Sunday, August 15, 2010


Last week, i had 2 days of teachings in a row. Should be 3days of teaching in a row. But last friday class was cancelled. All of us got to know it on dat very morning itself. I was like~ duh~ shoulf tell us dat i can bought earlier ticket to go home & have iftar with dear family

11th August 2010

We had class with the HOD. We discussed about inflammatory bowel disease. Simple class indeed. Mostly his comments were about the way of presentation & attitude of presentation. Thats is soooo his style. He also correct our way of answering questions. Being a doctor, u got to know how to highlight the important of the case you are presenting. So, the MO&specialist that listens to you could understand the problem of this patient & could evaluate wether it is an urgent case to treat or the other way round.

12th August 2010 (10am)

Today we had 2 classes. am classes was with prof naseer. Im so excited that i able to have class with him. At the same time i pray that i read enough to answer his questions. It turns out unexpectedly & a very memorable one.

We were asked about a patient with gastric ca. He was successfully operated. Usually, person succumb to gastric ca will presented in advanced stage & undergo palliative treatment. But this uncle was quite lucky. When he presented to us, he was T3N1Mo. Still operable. During operation, found to have mets to liver which not detected by CT. Total gastrectomy & liver resection (seg 2&3) was done. He was stable after the surgery & his condition improves gradually. After the operation, non of us follow up his progression. We were busy covering other patients. When Prof asked us why is this patient in the ward & what was his issue. Non of us could answer his operation. So he stopped the class & order us to write about the patient from history to today's progression & submit to him before 5pm. We did as he said. I admit it was our fault.

Later, we got to know that this patient had hypoalbuminemia & hypokalemia on day 4 post operation. On day 2, he started on TPN. Guess, he needs more nutrients & at the same time he develop diarhea in the ward which worsen his pottasium level. The electrolytes need to be corrected as soon as possible especially pottasium. Before his pottasium&protein were increased in his TPN, he was given fast correction for his pottasium level. Currently, his electrolytes normalised.

Day 7 post operation, he complained of dysuria. Otherwise, no frequency, no nocturia & no hematuria. I suspect he had UTI secondary to infected CBD. Urinalysis was done on him. The result havent come out yet on friday. InsyaAllah i follow up with him tomorrow (if he still in the ward=P)

12th August 2010 (3pm)

Our second class was with Mr Zailani. I didnt know that he still remember my name. Haha. This shows our lecturer actually cares about us. Its just sometimes they didnt show it to us. So we are not spoilt & learn more.

The junior presented a case of 63 years old chinese gentleman who has been diagnosed t have hemorrhoids for 30 years with underlying hypertension & history of stroke. Currently presented with per rectal bleeding. First impression was to rule out Colon Ca. After assessment & investigation, its was just hemorrhoids after all. Lucky uncle.

Mr Zailani discussed with us to very great detail. I still remember his teaching back when im in surgery posting previously. Alhamdulillah, i can answer most of his questions. Learning about colon cancer, reminds me of nazu's father. Hope his father recovering well. Last time, i heard his father's condition was just fair. may Allah give uncle strength in this ramadhan

13th August 2010

As usual, i went to ward early. Examined a thyroid case - multinodular goitre with one prominent nodule turned malignant. I kinda like thyroid cases since 3rd year. Hehe. The other day in the clinic, four of us were called by prof naseer to examine a new case of thyroid. he asked us to examine the patient in front of him. As expected, he always highlight to us 5 points u need to elicit in thyroid examination
1) confirm the swelling is thyroid
2) the character - solitary, nodular or diffuse
3) any obstructive symptoms
4) any malignant symptoms
5) thyroid status

Since we managed to answer his questions, we were given chance to ask him questions. so i asked about role of isotope & biopsy. Compulsory investigations with thyroid patient are thyroid function test & ultrasound of the neck.

Isotope scan currently done in patient
1)who is hyperthyroid but no mass was palpable
2) post operative for patient with thyroid cancer - to check any residual thyroid tissue left which can cause recurrence later. If still present, it needs to be removed

1) done for solitary thyroid nodule
2) MNG patient which one prominant nodules turn malignant
otherwise, no need to be done.

Indication for thyroidectomy
1) failed medication / non compliance
2) malignant
3) compressive symptoms
4) patient with retrosternal goitre
5) cosmetic reasons

hope it benefits =)

1 comment:

  1. Terima kasih Cik Yana. Rindu sungguh saya pada lecturers kite bila membaca cerita Yana ni =)