"PULSATILE MASS" & ME

Assalamualaikum readers!!

YAHHOOOO!! Officially aku dah habis end posting exam untuk medical. Penatnya study last minute and end up padan muka aku dapat soalan yang susah gila bab! By the way, aku tak nak cakap pasal performance aku untuk exam baru-baru ni sebab takda mood nak cerita. Next time aku story- mory kat korang suma.

See!! the topic hari ni...tajuknya pasal " pulsatile mass" dan aku. 

Whats going to happen next??

Suspens dowh especially bagi budak-budak noob medical student macam aku. Pulsatile mass kalau korang jumpa kat mana-mana pun bahaya sangat aku nak cakap. Bahasa masyarakat senang cakap boleh meletup dan babai lah dunia. Sayonara~~

Aku presenting my really own authentic case, 25 years old Malay lady, single (wuhuuu.....), no known medical illness presented with 1 week history pulsatile mass over the scalp. To be exactly, at the right parietotemporal area associated with mild unilateral headache. No weakness or loss of vision. On examination, uneventful, no bruit heard.

Apa diagnosis korang?

MENGADE!!

Seriously, sebelum nih memang aku dah rasa pulsatile sensation tu cuma tak la besar sangat, but recently dah besar betul! Risau gila aku, dah bermacam-macam differentials came out and seriously apa yang aku browse through Mr. Google memang seram like he said " You are going to die soon~~" I'm not afraid of dying but I have a lot more that I want to achieve.. GRADUATE PUN BELUM!! KAHWIN?? sedih bila fikir...

So, at the same time, aku on preparation for this exam yang stress nak mampus, so aku fikir after exam je terus aku nak pergi check up kat primary care clinic IIUM. Tapi korang cuba la bayangkan, boleh ke nak study sambil risaukan that damn "mass". Memang tak la kan??

Sampai-sampai aku siap bukak Googlescholar untuk browse pasal SCALP ANEURYSM!! Tapi mostly patient memangla ada long history of pulsatile mass, siap tortuous penuh satu kepala. Aku punya takda la sampai macam tu sekali. Cikonet je TETAPI kecik-kecik pun still la kan kena risau!

List differential aku~semua dasyat-dasyat okeh!!

1. Scalp aneurysm

takdela sampai tahap macam nih!! 

2. Scalp AVM

3. Giant cell arteritis

Aku ada baca satu journal on management of scalp aneurysm done in India. 8 patient presented. Result form endovascular surgery, 7 uneventful but 1 DIED due to cerebral edema tapi sebab eneurysm dia secondary cause.Hopefully not in my case.

Yang pasal giant cell arteritis, there was a case 19 years old lady, presented with pulsatile mass and headache foe 1 month.Clinically was normal and removal surgery done. They sent biopsy for that and ended up to be giant cell arteritis.

Oooomaiiiiigadddd!!

Relax babe!!

Senang la kau cakap relax! Cer rasa tengok! Bercakap memang senang tapi kalau sendiri yang dapat memang wassalam la ye~~

Continue story aku, after exam medical habis semalam, terus besok tu aku pergi ke PCC IIUM nak dapatkan treatment yang sepatutnya.

Cik Nursyahirah? 

Ye saye....

Masuk bilik 1 kayh...

Tup tap...tup tap...saspens sikit ehh~~

Assalamualaikum (Eh! aku kenal doc neyh, doc postgraduate fammed )

Ade apa masalah?

Dgn sedihnya, DR.........saya ada pulsatile mass DR dekat kepala. (Muka memang macam nak nangis!!)

Hahaha...nih bukan mass la, vessel nih... (Okay, aku rase bodoh tetiba tapi bukan ke sama je..)

Tapi, DR saya ada headache belah left sided  plus rasa macam tarik mata belah kiri nih...

Okayyyy...so awak fikir apa? aneurysm?

Aku angguk-angguk kepala laju ja...(ye la DR!)

Ye la tapi awak punya dahla kecik je, baru seminggu kan? 

(Dalam hati, kalau kita found awal and treat awal lagi bagus kan, supaya mortality rate pun turun..., tapi siapa la aku nak berlawan kata-kata, telan je la)

Selain tu DR, saya rasa maybe nih giant cell arteritis, even though not like typical presentation tapi saya found one article on that case similar like me...

Okayy!!! Haha.. (DR gelakkan aku....sedih mak)

DR tanya soklan aku macam nak exam pulak!! 

So how you want to diganose GCA?

Aku blur? ESR?

Nope, its just to monitor kan~~ MRA la dik!! So awak nak ke saya refer awak untuk MRA?

Err....takpela DR, saya observe dulu la... (MRA? That is so damn serious thingy!)

Sekadar hiasan~~

MALU NAK MAMPUSS!!  Ake realize that time yang aku ada HYPOCHONDRIASIS!!

Aku nak blah cepat-cepat, malu dowh!! Sorry DR for bothering your time! 

Its okay, dah banyak kali dah ~~~

Dalam pada macam tu pun aku, still risau weyh!! sebab kecik bagi dia , gedabak bagi aku...

That the end of my "mass".

Nak sleep sebab penat study group!!

Till then with love!!

Apa aku buat 5 bulan lepas?

Fuh fuh fuh....ohhokk! (coughs sekejap sebab berhabuk dah blog ni) How do you feel today peeps?

What a lazy blogger I am.Biasala hidup ni ade naik turun dia, ada time aku rajin gile nak menaip nih hah tapi sometimes tu...I just want to hibernate macam beruang kutub.Jangan cakap nak update blog, nak makan pun pemalas. Hahaha oppsss! habisla saham I nih...whatever la kan...

Seingat aku last aku update blog nih dalam 5 bulan lepas. Lama gila kan? Aku pun dah final year sekarang. Dah nak masuk 3rd posting dah pun and my FINAL PRO tinggal tak sampai 7 bulan lagi. Dan aku sekarang masih menaip blog utk korang...hahaha memang tak sedar diri kan? Kita ni kalau nak study takleh tekun-tekun sangat sampai tak ingat dunia...sekali skala kena spent times doing things u like jugak kan...barulah HEPI!! pandai pulak aku nak nasihat korang~

Kenapa aku menghilang?

Hmmm...senang cakap aku macam serabut la dengan semua benda sampai aku rasa macam "i need to get things right first"...especially masa aku kat posting psychiatry .Aku ada macam-macam perasaan pasal psychiatry....

sampai  aku terpikir benda pelik-pelik...

Am i crazy?....

Aku ade personality disorder ke?....

Depression...(maybe tak sampai tahap MDD , setakat dysthymic tu boleh larh..)

OCD? YES!...Aku memang ade OCD yang teruk.Contoh la kan , macam aku rase aku dah lock kereta aku tapi still aku sanggup jalan jauh ke parking lot tuk check aku dah kunci ke belum? Tu kira OCD ke, tak cukup DSM lagi...criterias B tak fulfilled...safe~~

why  can't I be passionate about psychiatry?

Aku sampai tanya kawan aku, " ehh ko rase aku pelik ke? Macam patient ke?" Kawan aku pulak gi tokok tambah aku yer worriness..." eh beb! aku pun rase cam tu" ohhhhmaiiigadddd!!! This is serious things...

"Do I in need to see psychiatrist?"

But, i still can function very well meh.. ( Boleh la tu kan, aku pass exam & boleh gi kelas suma)

Maybe i shouldn't.Baik aku bukak Kaplan and tengok management dia so that aku boleh manage sendiri problem aku...Gila kau kalau aku nak kena amik antidepressant semua, stigmata ok? OR medically based said dia banyak side effect. So aku tak nak!

Sepanjang aku berpsychiatry, nothing much interesting to tell sebab aku personally memang tak minat LANGSUNG dengan psychiatry...Passion aku lebih kepada active management kat patient contoh macam medical, surgery, ortho....Aku suka gila!!! Hahaha...

Tapi banyak lesson yang aku belajar from psychiatry patient..

They are not guilty~ sebab mind dorang dah subconscious in which dorang tak tahu apa yang dorang buat tu salah..

Semua salah upbringing!~ being raised dengan suasana yang stress, parents problem, financial, jiran yang macam sampah!..Korang bayangkan la macam mana dorang nak survive and at last wayar putus...

Coping style poor~ Coping style? Semua org ada his or her own way to cater with problems...antara berkesan atau pun tidak je...but mostly patient memang ade poor coping style, tends to keep to themselves ataupun dorang mengarah masalah kepada jalan yang tak betul eg; drugs, alcohols

Family acceptance~Bila dah dilabel gila, anjing gila pun tak mau...apatah lagi family....kesian aku dgn sorang patient nih, dah 20 tahun dah duduk dalam wad sebab family tak nak terima dia...

Selalu kalau aku clerk patient lain mesti dia nak nyibuk...kesian kan? Aku pernah je clerk dia tapi sorry to say " i don't get what i want..." last2 aku yang pening... Tapi still la we need to be good to them sebab dorang istimewa~

Runtuhnya agama~ Paling tersentap bila aku tanya sorang patient yang masuk sebab methamphetamine induced psychosis. 

" Adik, solat macam mana kat rumah?" 

Saya tak solat pun dr... 

"Kenapa awak tak solat?" 

Dr, orang muda-muda macam kami nih, kalau solat tak rockla dr... 

"Gulpss! (Ak tersentap sekejap..speechless aku kena susun ayat nh nak tarbiah sikit budak nih...geram sangat...dah berkepal buku tangan!)"Adik tahu kan, solat dalam Islam tu wajib, jadi kita kena tunaikan..." 

Malas la dr....(Dalam hati, aku pun malas dengan ko!) Aku rasa macam tak bersemangat je nak nasihat budak nih sbb malas nih mmg takde ubat...(Aku tak cukup kuat lagi nak berdakwah aku rase la...)

Melayu Binasa~ Hampir 99.9% patient kat ward tu Melayu..Kenapa la korang rase? Kaum lain terkinja-kinja buat kerja bina hidup, Melayu meroyan hisap itu ini sampai gila...Seriously aku menyampah betul dgn anak muda yang tak tahu purpose hidup kat dunia.. K bai!
Thats all la rumusan yang aku dapat sepanjang aku dekat psychiatry...

Alhamdullilah aku pass exam...(walaupun time clinical exam dgn dr ak rasa macam hancur sbb patient tak cooperative)

Next time aku sambung...

Till then with love,

Tips nak jawab soalan MCQ-negative marking

Salam Ramadhan to all :)

Mood aku lepas exam psychiatry=elated sbb aku nak holiday! boleh tahan jugak la soalan dia...even though exam nih just carry 10% mark utk final psychiatry posting tapi still banyak jugak la kan? Soalan multiple choice question tapi yang menyakitkan hati, korang pernah dengar tak pasal negative marking..Kalau jawab betul dapat 1 mark, salah tolak 1, dan tak jawab 0 tak dapat pape la.So aku yang dah berusia nih kira berpengalaman jugakla dalam bab-bab menembak nih...Dah nak masuk final year la katakan...hehe

Korang jangan lak risau pasal tips yang aku nak share nih..

 " boleh caye ke? dia takpe la terer?

bab2 shooting nh senang je, janji ade brain je..dengan logical thinking...Tapi  jangan la tak baca langsung, at least korang get through je notes and textbook...impossible la kalau kau tak bace buku tapi nak dapat DISTINCTION unless kau bela jin ke toyol ke kan? Nauzubillah...

Nak excel memang perlu knowledge okay, takde jalan lain dah...tapi kalau bab nak jawab MCQ nh simple2 pun cukup haha...

nih berdasarkan experience aku yang kalau nak kira dah beratus2 dah aku jawab MCQ sejak aku sekolah tapi yang paling tough time aku belajar medic nih la...no lies ok!

So boleh tgk tips aku nh...yang mana berkenan dan rasa reasonable boleh amik...yang merapu tu buang tepi ja...hak sendiri2 kay nak apply ke tak...

• Pertama skali korang kena ade pensel dengan pemadam la kan? better pakai yg kayu punyer sbb lagi menyakinkan haha...Jangan lak guna pen hitam pulak sbb machine mmg ofcos tak dapat detect korang yer jawapan.
• Sebelum nak start nanda2 tu, bace doa dulu...amik berkat.Kita kan dah usaha dan yang selebihnya serahkan kat ALLAH SWT.
• Check pages cukup ke tak sebab aku pernah skax tu dorang lupa letak answer sheet...mmg spoil mood jugak la kan.Aku kan tengah bersemangt nak jawab exam tp hampeh....
• Buka je first page, BISMILLAH dulu...hehe..dan jawab!
• Bila nak jawab tu JANGAN TERAGAK-AGAK! JANGAN PFIKIR LAMA SANGAT! Sebab ap? Sebab nanti korang akan tends to ubah2 jawapan yang padahal mmg awalnya dah konpem sesangat nih....
• Bila ade question yang "always", "not" tu selalunya la kan jawapan dia SALAH...saje dorng sengaja nak trick korang alert ke tak..haha aku memang da banyak kali kena dah...huhu (sebab tu markah pun cukup2 pass je)
• Bab MCQ yang negative marking nh memang korang kena berhati gila2 sebab cuba bayang kalau korang dah konfem 4 jawapan nh..pastu gi la hentam 1 dan salah pulak tu...Dari markah 4, dah tolak jadik 3....kan rugi tu bebbb!!! Tapi aku kekadang mmg berani jugak menghentam nh kalau konfiden betoiii la...haha its all about experience! aceceee..
• Bila dah habis tu kira berapa banyak lubang korang dah hitamkan...sebab kalau exam aku, MCQ nh kena pass means markah kena more than 50%..
• Contoh ehh...Total soalan ada 25, 1 soalan ada 5 choice..so 25x5=125 markah kan??
• So make sure korang jawab lebih daripada 62 pilihan jawapan dan make sure nh mmg konpem dan bukan hentam kayh...
• So, bile dah lepas...boleh la korang hantam sesuka hati! yahooo!!
• Jangan risau selalunya korang akan still pass haha!
• Habis je jawab tu...antorla kertas! tapi sebelum masa habis tu tgk betul tak korang tanda nnt kan salah tanda memang 0 la jawabnya...
• Dah2, send je la paper tu...dan jgn la asyik fikir macam mana mana performance kau? MCQ je...go on dgn next paper la...LIFE'S MUST GO ON EVEN KO RASA NAK TIKAM DIRI BERKALI-KALI!

Amacam tips aku? mmg nampak biasa tapi bagi aku nih la cara aku guna nak survive exam MBBS nh...

Doakan aku pass psychiatry!! Hoho..

At the same time kitaorang kena isi feedback form from department...yang paling tak tahan dia tanya,

"Do you want to further your study in psychiatry?" 

SORRY, i'm not interested

How do you find this posting?? "so-so"..

Haha, aku memang jenis yang bukan kaki ngampu..kalau aku cakap tak suka memang aku tak suka sungguh2...

Please be professional dan jangan disebabkan aku tak suka kau, kau nak blacklist aku pulak kan??

Memang tak adil la dunia!

End.

Till then with love <3

p/s: Broom2 aku nak balik kedah hari ni...bubbye! 

TRYPOPHOBIA The most WEIRD and disgusting phobia!

Salam to all :)

It is really a new thing when you just come across this kind of phobia..

My warning please do not eat while you see this..

I come across to write the post when one of my friend tag me this kind of photos..

REALLY REALLY DISGUSTING!!

AND BE AWARE THAT IT IS NOT A SKIN DISEASE!

It just a phobia!! 

Trypophobia defined as phobia which involves the pathological fear, revulsion and disgust by objects with patterns of holes, such as beehives, ant hills and lotus seed heads

See the pictures and its just enough to make you vomit!

OMG!! ewww!

oho!

Cant see it anymore...chow!

Till then with love <3

Siri mengenal masalah mental part 1

Salam to all :)

Cuaca hari nih memang panas kan? dengan jerebu lagi...memang tak sihat la utk aku keluar bersuka-ria...

Hari nih masuk hari ke-5 aku dekat psychiatry posting dan dengan bangganya hari nih aku tak tido langsung kat kelas...memang pelik la kalau aku tak tido kan? previous class mmg membute je...tak boleh nak buat apa dah...

Punca aku tak tido dalam kelas firstly sebab seat depan aku betul-betul Dr. Kartini...whoa! memang cari nahas la kalau aku tido kan? Hari nih kitaorang ada seminar pasal somatization disorder presented by students@kawan2 aku jugak and they did a very good job! Memang best and Dr.Kartini pun puji jugak...hehe bangga aku dengan dorg...

So, hari ini aku nak bagi kelas free kat korang? tak nak sudah tp gerenti menyesal punya la... Sebab apa?? sebabnya... berkemungkinan di akhir lecture aku nh korang akan tahu yang sebenarnya korang memang ada masalah mental...hah!! MASALAH MENTAL OKAY! Bukan gila! lain tu...Kita bercakap tentang kesihatan mental...ecece bunyi dah macam pegawai kesihatan dah aku...

Tajuk hari ini bertepatan dgn apa yg aku belajaq...berkongsi ilmu tu kan bagus...

Membebel lak kan? Ok back to the bussiness, aku nak share pasal firstly somatization disorder.

Sory la aku campuq2 melayu dengan english..buat-buat paham je la ye...

SOMATIZATION DISORDER

The manifestation of psychological distress by the presentation of bodily symptoms

Maksudnya, macam nih, aku bagi contoh;

Makcik A, 40 years old presented with complaints of unresolved abdominal pain, diarrhea, vomiting. Investigation done was uneventful. So, she seek psychiatrist for second opinion. On further questioning, actually she had marital disharmony and had to take care of her sick mother.STRESS KAN??

<cerita nih rekaan semata-mata utk tujuan pembelajaran>

So, kita boleh tgk makcik nh mcm ade surgical problems kan? Tp despite all, still unresolved. Lepas korek2 history rupanya ada masalah lain. 

Patient ada masalah mental dan badan dia yg tunjuk symptoms. Otherwise, dia takde hallucination, delusion or something else...

Penyakit nih common in female, less educated people and onset selalu before 30 years old

CONVERSION DISORDER

English dictionary oxford: 

Psychiatry The manifestation of a mental disturbance as a physical disorder or disease:
Cara senang nak faham and taknak bagi confuse dengan somatization disorder macam nh...
Patient have psychological problem but manifested as physical symptoms like motor symptoms and sensory.
Okay, peeps contohnya macam nh;Pakcik B, 54 years old Chinese admitted to medical ward for history of sudden bilateral lower limb weakness.The diagnosis made was Gullain Barre and he was given Ig. Surprisingly, he recovered after 1 day. On next 2 month, same thing happened again and the medical team doubt the diagnosis and refer to psychiatrist.After having along talk, the patient actually have history of fighting with her wife and he told that the symptoms usually happened suddenly while he arguing with the wife.
Nampak tak, patient tiba2 tak boleh jalan dan symptoms tu sekejap je and no prolonged.This one kita panggil conversion disorder. Tapi kena ingat, mesti exclude other IMPORTANT MEDICAL CAUSES first sebelum diagnosed as CD.

Setakat tu je...aku dah ngantuk and thanks sebab sanggup baca...

ESOK AKU NAK PERGI PICNIC ! SILA JELES! 

PLEASE JANGAN JEREBU PULAK!

Till then with love <3

p/s: Nanti aku continue part 2  lepas aku balik picnic :P

sharing on psychiatry posting

It has been such a looooonnngggg day for me...

Ok, aku terlupa pulak! Salam to all :)

Previous post aku ad cita kan yg sekarang aku tgh posting psychiatry....

my logbook :)

My first impression of this posting??... i just want to pass it safely...jahat betul!!

tapi seriously psychiatry bukanlah passion aku sgt sbb aku sendiri  pun dah macam tak betoi sikit so mcm mna nak treat people kan? so i just want to play safe game...

tapi lagi...posting nh mcm interesting sikit la sebab mostly covers on human behaviour dan yg lain daripada lain sikit sbb more focus on the history taking....

Setakat nih, our class just full of lectures yg mmg sya tido la kebanyakannya...and jgn igt sya student bermasalah tp kalau korang tya meds school lain....sitting in the lecture hall just like a torture for us tau..ngantuk sgt...tambah2 kalau lecturer monotonous..me yg helpless bukan nak salahkan lecturer! sorry drs!...

Tapi tido2 aku pun still able take note mana2 yg penting tau...bukan la memanjang ja tido....teruk betoi kan?
Nak review skit...aku ada lecture on mental state examination which mainly focus on observation and speech...

To  people yg determine nak jadik psychiatrist tegar tu mmg kena ada good eyesight and mesti kena sensitif mcm detektif conan tu... supaya korang tak terlepas body gesture yg suggestive for the diagnosis...

Aku salute hormat la kat korang yg ada angan2 nak sambung master psychiatry!!

Ok back to my lecture's review...

bile dah belajar nh kadang aku rasa semua org mmg ada masalah mental cuma beza serius dgn tak serious je...

KO ade??? pls see ur own GP ASAP woii!!

Yang serious tu macam mn? pesakit mental YANG SERIUS selalunya kita tgk symptoms sama ada kacau ke tak hidup dorg dgn orang sekeliling....PALING SERIUS! Patient yg ada suicidal tought!

For mental state examination, things that should be checked :

1. general appearance; gait, grooming (org kalau depression slalu pakai baju gelap2, seghabai dan tak terurus TAPI kalau manic patient, dia akan pakai colorful), posture ( awkward suggest for extrapyrimdal disease...acute dystonia? parkinson?), facial expression (masklike facies /flat expression boleh jadi schizo, parkinson, depression)
2. motor behavior; restless, mannerism, stereotype movement, waxy flexibility cerea..
3. response to the interview; kena tgk body language patient; aggresive ke? restless? less interest ke?
4. mood; penting utk narrow down diagnosis..tgk mood dia sama je ke, berubah2 atau incongruence? incongruence nh mcm mood yg salah utk situation example mcm kalau pt gelak bila cerita tentang ahli keluarga yg dh passed away...kan xkena tuu...nh symptoms mixed manic!
5. speech; slow ke fast? fast nh selalunya pt manic; overtalkative
6. hallucination; tgk pt gaze kalau2 fixed at one place..maybe heard something?
7. delusion
8. illusion?
9. thought; ask patient about suicidal thought? BAHAYA NH!
10. sensorium?
11. cognition; patient memory?

effective interview kena start dgn building rapport first...dont start kalau pt drowsy sbb kta takkan dpt the real story from them...

contoh effective interview utk manic patient

kalau tgk video nh, pt tu look restless, full of ideas...talk non stops and patient's shirt colorful kan?? Aku kalau dpt patient mcm nh seghabut la...melayan dia sembang smpai esok pun tak habis...

yang nh pulak interview utk patient depression

starting video tu pun facial expesson look sad, always look down...mcm ada masalah...patient lingering fingers showing some mannerism...lack of sleep..fear...

My lecturer ad pesan, for psychiatry bile time nak interview tu jgn tunjuk kita nak rush sgt and let it be open ended question...Patient somehow just need someone to share the problem and listens to them...tu pun dah dikira therapy...

That is one part...

Second lecture was about HANDLING SUICIDAL PATIENT!

The best thing bile Dr Syed tunjuk video nh! check it out..

Haha, mmg lawak!! igtkan dah berkecai dah...tgk2 vacuum jadik hero :)

Why people want to commit suicide?? Hidup nih sekali je senang2 je matikan...Its in the hands of ALLAH SWT and you don't have any right to take charges of it...

HEARTBROKEN?? LOSS OF HOPE?? FEELING USELESS?? DEPRESSION??

Sape2 yg ada suicidal thought tu sila2 mengucap panjang2...ingat mak ayah....kesian kt keluarga and diri sendiri jugak....

org2 yg ada tendency nak buat kerja2 gila nh kita takboleh tinggalkan dia soghang2...kena selalu pantau...

family pulak kena support patient2 yg mcm nh...jgn pulaukan sbb masalah personal masing...

kalau kita tgk dkt paper, blog byk cita pasal gadis bunh diri la sbb pakwe lari..., pakwe xnak bertanggungjawab la...dah mengandung la...gambar bogel tersebar....MALU woii!!

Satu je aku nak pesan...please think first before you do it!! jgn sebab CINTA ITU BUTA, last2 korang merana kat neraka!

okay keep calm and go on sya...

my last lecture was about BIPOLAR MOOD DISORDER, as name imply bipolar so ada dua personality...

selalunya org2 mcm nh kejap kita tgk ok kejap tak....tapi kalau tgk balik aku pun kadang2 mcmtu jugak....

hah!! nh la beza org normal dgn tak normal....kita kena tengok duration of symptoms tu...kejap ke berpanjangan...

definition mestilah EXTREME SUSTAINED DEPRESSION OR ELATION ACCOMPANIED BY CHANGE OF BEHAVIOUR, PERCEPTION, AND IDEATION!

alahai, something comin up! wait for part 2 pulak ye...

till then with love <3