience with another medical personnel

3)their idea that it is useless talking about their pain to medical students who can do nothing about it. They want to see the Senior Consultant.

4) They are stressed about their condition and would rather not talk about it

5) they have seen medical students being reprimanded by a doctor( Registrars or Consultants) and lost confidence

6) Medical students appear not so confident

7) They may be in pain at the time u ask them.

Sometimes, these type of patients have very rare conditions(e.g. Ventricular Bigemini) that makes it all more necessary for you to clerk them. So how to approach? Here's a few tips.

1) Always approach patient by 1st asking them "How are you today?""How do you feel today?". This will give the patient a good impression. They know you care for them. This question also sometimes makes the patient tell you their current (acute) problem. If they do, say to them"I see...but what happens in the first place when you are admitted?" Most of the time they will tell you everything :)

2)While the PPD style "Selamat pagi encik, saya So&So, pelajar perubatan tahun 3" introduction may work well for some patients, most of the time it will not especially if the student looks timid. Patients will not have confidence to confide their problem to you. Therefore, always look confident. Don't hug your clipboard or notebook or whatever while introducing yourself to your patients. Because even for me it reflects that you are afraid. Put your clipboard on the table, walk to the patient, shake hands and introduce yourself, confidently and politely.

If your supervisor had asked u to clerk the patient, all the better. Say " Saya pelajar di bawah Dr So and So, saya nak tahu keadaan puan/encik untuk dilaporkan kepada beliau". 100% success.

3) The patient may reject you because they are occupied with something else at that time. In this case, make an appointment. Ask to clerk them after tea, after lunch etc. Usually patient may agree.

4) Some patients refused to be clerked because sometimes, medical students take a long time to clerk and they felt bored. Therefore, give them a time limit. Tell them " Pakcik, saya nak minta masa 15 minit untuk pakcik beritahu saya keadaan pakcik, boleh tak?". Make sure you adhere to time limit and if you exceed, please apologise. Normally the patient will not scold you. It is also a good practice for long case because in long case you only have 10 to 15 minutes to take full history.

5)Always visit the patient till he is discharged. Treat him like a human being.

Lastly, even if you are not clerking a patient, always flash a smile at them. A smile can bring lots of comfort, especially to the sick. Don't do catwalk in the ward and act as if the patients are not there. Your whitecoat is not a nice dress to be in for catwalk. After all, you will never know when you have to clerk those patients, and having been friendly and warm to them, it will make your job much more easier.

Goodluck!

?what you should know by now

2009-06-04T02:17:00.000-07:00

Important Must Knows
Cardiology
Presentation of cardiac pathology
Angina-types
Angina-MI difference
STEMI and NSTEMI and how to differentiate them
Complications of MI
Principle of management of MI and Angina
CCF-at least know the 3 most common cause i.e. MI,dilated cardiomyopathy and systemic hypertension, others such as congenital heart disease, valvular heart disease and cor pulmonale is additional
Types of CCF
Effect of CCF on CXR and ECG
Complications of CCF
Heart block-ECG changes(may be asked in long case)
Atrial Fibrillation-causes, effect and management. For causes, i use the mnemonic I SMART CHAP, there are other mnemonics such as CVS HaRUS CePat etc...use whichever 1 convenientI=inflammatory condition such as pericarditis and pleuritisS=sick sinus syndrome, in old people where there is idiopathic fibrosis of the sinoatrial nodeM=Medications such as verapamil, levothyrosineA=atherosclerosis of the vessels leading to ischaemiaR=Rheumatic heart diseaseT=thyrotoxicosisC=congenital heart diseaseH=systemic hypertensionA=alcoholP=pulmonary causes e.g. pulmonary embolism and pneumonia
Infective endocarditis- Memorise the Duke criteria inside out,aetiologic agent and appropriate antibiotics is extremely important.many neglect this
Rheumatic heart disease-The bacteria involve, involve what valve, what is the extracardiac features(Duckett Jones criteria)
Dont forget the drugs used to treat cardiac disorders.
I think this is enough to cope for now kua.....respi, neuro and gastro and others next time tell la..

Of Surgery and Medicine

2009-05-31T16:26:00.000-07:00

Abstract from my 3 hour story with my juniors in Cafe Wahid

For Surgery
Staying at ward for long period of time and going for "walk-around" instead of ward round is foolish. So, minimise ward visit(maybe 2 case clerking in ward per week?). Visit clinics and read more instead.

For Internal Medicine
Stay at ward, clerk at least 1 full long case per weekday. Clerk different cases. If possible, have at least 2 Observed long case per week.

For both posting, everyone must not worry about not being able to clerk properly because everybody start from zero. WIth time and practice i am sure you will be competent.
Do not panic. Relax and study smart.
Wish you all the best~^^

The essence of medical life

2009-05-30T06:02:00.001-07:00

Complete each other, not compete with each other. Remember this always, whatever you do, wherever you are...

Of SPM and JPA

2009-05-23T17:22:00.000-07:00

Currently the government is trying to put a limit to the number of subjects a student takes, and to try to rectify the thousand-year-old problem of JPA scholarship awards.

All I can say is, please walk the talk. It seems that in our country, the month between May to July will be the Complain and Appeal period, where hundreds(if not thousands) of deserving students are set aside while even more not-so-deserving students rejoice.

Among the silliest reason given is : Not only academic prowess is assessed, co-curicular activity is also assessed, which is why some students with 6A(1and 2) triumph over a student with 14A1s. This is absolute nonsense. Unless I am mistaken, they are giving out SCHOLARship, not LEADERship or COCURICULARship. Scholarship priority should therefore be given to students with the makings of a Scholar. Not prioritised to those who join 10 co-curicular activities!

Of course, if the student can only study and don't have co-curicular activities, then padan muka la. But to choose a mediocre student to receive scholarship just because they're have more co-curicular activities will produce mediocre scholar as well. Worst, it will produce no scholar at all!

Being good in studies doesn't mean you are good in leadership and other qualities, likewise, being good in co-curicular activities does not make you good in studies. SInce the main purpose of giving scholarship is for the scholar to study, it should be given to the obvious choice!

To add salt to the injury, even if the students hold many post in co-curicular activities, they are not necessarily good leaders! They have a post in the society, but how they work and bring up the society is a totally different thing! We cannot say they are good just because they hold a post in the society!

Some students take 21 subject and excell in them all! COngratulations! But for me, it only shows that you don't have a plan yet for your future, what you want to be. In form 4 students should actually have a rough idea the life they want, and focus on it. If you take 20 subject (The silliest is taking Science when you have already taken Physics,Chemistry and Biology) it show that you have a very good hippocampus but an underdeveloped cerebral cortex :). You quietly tell me that you fail to recognise that sometimes, quality is important, not quantity.

I was in this JPA dilema in 2003 after my SPM. My application for JPA is rejected despite my 9A1s(I am not silly enough to take 20 subject back then) and excellent co-curicular activities,not forgetting that I gave the most(but not very valid i think,looking back) opinion during the silly "globalisation" JPA interview. MCA couldn't help me. So, no choice la, go form 6. 2 years later, I graduated with a 4.00 pointer in Biology, and the dilemma start again. WHat if the public Uni reject me again? Thankfully, luck is by my side, I am inducted into medical school:)This time it is my turn to reject JPA and took PTPTN instead:D

When will this JPA and string-of-As issue will ever end, i don't know, for as long as i remember, every year more and more young brilliant people resents the government. Soon, it will not be hard to find a successful Malaysian in foreign countries...but hard to find one back at home.

Starters for Internal Medicine

2009-05-23T01:47:00.001-07:00

Endocrinology

Thyroid
What are the signs to look for when examining a patient with a thyroid problem?
What is the best way to visualise a mass in the neck?
Are there any non pathological cause of hyperthyroidism? If yes, how do we manage?
What is meant by thyroid storm?
a patient's blood test show that she have subclinical hypothyroidism. Explain what is meant by this and plan your management.
a 71 year old lady presented with anorexia, depression, weight loss and muscle weakness for 2 years duration. There is no history of heat intolerance or tremor. ECG showed changes consistent with atrial fibrillation. On examination, the only finding is eyelid ptosis. Neck examination show a mildly enlarged thyroid gland. What is your differentials? What investigation would you do?

So sorry for the controversial post yesterday

2009-05-20T05:46:00.001-07:00

That is just my reflection on the changes that i've made in life. SOmetimes we need to reflect on the root of the problem and rectify all mistakes. I am NOT saying that all my friends don't deserve good treatment from me. I am talking about myself, how overzealous passion and unwise behavior can lead to disaster. What the changes i've made throughout my life!

I don't mean to make anyone sad. Its probably the strong words that i use make some people feel uncomfortable.

To my friends, you are all my friends and any problem actually arises from myself, which is why i need to reflect and rectify for your hapiness and mine too.

To Kuan Yew and Magicarp, thank you for your concern! Dun worry, its not that i'm unhappy with you all, its just a KPI(Key performance index) for myself:)

Being a Human ain't easy~~

2009-05-20T05:46:00.000-07:00

so let us spend a moment to reflect on our Human side.
1) Being compassionate and selfless leads you nowhere
2) Being hard-hearted leads you to your enemies
3) being cold hearted makes you soulless

I had always believed that happiness is when you are surrounded by my family. Because i assume my friends to be part of the family, I subconciously deceived myself that i am happy.

However, I learnt that friends can never be part of your family. You will never know when your friends are going to hurt you. And they will hurt you real bad, especially if you think they are the family you built yourself.

A friend of mine, whom i used to treat as a member of my family, even told me, "We will never be like brothers". So when we treat someone nicely they may not treat you the same. They may even be wary of you as if you have something up your sleeves.

Therefore, a new policy this year is, I will be happy as long as my true family members are with me. Friends, are just your colleagues, the people you see everyday. If we are too good, it will be unfair for our family members and our good friends~

My family members, thank you for being there for me all this while.
To my 3 best friends: Desmond, Frankie and Guan Rhung, Thanx for the support!
To my other friends : sorry if i offend you, but friends are friends! So lets remain that way :)

3rd years

2009-05-18T05:14:00.000-07:00

Since all my colleagues are already in 4th year, i doubt they will visit this site to revise Internal Medicine till next year.

So, most of the message and questions i put on here is for the 3rd years. Please make good use of it.

For starters, I will just summarise the long long advice i gave during the MTK.
> For JKM posting people, please start reading Tallys on the 4 main system
>For Internal medicine, please start practicing your long case, especially presentation latest by the 3rd day of the 1st week. Read Endocrine first, as the first workshop is on Endocrinology
>For Surgery, I dunno what to say. Go clinic and practice, read more.
> For O&G, please adapt as soon as possible. Ask for help from your seniors, don't be shy. Its better to be wrong in front of your seniors than in front of the Lecturers.(Especially the Gengar)

All questions are welcomed here(especially Internal Medicine). All the best :)

Jokers

2009-05-15T20:36:00.000-07:00

I am quite concerned over the "spoonfeeding syndrome" we Malaysians are having, to the extent that personal hygiene must be educated to the public!

Personal hygiene, body odour etc used to be learned at home, taught by parents. Now must make roadshows to educate on body odour.

Students learn about overcoming body odour.

Truth be told, many Malaysians either don't notice, don't care or maybe love their body odour. Try taking the LRT at 2pm when the LRT is full of school kids. If you have asthma you would probably be suffocated to death

Not only students, adults too. People say, the more the merrier. I say, The more the smellier. It reflects bad upbringing.

Thank you Rexona for teaching the kids.

2 weeks of Orthopaedics

2009-05-15T00:14:00.000-07:00

and i am enjoying every bit of it!

And I think that the reason is I got a super nice team.

Team headed by a ultra nice prof, Prof Amara assisted by equally nice Dr Rashidah

This make us more motivated to learn, and i actually learn more in 2 weeks of orthopaedics than 8 weeks in other postings

So hopefully my next team, Paediatric Orthopaedic will be equally nice......

What I did in 2 month

2009-05-02T10:14:00.000-07:00

What I did during the longest 2 month of my life

1) Did an elective posting at an orphanage, playing Ultraman
2)Attempt to write a book on PE for miscellaneous conditions in short cases, somehow discouraged today after looking at UM's very own Orthopaedics PE book, which is about the same structure as mine but written by a person with the prefix "DR" :( maybe i'll publish a better one when i get the prefix, hopefully in 2 or 3 years time.
3)Learn cooking and finally succeed in stirring up my favourite "pai ku wang", where the only mistake i made in the ingredients is using the wrong brand of tomato sauce.
4) Complete my "housewiving" posting at my house. I didn't do much, but its tiring,mind you.
5) Attempt to catch up with my friends, some whom i have not met for almost a year. learn some unpleasant surprise regarding some of my classmates backstabbing ways :-(
6)Help in supervising my ex-alma mater's Wesak day float, which I think is the most beautiful i have seen over many years.
7)Travelling, from penang to ipoh to melaka to muar to JB and to singapore in search of food.(which we fail to find during our singapore trip)
8) Went to singapore again and finally managed to dig out the food treasures from the island.
9) Resolution : Be a better person, do not get pissed off so easily, be wise and strong in face of adversity. Reduce the amount of dirty jokes and polishing my skill of "delayed-effect" laser mouth.

Kicking off with Orthopaedics~

2009-04-30T07:58:00.001-07:00

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

2009-04-29T22:47:00.000-07:00

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

2009-04-27T19:42:00.000-07:00

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

2009-04-26T03:48:00.000-07:00

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????

2009-04-23T08:34:00.000-07:00

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

2009-04-20T23:27:00.000-07:00

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

2009-04-19T18:53:00.000-07:00

This article is interesting
Culling for Quality

Booklist for 3rd Year

2009-04-17T23:26:00.000-07:00

*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

2009-04-15T19:52:00.000-07:00

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

2009-04-15T19:27:00.000-07:00

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~

2009-04-15T06:40:00.000-07:00

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

2009-04-15T00:39:00.000-07:00

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

2009-04-14T09:13:00.000-07:00

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

2009-04-13T05:58:00.000-07:00

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

2009-04-13T03:23:00.001-07:00

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

2009-04-11T05:21:00.000-07:00

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

2009-04-09T04:07:00.000-07:00

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.........

2009-04-08T18:54:00.000-07:00

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

2009-04-08T00:08:00.000-07:00

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?

2009-04-06T07:12:00.000-07:00

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

2009-04-06T06:39:00.000-07:00

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?

2009-04-03T19:17:00.000-07:00

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

2009-04-03T09:21:00.001-07:00

is out! Check it out at KTDI website

Relation between hot beverages and oesophageal Ca

2009-04-02T20:25:00.001-07:00

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

2009-04-01T19:00:00.000-07:00

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

Of woman and man......

2009-03-30T03:51:00.001-07:00

comparative complexity

is this for real?

MErits for 08/09

2009-03-30T02:44:00.000-07:00

on KTDI website

http://ktdiukm.wordpress.com/exco/merit/merit-tahun-3-0809/

Jabpenis Celebration

2009-03-29T19:28:00.000-07:00

want this on your mantlepiece?
If they want a penis THAT big its no wonder why birth rate is low....

All hail the Penis!

Very good drawing, complete with pubic hair XD

this is a very very interesting celebration by the Jabpenis people......they actually venerate the Penis! Considering the low birth rate in japan, maybe they should demonstrate how to use it :P

Writing a book......

2009-03-25T02:55:00.000-07:00

wasn't easy! haha.....i really relied on my memory and experience in writing the new edition of PE booklet, because i forget to bring back the old one! haha...but i think the newer edition includes much more information than the old one. For example, want to know what's is Cogan's Lid Twitch sign? Just get a copy of the ____________________ for free!

I put ____________because i couldnt think of a title for the book yet........so any suggestion? Thank you :P enjoy the holidays!!

Paktorlogist

2009-03-22T06:22:00.000-07:00

This have nothing to do with medicine but to my Paktorlogist

I hereby announce that the Dean will be on Study leave till a date which is uncertain. Therefore the post of the Dean of Paktorlogy will be held by Prof Sam Jo Ee who is also the Head of Mammarology department.

The dean will go on leave(and on a mission) and will be back when he become more qualified to head the Fac.

Take note!! don't call me dekan anymore...i'm on study leave...yahooooo!! haha

Stress Induced cardiomyopathy a.k.a broken heart syndrome

2009-03-21T20:45:00.000-07:00

This is a rare condition. But rare conditions always result in death, dont they? so its good that we have an idea of what we're dealing with

BROKEN HEART SYNDROME

Management of Diabetic Neuropathy

2009-03-21T00:00:00.000-07:00

These article is a good read. It is detailed and fun to read.

Management of Diabetic peripheral neuropathy

Diabetic Neuropathy

2009-03-20T23:31:00.000-07:00

Ok...i know exam is over,results are out. But i would like to share these article as a revision for one of the most important disease in Medicine, diabetes.

Diabetes can affect all 3 division of the nervous system: sensory,motor and autonomic nervous system. The most common early presentation of diabetic neuropathy will be numbness of the extremities commonly described as "gloves and socks" numbness. It is a form of peripheral neuropathy and because of that, it affects all dermatomes. Therefore, during examination of diabetic foot to look for numbness one need not test according to dermatomes. Sensation is loss for both pain and light touch and for some reason, temperature sensation is not affected. Loss of proprioception is also an early sign, however, patient often does not notice this because the dominating or main problem to the patient is often sensory loss. The patient may also complaint of gait instability. Therefore, this sign must be elicited by the examining doctor.

In the motor division, neuropathy can take 3 forms : Acute painful neuropathy, diabetic amyotrophy and mononeuropathy. Acute painful neuropathy cause burning pain in lower limbs, typically at night. In severe cases even light touch can become intolerable. It can be precipitated by drugs such as itraconazole, commonly used to treat fungal infection in diabetic patients. Diabetic amyotrophy cause painful,marked wasting of the quadriceps femoris muscle. In extreme cases it cause absent knee jerk reflex. Diabetic mononeuropathy refer to involvement of only 1 nerve. The most common mononeuropathy is the carpal tunnel syndrome. Diabetes can also affect the cranial nerves, especially cranial nerve VII and III, causing diploplia. If more than 1 nerve is affected, the condition is called mononeuritis multiplex.

Autonomic neuropathy manifest in form of postural hypotension,atonic bladder with urinary retention, diarrhea etc.In long standing uncontrolled diabetes, gastroparesis can happen leading to uncontrollable nausea and vomiting mimicking intestinal obstruction. Diabetic patient often complain of syncope, lethargy, dizziness. Note that sometimes, these signs can be a side effect of the oral hypoglycaemic agent, e.g. diarrhea may be caused by Metformin.

Malaysian style of easing a traffic congestion...

2009-02-27T19:03:00.002-08:00

...is to create a congestion somewhere else!

http://thestar.com.my/metro/story.asp?file=/2009/2/28/southneast/3349285&sec=southneast

Malaysian style of easing a traffic congestion...

2009-02-27T19:03:00.001-08:00

Short cases

2009-02-26T19:45:00.000-08:00

Examination is over and its time for celebration:)

These are the short cases that i gather, thanks to Koh Ging....any addition to this list please leave a comment or e mail me at jeffsylee@yahoo.com...thanx

Examine the respi system
1) Rheumatoid arthritis with lobectomy
2)Lung Cancer
3) Pleural effusion
4) Bronchiectasis due to agammaglobinaemia

Examine the cardiovascular system
1) Mitral regurgitation pansystolic murmur
2) atrial fibrillaion

Examine the Neurological system
1) Upper limb CVA
2) Lower limb for ___?

Examine the neck for Graves disease

Examine the GI system for hepatosplenomegaly due to beta -thalassaemia

please leave a comment or e mail me for any further information or correction...Thank you so much

Review for In a page: examination for common uncommon disorders found in the ward

2009-02-11T18:34:00.000-08:00

As some of you might know, i've already started writing about the examination methods of various "uncommon" disorders sometimes found in the ward and long and short case exams. These include rheumatoid arthritis, Cushings, Parkinson, Myasthenia Gravis,diabetic foot etc.

After "testing" the writing with my friends, i find that not only the techniques but also the method of presentation is important. Therefore, to upgrade the booklet, i humbly request some help from our coursemates for input about the presentation format for any "uncommon" disease found in the ward.Anyone who want to help me write, all the better. We can do this during our holidays. I know its a bit too much to do that during the holidays, but, this booklet will be useful for our juniors and for us in the fifth year.

The newer version that i'm thinking of will also include common questions asked in short and long cases. for this, i need as much input as possible.

No help is too small. Constructive critism will be very much appreciated and destructive critism will be forgiven. I hope we can do this together, because as far as i see, no books from UKM students are in the market yet.(there is at least 1 from UNIMAS)

comments and suggestions can be dropped here or at medicalpblukm.blogspot.com. I appreciate all that is given very much. thank you

Brilliant students of Malaysia today

2009-01-27T18:54:00.000-08:00

Today, i read something in the star that really amuse me. A Science stream student taking Biology,Chemistry and Physics, felt disappointed because he/she couldn't take an additional paper, Science.

I AM a Form 5 student who will be sitting for my SPM examination this year. Initially, 40 of my classmates and I planned to take both Science and Ekonomi Asas, but now we are unable to do so.
This is because, as according to our teachers, the Science and Physics paper are slotted at the same time and date, and similarly the Ekonomi Asas and Biology papers.
Being Science stream students, Physics and Biology are compulsory. After studying Science and Ekonomi Asas for more than a year, it is very disappointing that we are unable to take these subjects.
Last year, there were no clashes. And I wish to stress that we checked the 2008 timetable before choosing our subjects. We were even advised by the seniors, and we were not told earlier that problems like these would arise.
Education Ministry, please do something. Do not let our efforts go to waste

Personally, i would tell the Education Ministry not to let your effort go into waste, but at the same time i would like to tell you not to let your TIME go into waste. Why do you want to take Science when you have already studied Physics, Chemistry and Biology in depth? What happen if you got A1 for science and C4 for Physics, Chemistry and biology? Will the A1 help you?
And reading this letter, this student have no aim in life. He/she still doesn't know what he/she wanted to do after school.

And do everybody know how this type of student is produced? Read the next article.

MY daughter is in Year One. She is very shy and worries a lot. She cries every morning without fail as she always has something to worry about.
During the first few days of school, she was scared and my husband and I took leave to be with her. We tried to help her to adapt to the new environment.
Today, I received a phone call from her school asking me to take her home as she had fever. When I arrived at her school, her class teacher told me that when she checked my daughter’s forehead, it did not seem like she had any fever.
I knew my daughter was lying to me because she was afraid to attend Chinese class. I was very disappointed and angry with her.

My daughter has a full week with tuition classes in different subjects. This year, she has one extra tuition class – Bahasa Malaysia.

Am I putting too much pressure on her? I want my daughter to be happy. She’s just six-plus, and she worries so much. I’m worried that she may have a breakdown one day.

Imagine a year one student who just got into school, who havent got used to the new environment and life, is forced to have, in her mother's word, a FULL WEEK WITH TUITION CLASSES IN DIFFERENT SUBJECTS,WITH ONE BAHASA MALAYSIA EXTRA TUITION CLASS THIS YEAR.

I couldn't imagine the mental torment that poor child must be suffering. If i am her, i would have hated school soo much. I would lost interest in school.
If i survive, i would grow up and wonder what i did in my childhood. In my form 5, i would try to take Physics, Bio and Chem and also Science because i've already went to tuition for that. And i will be angry with the Education ministry when the time for Chem coincide with Science.

Then when i'm older and have a child, my child would ask me what i did when i was younger. I would proudly tell her ," in 1 week, i went to 20 different tuition classes,3 tuition everyday." Then my child would ask me what games i played during my childhood, what enjoyable things i've done and what cheeky things i've done during my childhood. I tried to think, but couldn't thing of any, the most interesting thing in my childhood is when i got my 1st Casio 350 scientific calculator.

In short, my life will be just, black and white. There's no colours to it at all.

This is what happen today. In my 13 years of formal education, i only go to 1 tuition class, that is in form 6, but i didn't think it helped because its exactly the same with what is being taught at school. So to parents who is so eager to sent their children off to tuition hoping they will score 30A1s in their SPM, forget it la......Spend more time with your children, encourage them to study on their own like what my mum did....then SPM wont be a problem.

As for the student, no need to go to any "famous" tuition classes. No need to take Science when you've already taken the 3 science subjects. USE YOUR BRAIN before you do anything la......don't take subjects in spm just to make your result look great ok......If you want to take, take EKonomi asas is ok, Perdagangan etc. That will show that you are good in both fields, but still it doesnt show how holistic you are right?

cooling down:)

2009-01-20T07:15:00.000-08:00

sorry for being a bit harsh in the previous post...feel disappointed and disheartened to hear such comment going around.

So, like prof Hashim said, we must noe the normal physiology b4 repairing the abnormal. Rite now my problem is hearing comments i don't like. I couldn't possibly keep people's mouth shut. But i can turn on a deaf ear! So, now i just ignore and do what i think is right.

Hopefully this is a right thing to do. hopefully.

Sharing and caring

2008-12-30T03:08:00.000-08:00

I started this blog few month ago with high spirits. To share my limited knowledge and offer some guidance to my colleagues taking internal medicine.

I've always wondered why despite 3 postings(180 people) who have taken medicine, less than 10 is willing to share. Like i've always said, We need to complete each other, not compete with each other. Holding on to this, I tried my best to offer guidance to my colleagues, whoever interested.

But it seems that i overlooked the dangers of teaching, especially in a medical faculty. Different people have different styles and these people always say other methods are wrong except for their own.

Therefore, my opinion may differ from other people. Although i am 101% positive i am right, how am i going to argue with an MMed or MRCP's opinion?

and some not so nice comments also passed from mouth to mouth that I am being "too free". The irony is, i am in O&G. So i think i must be very brilliant such that someone noticed me of being too free in this hellish posting.
Some wind told me about getting arrogant, from my style of walking etc etc

Come on.....some times i walked a little fast and maybe limping to one side because i have chronic back pain of unknown origin(possibly due to my mattress contour). Not trying to look like a consultant or something. And most of the mistakes i corrected is MY mistakes. In every little advice i give, i was hoping the receiver will be far far above me in the exams by not repeating every little stupid mistake i make.

If you think its useless, you can just assume i am singing a very lousy song. If you think i'm being too fussy over small small mistakes, trust me, the consultants you will be meeting will be far more fussy than i am. If i don't know an answer to a question you asked, i will say i don't know, i will offer a possible explaination, i will ask you to look it up and up to you to prove me wrong! If you choose to swallow whatever i said, then whose fault it is?

So the best thing in my mind now is, don't ask me anything, go find from books. Any questions from now onwards will meet a same universal answer from me -->"I don't Know".

And 1 most irritating things going around is that i only share with my "gang". Whoever is my "gang" i don't know, but so far, i think i've never turned down any request for advice or guidance.

Some people find it irritating for me to question them. They want everything to come out from me for me to absorb. But believe me, questioning is a method to know where you stand. If i do not ask the questions that had been asked in short and long case, how are they going to know what to expect? Sometimes, i may ask some quite "unimportant" questions, this is to scare you into studying so that you will excel......not to,like yi hui put it, "berlagak" that i know the thing in front of you!

Sometimes, i overestimated people's level and sometimes, i underestimate. Trust me, this is disastrous.

In my medicine posting last time, how i hope that someone will offer some guide to me. How i hope someone will show me what short case is like. How i hope to know how long case feels like. Luckily, i have a very dedicated supervisor and registrar who did just that, with liberal amount of tachycardia, of course. Which is why i wanted to give exactly the same thing to my colleagues, without the tachycardia.

But i just seem to create a not so nice environment for myself. Feel weird that people don't even smile at me when i pass through the corridors in the Medicine wards. Really, i am 190 cm tall, its not that hard to saw me isn't it?

Back in my form 6 days, i used to generate a wonderful bond with all my friends in our Biology study group. I tried to apply the same idea here, unfortunately the early results seem to fail quite miserably. My style is terrible and incompatible here

therefore, my point is i am not giving any more teaching or guide to anyone anymore. It's not worth sacrificing my image for it.

Before i get labelled as a Consultoid (Yew yew teach me this term haha) by other people, i'd better quit now:)

PPD component
I learn that medical students are just too smart to be cared for :)

Ashamed,,,,,

2008-12-15T06:00:00.000-08:00

in response to kuan yew's blog Times when I am ashamed to be a chinese. -不管别人瓦上霜

This is my comment

I agree!! Sometimes chinese people just don't give a shit about what happen around them.
They think that to care about their surrounding is a stupid thing to do.What happen is, when they are in trouble and nobody help them, they start making so much noise!! Complain to DAP,complain to MCA, complain here complain there, government not good la, dis la, dat la...sometimes quite insensitive to other people's feeling.
I've got 2 excellent examples here:1) In front of my house, last few months, a 50++ year old woman have her necklace snatched and this cause her to fell off her motorcycle. My neighbours saw it happen because they tengah menyibuk. But they did not help the poor lady at all! They straight away cut short their menyibuk session and go into their home and shut the door,because the victim is a malay lady!
2) when jo ee visited melaka, i was waiting for him at a famosa when a road bully(CHINESE) is bullying a female driver(ALSO CHINESE). I intervened and the bully threatened to hentam me as wel. A whole lot of CHINESE kepoh chees are looking but they couldn't be bothered. At last, before i start wrestling with that fat guy, a MALAY lady shouted and called the police and the bully fled!And the worse part is the female driver just go off, without even a word of thanks!
Tun Dr Mahathir said, Melayu mudah lupai say,

I said, Cina takkan lupa, kerana cina tak pernah ingat :(
Wake up people...

Syabas!!

2008-12-15T04:19:00.000-08:00

Syabas to HUKM docs and nurses

Viva Cardio team ! :)

All the best!!

2008-12-08T17:29:00.001-08:00

to all my friends going for Medicine shortcase on wetnessday....
Just relax and hope for the best!

Everybody will do fine. Why do i say that? Greet the patient and ask for permission to examine, you got 2 marks out of 12 already. Just conduct the examination step by step and you got 4 marks. Now, that's 6 out of 12, pass already: ) During discussion, even if you are making up stories, do not look as if you dont know. Look at the examiner in the eyes.

To kuan yew, soon hooi, alex and gang, i'm sure you all will score one! Just be confident :)

Who say people Malaysia no clever speaking the England?(Siapa kata orang malaysia tak pandai cakap Inggeris?)

2008-12-05T08:01:00.000-08:00

This is the most atrocious English I've ever imagine i could encounter in this life. What's more, it comes from a Government office website!! Kudos to Department Registration Country (direct translation of Jabatan Pendaftaran Negara) for giving me, and the whole world a good laugh.Keep up the good work!(and we will soon be down the drain)

. I’m 17 year old, when should I change my identity card replacement?
A person whose had got first-time identity card namely during old 12 year, are required change again his identity card when have reached the age 18 year. If this change made within life time 18 - 25 year, no any penalty imposed.

2. I already 25 year old and still not have my own identity card. What shoul I do?
To them not yet own identity card although already aged more 16 year are advised to come to any nearby NRD to apply identity card past record. Applicant and promoter must showed up together to be interviewed, bringing with together following documents:-Applicant Born Certificate / AnakAngkat’s Certificate / W’s Form OrApplicant Enter Permit / Confirmation Form National Standard(if concerning)Promoter Identity Card

3. I a foreign citizens and have gotten permit of entry from Jabatan Immigration Malaysia. Whether I qualified to apply identity card? What is conditions for I apply identity card.
You qualified to apply identity card with permanent resident status(Red). Applications requirements is bringing with permit of entry and passport and copy both of them and application fee as many as RM 40.00. Applications can be made in NRD Putrajaya Headquarters and NRD Branches only.

4. Is there any payment am being imposed in case happened damage for chip in my identity card.
Chip damage who is not due to purposely destroyed, misuse and others within one year from the date of submission card is give replacement by free, and if card period has been held by the applicant exceeding one year, payment as many as RM 10.00 imposed.

5. How many payment am being imposed if I loss identity card?
Lost identity card would be charged follow loss number. Please see payment schedule.

6. How long MyKad’s application period can be completed?MyKad can be completed within 24 hours as applicant whose opted to take MyKad in NRD Putrajaya headquarters.
For applicant opted to take MyKad in any NRD branches office in Peninsula of Malaysia, then MyKad would be completed within 10 working day while 30 working day for applicant opted to take MyKad in any NRD branches office in Sabah, a Sarawak or Labuan. MyKad’s charter completed this only involve applications from Warganegara Malaysia and prayer not problematical only.

7. Could I change address without change my identity card? If I can how many rates imposed?Yes. With payment RM2.00 and new address information would be updated inside chip. If you want change identity card one time, the charge is RM10.00 .

8. Is it NRD receive payment other than cash ?
Yes, NRD comply accept payment electronically namely via credit card, card debit and MEPS.However, there were limit minimum sum accept to payment via credit card

Actually, there's many many more of these garbage in the website, but i think the more we read, the more we feel ashamed of ourselves. If this type of english is allowed on a government website, then i doubt we could ever achieve Vision 2020,3030,4040 or 5050. How can this happen? Hopefully the ministers(especially Minister of Education) will be able too see this and make appropriate changes to our education system. I will use a Malaysian quote to describe this english. "The stage of england in Malaysia half eye cannot see la..."(Taraf Bahasa Inggeris di malaysia, sebelah mata tak boleh tengok)

The effect of Onania

2008-12-02T05:16:00.001-08:00

Another interesting read..

Tissot’s scientific aims extended to the mental effects of masturbation.
Following the third law of Newton on action and reciprocal reaction, Tissot theorized
that orgasms were spasms of extreme nervous activity that necessitated an
equal and opposing depression of the nerves. This dampening of the nervous
activity caused permanent derangement when it occurred too frequently,
making the individual more susceptible to apoplexy, paralysis, insanity, and
other nervous diseases (17). This idea contributed to the 19th century notion
of “masturbatory insanity” caused by permanent brain damage due to constant
irritation.

Therefore, according to Tissot, masturbation denuded the body of blood
and, thus, gave rise to grave physical and mental consequences. Included
among these were weakening of the digestive system, loss of or excessive appetite,
vomiting, indigestion, breakdown of the respiratory system, general debility
and lassitude, as well as damages to the faculties and memory. The consequences
to women were even more grave, because masturbation led to hysteria, “vapeurs
affreuses,” incurable jaundice, stomach cramps, prophase and ulceration of the
womb, and clitoral rashes, for example. The young were particularly vulnerable,
as the loss of “precious liquid” stunted their natural physical development and
contributed to feeblemindedness (14,17).

By providing a pathological model of masturbation rooted in the seemingly
scientific and secular domain, Tissot’s book sparked the 19th century
medico-scientific masturbation phobia in the United States. Masturbation
was transformed from one of the many forms of seminal and excretory
loss into a sexual practice potentially fatal to individuals and society alike

Late onset of Hypogonadism

2008-11-29T17:44:00.000-08:00

This is an article by Prof Zul regarding Hypogonadism.......interesting read :)

Shrinking willies

What i'm planning next week

2008-11-28T05:30:00.000-08:00

1) Go labour room observe vagina.....NO!! i mean observe delivery
2) Go medicine ward, slaughter anyone who want to be slaughtered in short case
3) Go watch madagascar II
4) ?go back melaka for a day or 2
5) Go......go.......aiya where else a.....go.....whatever la..

Gender Poser

2008-11-26T06:55:00.000-08:00

Gender uncertainty....looks like there's many things which need research......Paktorlogist sekalian...please take note haha

Gender Poser

Sorry, this have nothing to do with Medicine..Just to pen my thoughts..

2008-11-23T06:58:00.000-08:00

Yoga is Haram for muslims, says NFC

So i don't know what the fuss is. everyone is politicking this issue to make it sound as if Hinduism is banned in malaysia.

Why in the blue hell the non muslims must worry about this ban? Why they keep criticising the ban? The ban only applies for muslims. Any objections, should come from muslims la! I don't see why the non muslims should go on critisising one of the highest muslim authority in malaysia! Dont be so kepoh la.....they ban that's their problem....tak kena mengena with you all one!

National Fatwa council say that yoga should not be practiced by the muslims......only the muslims...understand? That's their law, we should respect although we may not agree with their reasons. After all, again i would like to reiterate, it only applies to muslim!! Non muslim want to practice yoga, go on practicing till become dhalsim oso nobody will disturb you!

Sometimes, i think that somehow, people of malaysia really DO forget the Federal Constitution. or maybe the newer generation don't know about Article 153 of the federal Constitution....Maybe should make Pengajian Am compulsary for form 1 students onwards. After all, i learn more useful things from 1 year of Pengajian Am compared to 5 years of Sejarah

For the sake of unity, stop the squabble la.....Do not question something you don't know...
small small matter want to make big big....nothing better to do ah?

Does size matter?

2008-11-15T18:14:00.000-08:00

Important for life ok!:D

Concerns about the size of genital organs are often unwarranted.
MOST humans are concerned about the size of objects. For many, big is beautiful up to a point after which, it may become ugly. For others, small is beautiful again up to a point after which, it becomes unacceptable. Only a few of us have no views on size.
As it is with inanimate objects, so it is with the human body. Many adults are concerned about the size of their genital organs, particularly its relationship to sexual performance and satisfaction.
The paucity of information in the public domain, the gaps in consumers’ medical knowledge, misinformation and advertisements in the print and electronic media and the reluctance of many doctors and health care professionals in discussing such matters have contributed to misperceptions.
Men’s size
The male is fascinated with the penis from an early age. As boys become adults, many become convinced that it would be better if the penis is just a bit longer. Information from friends and advertisements reinforce the perception that there is a relationship between penile length and manhood.
Most females cannot understand this fascination or obsession. There are reports that chance remarks about small penile size, particularly in the bedroom, have led to impotence (erectile dysfunction).
When a male sees his penis, it is at an angle, which makes it appear to be shorter than it really is. But when he sees another male’s penis, there is no such foreshortening effect, so it appears that the other’s penis is longer.
One should remember the facts about penile size. Wessells and his colleagues reviewed publications on penile length in 1996. The average length of a flaccid penis, measured from the base to the tip, is 8.85 to 10.7cm while that of an erect penis is 12.89 to 15.5cm. During an erection, the shorter flaccid penile length of a male will increase more than that of another with a longer flaccid length.
It should be remembered that the vagina can accommodate any penile size as it is distensible because of its capacity to increase in length if an object is introduced gradually. There is no relationship between race, height and penile size. Neither is there a relationship between penile size and sexual performance and satisfaction. Some men have bigger penises than others, just as some men are taller or of bigger build than others but penile size is no indicator of virility.
Concerns about sizes
If one is unhappy about his penis size, it is advisable to consult a general practitioner or urologist. In most instances, reassurance that the penis size is normal is all that is necessary.
Many people advertise their claims of methods of increasing penis size. The expert opinions on the methods are:
Pills or patches – a complete waste of time
Penile enlargement exercises – probably futile
Penile suction devices – probably of little use
Penile enlargement surgery – uncertain value with risk of bleeding, infections and deformity. Surgery may lead to the flaccid penis appearing longer but it makes no difference to the size at erection. There are reports of some modest improvement in length with penis stretchers (expanders). Some men may want to reduce the penis size. Although this can be done, there are risks of bleeding, infection and deformity. A urologist should always be consulted prior to the use of devices or surgery.
Female size
The vulva is the visible part of the female genital organs. It includes the clitoris, labia and urethral opening. It is not uncommon for women to be concerned about the size of their vulva and vagina as it plays a major role in their sexuality. A common myth is that a large vagina is associated with excess sex. This is incorrect as the frequency of sex has no impact on vulval and/or vaginal size.
Braun and Kitzinger in their publication Culture, Health and Sexuality put it succinctly: “With the construction of women’s genitals as problematic, the ‘private’ female body becomes a site for potential improvement. Socio-cultural accounts of vaginal size in the West construct a tight (but not too tight) vagina as desirable, and a ‘loose’ vagina as undesirable. In women talk, we found a curious pattern: women identified the cultural desirability of a tight vagina, and noted negative uses to which this is put (such as the positioning of women with ‘loose’ vaginas as promiscuous).
“However, when women described their personal concerns about vaginal size, these were couched in terms of anxiety about being too tight. We argue that constructions of vaginal size are problematic because they create another site of bodily concern for women, and are used to control and abuse women. We suggest that they also reflect a disregard of women’s sexual pleasure, and a lack of familiarity with the functions of the vagina.”
Weber and his colleagues studied the relation of vaginal anatomy to sexual function and concluded: “Vaginal anatomy measured by introital calibre, length and vulvo-vaginal atrophy does not correlate well with sexual function, particularly symptoms of dyspareunia (painful intercourse) and vaginal dryness.”
If a woman has not given birth, there is no way that her vulva or vagina is too big. However, childbirth affects vulval and vaginal size. The more babies delivered vaginally, the more likely the size will be increased. This is because the vaginal muscles and its supporting tissues are damaged during childbirth, particularly when labour is prolonged or difficult.
The increase in vulval and vaginal size can be prevented by adherence to pelvic floor exercises for six months after delivery. This involves tightening up the pelvic floor muscles, like trying to stop passing urine, holding the contraction for 10 to 15 seconds, relaxing for 10 to 15 seconds, repeating the contracting and relaxing for five to 10 minutes and doing the exercises three to four times a day.
Too big
The effects of too big a vagina include less than satisfactory vaginal intercourse for the female and/or male, air and/or water getting into the vagina and descent (prolapse) of the vagina, uterus and other pelvic organs in later life.
There are different treatment methods. Intensive pelvic floor exercises described above for six months will lead to improvement. Working at vaginal muscle developers for some time can also improve matters. A pelvic floor repair done by a gynaecologist brings together and tightens the weakened pelvic floor muscles and tissues.
Many women are concerned that the vulval lips (labia) are too large, too long or protrude unequally. If there are such concerns, a gynaecological consultation will be helpful. In most instances, reassurance that one is normal is all that is necessary. If there is a genuine abnormality, it can be corrected surgically.
Sometimes, a female may feel that her vulva and vagina are too small. They are statistically very rarely correct. A small vulva and vagina may be the result of surgery to the vulva and vagina. Too small a vagina can occur when there is a vaginal septum, which may lead to a double barrel-shaped vagina. The symptoms include inability to insert a tampon, pain on vaginal intercourse or total inability to have intercourse.
The vast majority of women with these symptoms have a normal sized vagina. However, many of them suffer from sustained contraction of the vaginal muscles whenever there is an approach to the genital organs (vaginismus). An internal examination will provide the answer to questions about smallness. A vaginal septum is easily treated surgically. The treatment of vaginismus is challenging and requires an expenditure of time and effort by both patient and doctor. If the vulva and vagina are genuinely small, it can be corrected surgically.
Whenever there are concerns about the size of the genital organs, it is advisable to consult a doctor. To do otherwise is risky and to have an untrained person do the job is to court disaster.

Important Must Knows

2008-11-15T02:25:00.000-08:00

Cardiology
Presentation of cardiac pathology
Angina-types
Angina-MI difference
STEMI and NSTEMI and how to differentiate them
Complications of MI
Principle of management of MI and Angina
CCF-at least know the 3 most common cause i.e. MI,dilated cardiomyopathy and systemic hypertension, others such as congenital heart disease, valvular heart disease and cor pulmonale is additional
Types of CCF
Effect of CCF on CXR and ECG
Complications of CCF
Heart block-ECG changes(may be asked in long case)
Atrial Fibrillation-causes, effect and management. For causes, i use the mnemonic I SMART CHAP, there are other mnemonics such as CVS HaRUS CePat etc...use whichever 1 convenient

I=inflammatory condition such as pericarditis and pleuritis
S=sick sinus syndrome, in old people where there is idiopathic fibrosis of the sinoatrial node
M=Medications such as verapamil, levothyrosine
A=atherosclerosis of the vessels leading to ischaemia
R=Rheumatic heart disease
T=thyrotoxicosis
C=congenital heart disease
H=systemic hypertension
A=alcohol
P=pulmonary causes e.g. pulmonary embolism and pneumonia

Infective endocarditis- Memorise the Duke criteria inside out,aetiologic agent and appropriate antibiotics is extremely important.many neglect this
Rheumatic heart disease-The bacteria involve, involve what valve, what is the extracardiac features(Duckett Jones criteria)

Dont forget the drugs used to treat cardiac disorders.

I think this is enough to cope for now kua.....respi, neuro and gastro and others next time tell la..

SFI did it,again:)

2008-11-14T16:14:00.000-08:00

Being an alumni of SFI, i felt proud that again, SFI have made it to the news again, after a while:)
Congratulations to the team and Mdm Cheong! You're the best! : )

BOYS DO MALACCA PROUD AT THIRD ASIAN YOUTH FESTIVAL

Neurology

2008-11-08T21:58:00.000-08:00

Neuro examination is always considered hard, with its many localising signs to remember. However, it is not that hard if you've practiced well in the 8 weeks

I'm lazy to write about neuro exam here, because there;s too many of them. If you want to learn, learn it from your supervisor, seniors, or our colleagues who have done their medicine previous semester. They should be able to guide.

But the most common mistake made is the use of the word normal. e.g. "the muscle power is normal" or "reflexes are normal". This is really contraindicated in short or long case, as the word normal denotes nothing but ignorance. Muscle power must always be expressed in "5/5" form,5 is maximum and 0 is minimum. Reflexes is expressed in +,++,+++, or ++++ with ++ and +++ considered normal.

If demonstration is needed feel free to ask. :)

Respiratory Examination

2008-11-06T08:21:00.000-08:00

Respiratory examination need to be done fast because it involve examination of the chest and the back.

Important points to ponder

1) NEVER FORGET the RESPIRATORY RATE. --> common killer in short cases

2)Do the asterixis properly. Do not look like you have never done it before.

3) Hypertrophic pulmonary osteoarthropathy is peculiar to chronic pulmonary disease. So, in the exam, say HPO instead of clubbing, which is not specific, as it may be caused by some gastro and cardiac problems.

4)BCG scar --> impress some lecturers with this inspection, annoy others with it.

5) face, don't forget Horner's,nasal polyp, nasal septal deviation,central cyanosis, pharyngitis etc.

6) Neck--> Trachea(be gentle) and lymph nodes(do it fast, don't waste time here)

7) Trunk--> examine front and back except when told otherwise. Chest expansion, do properly. Ur thumbs should go away from each other when the patient INSPIRATE. Make sure ur thumbs are opposed when the patient expirate. To do this, cekik the patient chest during expiration. Ask any previous medicine posting ppl to demonstrate this.
Vocal fremitus is described as equal bilaterally, reduced on what site. DOnt say vocal fremitus is normal.
Percuss at least 8 spots on the chest including the base, which is in the MID axillary line.
Auscultate all ZONES, not lobe. There are 3 zones of the lung, while there is 3 and 2 lobes. Always describe breath sound as being vesicular(normal), bronchial(lobar pneumonia) etc. Do not say breath sound is normal. If crepitation is present, describe it. Pan inspiratory or mid inspiratory, coarse of fine and at which zone. E.g. bibasal mid inspiratory fine crepitation.

dont forget pedal edema :)

Gastrointestinal and Abdominal Examination

2008-11-02T01:49:00.000-07:00

I'm not going into detail step because i'm sure everyone can do GIT examination. What i'll do is highlight the signs which may be present but frequently overlooked

Hands- Koilonychia, leuconychia, Plummer's nail(partial detachment of the nail from nail bed
Dupuytren's-alcoholism, excess use of the hand as in carpenter,NOT a sign of chronic liver
disease
Asterixis-->always forgotten
scratch marks-obstructive jaundice causing pruritus
jaundice, anaemia
mouth-leucoplakia, erythroplakia,stomatitis, glossitis, Pigmentation as in peautz jegher polyposis,
neck-virchow nodes and troisier's sign
chest-differentiate between venous stars,spider naevi and campbell de morgan's spots
abdomen inspection- cullen's and grey turner(discoloration)
abdomen palpation-sister mary joseph nodule, differentiate from fat hypertrophy in chronic insulin injection
Auscultation-renal bruit, differentiate from portal hypertension bruit by compression(portal vein bruit disappear on compression)

Signs that can be elicited for fun, but not compulsory:
Murphy's sign-> who dunno dis can go hang themself
Boas sign-> who dunno dis can also go hang themself
Rovsing sign-->erm...here we go again.who dunno dis can go hang themself
Psoas sign--> in acute appendicitis, attempt to extend a flexed knee will result in right iliac fossa pain
Cartnet sign--> if the pain is visceral, palpation of the abdomen after the patient sitted 45 degree with arm cross over the chest will not cause pain, because the pain is inside, not the abdominal wall.
The sign of hippocrates--> if gastric outlet obstruction, after warning the patient what is about to happen, the patient is rocked from side to side with the stethoscope diaphragm on the stomach. If there is GOO, succusion splash is heard.

CVS examination for Internal medicine

2008-10-29T23:02:00.000-07:00

Cardiovascular examination

Examine the patient lying down at a 45 degree angle. Exposure of the chest(take off the shirt if possible)

Begin Examination by inspection of the general condition of the patient

“The patient is lying comfortably at a 45 degree angle. He appear ?alert, ?concious, ?not in any immediate pain or in any respiratory distress(describe what you see, don’t memorise script). Count the respiratory rate.###IMPORTANT

Examine the fingers for signs of clubbing, peripheral cyanosis, splinter hemorrhages, and Osler nodes.
Examine the hands and look for Janeway lesion.
Check the pulse for rate, rhythm and regularity. Compare the radial radial pulse (indicate subclavian artery stenosis due to aneurysm), and radio-femoral delay(indicate coarctation of aorta).--> Some doctors say radial radial delay is due to coarctation of aorta, but my logic and my findings find no reason to support such claims. No literature said that radial radial delay is due to coartation. If you find one, please let me and others know

Check for collapsing pulse which indicate aortic regurgitation,arteriovenous fistula, Patent ductus arteriosus, arteriosclerotic aorta or hyperdynamic circulation due to anaemia, pregnancy, thyrotoxicosis etc.(Remember all the pulse character such as plateu pulse, pulsus bisferiens, pulsus alternans, pulsus paradoxus and what they indicate)

Examine the face for flushing or grayish discoloration (mitral facies) suggestive of mitral stenosis.
Examine the eyes and periorbital area looking for corneal arcus and xanthelasma.
Check for jaundice and anaemia.
Examine the mouth for hydration, central cyanosis and oral hygiene.
Next, examine the neck for JVP
Use the right external jugular vein, look for sustained increase on inspiration which indicate constrictive pericarditis or cor pulmonale(Kussmaul’s sign)
Hepatojugular refluxà when abdomen is compressed, JVP elevate for less than 4 second in normal person. If elevated more than 4 second, indicate heart failure.
Use torch light at an angle, look at the shadow produced.(Datin Norella style)
If cannot detect, it is not elevated and hence normal.
** Difference between JVP and Carotid pulse should be fingertips by now J

Now examine the precordium. Look for scars from previous CABG or other thoracic surgery. Look for any visible pulsations.
Next, palpate the apex beat. Feel for the character(e.g. tapping in mitral stenosis), position and regularity of the apex beat.

Once apex beat is felt, proceed to palpation of the tricuspid area. Feel for thrills and heaves( Once felt will never forget, dun worryJ). Proceed to pulmonary and aortic area feeling for the same thing.

Percussion is not significant in CVS examination except for estimation of the heart border, which is rarely done.

Auscultation for heart sounds.
Begin at the apex using the bell of the stethoscope. Listen for low frequency murmur. If murmur is soft, ask the patient to lean to the left and listen for accentuation of the murmur.
Still using the bell, listen at the mitral area, listen for pansystolic murmurs which radiate to the axilla.( Mitral regurgutation)
Listen at the pulmonary and aortic area. Any murmur end diastolic murmur indicative of aortic or pulmonary regurgitation should be heard. Accentuated by sitting the patient up, deep breath and hold in mid expiration while listening to the murmur.
If a ejecion systolic murmur is heard, listen to the carotid artery for carotid bruit.

** in atrial fibrillation, pulse deficit can be elicited by counting the number of auscultated apex beat and radial pulse in a period of time. Any difference between apex beat and radial pulse of more than 10 indicate deficient pulseà atrial fibrillation.

Lastly, examine the leg for pedal edema. Examine the ankles and Achilles tendon for tendon xanthomata.

***I wanted to upload this, actually its in Words format, but being the Buta IT person that i am i dont know how.

Essentials of 3rd year Internal Medicine

2008-10-26T08:50:00.000-07:00

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..

Hello

2008-10-24T18:01:00.000-07:00

Purposely start this blog, hopefully it will act as a guide to those who will be taking Internal Medicine this sem.

Firstly, i would like to suggest several books that NEED to be read before starting the posting(or after if you've already start it). The suggested sequence are:

1) Nicholas Tally and simon o connor: Read and master all the signs and physical examination technique of all 4 main systems :CVS, Respiratory, GIT and Nervous system.
2) TheECG made easy--> make sure u can interprete the 9 ecg given at the end of the book
3)HEart sound made easy(use stethoscope to hear, not your bare ears)
4) CHest X ray made easy**
5) KUmar and Clark (small one is enough, complement with Papa Robin)

Other miscellaneous examination such as rheumatology can be learn later after you have learnt about the disease.

**Important chest X rays that must be mastered is 1)pneumothorax 2) pleural effusion 3)pneumonia 4)tuberculosis 5) pulmonary edema 6)bronchiectasis 7) COPD

Read first ok : ) gudluck