MBBS UM (malaya) EXTENDERS

1) Today started my new posting - paediatric. Prof Asma was very critical to our history taking and i managed to get something from her class today this morning.

2) Although the first case was very simple, a respiratory infection, it seems that there are a lot we still don't know.

3) The way we should took a history is to let the patient tell the event from the beginning until the end without us interrupting in the middle.

4) After the patient finish talking, then we clarify the gaps and take further history which are relevant.

5) English, again are very important, enough say.

6) We don't create a history. Read back what we took. Is the history was really a logic event? If it not, clarify again with the patient.

7) Prior to admission, is the 'key' date. In the mean while, we can also use the 'day of illness' for associated symptom. How many days did the patient has admitted is also an important history.

8) 4C's should be in the history - chief complain, causes, complication, and course of the disease. Thus we really need to know how was the patient progress.

9) Current situation such we're having now - H1N1 should bear in our mind now.

10) The 2nd case is a dengue haemorrhagic fever.

11) I should admit it, this was the first time i saw the rashes like the patient had. If Prof Asma don't tell me it's rashes, i wont know.

12) The last time i saw a dengue rashes was a bit different from this. I should see and identify a lot of different presentations of dengue rashes.

13) There was 3 other differentials based on history - acute glomerulonephritis, hepatitis, and urinary tract infection.

14) Investigation that has been done are FBC - to see the platelet level, haematocrit, UFEME. Prof said we need to exclude the differential also by doing ASOT or ESR.

15) Treat dengue by giving IV maintenance half saline and check for heart rate, resp rate, urine output, and also sign of ascites and pleural effusion.

16) Lastly, thanks Prof Asma. I was hoping my URTI heals faster.