Tuesday, September 18, 2012

Week 2 Day 1: Phew, I'm Still Fine




Today was a busy day. We had Long Case in the morning and PBL in the evening.

1) As usual, I get ready at 7.15am, drive to the hospital, and arrive just a few minutes before 8.00am. It's not that I am always eager to get to the Ward, but it will be very, very difficult to find a parking space available near JHC when you get there past 8! I know it because I was once late, it took me almost 20 minutes to get my car parked. 

So the lesson learnt - I've got no other choice other than getting there earlier than the other students.

2) I went up to Orkid 8C and clerked a patient with Acute Exacerbation of Chronic Obstructive Airway Disease (AECOAD) Secondary to Partially Treated Pneumonia. COAD = COPD.

This pakcik was admitted to the Ward due to complaints of shortness of breath and cough for 6 months duration, accompanied with loss of weight and loss of appetite. He was diagnosed with asthma 8 years ago. He is an ex-smoker for 32 years. He smoked cigarettes 16 packs/year. 

What's interesting about this patient is that he is wearing a pacemaker. You could see the outline of the pacemaker under his skin. He mentioned that it can only last for 8 years.

During auscultation, you could hear rhonchi very, very clearly in both of his lungs. I was truly amazed.

3) Long Case with Dr.Harris started at 10am and ended at 12.30pm. Aina presented a case of Bilateral Lower Limb Swelling for one month duration. The patient also has abdominal distention and fever. He has Liver problems.

The Top 4 Differential Diagnosis (Ddx) would be: Congestive Cardiac Failure (CCF), Chronic Liver Disease, Chronic Renal Failure and Nephrotic Syndrome.

Other inputs mentioned by Dr.Harris are:
--> If the patient has Diabetes/any other disease, we must also ask about Duration, Control, Compliance and Medication that he took for his Diabetes.
--> The books that Dr.Harris highly recommends are Talley O Connor and Dr. Mustafa Embong's Guide to History Taking and Physical Examination.
--> Explore more on the symptoms of the patients. We must have Ddx in mind and ask questions to patient based on the Ddx.
--> Mnemonic for 'Precipitation Factors for Hepatic Encephalopathy) is HEPATICUS - Hemorrhage, Electrolyte (hypokalemia), Protein-rich diet, Alcohol/Analgesic, Trauma, Infection, Constipation, Uremia and Surgery.

We managed to hear from one presenter only, because Dr.Harris gave comments and explanations about the Case. He also gave us advice, reminding us to keep on reading about how to take correct history from patient. He asked us to finish reading the recommended books.

4) PBL with Dr.Marzuki was fun. However, 33 students in a PBL discussion is not very convenient. I could see my friend played random game on phone and some yawned or fell asleep because they could not concentrate on what we were discussing. 

Dr. Marzuki is the first lecturer to ask us to introduce ourselves before we start the session. He's cool. And funny too. You could hear brothers laughed out loud every time Dr. cracked a joke. He has quickly become our Favourite :D

Oh. I would like to tell you about our new classmate, Kak Fatimah. She is 26 years old, and she is a graduate from Newcastle University, UK. Apparently, she has to join us for another 3 years of studies because of some problems with her former university, the degree is not recognized by Malaysian government or something, I did not ask her much.

She is like our Senior, she knows a lot of things and she teaches us lots too :)

5) Trying my very best to finish my first Clerking Notes. Me and Aina would like to ask for our Mentor's (Dr.Naim) comments on the Notes first before we send another one. **Nervous

6) Tonight, Syira and Wani asked me to join them On-Call. We talked to a 16-year-old patient with Down Syndrome + Pneumonia and we saw few Dengue cases in the Ward.

Ah. Exhausting Tuesday.

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