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.