Once a while, people will look out for it to throw away unneeded materials, but most of the times it just remains there, unnoticed.

Tapi tak semua punya pendirian yang teguh dalam diri masing-masing. Ada yang langsung tak punya pendirian hidup sendiri. Ada yang tak tahu bagaimana untuk mempunyai pendirian sendiri. Ada yang tak tahu apa itu pendirian hidup. Ada yang perlu diajar untuk berpendirian. Ada yang jenis suka mengikut pendirian orang lain. Ada yang sering goyah dengan pendirian sendiri. Ada pula yang menyerahkan langsung pendiriannya kepada orang lain.

Kita diciptakan berbeza-beza bukan? Jadi cubalah untuk menerima kelemahan masing-masing

Nak dijadikan cerita, semalam saya sampai termimpi berkahwin juga.. hahaha! Kahwin dengan siapa? Yang itu terpaksa dirahsiakan atas sebab-sebab tertentu hahaha.. Yang sedihnya, dalam mimpi tu, perkahwinan tu diaturkan oleh sesuatu pihak.. kiranya macam terpaksa kahwin la.. yang lelaki tu pun macam tak happy je nak kahwin dengan saya.. alangkah pathetic nya saya dalam mimpi tu.. kuang kuang kuang.. minta dijauhkan Amin…..!

Anyway, cuti dah hampir ke penghujungnya.. saya rasa sangat sedih.. kalau boleh, nak sambung cuti lagi sebulan… isk isk.. Hmm apa-apa pun, hidup mesti diteruskan bukan? Saya mesti bersemangat untuk masuk tahun 6! Harap-harap segalanya berjalan dengan lancar tahun ini.. Doakan saya okeh!

I was so sad, and upset. I felt like crying so much. And I am tired.

p/s: Selamat Pengantin Baru buat kawanku dan pasangannya yang menjadi orang pertama memecahkan rekod tanpa kahwin batch kami. Tahniah dan semoga kebahagiaan kekal abadi.

-Wednesday night. The night before the exam. Location: Hostel, Temerloh.

There were only 4 of us staying in the hostel that night. Funny, I thought I heard some creepy sounds in the toilet, urmm.. But tomorrow’s clinical exam is a lot scarier. I didn’t bother much about anything else since I have so many topics to cover. I glanced through some favourite topics for long and short cases and discussed with friends, spotting questions etc. For this last minute study, it’s much more effective to study through discussions and more discussions with other people. That way, it’s easier to memorize them.

A: F, boleh ajar pasal epilepsy tak? Dah takleh masuk dah nak baca sendiri.

F: Oh, em, yang kite tau pasal epilepsy, bla..bla.. bla.. nak investigate guna EEG untuk tentukan types of epilepsy and buat MRI.. Pastu nak manage dia bla.. bla.. bla.. ubat untuk epilepsy kite hafal carbamazepine.. in case kalau dia tanya pasal side effect carbamazepine, ingat 3D- drowsiness, dizziness & diarrhoea.. bla..bla.blaa..

F: Nak tengok nota febrile fit A buat.. Ermm, kalau meningitis kan, history taking same je kan dgn febrile fit? Pastu kena rule out electrolyte imbalance suma bla..bla..bla.. investigation kena buat lumbar puncture bla.. bla..bla..

-On the examination day. Thursday morning. Location: HoSHAS, Temerloh.

To cut the story short, I got a long case of Epilepsy and a short case of Bacterial Meningitis. Haha yay!

I was so thankful that my examiners were both the benign type. For my long case, I didn’t get to finish my physical examinations due to language barrier during history taking and thus not enough time to finish everything. I was only able to palpate the abdomen (because the child’s abdomen looked distended, and it turned out that she had hepatosplenomegaly!), and the reflexes (the child had hyperreflexia). Then my examiner asked me to examine the patient on the spot. Some of my history were incomplete here and there, and my examiner asked me to reconfirm on the spot. There were so many things I had to do on the spot. It was so miserable but I didn’t feel miserable because the examiners were very kind-hearted.

It’s true that sometimes clinical exams are so much depending on luck (of getting difficult/easy cases and benign/malignant examiners) plus a little bit of medical knowledge. The rest are just self-confidence and a good English command.

About the PMP, even the first question had already confused me. The history was suggestive of UTI with complaint of fever, vomiting, lethargy, abdominal mass on both flanks and failure to thrive. But then I got mixed up when they mentioned in the past medical history that the child had previous episodes of diarrhoea and they also mentioned about staying in ‘overcrowded nursery’ which made me think of AGE. I was diverged more towards AGE, until they gave the urine dipstick result with evidence of haematuria and proteinuria. So okay, I was back to UTI. The answer was UTI, Alhamdulillah. But on the diagnosis of the abdominal mass, I forgot to mention the cause of hydronephrosis, which was the formation of the posterior urethral valve. The full answer should be; Bilateral hydronephrosis secondary to recurrent UTI with PUV formation. I also forgot the full name of MCUG (micturating cystourethrography), the radiographic imaging used to look for VUR and PUV. Served me right. I should get myself trained not to use short form. The second question was about pathological neonatal jaundice, and the third one was about meningitis. There was a question on the aetiological agent that causes meningitis in that child, given the child is 7 month old, negative gram staining with coccobacili organism. The answer was Haemophilus influenzae. I answered Neisseria meningitides. There. I’ve totally forgotten my microbiology.

I’ll be having clinical examination on Thursday morning in HoSHAS, Temerloh. They divided the students into 2 groups, half is examined in Ampang and the other half in Temerloh. So I’ll be heading off to Temerloh tomorrow afternoon. There will surely be great findings there especially for short cases, so I hope to do my very best for it. Wish me luck!

History Taking

1. What type of seizure?

• Simple febrile fit: Only 1 episode of convulsion in the same illness, with less than 15 minutes duration, no focal sign (generalised)
• Complex febrile fit: > 1 episode of convulsion in the same illness, with more than 15 minutes duration, with or without focal signs

2. How long did it last? Was the convulsion aborted by himself or relieved by medication?

3. Associated symptoms

• Pre-ictal: Fever, infections – URTI (sore throat, runny nose, noisy breathing, dyspnoea, ear pain/discharge), UTI (dysuria, haematuria), GIT (diarrhoea, vomiting, abdominal pain)
• Ictal: Tonic (Stiffness) & clonic (jerky movements) of limbs, loss of consciousness (not arousable), uprolling of eyeball, drooling of saliva, urinary/bowel incontinence, pallor/cyanosis (lips turned blue), clenching of teeth
• Post-ictal: Drowsiness

4. Past Medical Hx:

• Previous Hx of convulsion. Does each time preceded by fever? Any previous hospital admission for control of fit

5. Family Hx:

• FHx of (a)febrile fit, (b)epilepsy, (c)mental retardation

Physical Examination

1- Signs of infection

• Vital signs: Temperature (febrile), Pulse Rate (tachycardia), Respiratory Rate (tachypnoeic), Blood Pressure
• ENT: Injected throat, enlarged tonsil, infection of middle ear, nasal flaring, enlarged turbinates
• Respiratory: Using accessory muscles for breathing, recessions, sputum
• GIT: Hydration status, abdominal tenderness

2- Any neurological deficit (TRO meningitis, encephalitis)

• CNS, PNS

Management

1- Hospital admission; (a) TRO meningitis/encephalitis, (b) to investigate & treat the cause of infection, (c) fear of recurrent seizure, (d)to allay parent’s anxiety

2- Investigations; Blood & urine culture, BUSE, lumbar puncture (unless patient is unconscious)

3- Febrile fit education (advice) to caretaker:

• Fever control: Take off clothings, tepid sponging, antipyretic
• First aid management: Don’t panic, left lateral position (to avoid backfalling of tongue), wipe vomitus/secretions from mouth (don’t put anything into mouth), stay near the patient, if lasts more than 5 minute (ideally 15min) go to the nearest clinic.
• Rescue therapy: Rectal diazepam, buccal midazolam

p/s: Oh crap, this blog doesn’t seem like a blog anymore

Serba sederhana, itulah dia Ahmadinejad

Saya sememangnya kagum akan keperibadian beliau. Beliau merupakan seorang yang sentiasa merendah diri walau punya jawatan tertinggi di negaranya. Sepanjang pemerintahannya, tidak ada satu pun berita mengecewakan yang saya dengar tentang beliau. Berita-berita tentang beliau sentiasa membakar semangat juang sebagai seorang Muslim. Beliau punya prinsip yang kukuh dan tegar serta suara yang berani dan lantang dalam mengutarakan sesuatu isu. Pemimpin manakah yang berani meminta agar negara Israel dihapuskan daripada peta dunia? Dan, berita hari ini sekali lagi membuat saya tersenyum lebar sebagai rasa bangga terhadap Ahmadinejad.

To Ahmadinejad, you are a true leader. Thank you for speaking up against Israeli’s racism. Let alone those Israeli’s dogs – US, Brit etc, they are more racist than anybody else!

Nota: Entri ini bukanlah bertujuan mengidolakan Ahmadinejad, cuma sebagai ekspresi penghormatan atas jasa-jasa beliau terhadap komuniti Muslim sedunia.

Teringat kisah beberapa bulan lalu. Kisah yang agak serupa, cuma berbeza situasi, masa dan tempat.

Allahyarhamah merupakan junior kami setahun di fakulti. Semasa sedang menuntut di Tahun Tiga (preklinikal), pada suatu hari beliau merasa lemah-lemah badan, lalu terdetik untuk berjumpa doktor dan ketika itulah pertama kali beliau mendapat tahu tentang penyakitnya. Saat baru sahaja mempelajari tentang subjek haematology, beliau disahkan menghidap sejenis barah sel darah putih, Acute Myeloid Leukaemia (kalau tidak silap). Kami senior-senior sangat terkejut dengan berita itu, apatah lagi kawan-kawan sekelasnya yang selalu bersama dengan beliau. Agak terkilan kerana tidak berkesempatan menziarah beliau semasa di hospital. Beliau terlantar di HUKM selama beberapa bulan bagi menjalani kemoterapi. Mujur ada seorang doktor di sana yang merupakan pensyarah kami di universiti, jadi sebarang perkembangan beliau akan disampaikan kepada kami.

Mendengarkan cerita daripada rakan-rakan terdekat beliau, agak ketara perubahannya sebelum dan selepas mendapatkan rawatan di hospital. Keadaan beliau menjadi semakin teruk selepas rawatan kemoterapi yang mana menyebabkan sistem imuniti badannya semakin lemah. Akibatnya, risiko mendapat jangkitan kuman adalah lebih tinggi, dan itulah yang berlaku pada beliau. Hari-hari terakhir beliau, beliau dirawat di ICU dengan bantuan ventilator kerana jangkitan paru-paru. Suasana ketika itu amat sayu. Saya yang berada di rumah berdebar-debar setiap kali mendapat khabar berita daripada kawan-kawan tentang perkembangan beliau. Dan mesej terakhir yang sampai kepada saya beberapa minit sebelum azan maghrib itu amat menyedihkan kami semua. Beliau sudah pergi buat selamanya. Amat terasa sekali akan kehilangan beliau buat kami semua. Allahyarhamah merupakan seorang pelajar yang pandai (an above average student). Namun Allah lebih Menyayanginya.

Al-Fatihah dan Yaasin buat Allahyarhamah Huda dan Allahyarham Muaz. Semoga roh kalian dicucuri rahmat-Nya.

“Sesungguhnya kita milik Allah dan sesungguhnya kepada-Nya kita kan kembali”

Nota: Terserempak dengan Prof. di majlis tahlil tersebut. Rupa-rupanya ibu bapa arwah merupakan kenalan Prof.. Ibu bapa arwah bekerja sebagai doktor perubatan, jadi ramai juga doktor yang datang. Kalau tidak silap, Dr. Jamilah (Mercy) pun ada.