10 Minutes should be enough!

As Salaamm....so today we are going to learn how to do hand examination within 10 minutes~ its possible! XD


Introduction

Inspection

• Inspection consist of describing all the abnormality of the hands, or the relevant negatives (psoriatic plaque etc).If patient have 5 important abnormality but you mention 4, then your mark shall be 4/5 of 1 mark.geddit? XD

Warmth and tenderness

• Palpate for warmth and compare with the upper part of the arm 
• Palpate for tenderness at each joint, at BOTH SIDES OF THE JOINT, not above and below it. No need to move the finger around (checking for mobility n what not), you're just trying to look tenderness of which joint

How to palpate the joint

Screening : OK sign (+ prayer sign. But if you miss this, its still ok)

• Most importantly when doing screening is that you know what's its for
• OK sign:- radial, ulnar and median nerve function.
• Prayer sign :- to see if the deformity is it fixed or is still reversible
• ****usually in RA, patient don't have nerve prob so if the radial, median n ulnar nerve are normal from the OK sign no need to do special test to confirm these nerve problems.But if they have, then know which sign is for which nerve prob (Homan's test, phalen, tinnel, etc)

Power and Functionality 

• Test for power of each fingers
• Function as usual : comb hari, button unbotton, use key...

Diagnosis 

• RA

Differential Diagnosis

• Psoriatic arthritis
• Overlap syndrome

Ix and Mx 

• Ix : Rheumatoid factor & anti CCP
• Mx :DMMARDs- Methotrexate

Settle!

Flyers on Child Safety

Alhamdulillah...

After such little preparation, we did manage to pull off the community project for Peadiatric posting on Child and Safety. I was appointed to do the flyers and I just thought of sharing it here so that anyone can use it. It is in Malay and the infos was extracted from the Panduan Pencegahan Kecederaan Kanak-Kanak untuk Ibu Bapa Malaysia, by Persatuan Pediatrik Malaysia (http://www.scribd.com/doc/21550181/Panduan-Keselamatan-Kanak-kanak)

Flyers : Panduan Keselamatan Kanak-Kanak untuk Ibu Bapa dan Penjaga

the color version

the black n white version

the other side of the pamphlete

These are just the screen shots, if you want the original copy just email me at : zatel.iman@outlook.com and I will email the PDF form...If I notice your mail that is... :D

Being Friends with Patients

After more than 5 years being a medical student, I’m glad I manage to finally learn this before I started working. Of course, I still find that what my mum keeps telling me is partly true ; “being friends with doctors are boring… All they know is to talk about medical stuff and they are only good in socializing with their own kind”. Yes, I’ve seen it, unfortunately… Which is why I’m glad I am a part of a big family that talks about more important things in life at least once a week… hehehe….

I’ve been a friend of patients in the Obstetric ward that sometimes I visit at her workplace here in the social service of PPUKM, and one that wanted to name her newborn baby “iman”. I’ve been friends of most of my case write up patients, even though mostly it’s because I wanted to get the PPD part…(oh dear me!hohoho….), friends of at 3 psychiatric patients with different diagnosis and a few others. Well, not that much really.

This is really something that PPD doesn’t really go details, but being able to befriend with patients is actually that shortcut to getting to all that communication, spiritual, ethical, etc issues that we’re supposed to instill within our hearts as doctors.

Today I made a visit to a friend, an akhawat, at the psychiatric ward. Kak Raja have been in and out of the ward for the past few years. For those who don’t know the story yet, she had been diagnosed with Bipolar II disorder few years back. Currently, the issue is that there might be some Axis II involvement. She is also having trouble with support from the family, trouble with employment, and with the disease currently on the relapse.  For those who had most probably forgotten about Bipolar II disorder, here’s a quick recap:

1. Presence (or history) of one or more Major Depressive Episodes
2. Presence (or history) or at least one Hypomanic Episode
3. There has never been a Manic Episode or a Mixed Episode
4.  The mood symptoms in Criteria A and B not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
5. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Its difficult to understand the patients feelings and what they have to put up with, let alone psychiatrict patients. In this case, someone involves in tarbiyyah… We know that studies had shown that religion is one of the protective factors against psychiatric diorders.  But, “studies” does not follow Allah’s rule per say. Being clinical-evidence oriented people, we tend to forget that, and the one that suffer the stigma will be the patients themselves. How do feel about that?

The similitude of the believers in their compassion, mercy, and affection toward each other is like a single body.  When one organ ails, the whole body suffers and reacts.

When one organ ails, the whole body suffers and reacts.

When one organ ails, the whole body suffers and reacts.

When one organ ails, the whole body suffers and reacts.

Being a muslim… how much do we feel this suffer? How much have we done to help?

There is nothing I can do much beside offering my friendship as an act of kindness to relieve one’s heartache from a disease with not such a good prognosis. 

Being a muslim… we are taught that action speaks louder than words and to walk the talk. 

With all the talk, when will the walk start? They say “start now, start small, and start with the closest one to you…”

If I’m not making my point any clearer, let me just end this post with a hadith, one that I pasted beside the door of my house (which I frequently forget to read everyday before going to the ward):

Wallahualam....

p/s: to kak Raja who's probably be reading this, I hope you'll stay strong. As much as you are hopeful for recovery, I am also hopeful to see you stand up strong and functioning as a great daie that you're meant to be. I am grateful for our friendship, and everything I learn and gain in between. Always remember that in this road, you are never alone. Allah and the faithful men are always with you. Wait for it patiently, wait for the day that all the pain will be insignificant even if that day comes after everything ends because Allah NEVER break a promise.... Please be strong... 

with love, your sis, iman...

Remembering Developmental Milestones

Ahh....Its been a while since I last wrote in my blogs.Its not that I don’t have the time… its just that there is a lot of ups and down to take care and somehow I loss interest to talk about it. I guess there are times where silence is better than the words spoken. But long story cut short, basically I was not well during the middle of my 5th year, took too many MC, couldn’t fulfill 80% attendance, therefore barred from taking the exams, so currently waiting to repeat 5th year which will be in early July. Okay! *catch breath*

Let me also take this opportunity to wish, CONGRATULATIONS!!! to my fellow batch mates who had made it safely through the pro-exam and will be doing their housemenship sometime in May. May Allah help them get through that.. :)

For those whose wondering how am I taking all these, well it was a bit difficult at first, but after that, you move on ya know~ hopefully this will make me become stronger and more prepared in facing difficult situations in the future…InsyaAllah...

Okay! Lets get back to business~!

We are going to talk about, Developmental Asessment! Or developmental milestone~! This is one of the major ‘will-forgot-info’ of the medical student life, well for me at least. So lets find a more easier way to remember DA. 

If we talked about presenting DA to our lecturer, we will present according to the four developmental field;

1. Gross motor
2. Fine motor and vision
3. Hearing and speech
4. Social behavior

One child can have gross motor developed at 6 month but socially around 9 month or fine motor and vision at 3 month. Therefore, when we want to remember DA, it would help to remember the developmental stages in one particular area according to age rather than what we usually do which is remembering the stages in all 4 field of a particular age. The end result would pretty much be similar, but somehow I find that remembering according to each field is much faster and esiear to understand compare to remembering according to age. If we remember according to age, most of them will only be simple memorization rather than understanding how the child develops.

Therefore, using the DA guide given to us UKM medical student in our 4th year, the Developmental Milestones 0-2 years by Mary Sheridan, I come up with a table of developmental stages according to each field to ease understanding of developmental milestone. 

Basically I divide all field into 3 levels. Why three? Because 2 is not enough and 4 is just too much. 3 is just nice. If you got a problem with that, that's non of my bizweaaak~

Each level may have 2 to 4 age group. Different field is divided differently. Maybe that will make it more confusing, but who cares, this is for me, if you want to remember your way, make your own. Caphice?!

I don’t have time to explain all, if you want to understand just go through the table. I use common sense. Every level have its specific names, these names are given according to what components in that particular level is best be use to assess the development. For example:

• The Object permanence phase in Gross motor is named in such a way because just by assessing whether the baby have object permanence or not can determine which age they belong to, either 6 month or 9 month. Ain’t that cool?? XD
• The hearing phase in hearing and speech is because in that certain age group, the baby most prominent feature or the feature we can assess is the hearing, other feature are less prominent. Same goes for the early table manners phase in social behaviour. In that particular age, most of the things that can help us identify the age is by assessing the food related thingy mejigger. 

Geddit? So go ahead, if you find it useful, please feel free to copy, paste, share, use, print or whatsoever. I hope I can make things a little easier for anyone~

Thank you for reading! Have a happy peads posting! XD

*note: please click and download for bigger view

Logo Making

I have a thing for making logo,not that i'm good at it.But its kinda fun...:D

How I want to Remember my friends....

The beauty inside

Sorry Nina, I know you told me to just make a synopsis, but I can’t help writing!! You have induce my heart to wriiiittttteeeeeee my heart out….hahaha…. it’s been quite a while I don’t feel like writing up a long essay. But, I promise, the point I want to make, I will highlight it, so for those who hate reading or have tons of other things to read, you can scroll down and go to the bottom of the post, where I summarized what I want to say.

I told Nina today, something I usually told certain people, close people, I told her about what I usually feels after every dinner. Most of the dinner, well actually all of the dinner I went (except for the one….. I shouldn’t say which) I always feel left out. Imagine now, already ‘left out’ after being barred, another dinner for me just to feel left out. Oh man....and I'm the exco some more...? So lets see, why do I feel left out?

REASON 1: Am I not beautiful too??

People coming to dinner always wears their best clothes and make ups. I don’t blame them, I do that too. But not everybody will come to dinners wearing ‘appropriate’ clothes. As Malaysians we all learn to respect each’s other religion. In islam, there is a certain boundaries to what a muslim can wear, doesn’t mean they can’t be beautiful, we can, in any ways, just not the wrong ways. For the non-muslim, they have the right to wear anything they want as beautiful as they want, but…. Being 1 Malaysia, in a place where all races are present isn’t it nicer that we respect each other believes? I’m not asking for every girls to suddenly wear the hijab and the guys wears baju melayu, but at least we wear something that doesn’t ‘offend’ others. I’m quite sure too that other religion also teaches not to wear very ‘revealing’ clothing. Its painful seeing our friends, who we sees going to the ward wearing such modest clothing and just being themselves, but coming to dinners as someone you hardly recognize! On top of that, some with too revealing clothing….its like, “oh this a part of you (body parts) I never seen before! Literally!”. I’m not referring to anyone, since I can’t remember any dinner experiences before, I erased it in my memory long ago. Sorry, but some are just, offensive to the eyes…. For those non-muslims who read this, this does not make me an extremist, I’m just being what a muslim should be.

Tell the believing men to reduce [some] of their vision and guard their private parts. That is purer for them. Indeed, Allah is Acquainted with what they do. And tell the believing women to reduce [some] of their vision and guard their private parts and not expose their adornment except that which [necessarily] appears thereof and to wrap [a portion of] their headcovers over their chests and not expose their adornment except to their husbands, their fathers, their husbands' fathers, their sons, their husbands' sons, their brothers, their brothers' sons, their sisters' sons, their women, that which their right hands possess, or those male attendants having no physical desire, or children who are not yet aware of the private aspects of women. And let them not stamp their feet to make known what they conceal of their adornment. And turn to Allah in repentance, all of you, O believers, that you might succeed. (Source: Holy Quran; Surah An-Nur:30-31)

So as Malaysians, you don’t need to understand this, you can if you want, but at least respect it. So the point is, if there is one time, where we all gather for that very last moments, what do we want to remember about our friends?

• A. Their clothes
• B.Their make-ups
• C. Their body (??!!!)
• D. Their heart

Well, I don’t know about you guys, but I want to remember their heart.  Who says that beautiful is only to the eyes? Well, there are… but those guys are probably big time models and superstars, and we are future doctors, I’m quite sure there is a big difference to that. People can lie about how they look by wearing beautiful clothes and thick make ups, but no one can hide their inner beauty, it just shows… for some reason...

REASON 2: What’s the theme again??

I never follow dinner themes… except for the black and gold something…. Because by chance I have a black and gold jubah, so I just wear it. But honestly, those who really follows themes, I give them the two thumbs up!! Some put so many effort to really go with the flow~ its good really, but I wonder what happen to those expensive clothes we wear especially for our dinner, hmmm…… I don’t think I ever seen anyone wears them to the ward… honestly, I came to a dinner once, wearing something I wear going to the ward…hahaha… And I actually feel a bit proud, because I don’t see anyone who dares to do the same…heheh…I don’t know, maybe there are, but I didn’t see you, sorry..hehe.. so the point is, isn’t it easier if the theme is, well, the theme is just be yourself, release your inner beauty. Drink inner shine a lot… no need make ups, you can still look as cute as Nina Hoklai. (wink!wink!)But of course I wear a bit of make ups too sometimes. (coz I’m not as cute as you):D

REASON 3: Who was it the king and queen again?… but why…..???

Well, I’m quite sure most of the time we judge winners by how awesome they go with the flow~ I remember one of the judges of one of the dinners told me, “I don’t know who to pick….”, FYI, its not because there’s too many candidates, but during that time, everybody seems to be too “malas” to follow themes. But now, since medic student is more rich, such issue will not be raised laa… can follow theme punya la, no hal…. But on what basis do we pick the King and Queens? Just by what they wear? Its okay, it’s a good idea, since people put a lot of effort to look good in every dinner. In that case, so why don’t we make a dinner where inner beauty would be the theme, and the King and Queens would be, the nicest of friends…. The nicest of people…. The one who make a lot of sacrifices for all of us…. The one who sometimes cried for us…. Belanja us....when JPA is not in yet…. Let us sleep in their bed when we have nightmares…(tribute to Nabila who let me sleep beside her on the night i have nightmare during posting at HTI).....you know... those guys…. The one we really want to remember as Kings and Queens… hey this IS the LAST dinner for you guys right? So why not? Make the King and Queen someone who really are the kings and queens of 5^th year medical student… as a way of saying, thank you friend, we will remember you always….

and hey! Why not make a lot of Kings and Queens? Different type of King and Queens for different categories.... and everybody should bring present too...oh oh...and maybe we can make small cute medals, and put there "best friend award" make it as dedications...:DD

I know the idea and conditions I’m asking here seems to be the opposite of what we usually do, but isn’t that the point of the LAST DINNER? One that really LASTS, not just in pictures, but in our hearts… We respect each other’s believes and boundaries, remember our friends for who they are, and give a BIG THANK YOU to someone who deserve it…..(oh, I think I’m gonna cry…TT_TT)

So here’s a proposal for a theme, if you don’t like it, well, I don’t mind, I still have another year to try this out! Haha!

“Release Your Inner Beauty”

Here is the reasons (for those who don’t read the doodles up here)

Inner beauty is not something you can paste with makeup’s and buy with expensive clothes, but you can show by just being a friend, being who you are, and respecting others as 1 Malaysia

It is a theme made to treasure friendship so that we will remember it during those last moments. No need to hassle on what to wear, just whatever makes you feel pretty everyday (you are pretty right?? And handsome too la…)

As a way to say thank you to those friends who really give all out for us for the past 5 years, they will be our Kings and Queen

Let’s not just treasure beauty, but let’s treasure, INNER BEAUTY

How I want to remember my friends:

Pictures of my friends,that they are proud of (if not, they wouldn't put it on facebook!)

 May God bless us all....

"Misi Jubah Merah"

Last Sunday, during the 2^nd Fiqh Perubatan, I met Kak Long, one of our beloved senior who had just fly from Sabah to attend their Graduation ceremony the day before. Honestly, I’ve never seen kak Long in such high spirits before. Its like she have all the energy in the world, I can see the glow of happiness when she talked about the “jubah merah” and the graduation ceremony. Me and my best pal, Hayat took a picture, and I take the chance to ‘test’ the “jubah merah” myself. Its surprisingly comfortable by the way!

I had been reflecting quite a lot on that day. Not only because I get to meet Kak Long, but during Fiqh Perubatan itself, a lot of emotions takes place. If I can, I want the whole world to know about what I’m facing during my final year, and how much it had been affecting my studies. But what I fear the most is the kind of reaction I will get from others that will eventually affect my way of thinking in a negative way. I’m not making sense am I? Well, some things are not meant to be understood. But for once, wearing that “jubah merah” made me forget about all those troubles, and I really felt like ‘my turn’ to wear it for real is really that close. The feel of that heavy red fabric hugging my body feels warm and so welcoming. Will be it be next year for me? and next year is really just a couple of months away.

In my opinion, the happiness one felt during their graduation does not depend on their PNGK or wether they received distinction or what not. It depends on the overall performance of that particular student. How much effort had he or she put in making all of it worth it. And that is something only the person themselves can determined. Success is subjective isn’t? I always told myself that success to me is really that simple, its when I manage to be happy and always giving my best effort to gain the best in the worst of situations. It doesn’t matter how well I perform, as long as I give it my best, to me that is already considered as a success.

Looking at myself right now, thinking about all the ups and downs I went through, I really felt like I had been struggling real hard. Maybe others would beg to differ, and some might even criticize me, but no matter. I was told by my teachers, that “only you know how good you are, and don’t let anyone else let you feel down”. Heck yes! I’ve been doing my best to get myself in a good shape. Sometimes I failed, but I know sooner or later I will stand up anyway and walked in one piece or in pieces. I know that above all, I have to accept myself in order for me to be accepted by others. A good friend once told me, “the only person who will make your life easier is yourself”. How true she was, even though we sometime hope that the people around us will give us all the support we need to succeed, but in the end, all we have is ourselves to decide whether we want to stay on or give up. I felt really lucky being blessed to be on the road of tarbiyyah. The locus of support I’m receiving extends massively. Sometimes I can feel that the whole world is doing their part to help me, and InsyaAllah, only Allah alone will decide for me and His decision is the best decision.