Showing posts with label Dr Sajar. Show all posts
Showing posts with label Dr Sajar. Show all posts
Today -- The worst ever ending??
5/08/2009 06:29:00 PM | Author: fadzly
Late

Today, as always, i woke up at 8.30a.m and class should be start at 8.00am. But then later, i was told that the class will start at 9.30am. So i sambung tido la.. another 15 minutes i woke up, prepare to iron clothes. I relax2 je.. Raffiq already went to the class. I thought i was on time, then i simply go la to the clinic. Rupenya, WTF we should be in clinic at 8.00a.m to clerk patient then present at class at 9.30am!! Dahla come 15 minutes lambat, i even didn't bring my pen and my note! ishk2...

Clerking & Presenting Case

When Dr Sajar ask me what do you see down there? I said i didn't know we should be there earlier.. damn... Good things got Syud, she saw many patient today and present alone with zawati.. LoLZ.... So i just add abit of discussion bla bla bla..

Ending

It started like this, after all the long discussion we have reach the end of it, and Dr Sajar asking, whether you have any question related to PCM? Then Syud asking related to basic or something like pathophysiology. It suppose to be a happy ending. I never thought that because of my act mumbling to Zawati (and i forgot y i mumble), Dr Sajar become angry.. I never realize it, until the end of the class, all blame me that Dr Sajar was suddely raised her voiced.

Quotes from my classmates

Dr Sajar tibe2 berubah muke, tinggi suara

Die bengang start when Syud tanya pasal physio yang tak penting pastu when tgk muke ko tgh mumbling die terasa giler dan terus cakap if you dont like how i'm teaching bla, bla, bla...

Aku da rasa lain dah bile die cakap yang die tak kisah sama ada kamu datang kelas die atau tak. Die tahu yang kite tak datang tiap2 hari pukul 2 tu.

In the end it's up to you whether you are really desire(?) to pass the exam

Why? why? why?

I never and ever in my mind talking bad things about her. Did i?
I've been always respect her as my teacher. Maybe on that time I and that day, i'm not....
After what i did today do i really respect her? after came late, didn't bring pen, notes, etc?

Sorry

Sorry for everythings I've done.. I didn't mean it.. Maybe it's time for me to change my attitude.. Thanks for making me realising it..

________________________________

Connector

But that was the bad part.. hehe, Now is the syok part..
Today we trying hard to get our internet back after college has cut down our wire to the router. After thinking and brainstorming, we are now using BUNBUN's idea where the net will be available only after working hour and also weekends!! So we set up a new temporary wire which we only put it during the time set. We've make our own wire which is long and cut it into two. But the problem is now, we don't have any connector.. A bit relief when Teck Siang gave us a connector, but.... it's broken. Sigh... Then again, i dont wanna drive to digital mall and only buy the RM5.00 connector. Thus I've an idea. How about we build our own connector! lolz. You might be surprise how we made our own connector. It comes from a switch/hub!! LOLZ


The connector tek siang bagi.. Hampeh



Ni la bahannyer!! D-Link Switch 5 port!



All the things above we trash it.. The only thing we use is....



The port!! yes!!


A bit of wiring.. Lolz.. Simba managed to plaster the copper wire..



Nice art rite for a final year (extended) medical student.. kahkahkah!!

Thanks to Simba, Ronin and also last but not least thanks but no thanks for your connector Tek Siang. We're so tired testing, try and error for almost 4 times changing the wire head when we thought that the wire had problems. The connector, we managed to do that 2 times before we really made it for real by using coppers in the hub instead of using wires which were easily lose to the connector..



Aaahh.... at last.. internet~~syoknyer...

So is this happy ending?? Of coz is happy! I can download my movie again tonite!!!
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Topic: Osteoporosis
5/04/2009 05:30:00 PM | Author: fadzly


Why me so bother talking about osteoporosis? Because Dr Sajar told so.. muahahaha... Osteoporosis is under group of metabolic bone disorder.

Definition
Osteo - Bone; poro - Pores; osis - condition
Apleys: Can found any.. LoLZ
Stedman: reduction in quality of bone or atropy of skeletal tissue; occurs in postmenopausal women and elderly men, resulting in bone trabeculae that are scanty, thin, and without osteoclastic resorption

Risk factor

Why so important of knowing the risk factor? So we can screen early ler.. Later i will talk how do we screen. Of coz almost all women who are menopause will get this osteoporosis, but if patient got +ve risk factor, it might accelerate the osteoporosis so it's important for us so we can prevent it earlier

Risk Factors are (from apley):
  1. First Degree family history of Osteoporosis
  2. Ectomorphic somatotype???
  3. Hysterectomy done before
  4. Cigarette Smoking
  5. Dietary faddism?

WTF is ectomorphic somatotype?? Stupid apley. That's y i never like this book. The book is so simple without explanation.. Hate it so much.. nway.. just forget about it now..

If u are 70 years onwards, additional factors come into play.
  1. Diminished activities
  2. Chronic illness
  3. Dietary deficiency
Clinical features
Basically clinical features depend on which fracture site it occur.

Hip Fracture
Hip fractures are a major cause of loss of independence in older women and men. Overall about half of hip fractures are intertrochanteric and the others are femoral neck fractures. In older women the proportion of trochanteric fractures increases. Trochanteric fractures, but not femoral neck fractures, are related to bone density. Femoral neck fractures, on the other hand, may be more related to mechanical factors. The vast majority of hip fractures occur after a fall. About 5% appear to be "spontaneous" fractures, in which the patient feels a fracture and then falls.

Vertebral Fractures

About 60% of women with compression fractures
do not realize they have had a fracture! Vertebral compression fractures vary in degree from mild wedges to complete compression. The symptoms also vary, but the degree of compression is not necessarily related to the amount of pain. It is possible that some of the fractures occurred gradually and therefore did not cause acute pain. When women and men do suffer painful compression fractures, the pain usually lasts from 1 to 2 months, is localized to the back with accompanying muscle spasms, then gradually subsides macam simple muscle strain except lebih lama skit. Usually patients with continuing severe pain should be evaluated for other pathologic etiologies of the fracture, especially malignancy or myeloma. Persistent pain can also be caused by continuing fracture, muscle spasms, spinal stenosis, or degenerative joint disease.

Wrist Fracture
Wrist fractures are more common in women who are 50 to 60 years old. These are caused by falls or other trauma. Osteoporosis does not appear to impair the healing of the wrist fractures, and they cause only short-term disability.

Others such as body shape and consequences
Kyphosis, Heigth loss, Protruding abdomen, decrease pulmonary capacity, reflux esophagitis


Investigations
Xrays

To correctly interpret a spine xray, it is important to know the definition of a vertebral fracture, which is not quite as straightforward as it first appears. A vertebra can be considered fractured if the anterior height is 80% or less of the posterior height. A new fracture requires loss of at least 20% of anterior or posterior height. See picture on left.


Xray of the long bones also typically shows an osteoporotic fracture. Usually there is a general reduction in radiographic bone density and abnormal thinning of the cortices. Therefore, here comes DEXA in terms of measuring bone density more accurately

DEXA
For medical student, by knowing what full name of the DEXA is sufficient. No need to know it in detail. Using DEXA is a gold standard to diagnose osteoporosis. It came out in my EOP, 2 years ago, LOLZ. However some centres, DEXA scan were used alot in terms of screening to those with high risk. Now you see the reason why we should know the risk of having it! However it still controversial..haha..

Prevention
  1. Dexa scan for those women who have multiple risk factor particularly those with suspected low oestrogen or some other bone-losing disorder, and those who have suffered previous low energy fracture at the menopouse
  2. Calcium and Vitamin D supplement
  3. Avoid smoking and alcohol consumption
  4. Oestrogen medication (Hormone Replacement Therapy) is the most effective way of maintaining bone density. There was question related to PCM OSCE where we need to advice the patient of having HRT, but the problems about HRT are the complications.
  5. The newest drugs is Biphosphonates. It is a useful alternative to HRT. Biphosphonates have been shown to prevent bone loss and the to reduce the risk of vertebral and hip fractures.
Treatment
Managed the fracture first - Internal fixation, rehabilitaion.
Then genaral treatment - Vit D and Calcium supplement, diet with this elements, expose to sunlight, exersice and treatment with Biphosphonates or HRT should also be considered to prevent further loss.

A nice Clinical Practice Guideline you can download here
There is also some Orthopaedic book i like to share. Click here
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May 1st - holiday!! 2nd Question!!
5/01/2009 10:37:00 AM | Author: fadzly
Okay, because today is holiday, i'll continue happily typing the 2nd question for you all.. haha

Note: This question basically a short answer question, which might come out in the END OF POSTING test, OSCE, and also long case exam.

Mrs. Wee a 56 years old clerk has hypertension for the pass 1 year. She's currently comes for follow-up. She on tab amlodipine 10 mg daily. His blood pressure (BP) is 150/100 mmhg. Discuss the management of this patient. (10 marks)

So like always address the issues first! So what are the issues here?

Hypertension (HPT) for the pass 1 year. So we need to assess her IDEA about the HPT.

Her BP was 150/100. What do you think this is? Basically in any disease (i mean any medical or psychiatric illness) when the disease is not improving, there are 3 things to bear in mind.

1) COMPLIANCE
2) DOSAGE
3) WRONG DIAGNOSIS

So we need to assess all this three things first. In this case, usually the compliance and the dosage are all we talk about.

Then the other issues are to establish the degree of control of disease process

Then is there any complication from the disease?

And is there any co-morbid condition such as Diabetes, Obesity

Then after addressing the issues we tackle it one by one.. ok?

So answer should be like this

- I would like to assess this patient Idea about Hypertension. How much the patient knows about hypertension? How much the patient concern about the disease affect to his life, family, work?
- Then i would give top up the information and re-educate him so that the patient knows adequately about HPT, such as complication of the HPT. I would also like to tackle the biopsychosocial problems accordingly.
- I would like to assess this patient compliance. Did the patient compliance to medication? Did the patient compliance to the advice?
- If not why? Is there a problem? - Side effect? no access to medication such as patient poor, home is far, no transport, no clinic nearby? No one take care of him? Traditional medicine
- If compliance is the problem managed accordingly by giving education on medication, emphasis again about pharmacology and non pharmacology management, stop the traditional medicine.
- If the patient can’t tolerate the medication, such as side effect, change other type of drugs. If SE is not a problem, i would try to increase the dosage of the drug.
- Assess the patient compliance to advice and clinics. Did the patient go for follow up regularly? Did the patient have BP monitoring at home?
- I would like to emphasis on Non pharmacology management such as exercise regularly 30 minutes a day 3 times per week, eat healthy diet, less sugar, less fat diet, etc
- I would like to referred the patient to dietician
- I would like to assess any complication from HPT by doing CVS examination, EYE- ophthalmoscope and also do some investigation such as Urine dipstick, UrineFEME for protienuria, ECG for ECG changes.
- I would also want to assess this patient co morbidity such as DM or obesity by doing BMI, FBS, and cholesterol level.
- I would like to follow up the next 3 months or 4 months to monitor the progression.

I do agree with it's a bit wordy and difficult. Dr Sajar said, we just need a lot of training, that’s all. Good luck in your study! Till we meet at the next question! haha

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