3rd year, 3rd posting : Internal Medicine

Assalammualaikum wbt

Hah, seperti yang dijanjikan, aku akan tulis pulak regarding 3rd posting. 3rd and 4th posting aku adalah masa 2nd sem 3rd year. 

Internal medicine. Posting yang paling cuak katanya. Paling susah. Senior-senior semua cakap macam tu, majority kawan-kawan yang dah lalui posting internal med semua cakap internal medicine ni susah. So, dalam kepala aku, dah set dah sebelum masuk posting ni.."susah, susah, susah, susah"

with head of department medicine of Kulim Hospital

after my long case examination

Dr Najihah

Basically, korang kena mantapkan physical examinations macam cardiovascular, respiratory, abdominal, neurology (include cranial nerves, upper limb and lower limb). Actually benda-benda ni just refresh semula second year punya clinical examination. Bezanya, kali ni we concentrate more on techniques and findings. Steps semua diorang fikir korang dah pro dah. Masa second year just mantapkan step je kan. Without knowing why did you do this and that. So, kali ni, no more practise on bantal, teddy bear, etc etc. T_T

Bagi aku for physical examinations, yang susahnya ialah korang need to remember every reasons for that findings. You must know why it is happened, and how. Once you get your concept right, rasanya tak perlu kot nak hafal, hafal. Cumanya nak dapatkan concept tu kena la study buku Talley for physical examinations tu. Banyak jugak la sebenarnya nak baca buku Talley tu. Aku prefer buat nota from side box dekat tepi-tepi buku tu je. Contents dia baca sekali lalu je.

how I study for internal medicine.

I use mini clerk kumar, oxford handbook of clinical medicine, 

short notes from ukm, sarawak handbook of medical emergencies, 

then clerk kumar besar or harisson on certain chapter. 

(mana larat semua nak guna yang besar weyh -,-)

Lagi satu yang penting masa posting ni ialah ECG interpretation. Baca la buku ECG made easy (yang tak pernah easy bagi aku....haha.) Tapi kan, bila kau dah tau ECG leads semua benda jadi macam senang. Common cases are common. So, benda sama je lah dia tanya for 3rd year med student. Mana nak tanya lebih-lebih. Habis-habis pun dia tanya atrial fibrilation, MI, previous MI, hyperkalemia, bla3. Then suruh kira heart rate, sinus rythm, find abnormalities. Tengok leads, relate. Should be easy! Eceh.

Throughout this posting, agak penat jugak la sebab aku jadi posting leader. Hari-hari tachycardia arrange class, message consultant, merayu dekat doktor, lari sana, lari sini bla3. (gelabah). Our class start at 8am. Biasanya consultant akan marah sebab kitorang tak ikut round (hahaha), tapi doktor college cakap, better buat class compared to ward round. Entahlah. Tapi consultant biasanya akan suruh kau clerk case best kalau kau ikut dia round. Then after dia habis, dia suruh kau present. Tak pun, dia suruh kau present depan houseman dengan MO kalau korang dah clerk awal. Cuak beb!(tapi lepas tu diorang suruh MO present balik la, takkan nak percaya dekat kau kot. 3rd year med student je..huhu) Tapi best. Then after round or class tu, selalunya ada bedsite teaching or clinic. Clinic internal medicine ni tak banyak procedures pun yang kau boleh buat. More to mantapkan your history taking, and discussion on certain cases. Or takpun diorang suruh kau buat physical examination dalam clinic.

Petang tu biasanya akan ada lecture or workshop. Internal medicine ni banyak sikit workshop. Every system ada workshop dia. Macam one system should be covered in one week la lebih kurang. Ada je yang 2 systems in one week. Bayangkanlah masa 2nd year for one system berapa lama dah korang kena cover. So, 3rd year ni dia anggap ko dah ingat benda yang kau belajar masa 2nd year. Cuma kali ni mantapkan on diseases, signs symptoms, investigations, management..Ada CVS, Respi, GIT, Neurology, Rheumatology, Dermatology, Nephrology, Emergency medicine, Poisoning, Infectious diease. Ada lagi ke? Entah. Malas la nak bukak buku check balik. (kan cuti ni!..ko ni mesti skema kan, cuti pun tulis pasal medic) Haaa, semua systems ni u'olls kena habiskan dalam masa 7 weeks! (menyesal amik medik?) Nak penuhkan logbook lagi, mantapkan physical examination lagi. Tapi bagi aku internal medicine ni considered as boleh la nak bawak. Entahlah. Sebab masa second year dulu aku resit 6 modules kot. So, ada la saki baki ingatan tu yang boleh guna. (serious jangan down kalau kena resit exam, benda tu berguna..TAK TIPU)

Log book pun tak banyak procedures kena isi. Pasang ECG, ECG intepretation, tengok ABG, blood taking, canulla insertion, blood culture procedures, taking BP, blood glucose, catheter insertion (male and female), spirometer bla3. Rileks la logbooknya. Tak heavy. Ada jugak belajar X rays (which a lot more easier compared to surgery), CT scans, MRI, bla3.

For exams.."korang senang la, ukm, exam semua bahasa melayu"

Aku pernah dengar orang cakap macam tu. Meh sini aku bagi penampor buaya sikit (sensitif oi). Ada ke patut. Clinical osce, written osce, theory semua in English la. Eh lupa ada bahasa melayu! Muka depan kertas soalan tu, tulis "perubatan dalaman" Muka depan je la T____T

For clinical osce, short cases. Aku dapat 2 cases. Sorang 30 y/o malay male with chronic obstructive pulmonary disease, COPD (which i guess i did well) and a young 16 y/o girl with haemolytic anemia. Palpable spleen and hepatomegally. I did bad. Sebab cuak, selama ni kalau nampak patient perempuan muda-muda aku segan nak mintak permission untuk examine (walaupun ada chaperon) hahaha. But luckily i got my diagnosis right. 

For long case aku dapat a 53 y/o malay male with heart failure and acute exacerbation of bronchial asthma. Gila ko, banyak findings pakcik ni. Nasib baik ok present case.

hukm.

study week and exam week.

Theory paper and written OSCE, kitorang kena jawab dekat HUKM this time. Ya Allah punya la stress last minute dapat tahu kena exam dekat hukm. Kitorang kena travel dari Kulim ke Cheras. Nak exam lagi, duit lagi. rm250 habis gitu je for exam tanpa boleh claim. Sedih T_T Tapi tak apa, Allah tahu penderitaan kitorang. Punya stress buat sendiri nak uruskan petempatan, bergaduh-gaduh dengan member batch, admin college. Stressnya Allah je yang tahu. At last 3 days of my study week aku korbankan. Seharian travel from kulim to Cheras, then 2 hari aku balik rumah jumpa mak abah sebab sangat stress (balik rumah mmg tak study la kan!..huhu)

one day before exams, orang cakap jangan study, relax

ye ke? haha

during study week.

Balik rumah 2 hari, release stress orang kata.

Top speed 278km/h ni

Aku berani try up to 180km/h je.

(sayang nyawa weyh, belum jadi doktor lagi..huhu)

One or 2 days before exam kitorang buat study group make our discussions from 9am up to 10pm. Dekat library hukm.

For theory paper, OBA, EMI and KFQ. My diagnosis for KFQ was hyperglycaemic hyperosmolar state (HHS), autosomal dominant polycystic kidney diease, chronic liver diease secondary to chornic hepatitis B with portal hypertension, and  tuberculous meningitis with hypotension. Aku tak tahu la, tapi bagi aku theory paper was alhamdulilllah ok.

For written osce, I got one KUB x-ray of staghorn calculi, one picture of gouty arthritis, one peripheral blood film showing features of haemolytic anemia, thalassemia, iron deficiency anaemia, and spherocytosis. Then ada one ascending cholangitis secondary to choledocholithiasis dengan apa lagi entah? Tu je lah dapat recall.

Overall, bagi aku internal medicine adalah posting paling best dalam 3rd year. Aku sangat enjoy dalam posting ni.(tak tipu weyh!!) Benda-benda yang selama ni kau belajar penat-penat semua kau boleh relate using your logic and common sense. Semua jadi macam map. Ya Allah. Serious happy sangat posting ni. 

Alhamdulillah i pass my internal medicine.

P/s : Tak tahu la perlu ke tak tulis posting public health. Posting tu paling best, but nothing much to describe. hehe.

3rd year. 2nd posting : Surgery

Assalammualaikum

Sepatutnya harini nak kena basuh semua kemeja bagai. Baru balik holidays, tak sempat buat benda-benda tu semua. Sebabnya next week dah nak start elektif postings. Belum tahu nak buat apa. T___T

Sementara tengah bermalas-malasan, taip je la entry baru u'olls (eww), surgical posting.

after clinical osce examination. Dengan member se-posting in surgical ward of 

kulim hospital.

Surgical posting ni adalah posting kedua dalam first semester 3rd year aku. Basically aku rasa aku not into surgical posting sangat. Study okeh je, tapi cuma kurang minat surgery. Kenapa? Entah, masih mencari reason yang sesuai. Haha. I just know im not into it. Thats it. Faham? Overall 7 weeks in surgical postings and we will come again to surgical posting in year 5.

Basically in surgical posting, you have to revise back your anatomy (wargh!), mantapkan physical examination like hernia, breast examination, neck examination, abdominal examination, ulcer examination, cyst, varicose vein examination and bla bla blerghh..Bagi aku benda-benda ni agak susah sebab dia benda baru. We never learn it before during second year or first year. Kecuali abdominal examination lah. Lain lah macam O&G, kau just praktis check perut, perut dan berut. Haha. Senang je! (padahal menggigil jugak time exam! T.T)

Then, kau kena mantapkan macam mana tengok X-ray. (seriously aku blur gila masa awal posting macam mana nak tengok air under diaphragm, meniscus sign, frail chest, haematoma, pneumothorax, tumor, bla3..) Bulau weyh mata aku tengok X-ray. Tu belum lagi tengok ERCP, ultrasound, CT scan, MRI. Beza dengan ong, kau tengok baby ultrasound, baby ultrasound, baby ultrasound..Sebab hospital kulim tak ada detail scan bagai. T___T Thats sad

This picture basically how I learn surgery. 

I read davidson and manipal as main reference.

In A Page as quick reading notes.

And do my own notes through you tube. Haha

Ipad dekat sebelah tu gua buat refer Wiki. Hahaha :P

(baca jugak wiki sebab senang hadam..hehe)

Then kau kena mantapkan hafal segala jenis surgical instruments. Forceps (yg entah berapa jenis entah..huhu), needle holder, retractor, NG tube, Stengtaken blackmore tube, airway, catheter, and banyak lagi. Terkebil-kebil aku nak hafal benda alah tu semua weyh.

Ward round surgery paling best. Sebab banyak gilos cases kau kena ingat. Then balik, kau pun tak tahu nak study yang mana satu dulu. Haha. Bedsite dia biasa la macam bedsite yang aku pernah cerita sebelum ni. Tak banyak beza sangat. Clerk, present, physical exam, soalan-soalan sikit. Kau buat banyak kali, kau pro la. (ceh! bajet! haha..padahal..). Clinic dia best! Sebab banyak gila benda kau boleh belajar. Tapi malangnya ada sesuatu yang berlaku menyebabkan kitorang jarang dapat masuk clinic. Sob3
Tapi kalau kau jenis yang muka tak tahu malu, clinic petang tu datang la, belajar. Tak selalu kena halau kot. Kalau kena halau, blah r. Kalau ok, kau stay. Ada FNC clinic, breast clinic dengan dressing. Aku selalu join dressing clinic. Sebab kau boleh perform basic procedures like surture removal, dressing, and wound checking. Unlike macam breast clinic, tak boleh suka-suka je nak join kalau tak ada student perempuan, tak boleh la join..FNAC pulak agak bosan, sebab kau boleh tengok je (sambil cakap "ouch" dan pegang leher sendiri) and tengok sampling.

Sesi selfie sementra tggu consultant for lecture. Ahaks.

Procedures pun tak banyak sangat kau kena perform. Blood taking, cannula insertion, IV line set up. Lain2 banyak kena observe je. Same goes to OT. One major surgery and one minor yang korang kena observe. Tapi!!!!, ada satu procedure ni yang kau kena perform and dapat trauma lepas tu. PER RECTAL examination! Dalam log book kitorang, kena perfom 2 kali je kot. Tapi tak tahu kenapa aku dah perform more than 4 times kot throughout surgical postings. First time aku buat, aku lupa pakai double glove. Ya Allah, serious, lepas tu seminggu aku makan guna sudu! haha. Bau tak hilang dari tangan aku T.T

Yes! I do have a "life" lololol Friday evening and Saturday!

Kitorang cuti sehari je sebab Kulim kerja on Sunday.

Friday we do have class in Penang for radiology, or video conferencing with ukm-cheras.

and i do joined mountain bike tournement. haha

Dapat medal kot!

For examination, short case aku dapat 2 cases. One diabetic foot ulcer (which I did really bad). Gila ko! dia tanya aku pathogenesis of diabetic foot ulcer. Terkebil-kebil aku. Huhu..And, another one, I got incisional hernia. Hernia from cesearean. Obvious hernia. Agak senang la case tu. Nasib baik boleh back up case diabetic ulcer tu. Then, ada soalan X-rays which I got fractures, air under diaphragm, pneumothorax dengan apa lagi entah. CT scan I got extradural haematoma. And one ERCP, stone in common bile duct. Instrument I got Stengtaken blackmore tube, mosquito forceps, 3 way cathether (sengal aku pergi sebut 2 way!), needle holder, airway tube dengan apa lagi entah. Banyak sangat. Lupa. Dannn dengan cukup-cukup makan, pass surgical short case. Huhu.

For long case, I presented one case of testicular tumor. Serious cuak. Left testis with the size of ostrich egg! Non metasthasize. Nasib baik ok. Dia tanya aku classifications of tumor, how to approach the tumor, investiagtions tu confirm. Ok la kot.

For continous assesment. Kena pilih 2 surgical cases. I choose left inguinal hernia (from paediatric ward actually case ni. Mampus aku nak kena cari surgical management dengan dosage ubat semua under paediatric..Dah la paediatric ni posting year 4 T.T), and one more case is thyroid cancer.

Theory paper OBA, EMI dengan KFQ ok la. For KFQ sekarang ni aku dah lupa sikit diagnosis apa entah keluar haritu. Rasanya satu case on ascending cholangitis, satu breast cancer, satu portal hypertension. Lagi satu apa entah? Trauma case rasanya kot..Written OSCE ada X-ray on staghorn calculi, X-ray on intestinal obstruction, instrument of central venous line, CT scan on haematoma, ERCP machine dengan apa lagi entah..hahaha. Susah la nak recall T_T

Overall, surgical posting ni banyak benda baru yang kena belajar. Tapi ok la. Overall for semester one third year, aku lagi suka O&G, tapi surgery punya markah was higher compared to O&G. Surgery aku tak berapa suka maybe sebab aku agak lambat on surturing degan aku ada sikit fine tremor when holding instrument. Macam tak sesuai. Lagipun I do hate anatomy bila dia jadi too details and too many to remember. You cant simply use your logic, imagination, and theory or even algorithm masa belajar anatomy. Kau just kena faham, hafal dan hafal dan hafal dan hafal. Tu tak suka tu. Haha

celebration of our results. Hah. Thank you for yang edit this picture!

Macam pakai fair and lovely muka aku aku kata ko~ hahah

combination of 2 posting groups for surgical posting on first semester.

Andd, i passed both my O&G and surgery for my first semester in 3rd year md ukm. Alhamdulillah. Special thanks to my parents, teachers, lecturers, consultants, doctors and friends for the guidance, help and all the discussions. Lepas ni boleh tulis pasal internal medicine pulak! huuuu

3rd year. First posting : O&G

Assalammualaikum wbt

Dah lama tak update belog ni gara-gara busy yang melanda. heh. Alasan.

Nak tulis sikit perkongsian pengalaman sepanjang 3rd year ukm. Aku akan cerita sikit la pasal postings, pasal exam, dan pengalaman yang sangat berharga yang kitorang satu batch dapat rasa. Apa yang kitorang buat, macam mana kitorang overcome certain situations yang tak memihak kepada kami.

Postings 3rd year ukm ada 4 which are Surgery, Obstetric and Gynaecology (O&G), Internal Medicine and Public Health. 2 postings run in one semester.

So here, aku start cerita dengan O&G dulu kot..

my first 3 labours that I conducted. (halfway..haha)

Rambut serabai sebab stay after class and stay at labour room.

My first semester for 3rd year I started with O&G. Dalam syllabus ukm for ong ni antara yang paling busy kalau tengok log book dia. Ya Allah, menangis weyh nak isi. (tipu, aku tak nangis pun). Basically dalam log book tu kau kena conduct 5 deliveries. Yang mana for delivery baby ni aku tak pernah conduct full labour lah 5 ni. Mostly assist. Pernah conduct sampai keluar kepala masa rotation of baby head tu, then masa nak tarik badan dengan umbilical cord tu mostly aku agak cuak sikit sebab badan baby tu sangatlah licin. Kang tak pepasal gelabah time tu  jatuh anak orang, habis aku..Huhu. So, aku conduct halfway la untuk 5 tu. Tapi pengalaman paling best dalam o&g ni adalah azankan/iqamatkan baby. Ya Allah, meremang bulu roma nak qamatkan or azankan anak orang. Biasanya aku amik peluang ni kalau ayah dia tak masuk dalam labour room or mak dia suruh, or nurse suruh. Or aku tanya sendiri doktor, boleh tak kalau nak azankan? hehe. Tak sabar nak ada anak sendiri LETTEW. errr (pandang kiri kanan, garu kepala)

ong best jugak sebab ada baby-baby comel.

Baby miscarrage, die in utero, and macam2 yang buat korang tak tido 

malam pun ada. Rezeki masing-masing. Moga adik-adik ni membesar dgan baik. Aminn.

Lain-lain tu biasalah, perform episiotomy surture (if you are confident enough). Biasanya nurse tu bagi la kau try satu ke dua surture, lepas tu lain2 midwife tu sambung or MO yg buat. aku buat tak? mestilah buat..dekat model workshop je. haha. Tak berani weyh! kalau nak try surture, boleh je pergi jahit light cases of trauma dekat ER. Try la kebolehan kau. Haaa..yang ni ok la.. Berani? Lepas tu insertion canulla, blood taking, catheter insertion, vaginal exam, speculum. Ni semua kau kena buat la. Part of benda2 yg you have to practise macam abdominal examination dengan basic overall physical examination. Ok la kot? huhu

my first and very bad try of episiotomy surture. haha..Buruk gila!

Pagi before round biasanya aku datang awal clerk cases (lantakla kau nak cakap poyo ke apa, tapi serious aku buat..ahha), Then ikut ward round aku akan dengar management from specialist. Lain2 punya discussion aku malas sngat nak amik port. Then hafal cases yang ada dalam ward untuk that day. Depends la aku ikut obs or gynae. Tapi sedih la sebab gynae tak banyak cases dekat Hospital Kulim. :( Then lepas tu biasanya akan ada bedsite teaching. Sorang clerk, present, buat physical examination depan specialist, then present your findings. Specialist akan betulkan kau punya findings sikit-sikit, comment on the way u examine patient, tanya korang investigations, then management. Itu yang diorang buat masa bedsite. Kalau hari masuk OT, korang boleh la join. Cases yang menarik nak join OT for O&G dekat kulim ni macam fibroid, twins, emergency on cord prolapse. Lain2 macam molar tu apa semua malas la nak tengok. Lagipun observe je. Nothing much you can do in the operation theatre. (as a medical student).

Kalau hari clinic, join clinic. Clinic o&g agak boring la sebab case ulang-ulang dengan agak basic. Tapi basic ni la kalau kau tak tahu terkial-kial nak jawab dengan specialist. Tapi best la sebab nurse-nurse dia baik. Bila tolong diorang, siap kupaskan aku mangga lagi. Makan-makan. Kalau ada makanan free meeting boleh la tibai join sekaki dengan makcik2 nurse tu..hehe

Then tengah hari ada lecture. (masa yang paling mengantuk gila). Selalu jugak aku kena marah tido time lecturer ajar. Muahaha. *tapi lepas tu baca balik la weh. Kalau tak de lecturer biasanya akan lepak dalam library or any room that you can read your books or notes. Petang kalau ada consultant yang free, kalau untung ada la class. Kalau kau bosan baca buku, masuk la labour room. Study dengan HO ke, MO ke. Tolong amik darah ke, hantar ABG kat lab ke..Then after maghrib or isya, biasanya kitorang ada rotation sesama kitorang untuk pergi labour room (so, tak de lah crowded dalam labour room tu). Seminggu 2 kali (if you willing to come on weekend) or sekali. Balik dari labour room study pulak benda yang MO tanya. Sebab esok kau nak present dekat diorang pulak. Huhu. Memang penat lah!

while waiting for labours, study dekat labour room.

For examinations. We got short case (clinical OSCE), long case, continuous assessment (1 short case report, 1 long case report, 1 normal ctg report, and 1 abnormal ctg report..hamik kau!), theory and written OSCE. Yang mana, kalau korang fail any one of this compartment, korang akan consider fail terus. Tak kesahlah theory korang power gila nak mati ke apa, kalau korang fail clinical osce, and tak boleh backup with your written osce, consider fail postings. Menyesal tak amik medic?

For short case, lecturer from UKM akan dtg and asses kitorang dekat sini. Patient from kulim hospital. During my short case, I got uterus smaller than date. A patient with  big midline scar on her abdomen. The diagnosis was preterm prelabour rupture of membrane (PPROM). Luckily i got my diagnosis right and perform-boleh-la-kot? With slight hyperthyroidism sign that shown by my hand (ketuk tangan!)

Muka happy sebab lecturer ukm baik hati bagi aku pass short case.

(walaupun rasa buat macam teruk gila)

For long case exam, I got a patient with stable stage 3-4 placenta praevia. And management of bleeding placenta praevia. Ok lah kot.

For theory paper, all paper come from ukm. Susah jugakla soalan dia. huhu.. we got one best answer (OBA), multiple choice question (MCQ) and key featured questions (KFQ). Kalau fail any one of this compartment, considered you fail this posting. Contoh, your OBA is less then half, but others ok..So, fail lah (even you pass your short case)..kejam tak?? huhu..Mostly diorang cakap KFQ paling susah. Entahlah. Depends. Diagnosis masa tu PPROM, cervical cancer, diverticulitis kot, ke miscarrage entah?. Entahlah. Lupa. Dah lama la postings. Haih..kena ketuk ni kepala sikit..

Written osce we got a CTG, diverticulitis, Mc Robert position, rotation of baby head, cervical ca, stages of labour. then ada PPD station. Hurm..

Basically obs and gynae considered as ok la. Tak susah sangat. Best jugak posting obs gynae. Tapi dekat malaysia ni susah sikit kot lelaki nak jadi specialist o&g.

Nanti bila aku rajin aku tulis pasal surgery pulak.