....MINGGU CLERK PATIENT..

ASSALAMUALAIKUM...

aku br lepas tgk cita jepun hehehe tajuknya "things that school doesn't teach you"..cita pasal bebudak sekolah yg amatlah kelakar hehehe aku kerja gelak je..and ada la ckit adegan meeyebabkan me becoming the crying princess again hehehe aku stat tgk ptg td dlm kul 5 lebih sementara nak tggu bukak posa la kononnya last sekali berlarutan and the drama just finished..baik la cita jepun ada 10 episod camtu ja kalu cita korea yg suka ada episod byk tu sampai keesok pagi la gamaknya..bila tgk cita jepun relly feel want to go to japan,nak tgk sakura,nak jumpa nishikido ryo,toma ikuta (cam leh jumpa je bunyinya hehehe..

cam besa i will story what happen in this week..this week is the busiest,tiring week ever..why????
1.sebabnya mggu ni aku kna clerk patient and present case(really menakutkan+good experience)
2.assignment etnik tak siap lagi huhuhu
3.tetiba lak aku terlantik menjadi ajk publisiti untuk program sambutan hari raya msft(medical student facilitator team),so a bit busy..
4.being ajk akademik for psp(persatuan sains perubatan),tetiba je diz week busy ngan kerja ckit+meeting ckit..
5.my laptop anti virus buat hal so i have to g to PPKT
6.and the most important duty is study huhuhu banyak je lagi nota nak cover...

ok let me huraikan all the stuff above(ceh cam nak wat esei la bunyinya...)

pasal clerk patient..mlm ahd that is mlm 11 oktober aku ngan my pbl partner dah menyibukkan diri g hospital nak cari patient..plannya nak g mlm sabtu that is 10 oktober,nak g ngan kak syu 4th year skali nak mintak bantu pa2 yg patut especially bab pe(pysical examination)then dia ada hal and at the same waktu tu cik aini pun ada hal so ikut the earliest plan that is malam ahad..kami g dalam kul 8 camtu hospital g tingkat 7,wad patient umum..terkejut kami bila tengok dah ramai student 2nd year dah ada kat ctu atas tujuan yg sama iatu mencari patient tuk present case..cuba bygkan dalam 2nd year ni ada lebih kurang 22 group pbl,and every week mesti ada at least 1 student from each group that been duties to present for that week..and as this week is cvs week so we have to search for the patient with cvs problem but unfortunately kat hospital ni ada beberapa kerat je patient cvs yang perlu dikongsi at least 22 student..tu kalu 1 pbl just present 1 patient while for my group pbl we present 2 patient each week so menambahkan lagi bilangan pelajar yang berkongsi patient yg sama..
memang malam tu g agak kecewa..g belek buku kemasukan keluar pesakit tu tgk ada lebih kurang 5 orang je patient cvs utk wad lelaki la..and the 5 person tuk dah full sama ada dah tido or dah ada student ambik..so,aku ngan aini pun g belek2 kat wad perempuan,bilangan patient cvs ada la byk ckit..and all are available but the risk is higher if take patient perempuan..sebabnya nak wat pe tuk perempuan agak susah and selalunya mak cik2 a bit uncooperative..then tetiba ada sorang kak ni mengajar pe to a group of nurani student so aku ngan aini pun join sbb dah tak tau nak watpa masa tu,patient tak jumpa so we decide to join je..best sgt kak tu ajar and first time aku dgr cardiac murmur that is systolic murmur..suka sgt aku masa tu..dgr murmur tu cam bunyi pelan je cam bunyi angin antar first and second heart sound sbb dengar kat mitral area..leh la appreciate ckit compare sebelum ni belajar teori but never heard it reality..then ada dengar lagi satu murmur kat pulmonary,aortic area,tu lebih jelas la murmur nye sbb takda dgr 1st and 2nd heart sounds..then,tgh2 blajar tu sorang lagi pbl member aku,addy join gak..dia mggu dpn kna present so dia join km clerk patient tuk gain experience..

then abis blajar pe tu kami pun jumpa satu patient ni,malay male..alhamdulilah dia bg cooperation even though saravanan baru lepas wat pe kat dia..pak cik tu sangat lah aktif..he electively came for angio..he has dm(diabetis melitus)..his cvs symptom is only chest pain..dia memang dah lama ada chest pain but on and off chest pain..bila ada chest pain he juz use minyak until one day it is so pain sampaikan dia masuk a&e department before he entered the 7s ward..maybe the cause is smoking,he smoke for 20 years already that is since he is 14 years old..patient ni agak hyperactive cam orang tak sakit..its better sebab takda la kita rasa cam menyeksa patient je kalu dapat patient yg weak..lepas ambik history pa yg patut(agak serabut la aku ngan aini ambik history,cam tak tersusun,1st time clerk patient..sblm ni pnh tlg orang clerk patient ja)..then sempat kami buat pe,sblm wat tu awal2 dah mintak maaf kat pakcik tu,awal2 bgtau km budak baru blajar at least dia takda expect km expert sgt pasal pe ni.. no significant finding pun jmpa kat pak cik tu..ada satu aku rasa la apex beat dia dislocated sbb kami tak jumpa apex beat dia..it been dislocate lateraly..yang lain smua normal..then,km pun balik..

penat lelah tak berhenti sampai dictu saja..aku balik bilik aku terasa cam nak cr patient lagi sorang..it's ok kalu 2 student in the same pbl nak present the same patient but aku terasa cam tak best je so aku berazam nak cr patient lagi sorang..

then,the next day that is ahad(12/10/2008)
Pagi tu aku sibuk ke PPKT..laptop buat hal ckit tak leh nak remove avg8 dlm laptop ni so tak leh nak download kypersky so aku tggal la laptop kat ctu smntara nak g kls..then ptg tu kul 2 aku g still problem so ppkt suruh aku bw blik dlu laptop tu..oohhh aku dah kusut takkan aku nak g kelas and g hospital ptg ni bw laptop gabak ni..and the idea came hehehe aku tggalkan laptop kat bilik teacher chaizani,the best english teacher ever..baik la languange department dekat je dengan PPKT..then kalut la aku masuk kls and as expected doktor dah masuk so aku pun masuk mcm pencuri ikut pintu blakang hehehe

that evening,i went to hospital again..cam biasa sampai je wad 7s tu terus tgk buku kemasukan keluar pesakit tu..then dissapointed smua patient are full so aku masuk wad 7u(wad pesakit perempuan)..mula2 cam nak ambik patient laki kan sng ckit but bila fikir2 balik one day i will be a doctor gak so i have to adapt with it..so belek la buku kemasukan keluar patient..then aku pun tulis semua nama and no bed patient2 cvs sng nak cr nnti..alhamdulilah patient cvs perempuan ramai..so then aku pun ambik sorang mak cik,46 dalam buku tu tulih she has IHD(ischaemic heart disease)and HPT(hypertension)..so bermula la sesi history intake(kali ni a bit teratur ckit)..she also electively came for angiogram..
history of presenting illness
she detected that she got heart disease during clinical checking for pregnancy..then she follow up at kpp..then start this year the symptom arise,b4 this asymptomatic..1st she had SOB(shortness of breath) then she been hospitalized for 5 days..then,she got palpitation or dlm bahasa kelatenya call 'kenalin' that is equal to berdebar-debar dlm bhasa melayunya..it felt so fast and so strong and she go to a&e department and been hospitilized again for 8 days..and then she came again to hospital for angio..
no significant history of medical and surgical..
no significant symptom for systemic review..
family history..
her mother and father are hypertensive patient..she has 7 sibling and she is the 4th..her other sibling is all in good and healthy condition..she is married and has three chidren..all of her family are in good and healthy condition..she has no family history of DM,asthma,cancer,epilipsy or stroke..
social history..
she is a housewives..she never travels out of the country..she is a passive smoker as her husband is a smoker..she does not consume any alcohol..there are loss of weight..
drug history..
she is now taking 5 drugs that is frusemide 40mg,warfarin,hydroxin,digomin 0.25mg and lipitor 20 mg..before being hospitalized she just take propanolol and frusemide..all this drug are prescribed by doctor..no allergic to any drug..not taking any tradional or complimentary medicine..
that's all about her history setelah au berpenat lelah berulang alik 3 hari ke hospital sampai naik kesian aku tgk dia duk menajwab soklan2 aku..selain daripada aku ada lg student lain,student 2nd yr,3rd yr,4th yr and 5th yr..rami la..sian dia..pengajarannnya jgn masuk hospital universiti hehe penat melayan student je hehehe but the best in hospital university is it has many doktor pakar..like this hospital apex university so many pakar wooo..
then the pe..kak pah 4th year student yg buat aku juz wat ckit2 and try appreciate the finding..mak cik ni so many significant finding..
dia ada clubbing..her apex beat dislocation at the 5th ICS(intercostal space) and anterior axillary line so it means her heart is elarged..the normal location of apex beat is 5th ICS and medial to midclavicular line..there are presence of thrill(palpable murmur) at the mitral area..for ausculatation there are presence of murmur,thre are presence of pansystolic murmur at mitral area with no radiation to the neck area and there are also early systolic murmur at the pulmonary and aortic area with no radiation to axillary are..there also presence of basal crepitation..that's all the significant finding,others are normal..
case mak cik ni memang best..kan sblm ni aku tgk dia ada IHD then bila tgk record dia pulak tulih CRHD(chronic rheumatic heart disease) with atrial fibrillation..ohh sudah aku dah konfius..kena studi la sbb penyakit2 tu tak blajar lagi,the last week cvs br blaja.btul la org ckp be a university student must be dependent..cam aku ni blum blajar pasal IHD or CRHD lagi but dah clerk patient that maybe has one of the disease.. mmg masa present kat doctor terkulat2 aku nak menjawab pasal differential diagnosis..menakutkan but the doctor is so supportive..paedtrician la katakan..ok..that's all pasal clerk patient..mggu depan kena antar case report..added one more work hohoho..bab yg lain tu aku mls la nak bercerita..now its the time for me to do the case report..hope ok..hope doktor terima..

wslm..