differential diagnosis

Yesterday, we had a bedside teaching with one of the consultant. The consultant told us to take history of presenting complaint and try to diagnose the disease. We were taking turn for asking appropriate questions. After few minutes, we realised that this is not a common disease.

The patient has weird episodes which are induced by doing heavy physical activity. Each episode has the same symptoms. The patient will feel dizzy, palpitation, headache, pale face, feeling of anxiety and sometimes shortness of breath. No fever, nausea, vomitting, or pain. The episodes last for few minutes and will only stop after resting. This has been happening for few months.

We are thinking of epilepsy or migraine or myocardial infarction but further questioning shows that this is not the case.

The consultant keep on asking us what is the differential diagnosis for this patient. We were baffled by the signs and symptoms. Somehow during the tutorial, an episode of House ran into my mind. I've seen this before in one of the episodes of House and the signs and symptoms are similar.

I know the disease but I can't exactly remember the name. Few minutes later, one of my groupmate said the name of the disease. Apparently most of us were thinking of House but we forget the actual name of the disease.

This is quite a rare occasion for me to diagnose a patient from watching House. This is an interesting week for me :)

gut and liver

The new rotation is less busy than the previous one. The current rotation is Gastroenterology, hepatobiliary and general surgery. There are many tutorials that has been cancelled or postponed which gave us lots of free time. However, I usually stay late at the hospital either to do some revision or interviewing patient.

As usual, there are many things that I've forgotten and need to catch up on that. There is roughly 5 weeks before my semester exam. Can't wait for the holiday now :).

p/s: There is something wrong with few javascript that I've been using in this blog. Will fix it later when I've time.

catching up

Yesterday, I visited several of my friends and it was a good opportunity for me to keep up-to-date of what have been happening in the past few years. I rarely listen to any rumours and as a consequence of that, I'm always among the last to know about any event.

To illustrate this, I'm quite surprised to know that few of my former classmates will get married at the end of this year. I'm more astonished to know about their future spouse. Some of them are doing the same course ie medicine and not necessarily in the same university.

It seems that there are many big events at the end of this year and I will be going home somewhere in December. I guess I'll be quite busy during the holiday and hopefully I'll be able to attend all of the weddings. My cousin who is of the same age as me will get married too. I need to prepare myself for possible interrogation by my aunty and uncle about my future :)

Aidilfitri

Ingin menjawab tag daripada Kasyah, maka kali ini ingin menulis di dalam Bahasa Malaysia. Minta maaf jika ada kesalahan tatabahasa. Maklumlah agak jarang menulis di dalam Bahasa Malaysia

1. Bila agaknya mula berpuasa penuh?
Kalau tak salah, mungkin mula berpuasa penuh pada usia 10 tahun.


2. Pernahkah ponteng puasa? Dan apakah alasannya?
Ponteng puasa ketika masa kecil. Sekitar 6-7 tahun. Melihat adik makan dan minum menyebabkan semangat berpuasa berkurangan :).


3. Pernah main bunga api atau mercun?
Hanya pernah main bunga api dan tidak pernah terlibat dengan mercun. Namun begitu, ramai kawan di sekolah rendah pernah bermain dengan mercun.


4. Apakah juadah kegemaran ketika berbuka?
Hmm, soalan yang sukar untuk dijawab. Bukanlah seorang yang agak memilih dalam bab makanan.


5. Selalu lagu raya mana yang menjadi kesukaan?
Lagu bertajuk 'Hari Raya Untuk Semua' dendangan Raihan dan NowSeeHeart. 'Lebaran Ini' nyanyian Raihan, Rem, Ajai dan NowSeeHeart dan pelbagai lagu 'evergreen' yang sering berkumandang di radio tanah air.


6. Tahun ni beraya di mana?
Seperti biasa, hari raya tahun ini akan disambut di bumi Melbourne. Ini adalah kali keempat beraya di Melbourne dan kali kelima beraya di perantauan. Kali pertama beraya di perantauan ialah pada tahun 1996 di Cardiff, United Kingdom.


7. Pernah ke bertugas/berkerja di hari raya?
Masih lagi belajar. Namun begitu, sambutan hari raya di perantauan adalah sangat berbeza daripada Malaysia. Kebiasaannya hari raya Aidilfitri akan jatuh pada musim peperiksaan dan kena menelaah untuk peperiksaan. Oleh kerana itu, hari Raya Aidilfitri hanya disambut ala-kadar sahaja.


8. Ada kenangan manis tak di hari raya?
Banyak kenangan manis menyambut hari raya di Malaysia. Agak kurang kenangan manis menyambut hari raya di perantauan :)

Ini ialah gambar raya pada tahun lepas. Gambar ini diambil di hadapan rumah bersama rakan satu rumah.

Pada tahun ini, Melbourne akan menyambut hari raya Aidilfitri pada hari Sabtu. Di kesempatan ini, saya ingin mengucapkan Selamat Hari Raya Aidilfitri buat semua pembaca blog. Semoga kita semua dapat bertemu dengan bulan Ramadan pada tahun depan dan berusahalah untuk berpuasa sunat di bulan Syawal bagi menampung segala kekurangan amal puasa kita di bulan Ramadan.

the big C

which stands for cancer. My current rotation will be finished by next week. Few weeks ago when I commenced this rotation, I'm not sure of what I'm going to learn as this is quite advanced and involved sub-specialty.

Reflecting back on the past few weeks, there are some surprises in this rotation. Previously I thought that I will be learning on how to diagnose and treat few major cancers. Just know few chemotherapy drugs, radiotherapy and surgical options and that will be sufficient for my level.

I never thought the impact of cancer on the patient and their family. Some cancers were diagnosed at late stage and the only option for treatment is palliative. The patients might have few days or weeks to live. Some patients died on the ward and some passed away at home. Some patients have early stage of cancer and there is still hope for them but chemotherapy has some nasty side effects.

This rotation introduces me to psychological impact of aggressive disease towards patient and their relatives. I have learned few tips on how to tell the patient that they might have cancer. It is not an easy task to do though. Another challenge will be for the relatives. If the patient has young children, the oncologist needs to discuss with the patient the best way to tell the children the concept of dying.

This reminds me of my own experience watching my auntie passed away when I was 7 years old. I didn't understand that she is leaving forever and I only partially comprehend the concept when I never met her for a long time after that.

I close this entry with these verses from al-Quran.

He will say: "What number of years did ye stay on earth?"
They will say: "We stayed a day or part of a day: but ask those who keep account."
He will say: "Ye stayed not but a little,- if ye had only known!
"Did ye then think that We had created you in jest, and that ye would not be brought back to Us (for account)?"

[al-Mu'minun: 112-115]

internet resources

Since I've started my clinical years, I have changed my method of looking for information. Previously back when I studied at university, I used to borrow lots of books for my revision. I will go to the library and borrow some books that is usually on loan for short period of time. That method was sufficient at that time.

My current rotation requires me to modify my way of searching for medical knowledge. I need more up-to-date information and books can sometimes be outdated. This explains my reliance on internet resources. It is good to be a student under two institutions which are the university and the hospital. Both provide subscriptions to few excellent resources. At the moment, I frequently used Access Medicine, UpToDate and Clinicians Health Channel. Besides that, there are also free resources available on the net such as eMedicine and Online Medical Dictionary.

Even doctors rely heavily on these internet resources. I'm not sure how I am going to cope without internet. The medical field is always changing and we need to be updated with any medical breakthrough in term of treatment and management of patient.

I'm not sure about the situation back in Malaysia but I think I might be dependent on the internet in the future. I hope the internet service in Malaysia will be more competitive and cheaper to the people. High internet broadband penetration in any country will bring more benefit in the long term.