.ent.ophthal.anaes.

this post was actually inspired by this and this

but this one will be much much longer since triad means THREE in ONE

so bear with me :)

first and foremost, triad consists of 3 different postings *refer post title*

the duration was 3 weeks for the first 2 and 2 weeks for the latter

basically it covers problems of the eyes, the nose, the ears, the throat and last but not least how to put patient to sleep

all three postings has more or less the same requirements

so this post will elaborate on each requirement particular to that posting

the requirements are as follow :

- briefing

- log book

- case write up

- clinics

- operation theatre

- pbl

- mini clinical examination

- ppd component

so lets go one by one

1. otorhinolaryngology 

or ENT in short

i did this one in england

so i'm not really sure how this posting was carried out in UKMMC

i'll try nevertheless

and those who did triad with me, correct me if i'm wrong

briefing

i guess briefing is done in the department. so sorry since i didnt do my ent posting here :(

logbook

as usual, this need to be filled within 3 weeks in order to pass the continuous assessment

case write up

there is one case write up to be written and sent to respective supervisors by the end of the posting

*i didnt send mine, but we have case presentation there in england  in which the content was more or less the same* 

clinics

i dont know how ent clinics were carried out

but i supposed everyone need to attend their supervisors' clinic, clerk cases, present and all

*i went to clinic every single day when i was in england and we attend them individually*

operation theatre

since ent is a surgical specialty, attending operation theatre is a must i would say

you got to see operations as simple as grommet insertion up to as complex as mastoidectomy or parotidectomy

*i went to theatre every single day in england and i observed 6 tonsillectomy per day :)*

pbl

if i'm not mistaken, there were 2 pbls for ent.

i didnt have any pbl there in england, so i'm afraid i cant really elaborate on this

mini clinical examination

this one i did in clinic when i was in england

there isnt much, just simple nose examination, throat examination, otoscopy and stuffs

ppd component

i didnt do any assignment for ent when i was in england

so i guess it will be better to find my friend who did this

if i'm not mistaken, the topic was about laryngectomy

2. ophthalmology

briefing

the briefing was carried out in bilik nor marahakim in the department of ophthalmology

basically you will be told on what to do, what to complete and the visit :)

logbook 

this one as usual

i know all of you know what to do with it :)

anyway, in ophthal, there will be 20 funduscopy to be performed, presented and drawn in the logbook together with the ophthalmology colour coding

so make sure you have a box of colour pencils in ophthal :)

case write up

there is one case write up to written, presented, corrected and sent to the department within the 3 weeks

basically you will have session of presentation of your cases with your supervisors and correction will be done

the send in the correct version of the case write up by the end of the posting :)

clinics

ophthal clinics session were tremendously havoc

you'll be lucky to have your supervisor in the clinic since most of them will want their students to be with them

so normally, one specialist will have 3 days of clinic

*mine : tuesday, thursday & friday*

so we will normally attend clinics according to our supervisor's schedule

however, it is NOT wrong to attend clinic everyday if you want to :)

operation theatre 

the theatre was forbidden to medical students

haha :)

pbl

we have one pbl for ophthal consisting of 2 sessions

refer to the pbls we have had in preclinical years and it didnt really differ from that

just prepare prior to the session :)

mini clinical examination

basically, for mini cex, each student will have to perform a funduscopy examination either in the clinic or ward

then proceed with presentation and some q&a

for this purposes, read in detail about diabetic retinopathy, armd, hypertensive retinopathy and glaucoma

ppd component

in ophthal, we have a speacial visit to the school for the visually impaired

and reflective writing was to be written based on that experience

but it depends on your supervisor

some supervisors want you to write reflective writing on a blind patient you've clerk instead of the visit

3. anaesthesiology & intensive care

briefing 

the briefing was carried out in bilik siswazah lanjutan in the department of anaesthesiology which is located in the bridge connecting the cinical and academic building

logbook

in anaes, logbook is important since everything need to be signed in it including lectures and tutorials

besides, there are a few procedures that need to be performed such as iv cannulation and intubation

there are also a few procedures that required us to observed namely the epidural and spinal and what not

case write up

in my experience, anaes case write up was the simplest one

we have to write one case write up focusing solely on the anaesthetic component of the patient

the pre-operative assessment, premed, intra-operative monitoring, and post-op management which stopped after the patient was sent back to the ward

clinics

no anaesthesiology clinics :)

operation theatre

in anaes, theatre is most of the time the only place to be

it is not the surgery that is important, but the preparation of medications, the patient, putting the patient under and waking up the patient after the surgery are important

it involves multiple procedures depending on the type of anaesthesia given to the patient

it would be better to read and get used to the drugs available and their uses

besides the theatre, we also need to attend the icu

basically for the rounds :)

pbl

there's no pbl for anaes :)

mini clinical examination

basic life support

there's no mini cex for anaes

however, there's one special component of this posting that need to be passed in order to pass the posting

it is the basic life support course

it consists of the cpr and heimlich manouver and infant cpr

there will be theory test and practical test

certs will be given once passed :)

ppd component

for ppd component, one reflective writing was to be written based on the visit to the icu :)

that basically concludes triad

the things mentioned above were just guidelines which may change in time or based on your supervisors

all in all, triad was fun :)

p/s : there will be seminars and lectures for each postings which will be compulsary for all

-flying-

assalamualaikum

alhamdulillah

i received the call this morning

i am off to Ipswich, Suffolk UK for ENT posting

i have rewritten this statement on my facebook page and my twitter

and now i just cant stop grinning

we have to plan and settle our travel thingy on our own

and be there before june 6th

in order to start our posting at the The Ipswich Hospital

so i am currently in an aftershock condition

still surprised with the amazing news i heard this morning

i'll update my travel thingy here as soon as i have them

macam-macam

assalamualaikum

waaa

da seminggu duk rumah ni

indahnye cuti

bgn kul 10

tgk tv sepanjang hari

pg jogging ptg2

mknn sume ibu masak

tdo kul brape pun xpe

oh..indahnye dunia

hari ni rutin lain skit

since my sister is home sbb melaka cuti hari ni

*she's working at TM melaka*

so i decided nk ikut mr.Faidhi g anta proposal kt skolah tmpt saya bakal ber-elektif bulan dpn =D

tp xknla g seremban semata-mata utk g anta proposal je kan

so buatla mcm2 jgk =D

-1-

clinic appointment

this appointment should actually be tomorrow

tp xknla nk pg seremban 2 days in a row

bazir tenaga,masa dan petrol

*lagi2la harga petrol da naik ni kan*

so,decided utk pg td

i was the first patient yg smpi to the clinic

my impression was

"bestnye jd specialist then bukak clinic sndiri..xpyh dtg awl..bole bgn lmbt..wee"

pastu ble masuk jmpe doctor

ade pulak kne marah sbb xmkn ubat

hello doctor

saya sgt compliant oke!

xmiss mkn ubat lgsg

then doctor tu pun apologise sbb tuduh saya bukan2

*hehe..ini exaggerate!*

tp saya seronok sebab ini bulan terakhir utk tamatkan regimen antibiotik

saya sgt compliant smpi saya rse saya layak mkn OCP

*not that i'm currently on OCP =D*

my last antibiotic regimen =D

-2-

menghantar proposal

yang ini tiada gambar

inila motif sebenar g seremban hari ni

menghantar proposal ke Sek Men Keb Pendeta Za'ba utk elektif nnti

terima kasih mr.Faidhi =D

xsabar nk start posting elektif dgn kamu

-3-

jusco

this one of coursela shopping

weee =D

actually nk cari brg utk buat blueberry cheesecake

tp xjmpe pulak Philadelphia cream cheese yg sgt berkualiti tu

*ade je cream cheese lain..tp xnk jgk!!*

so cancella plan nk buat cheese cake tu

and we end up buying this

chicken pie

huuu...xsabar nk buat esk

nnti saya akn update dgn hasil die pulak =D

sebenarnya td ade beli chicken bolognese lasagna

tp xsempat da nk update dlm blog

balik je terus ngap!!

nntila ye =D

then belikn ini utk ibu 

mommy's

mmg da lame die nk

dpt jgk

plan saya sekarang adalah utk meminjam kasut chomel ini

huahuahua =P

dahla

itu je yg saya buat hari ni

p/s : hari ni saya,kakak saya dan ibu saya main kuiz vocab + pronunciation

hayati perbualan berikut :

ibu : ya..ibu ade satu soalan..anak ikan dlm english ape?

-saya dan kakak saya berfikir-

kakme : fishes!!

kami semua gelak terbahak-bahak

*ini jawapan makcik saya ble tanye ikan in plural ape..hahaha*

ibu : (selepas puas gelak ketawa) bukanla..anak ikan dlm english fry..ibu pun baru tau td

saya : bukanla bu..anak ikan gigolo la..

kami gelak lagi

ibu : oh..macam erry putra tu ke?

kakme : haah..yg pki botox tu..

betapa perbualan bole buat ilmu hilang

nasib baik saya da pass exam

LOL

double p/s : mintak maaf ye erry putra..ini gurauan malam2 tika hujan turun =) 

tp kitorg mmg penah bce statement mcm ni kat tabloid..huahuahua..maaf ye  

alhamdulillah -

assalamualaikum

entry pertama sejak balik rumah bercuti
alhamdulillah

i am officially a 4th year med student in UKM

result exam was just released
and i passed through my 3rd year uneventfully
alhamdulillah

thanks faidhi tlg tgkkn result
thanks semua yg tlg doakan saya

congrats to all yg da bole gelar diri 4th year
utk kwn2 yg still have some papers to do
best of luck
insyaallah kte sme2 start posting june 6th nnti


*mode : sgt gembira smpi speechless*


alhamdulillah

post - exam *review*

assalamualaikum

as u all might have noted

my end of semester exam ended today =D

so this post will be full of the following

review

komen

rase xpuas ati

kesalan

blablabla 

first of all : theory paper

i had 2 papers last week

surgery on monday  

+

obs & gynae on tuesday

simply said

kedua2 papers penuh dgn bleeding

segala jenis bleeding ade

just name it

per rectal bleeding

*ini plg byk skali..sampai kte pun rse mcm da dpt per rectal bleeding memikirkan jawapan*

per vaginal bleeding

*ini pun byk jgk..drpd early smpila org da nk beranak, asyik bleeding je*

lucky exam hall tu airconditioned

kalau x, most probably bole dpt epistaxis

*ini juga sejenis bleeding..pergi google kalau nk tahu*

seriously

tuhan je yg tau betapa byk darah yang telah dibazirkan dlm penghasilan kertas soalan tu

haih

okeh

cukup sal kertas teori

sekarang kite cite sal osce pulak

*osce : objective structured clinical examination*

i had 2 osce jgk

obs & gynae on thursday

+

surgery today

oke..osce obs & gynae xpyh cite

*nak cite jgk*

soalan payah mcm ape je

ade ke nk kne tulis referral letter dlm mase 5 minit

xlogik oke

time buat case write up pun kte amik mase 24 jam nk buat 1 referral letter

haih lagi

pastu g letak pulak gmbr molar pregnancy

mujur kte perasan bnde alah mcm anggur tu

dalam hati ble tgk gambar tu da terfkir, apsal gmbar liver kuar osce obs&gynae ni??

then ade pulak gambar fetal skull

then label mcm2 diameter

waaa

satu pun aku tatau

occipito-frontal

mento-occipital

what??!!

tataula...

haih

osce surgery hari ni kelakar oke

kne berlakon dgn sebijik breast

*sebijik oke..single..unilateral..SATU sahaja*

and pretend breast tu seperti seorang individu

to make things funnier

ayat examiner tu 

"oke nadhira, sini ade single breast..so u assume ade org btul2la kt sni..i want u to do breast examination..and action!"

oke..kte pun berlakon

rse2 mmg bole dpt award pelokan wanita terbaik oke! =D

yang lain went about uneventfully 

dahla

itu je cite exam

seronoknye da abis exam

gudluck utk ira and diba

hiphip hooray utk kte ngan faizah

p/s : epistaxis tu hidung berdarah..xpyhla google =D

examo ~

assalamualaikum

akhirnya

esok 28 mac

peperiksaan akhir semester tahun 3

untuk itu

good luck untuk semua kawan-kawan 1 batch

hopefully insyaAllah kita semua lepas and naik tahun 4

jgn stress sgt

tenangkan hati oke

alhamdulillah

time : 1050 am

i was sitting in the lecture hall when kan chan siang came up to me and said,

"nad, short case 230 this evening at OB2"

*short case - an assessment of your clinical skills in palpating patients in obstetrics and gynaecology plus some discussion on diseases related to pregnancy*

i was like

WTH!!!!

suddenly my mind went blank

omygod

mcm mne nk short case

totally unprepared

but still

no matter what i said that time, the short case will still be carried out and i should be covering what i can at that time

*****

time : 2.45pm

i saw her walking in the ward

in my opinion the most beautiful specialist in the department

my heart was tachycardic

and my palms were as cold as ice

nothing can describe the feeling that particular moment

then she called us one by one making sure all of us were there already

and she told siang to come with her first and the rest of us to wait in the tutorial room

so off we went to the tutorial room

time flies

*****

time : 3.40 pm

the three of us in the tutorial room were restless

what took so long?

as far as we knew, short cases normally will only take 15 - 20 minutes

and here we are waiting for almost an hour

then yin ru came in, and said,

"dr lim went to the labour room to conduct delivery of her patient from wad khas. u all tunggu ok. jgn pegi mane2"

we were like

ohmygod!!

more waiting

*sigh*

*****

time : 410 pm

the door of the tutorial room was opened by someone

and there stood dr lim, smiling to us and said,

"do u want to know what happened? haih..come..nur fathurah. i'll try to make you meet your death as fast as possible"

so we were dumbfounded

and fathurah followed her

*****

time : 425 pm

dr lim entered the room again calling chai xin hang as the next candidate

then there left me, alone, counting second by second

*****

time : 445pm

at last

my turn came

i followed her to the bed

and the patient was already diagnosed to be in active phase of labour with the cervical os 4 cm

so arm need to be done before sending her to the labour room

at first i thought that it would be the end of my life since we might need to find another patient who is pregnant to be palpated

and that would take forever since the red ward was already filled with postnatal patients

luckily, the patient said that she was okay for only another student to palpate her abdomen

so i went on

palpating pregnant lady with on previous scar, currently at 35 weeks and 6 days period of amenorrhea with uterus smaller than her dates

there were mistakes here and there

but overall i was quite confident with myself

and the discussion after that went well too

Alhamdulillah

Allah, i cant thank you enough

*****

time : 505 pm

i went back with smile on my face

enjoying obstetrics and gynaecology posting even more

and hoping for good result

with love

p/s :

~ thanks a lot Dr Rahana for teaching me skills in palpating abdomen with gravid uterus

~ thanks to my group members for helping me sharpen my skills and knowledge

~ thanks to Dr Lim Yun-Hsuen for making my short case uneventful

~ thanks you Allah for eveything =D

perempuan itu istimewa

two weeks until the end of obstetrics & gynaecology posting

*****

perempuan itu istimewa

6 weeks in obs & gynae opened my eyes a lot

even as a lady, i never thought women had the capability that i knew we actually do have now

in obs & gynae, we dealt with women from the very young up till the very old

yg paling magnificent sekali would be dealing with pregnant women

after all this time, kite cuma dgr people mention

penat ibu mengandung 9 bulan sepuluh hari

hormat mak, die jage kite dlm perut lame

die yang lahirkn kite

die yang besarkan kite

die yang jge kite malam2 up till the point xkn ade seekor nyamuk pun yang hinggap kat badan kite

but actually, do we really go deep into these sayings?

most of us actually did not experience watching the pain of women in labour

ya Allah..tuhan je yang tau

i may not experienced it yet

but watching mothers struggle with contractions pain, waiting for the cervical os to dilate up to 10 cm sent chills up my spine

kalau yang os fully dilate after 2-3 hours tu xpe jgk

tp bygkn yg kene tngu smpi 11-12 hours just to make sure the baby is safely delivered

dgn contractions 1 in 2 minutes

Subhanallah

the first thing that came to my mind after observing the first delivery in my life was

"ya Allah, macam manela ibu bole tahan semua ni smpi 5 kali"

seriously

only after observed yg itu baru sedar mcm mane peritnye seorang perempuan tu nk bersalin

dgn episiotomy nye

pastu kne suture lg

blood loss yang slalunya not less than 250 mls

only women can withstand that

first time conduct delivery

i only tarik bahu je after midwife tarik kepala baby tu

ble baby tu da kuar, da cord clamp, kte angkat tunjuk kt mak die

time tu baby da nangis and obvious dpt tgk mak die senyum and as if hilang sume sakit yang die rase time tu

then ble baby tu da bersih, da wrap comel2, letak baby tu dlm warmer sebelah bed mak die

time tu pun obvious mak die akn tgk je baby tu

and baby tu pun kebil2 tgk mak die

kne jahit time tu pun xrase da kot

indahnya kuasa Tuhan

kte yang melihat ni pun rase happy tgk the bond yg formed just by looking into each others eyes

that was an amazing experience

6 weeks thought me a lot

in Al-Qur'an, ade satu surah dinamakan sempena wanita

- an-Nisa' -

in medical practice, ade satu major specialty just addressing women

- obstetrics and gynaecology -

perempuan memang istimewa

itu hakikatnya

*****

2 weeks till the end of obstetrics & gynaecology posting

with love

exam, post-exam & first day at h.o.m.e

chapter 1 : e.x.a.m

first of all

result will be out on the 23rd

and i dont feel a thing

i should feel scared for the fact that i may failed paper/s

however, since it will be a week away

so, i'm trying not to stress myself so much about it i guess

in order to put everything that happened in my entire exam weeks in a nutshell

lets begin with a paper and continue with another one

or perhaps, lets make things easier

by concluding all papers into one

as usual

being UKM medical students

we have 4 modules to be completed every semester

and this time

the modules are :

the gastrointestinal & hepatobiliary system

the endocrine system

the neuroscience module

&

the reproductive system

so of all the four

the endocrine system would be my favourite

hormones give me rush i supposed

and

the neuroscience module would be the least preferred

maybe due to the fact that the first essay q which is terribly easy

unfortunately, i didnt remember a thing on cerebellum

and it ended up to be the worst essay q i've ever answered

seriously

two years of being medical student,

i've always had a thing with anatomy

but in this particular module

i purposely left out the whole topic on cerebellum when i did my final reading the night before that particular paper

and anatomy became my worst nightmare

*sigh*

no matter how i put it into words

none can describe how i felt

and i know that the only things left to do would be praying

so that i'll pull through the exam

and the results next week can put smile on my face

chapter 2 : p.o.s.t-e.x.a.m

bergembira bersama kawan-kawan

this time

let the pictures do the talking

chapter 3 : hari pertama di r.u.m.a.h

sunyi

makan

tido

cepatla semester baru mula

xsabar nk masuk tahun klinikal

nk pki white coat sepanjang hari

*insyaAllah*

till then

with love

of e.x.a.m.s and r.e.a.l.i.t.y

last night we had a session with a senior which had successfully turned himself into a doctor 2 days ago

i was like, bestnye...aku ada lg 3 tahun..huhuhu

the fact that monday is the first day of examination chills me

worse than that, it's gastrointestinal system

which for me is the 2nd hardest module i've learned during my preclinical year

*the hardest one would be membrane&receptor*

sigh

please please please pray for me

i'm kinda excited to enter clinical years

having different postings every 3 months

having clinicians scoldings for the lackness in our knowledge

having the opportunities to actually touch patients and experience the real fact of becoming a doctor

having to wear white coats all the time =D

seriously

this is my dream

this is what i want to become

this is what i live to achieve

an MD

and yet

this upcoming 2 weeks will determine whether i have the ability to proceed

or the other way round

we can only plan

but Allah decides everything else

amin

till then

with love

p/s : to those whom i've hurt before, i'm sending tons of apology your way with all my heart...

superior colliculus of the midbrain

first

to make things clear

i had at least 8 topics to cover

and sad to say

i'm still stuck at the superior colliculus of the midbrain

unable to move on

*cant find the reasons why*

even worse

next week *tomorrow precisely* will be the beginning of the third week of this particular module

*neuroscience*

and superior colliculus of the midbrain was the first week thingy

*sigh*

till then

xoxo

p/s : next week = home

*cant wait*