Excuse me, are you a first year too?

Someone tapped my shoulder while I was watching an infant was being resuscitated.

"Excuse me, are you a first year too?"

He was wearing a long sleeved labcoat - surefire sign of a junior (Hehe.)

"No, I am not. I think I didn't see any of your batchmates either."

"Oh, ok."

"How long will you guys be here?"

"For a few days."

"So you guys are having nursing week, right?"

"No, I'm studying medicine."

"......."

"Oh... yeah, it's my nursing week."

"I see. Shouldn't you be in the wards now?"

"Huh? Then where am I now?"

"You're in the Emergency Department."

hello from glasgow

heys lads and lassies! i was just reading random blogs and noticed that the m205 blog is kind of dead so i decided to just write a short update on how things are getting on in glasgow.

our exams are nearing...may 18th. the first ever exam we'll be having here. stress levels aren't that high yet but it will be soon enough. easter break has just commenced and we're, actually "i" in this case, is being a lazy bum as usual and procrastinating. it's a whole repeat of eos 5. argh!!! eos 5 all over again! however i shall not complain after hearing what our peeps at seremban had to go through for eos 7. congrats to all there!

well this is a short update. there's nothing much happening here with the exams getting nearer. till the next update ta!

GP Case 1 - the demanding patient

Just to 'liven' things up a little, I'ma post a couple of cases which I've seen in my GP clinic for you guys to think. Yes, I have my OWN clinic! Okay, so it's just for 2 weeks .. but damn, it's the most fun I've had since while studying Medicine.

Anyway, here we go.

Case 1.

Guy in 20s came in with his wife and 2 kids, complaining of being depressed. He admitted being recently out of prison, and said while he was there he could not eat and felt really down. Upon release, he described himself as continuing to feel depressed all the time, lost interest in everything, was not eating or doing anything at all. Once, he said he injected himself with heroin and his wife found out. He saw a GP previously who put him on Fluoxetine, which did nothing. When queried, he said this depression has lasted for years but he had never talked to anyone about it, and Fluoxetine was his first medication.

Then his auntie gave him this 'medication' to take, which he handed the empty foil over to me. I looked at it, 'Neurontin' (a brand of Gabapentin). He said he's feeling much better after taking them, and began eating and helped around the house with the kids. He has just finished the Neurontin so he had come to get a prescription for it.

He claimed that the medication has helped him so much, if he couldn't get a prescription he'll just buy it from the pharmacist. He said his wife can vouch for the change in him after being on it, so I looked over at his wife but she was just minding the baby in her hands.

Hint: Just to be sure, I consulted the BNF.

What do you think and what will your management of this patient be? I'll update this post with an answer in a few days (:

EOS 7 Days

Some pictures from the Taman Rasah Jaya gang depicting our crazy EOS 7 preps.

Letter From Tasmania

Pic of Japanese section of Royal Tasmanian Botanical Gardens

G'day mates.. Jeremy here. Thought i'd talk a little about life in Tasmania (feel bad that i havn't posted anything here in more than 12 months.. hehe..).

Let's go to the beginning. 4 M205-ians are here (Kang Ler, Joanne, Fatin, & myself) with Yuni from M1. Getting started over here was pretty much a rough ride. IMU and UniTas don't exactly coordinate things very well. We were given the wrong dates for commencement of term and the offer letter was late. There was confusion on which year (3rd or 4th) we were to join. Preparations were hurried and chaotic. We all came to Hobart (the main city here) at different times (3 of us came very very late) and ended up living in varying places.

Pic of the clinical school. It's connected to the hospital at the back.

Classes were going to be interesting. For the first term, we spent 2 days a week doing Neuro/CNS (the horror...) and the other 3 days were spent doing our rotations (which were mostly classes though...). Neuro exams here were way more tough than in IMU. Funnily enough, i passed this one and not IMU's. Dissection was a good change in learning anatomy though... For 2nd term, we aren't doing Neuro anymore... we're doing like a quick run thru of different stuff... Medico-legal, Forensics, Immuno, etc.... and nearer the end of the year, we get selectives (No Hx of Med... thank goodness).

Exciting medical stuff you say? Well... i enjoyed surgery. I got to assist in a below-knee amputation and an appendicectomy.. Got to go around the Emergency Dept in scrubs too... Okay that's not really exciting but i thought it's cool. I got my own patient to talk to and examine (and there's this cute nurse.. haha.. not kidding tho). I recently got back from a Rural GP Posting. That was really good. I had always thought i'd be practising in a rural area sometime in the future, but the difference now is that i'm more likely to stay here than to go back to Malaysia (Malaysians can sigh in relief).

The pic below is me with the GP.

Life here isn't as bad as people say it is. True that Hobart is quiet and practically a ghost town by 5-6pm.. and it's cold most of the time (hasn't reached 0 degrees yet, tho it's winter). There isn't a lot to do if you are a city boy/girl. If you're used to being in KL, then coming down here would take a bit of adjusting. There's only one or 2 malls and they're only 2 or 3 stories high.

Pic of Elizabeth Street Mall. Okay... not a good pic... It's all i got :P

Nightlife? There's a couple of clubs around but none of us IMU peeps go (though i went twice just for the experience and free beer).

Cinema? I havn't been there yet.. So i've missed all the movies this year (Damnit.. i wanna watch Batman).

What is there to do here? Well... they call this "The Natural State" for a reason... and it's not only because of the Tassy Devils (which are dying at a remarkable rate, thanks to cancer). There are lots of places to go for the scenary, bushwalking, and hiking. Lots of national parks to go to. I'm hoping the 3 years here will be enough for me to cover the state. Port Arthur is a good place to go too. It's historical for being the settlement for convicts transferred from Europe (the British i guess). They maintain/restore quite a few places there, though much of the big buildings are empty.

If anyone wants to come here for a holiday, i wouldn't mind playing tour guide :) Driving around here is pretty alright. You get to avoid animals (live and dead) when you're travelling out of town.

P.s. Pics/posts on my travelling around Tas are on my blog.. too lazy to repost it here.

8 months on

"Hey dudes and dudettes,
I'm leaving soon! All the best!"

went the sms that I received 2 weeks ago from mus. As silly as it sounds (yeah man, mus... "dudettes"?), there was something about the message that struck me unlike the other goodbyes before this. M205 has moved on.

Two and a half years rushed by like that.

The last lecture we had together

Back then, Praseong were still a couple. Siau wore bling blings around his neck.

Things have never been the same.

No more 2 hours of lecture and kamikazebbqwthshizukani after that (Outsiders: I really meant studying).
No more CGs at PBL rooms.
No more PBLs.
No more pseudo-escalator stairs.
No more Sun newspaper.
No more "staying awake" at the back of LT.
No more Sri Emas cafeteria (Thank God).
No more 5 minutes walk to Vista.
Friends are no longer a stone's throw away.
No Sri Petaling Chow Toufu (Ivy!!!!!)
No more jogging @ 9 loops lake.
No more air-con wherever we go.
No more pseudo-patients!
No more posters and videos to make (personal).
No more trying to study in the library but end up surfing websites at the e-lab.

I do appreciate the time we spent together. The jogs, the CGs, the chit-chats, the lame jokes, the cyber-cafe sessions, the game, the education et cetera.


Friends, how are you guys getting on?

thon glaikit laddie amang the mons isna daft efter a'

2 weeks into the bridging course in University of Dundee Medical School, can't say we've really learned much haha. Most are just 1.5 hour lectures on the overview on the different specialties - Cardiology, Orthopaedics, O&G, and the like.

And of course there's also the much boredom-inducing communication skills class. Which is actually an English class in disguise. We learned how to restructure questions. And 'British' colloquial slang words mean, like awesome, loo, wee, take a hike, pissed off, bimbo, fag. Yawns. Imagine 2 hours, twice a week on that. Swear we almost asked for a refund. Haha.

Anyway that wasn't the thing i wanted to blog about here. Well, earlier yesterday, we had a clinical skills class on history taking. 3 SPs, 3 cases. Here's what one of the doctors told us about her view.

The way we take the history of the patient, is bombarding the patient with all sorts of questions, and then sifting through the HUGE load of answers trying to figure out what is wrong.

The way they take the history of the patient, is trying to figure out what is wrong while asking the questions. Sifting through the patient's answers, while asking relevant questions to rule in/out the differential diagnoses they thought of. Sort of making arguments for or against the diagnoses in their mind.

So how did they go about taking history?

Look at the presenting complaint in three ways:
1. Anatomy
2. Systems
3. Disease Mechanism

Let's say the patient has right upper quadrant pain in the abdomen. Looking at the anatomy, it might be the liver, gallbladder, lung, kidney, colon.

A patient with bilateral ankle swelling, looking at systems, it might be CVS or Renal. By disease mechanism, you might want to think what can cause the swelling? Proteinuria?

Another helpful tip is how to come up with differential diagnosis. Remember:

VINDICATE
Vascular
Infection/Inflammatory
Neoplasm
Drugs/Degenerative
Idiopathic
Congenital
Autoimmune
Trauma
Endocrine/Environment

Using this mnemonic, the causes of the symptoms can be easily figured out. For example, glomerulopathy. Infection, drugs, autoimmune, endocrine?

Hope this helps in taking histories. Happy talking to patients! (:

ps - the title is in Dundonian, the local Dundee slang. haha have fun figuring it out :P