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latest updates

Malay in the wards - 16/4/2017
updated Blood pressure examination - 23 August
Approach to Anemia - 5 June 2012

Sunday, 16 April 2017

Malay in the wards

okay, this post is more to benefit myself - because I need to increase my prowess in Bahasa, I shall try and note useful terms in malay I could use in the Hospital wards in Malaysia.

I am a foreigner studying in Malaysia, so I had to slowly build on my malay - so I was wishing there was an easy reference to which I can refer to - but mostly I learnt from observation.

its going to be a long list, so i suggest using Ctrl+F to navigate yourself :)


Introduction

Hello, (good morning / good evening) My name is  -----, I am a medical student / doctor
Salam.(Selamat pagi / petang /) Nama saya  -----, saya pelajar perubatan / doktor

I wish to discuss about your condition/illness with you. is that okay?
Saya ingin membincangkan tentang keadaan/penyakit anda (encik / cik / puan / tuan). Boleh kah?

if you're comfortable with  it
kalau anda selasa.

Why did you come to visit us?
kenapa anda melawat kami?

Why did were you admitted here?
kenapa anda masuk ke wad ini?

how many days
berapa hari

how long
berapa lama

can we/I examine you?
bolehkah kami / saya periksa anda?

time-scale words -

satu - 1
dua - 2
tiga - 3
empat - 4
lima - 5
enam - 6
tujuh - 7
lapan - 8
sembilan - 9
sepuluh - 10
dua puluh - 20

hari - day
hari-hari - days
minggu - week
bulan - month
tahun - year

semmingu - one week
dua minggu - two weeks
sebulan - one month
dua bulan - two months

pagi - morning
petang - afternoon-evening
malam - night

----------------------------------------------

illness-words

Cardiovascular

sakit dada - chest pain
peluh - sweat
susah nafas - difficult breathing
nafas bersulit - difficulty breathing
batuk - cough
bangun - wake (from sleep)
bantal - pillow
jantung- heart
sakit jantung - heart disease
Darah tinggi - hypertension

Gastrointestinal

sakit perut - abdominal pain
muntah - vomit
angin - abdominal discomfort / bloatedness / pain (its a very vague word meaning "gas")
sendawa - burp
makan - eat
swallow - menelan
buang air besar - defecate
berak - poop (simple term)
tandas - toilet
sembelit - constipation
susah nak berak - constipation (simple term)
kencing manis - diabetes (literally - "sweet urine")
hati - liver
usus - intestine
dubur - anus

Respiratory

batuk - cough
kahat - sputum
bunyi - sound
nafas - breath
bunyi pernafasan - respiratory sound
asma - asthma 
rokok - smoking
paru - lung
tekak - throat
hidung - nose
selsema - common cold

CNS

Pening - dizzy
kepala - head
kepala sakit - headache 









... to be continued!
------------------------------------------------------

the following text is unrelated to medical education.

The "BERAT" story

I would like to share a story about my misunderstanding in malay, since you've stuck around till the end. 

I used to travel to and fro from Kuala Lumpur to Seremban weekly, using the private bus that departs from the Pasar Seni (sentral market) LRT station to the Seremban bus station. 

During the 2 years of stay in Seremban, I became increasingly efficient at using the public transport and bus journeys - there are several things that we need to take care in order to have a safe journey - but the topmost in my list is the control of my bowels and gastrointestinal conditioning. 

This is the story which lead to me learning this, the hard way.

about 2 months into my Seremban - Kualalumpur routine journey, when that faithful day happened. 

in the afternoon of my day in KL, I think I ate something bad - perhaps the egg in the Nasi Lemak was a bit off... but anyway I was clutching onto my lower abdomen while I was riding my LRT towards the bus station. 

once I reached the bus station, the first thing I would do is to check if the bus is there or not. Sometimes if the bus is there, if you would run towards it, the bus driver would kindly wait for me to alight. So I did the usual and looked for the bus-

and it was there - ready to depart. At that moment, I forgot about my large intestine which was getting a bit hyperactive, I ran towards the bus before it would drive off and leave me waiting for 30 minutes or more at the hot bus station, looking at passerbys. 

Thankfully (or not!) I arrived in time and the bus departed as soon as I was on it. 

once I sat down, I had to come to my senses and came face-to-face with the most pressing sense - literally as i felt something was pressing from the insides of my guts. 

I attempted to use shallow breaths, so that my lungs would not expand onto my abdomen - any more pressure onto my large intestine and it would need to find an exit for its contents... 

I also tried focusing on something else - the greenery alongside the highway, but everything seemed to aggravate my gastrointestinal earthquake and the tsunami of colic that would come and go. The blasting music in the bus also seemed to make matters worse too. 

The private bus usually does not make stops. It would just depart, and it will not be stopped by anything till it reaches its destination - even if it ran over a cow, donkey or perhaps even a man, and definitely not to relieve the passengers of its rectal content. (That was what I assumed with my panicked state of mind)

I began looking into my bag for a plastic bag, and around to see if i can ask the other passenger to move away as I use the plastic bag (I was VERY desperate), but I still had some pride in me to not do that while I fight with the thirteenth colic wave that washed over me.

but when the fourteenth wave came, I slowly stood up and began walking down the aisle, plastic bag in my hand. I decided nope, there are too many people in the bus, and the windows of the bus is bolted shut so I can't throw the plastic bag out the window after my deed is done.

I have to do it - so I hobbled towards the bus driver -

"encik, saya nak BERAT"

(Berat means "heavy" in malay - I meant to say "Berak" which is poop)

the driver, who looked at my facial expression which was a mixture of purple and maroon from withstanding my labor pains, seemed to understand the situation.

"HAH!? OHHHHHH YOU NAK BERAK!!!!"

and I am sure everyone in the bus heard it even over the blasting tamil music in the bus. I was clutching onto the driver's seat until the driver prompty went into the rest-area. I thanked all the Gods there is in the universe, and controlled all my sphincters in my body towards the toilet.

This story has a happy ending.

nobody got hurt, and there were no shit-stained bus seats, nor horrified bus passengers, or a poop-filled plastic bag clinging onto the car frontscreen.

Most importantly my Colons are now calm and happy. It was very satisfied by itself for the job that it has done - which is to transport waste material smoothly outside.

I walked into the bus, apologizing to the driver and the passengers. Everyone knew what was going on.

.... So this is how I have learnt the word "berak" and "berat",  It has then since been engraved, deeper than the  groove that the middle meningeal artery sits on the inner surface of the skull. 
I have also learnt to manage my bowels before any journey. 

Thank you for reading this far, I know it was a waste of time, but I hope you had fun. 


Wednesday, 1 October 2014

Tips for Final Exam

I have graduated from an MBBS course recently, and I thought I would put together some thoughts to help people gain confidence in getting through yet another "bump" before graduation - that is the final exam.

tips to prepare for the final exam

  1. you have made it this far -  which is hardly blind luck, so have a lot of faith in yourself, your study methods that carried you thus far, and your luck!
  2. find out what exactly is the style of your final exam. imagine the situation well, and apply that situation in your everyday work. time yourself and give yourself exactly how much you will have (or slightly shorter) on the day of exam. 
  3. find out the kinds of cases you would get during the exam. go through it, write reports of those cases. 
  4. practice your physical exam religiously - while imagining the exam situation. 
  5. consistently do 1 2 3 and 4 - imagination is key.
it's simple, mostly because if you are reading this, you probably have what it takes to pass - there is no reason why you should make it till the final semester without the sufficient knowledge, even if you feel like you know nothing (it is normal to feel that way, especially in medicine. it would probably never go away - and it is a good thing) 

now on the day itself, you won't have to worry because if you have done the above consistently, there is no way you are going to be nervous - you have done it in your mind a hundred times! 
lastly, believe in yourself. I know there will be doubts, but having doubts in itself, is a good trait of a good doctor. always doubt yourself, but have confidence that you will rectify it. 

Sunday, 25 August 2013

AV fistula Examination

there are several purposes of examining patients with AV fistula.
  • assessing function of present AV fistula.
    • the diameter and flow of fistula
    • where is the fistula? 
      • radiocephallic
      • brachiocephallic
      • transposed cephallic 
    • presence of other vascular access (which suggests previous AV fistula failure)
      • central venous access
      • peritoneal access
      • graft
  • looking for possible complications of AV fistula
    • infective / inflammatory changes 
    • aneurysm
    • hematoma
    • thrombosis
    • central vein stenosis
    • ischemia / steal syndrome
    • outflow stenosis of fistula
  • assessing adequacy of dialysis and renal failure
    • uremia
    • peripheral edema
    • anemia of renal failure
    • assessing complication of dialysis itself
      • common non-serious side effects
        • headache
        • itching
        • muscle cramps
      • cerebral oedema secondary to osmotic change (disequilibrium syndrome) \
      • hypertension
      • hyperkalemia 

inspection

inspection may involve the hands, arms (with the fistula), head, chest and abdomen with main focus on the fistula itself.
  • hands
    • check for signs of ischemia or steal syndrome distal to AV fistula
      • temperature
      • pulse volume 
      • capillary refill
      • pitting edema
  • head
    • check for anemia in conjuctiva
  • chest and proximal to AV fistula
    • difference in size of upper limb between left and right (central stenosis)
    • look for a scar for central vein catheterisation (subclavian site)
  • abdomen 
    • look or scars of peritoneal dialysis
    • scars of nephrectomy
  • legs
    • pitting edema (fluid retention)

inspection of the fistula

  • assess the location of the fistula
    • radiocephallic
    • brachiocephallic
    • transposed cephallic 
  • look for evidences of failed / old AV fistulas distally
  • look for complications seen on the fistula
    • infection / inflammation 
      • redness
      • swelling
    • aneurism
    • hematoma / bruising

palpation

  • lightly palpate over the fistula for;
    • increased temperature 
    • tenderness 
    • thrills (this is normal)
    • pulsation (this is not normal - suggesting outflow obstruction)
  • arm-elevation test for outflow stenosis
    • elevate the arm with the AV fistula - the fistula should flatten if there is no outflow obstruction.
    • sign is positive when AV fistula stays bulging
    • more signs suggesting outflow obstruction;
      • prolonged bleed after dialysis
      • loud systolic murmur (discussed later)
  • augmentation test to test for inflow stenosis
    • occlude the outflow by pressing onto the proximal arm along the vascular pathway
      • the thrills should become a strong pulsation- if not, there may be inflow obstruction
      • the extent at which there is a pulsation - whether there is strong or weak pulse, may be an indication of inflow patency

auscultation

  • on the fistula AND along the vascular pathway up till the chest
    • there should be a systolic murmur (low-rumbling) throughout
    • a harsh, high-pitched sound may suggest a stenosis somewhere along the vascular pathway.

Wednesday, 26 June 2013

prezi 2

I have made another Prezi Presentation - Antibiotic types and uses, based mainly on what I have learnt during one of the plenary session.

http://prezi.com/o5xt6fj6qah8/?utm_campaign=share&utm_medium=copy

Thursday, 13 June 2013

Prezi Presentation

I learnt of this new presentation software called "Prezi", which can make presentations actually fun to create and watch at the same time.

I'm bored of powerpoints, so it's quite refreshing for me to be able to make some interactive-looking stuff easily with a click of a mouse.

Made an elective posting presentation using this software;

http://prezi.com/eslrmcauimux/presentation-of-jgroopmans-book-how-doctors-think/#share

its most useful for conceptual presentations, i think.

Tuesday, 26 March 2013

methods of anesthesia


mode of anaesthesia
  • General
    • induction
      • intravenous
      • inhalation
    • maintainance
      • intravenous
      • inhalation
        • spontaneous breathing
          • classical LMS
          • Facial Mask
        • mechanical ventilation
          • Endotracheal Tube
          • Proseal
    • arousal
      • with reversal agent
      • without reversal agent
  • Regional
    • Central Nervous Block
      • epidural
      • spinal anaesthesia
      • CSE
    • Periphiral Nerve block
      • upper limb
        • bracheal plexus block
      • lower limb
        •  
    • local anaesthesia
      • infiltration
      • topical anesthesia
      • intravenous (bier's block)

Sunday, 2 December 2012

How Do I PASS pre-clinical exams?

An issue every Medical / Dental student face is theory exams.

the pre-clinical exam involves more of a memory-based factual theory exams, rather than clinical vignettes or diagnosis / management examination. 

I would like to suggest ways to improve the efficacy of learning, as the students would realize at some point of their university life, that learning in a university is different from studying for high-school examinations.

First message I would like to give to my juniors is to Be Realistic.

first thing to know about examination in medical university is that you don't have to blame yourself for not having a distinction or a gold medal. the chances are that most of the students in your university was a high-achiever in primary, secondary, and high schools. in the midst of high-achievers, is it understandable that you have a few gifted students whom would achieve double with half the effort? 

most of us have to realize that Passing in a medical / dental institute is an achievement, and aiming for distinction should come only if passing is a breeze for you. for most students, it is NOT! the important thing here is to do your best, and not kill yourself in the process.

how can we improve the efficacy of learning? 

  1. concentrate when you're studying.

    this applies to every aspect of the learning process. whether you are in class, during group projects, or studying by yourself, it is better to concentrate for an hour than studying with half the concentration for 2 hours.

    I don't suggest playing music when trying to retain facts - especially music with lyrics. classical music may help you relax while studying when you're too tense (I will talk about stress shortly)
    You may listen to music however when you're trying to pull out information from your mind - i.e. when doing past year papers.

    One suggestion to make such concentration possible, is to time yourself while studying. try to achieve the maximum amount of learning in the shortest time possible - this skill of mental sprinting will also be useful in the future, when there is literally no time to waste.
  2. control the amount of stress, and use stress to your advantage.
    Everyone gets stressed out before exams - but not everyone knows that stress can be beneficial!
    Stress and task performance follows an inverted U-shape according to a psychological research (1) [yes, this blogpost has references!] which means, you should have an optimal amount of stress for you to perform maximally. If you're feeling too sleepy or relaxed, drink a coffee or think about failing, If you are having palpitations because you are too stressed, accept the fact that you won't function so well, and go talk to your classmates, joke about something, or go for a drink.
    File:HebbianYerkesDodson.JPG
    try to be at the middle of the curve (the part that says "optimal arousal") or a little right of the curve, so that you will recognize your stress and slowly move your stress-managing capability.
  3. recognize that learning involves input AND output
    memory has no use, if you cannot output it from your mind. therefore, you need to make conscious efforts to practice on out-putting what is in your mind... through writing, ( like exactly what I am doing right now!), teaching others, and doing essay-based past year questions.  It takes practice to put concepts into coherent sentences, but it really does promote learning because when you try to put things into words, you realize that you need to recall the facts, and link the facts together when doing so.
  4. Do past year questions
    Past year questions are your strongest allies when tackling exams. every examination has its own trends, and you should make every effort to attempt past years - sometimes multiple times. not only to recognize the trend of the questions, but to realize which areas are your weaknesses, so you can revisit them.
  5. Plan your learning early
    why do we have to plan early? various reasons. One - we have to allow ourselves some time to fail. if you set your plan too stringently, say, 5 repetitions of a particular topic over 2 months and you figure out that you can probably do only 3, you need to readjust your plan accordingly. Two - it is always better to study a little everyday, than to study for the whole day for a day in a week. early planning will enable you to spread out your learning so that studying everyday would be a breeze. Victory loves preparations!
  6. Find your own studying methods
    everyone has a different strengths in cognition. some people can remember better when they read things aloud, and some others remember better when writing things down. try to find how you study best, and stick to it. when it is not working, change it! try many methods to find the one best suited for yourself.
    This blog is partly an attempt by me, to test out studying methods - as you can see, I have made several mind-maps! 

how do we improve our memory and recall?

  1. Memory improves with emotional involvement.
    we remember things better when we FEEL something when we try to retain facts. therefore, try to make opportunities to link emotions to facts - a good way to link them is through humour. try to make jokes out of facts. the sicker the joke is, the better, because that sense of disgust will also enhance memory. Have friends with a sense of humour around. they're usually good at turning everything into jokes.
  2. Memory improves with associations

    When we are young, we can remember facts as it is, but as we get older, we tend to remember more when it is associated with other information.

    for example if you were foreign to English language, and to remember the word... say, "ubiquitous" - if you were 5years old, you would probably be able to recall next week. if you were 55, you most probably will not. but if I were to explain the meaning of the word, that it means "Being or seeming to be everywhere at the same time" and because this 55 yearold man is a religious man, I tell him - "like god and his holy presence, it is ubiquitous", he may be able to remember this word not only for a week, but his whole life.

    try to relate everything you have learnt, to each other, and to something you known previously -which brings us nicely to my next point.
  3. Don't just study all the time.

    I just mentioned that people remember better when things are associated together. this means that your ability to memorize things will increase proportionally to your current memory of various things.

    If you have spent your whole life studying in your room, you won't be able to easily relate things together - simply because you have a lack of retained facts to link together! this explains why people who does lots of sports, and has lots of hobbies seem like they have less trouble remembering new things.

    having lots of things to do, is good for your hippocampus. what is that you say? it is the part of the brain responsible for remembering new facts. you can memorize new things thanks to this organ in your brain. In a nutshell, doing new things in life will stimulate your hippocampus, therefore making your ability to memorize more powerful.

    Having hobbies will be hugely beneficial in relieving stress. doing extra curricular activities in university will help you find friends whom you can turn to. the list of benefit is endless. when in university, join at least one extracurricular activity. Trust me, it is worth it.
  4. Teach people!

    Teaching is a highly complicated task that requires a lot of skill! but when we actually attempt to teach someone else, we are forced to search into our minds into our retained facts, and summarize them and output them as coherent words so others can understand. this will make us realize parts of our memories that are lacking, so that we can go back and learn them again, and train us in the terms of output. the person who benefits the most from teaching, is actually the teacher him/herself!
    This blog, including this post is the embodiment of my attempt to use this technique of memory and recall. I remember most things that I have written on this blog, because I had to crack my head over it. I am helping myself more than anyone else.
  5. More to be added!

1 - Yerkes RM, Dodson JD (1908). "The relation of strength of stimulus to rapidity of habit-formation"; Journal of Comparative Neurology and Psychology 18: 459–482.