Tuesday, October 30, 2012

Recap Recap

1) Just finished editing my Case Write Up. But somehow I feel that it is just 3/4 completed, considering the fact that I didn't acquire much details in the HOPI and there are some physical examinations that I had left out. How can I forget to do Pull Test in Parkinson's Disease!! And tandem walking to check for ataxia! And I couldn't remember if I had auscultated her lung or not, because the patient was given Augmentin! If the patient didn't have pneumonia, then why was she given the antibiotic?

I was so excited about her Parkinson's that I forgot to ask about her Hyperthyroidism! Careless mistake! **sigh

After Dr.Naim checked my paper and pointed out things that I didn't ask my patient, I was like, 'Yeah.. I totally forgot to ask her about that!'

Ah. I wish I have my patient's contact number.

2) Rewind back to this morning's ward round, I clerked a makcik with CCF and a kakak with dengue fever. Nothing interesting in particular.

But, But! We saw a patient with Umbilical Hernia! You can see his protruded umbilicus - red, warm and tender. The patient was half conscious, by the way. If you palpate his abdomen, you could feel that it's very distended. Once I thought I could feel his bowel!

If you follow ward round with Dr.Yousuf, you must be proactive and quickly examine the patient if he asked you to. Go touch the patient, don't just look. If not, he'll punch you. Trust me, it's a reaaally hard punch. Lol

3) I talked to a pakcik who has STEMI. He came to the cardiology clinic just to get a refill for his meds. But he was admitted to the ward anyway. He was really frustrated because he didn't want to stay in the hospital - he has to go to work in the morning!

He is a fisherman and he is in need of money to pay for his previous hospital bills. And if he has enough money, he wants to go for balloon angioplasty. If he has the money.

It is sad to hear his stories. It reminds me of how lucky I am. Alhamdulillah.

4) We saw Dr.Kuan and Prof.Fauzi this morning. It's not always you can find them in the ward, since they are very busy. It's nice to see them anyway! :D 

5) Short case with Dr.Che Rosle was fun. We had cranial nerves PE (on patient with dysarthria) and lower limbs PE (on patient with stroke secondary to brain abscess). He told us that in a young thrombotic patient, you should consider four causes; infection (meningitis, encephalitis), infarction (amphetamine, heroine), vasculitis (arthritis etc) or thrombophilia state. 

And we saw ring-enhancing lesion on Brain CT! It was maybe due to abscess (Strep/Toxoplasma) or TB granuloma among other causes.

6) Faizah and I helped Dr.Adlina with venepunctures. We examined a patient with suspected fibroadematosis.

Fibroadenomas are benign breast tumors commonly found in young women. Fibroadenoma means "a tumor composed of glandular (related to gland) and fibrous (containing fibers) tissues."

Breast fibroadenomas, abnormal growths of glandular and fibrous tissues, are most common between the ages of 15 and 30, and are found in 10% of all women (20% of African-American women). They are found rarely in postmenopausal women.

Described as feeling like marbles, these firm, round, movable, and "rubbery" lumps range from 1-5 cm in size. Giant fibroadenomas are larger, lemon-sized lumps. Usually single, from 10-15% of women have more than one.

She had a high fever, you could feel the warmth transferring to your hand while you examined her axilla. We couldn't be able to find the exact lump, though. 

On palpation, there was a firm small area on her left breast at upper lateral region. It has ill-defined border, non-mobile and it was tender upon touch! There were axillary lymph nodes enlargement as well. No nipple discharge noted. 

Doctor scheduled her for mammogram and maybe referred to surgical team later. I doubt it was fibroadenoma, but let's see the result tomorrow.

7) I am too tired to look up for differential diagnoses of breast-related diseases. I really need to sleep now.

G'night :)

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