Twilight’s Chapter7

arini dh siap kemas2 bilik kat uia, slamat ttgl umah ke2 ku…huhu… abes agkut sume brg td, tggl slipar toilet n mug je, yg lain sume angkut balik…

terharu nye, baik sungguh bdak2 jr, my rumate, thanks u very much tlg angkat brg2 nek kete, thanks kat huda and muhammad jgk, ulang alik dari bilik ke kete, tlg…  aku bab kemas mengemas ni mmg slow, org len bleh buat dlm sejam, aku buat hampir 4 jam…isk mmg takde kemahiran lgsg…

nak blnje ape eh kat rumate n nk beli hadiah ape utk farewell kitorang… tp aku mmg ada je kat ktn ni, so anytime blh ajak dorang kuar mkn… taktau lagi dpt hospital mana, harap2 dpt plihan pertama, keje kat hkt, kalau tak, hosp temerloh pun aku tak kesah.. cuma taknak htaa… dah buring duk kuantan, tak kuar2….

skg bile petang asik hujan ribut je, camana projek gi pulau perhentian ni… mintak2 doa bile ms aku pg sana, cuaca elok..

esok tggl nak settlekan clearance pakguard and mahallat, saman ada 6 tak berbayar, ha amek sekali! hohoho… pakai kete ni walaupun senang, tp saman parking je ada 4… pokai2…

okeh projek esok settlekan sumer, dan takyah ulang alik balik uia im dah… harap2 Allah permudahkan urusan ku.. amin…

im writing this hoping that i would not forget what are the cases i got in final prof xm 2009

long case: malunion of midshaft of left humerus

short case:

1. oblique lie and management

2. grave’s disease

3. cushing’s syndrome secondary to chronic steroid ingestion

wah… blog kat friendster ni dah tukarla… baru je pasan… haritu pilih warna ungu skg jd biru.. tp lawa la jgk, suka warna biru, warna langit, warna air laut….

salam sumer, hohoho mcm ada org bc je blog ni.. hahaha….

da lama tak tulis blog, hampir 4 bulan rasanya…. ke lebih? tgk2 ntah sape2 yg komen ntah.. tu sume spam je…

Alhamdulillah br abs xm psychiatry, dapat patient ?bipolar ke ?schizo? ntah la, harap2 dx aku betul…

Masa nak xm tu doa2 sgt dapat pt yg cooperative, taknak yg blunted, tup2 dapat pt manic! Flight of ideas… kena skali… mmg sgt cooperative, cakap byk, tapi byk circumstantiality, tak direct to the point, masa ada 1 jam je, encik ni ckp byk la pulak…..siap berfalsafah lagi, too cooperative pun susah jgk….

soalan2 yg ditanye oleh dr zafri:

Q: in manic patient, what is the common type of psychosis ?ANSWER: grandiose type.

Q: in bipolar, in what phase usually the patient commit suicide? ANSWER: in depressive phase….[confuse... rasanya dr uia ckp, in manic phase.....]

Q: what is the main factor that differentiate between schizo and bipolar-manic? ANSWER: the mood, bipolar is a mood disorder, schizo is abnormality in mood, thought and behaviour

Q: investigations to be done in bipolar manic with psychosis? ANSWER: RBS before start with anti-psychotic since it can cause hyperglycaemia

tips: if u cannot get the diagnosis due to lack of symptoms to fulfill the DSM-IV criteria in the HOPI, ask about symptoms in past psychiatric history, reasons for recurrent admission, what patient was on (treatment) before, MSE.

rasa kesian kat encik tu, nak citer byk, tapi nak watcamne, takde masa, 1 jam mana cukup nak dgr dia berfalsafah…. what have to be done, must be done…

pernah makan cream puff?
kalau tgk cerita Zettai Karashi ep2 (www.mysoju.com)
mesti korang teringin nak makan cream puff…
sedapnye tgk cream puff dalam cerita tu
dgn rotinye yg lembut, intinye yg lembut jgk,
sampai menjilat jari
fuh, sape yg tak teringin

tp, susah nak dapat kat mane2 kedai kat ktn ni
jadi kena la buat sndiri
utk org yg tak pernah memasak kuih@kek mcm saya
buat cream puff ni sgt sng, mcm kacang goreng
oklah tanpa mmbuang masa
menunye begini…:

For the pastry@dough@roti nye la..
3/4 cup water (3/4 cup= 177.5ml)
1/2 cup unsalted butter (=113g)
1 cup high-protein or all-purpose flour (=110g)
1/8 tsp salt (=secukup rasa..huhu)
1 1/2 tsp granulated sugar
3 eggs
1 extra eggs mixed with 1 1/2 tsp water, for egg wash

cream filling@ inti nye:
8 oz cream cheese, softened (=226.8g)
3/4 cup granulated sugar (170g)
2 tsp vanilla extract
2 cups whipping cream, very cold (=453.6g)

cara2 nya:
[A]
1. panaskan oven dulu kepada 220 degree celcius.
2. sediakan kertas minyak.

[B]

saya suggest kite buat inti dulu, sebab kita kena bekukan mangkuk besi dan mesin pengisar sebelum kita kacaukan whipping cream. NEVER keep the whipping cream in the frozen section.
1. Kacau kan whipping cream dalam mangkuk besi yg sejuk, kalau bleh buat dalam bilik aircond lagi bagus.
2. kacau sehingga cream tu jadi keras di permukaannya. jangan terlebih kacau! nanti texture whipping cream tu akan terurai sebab panas.
3. dalam mangkuk berlainan, kacau cream cheese sehingga lembut, campur kan gula dan vanilla.
4. campur kan kedua2 nya.

[C]
masa untuk buat dough aka roti nye.
1. amek butter dan air, masak dalam kuali sehingga mendidih. pastikan butter betul2 cair.
2. masukkan tepung, gula dan garam serentak. kacau sungguh2 sehingga jadi mcm bola. kacau lg sampai 1 minit. padam api. biarkan sejuk 5 minit.
3. masukkan sebiji telur. pukul bersama bancuhan tadi shgga telur betul2 bercampur. ulang proses ini utk telur yg lain.
4. gunakan pastry bag, di hujungnya ada large plain tip, picit adunan tadi, bentukkan menjadi bola kecil sebesar 2-inci diameter. pastikan jarak antara bola2 tu sejauh 2 inci sbb dia akan kmbg nnti.
5. sapu dough tadi dgn egg wash aka telur spy jadi kuning bile masak nnti.
6. masak dalam ketuhar (yg telah panas) selama 20 minit.
7. roti akan jadi kembang 2x ganda dari asal, kering dan warna keemasan.
8. potong di tengah, letakkan inti nya di dalam.
9. boleh makan terus, atau sejukkan dalam peti ais.

ok, menu ni dapat buat utk 12 cream puff bergantung pada saiz bola yg kita buat. sila lah mencuba, jamin sedap. bahan2 bleh dapat dr carrefour, atau kedai2 buat kek. budget… ermmmm.. mahal jgk la,
-cream cheese (250g): rm 9.++
-unsalted butter (250g): rm5.++
-whipping cream (200ml): rm 4.++
-high protein flour (1kg) : rm3.++
selamat mencuba….

tengahari tadi dalam kul 300ptg
gi tc beli mcD ngan abdul
almaklumlah, kupon tu tamat hari esok
kena gune selagi boleh
kekeke
sebenarnye lapar gile!
ayah suh makan nasi goreng
dia masak pagi tadi
taknak la makan buat kali ke-3

on the way balik
kat smpg 3, tc-jln teluk sisek-tok sera tu
ada motor biru nak kuar simpang
di belakang nye kereta mercedes gold, cantik kete tu
motor tu stop abruptly, tak jadi kuar simpang sbb tgk aku bawak laju
budget tak sempat kot
pastu dilanggar dari belakang oleh kereta mercedes tu
sure tayar belakang bengkok la aku tgk
barang2 kertas dia abes terburai
kesian….
bleh gerak tak lagi motor tu pasnih..
bukan aku yg bersalah kan
aku tak bawak laju pun….
80kph je…

public health:
1. what is hazard?

• A Hazard is a situation which poses a level of threat to life, health, property and environment. Most hazards are dormant or potential, with only a or  theoretical risk of harm, however,
  once a hazard becomes ‘active’, it can create an emergency situation.

2. what is risk?

• Risk is the possibility of an event occurring that will have an impact on the achievement of objectives.

3. what is health risk assessment?

• Method of describing an individual’s chance of falling ill or dying of a specified condition, based on actuarial calculations that allow for known exposure to  risk; expressed as expected age at which death or disease will occur, and intended as a way of drawing an individual’s attention to the probable consequences of risk behaviour.

4. what is pollution?

• The changing of a natural environment, either by natural or artificial means, so that the environment becomes harmful to the living things normally found in it.
• most often this refers to the input of toxic chemicals into the environment.

5. what is air pollution?

• The presence in the outdoor atmosphere of one or more contaminants such
  as dust, fumes, gas, mist, odor, smoke, or vapor in quantities and of
  characteristics and duration such as to be injurious to human, plant,
  or animal life or to property, or to interfere unreasonably with the
  comfortable enjoyment of life and property.

6. what is API?

• The air quality in Malaysia is reported as the API or Air Pollution Index.

7. what is data?

• Data refers to a collection of natural phenomena descriptors, including the results of experience, observation or experiment, or a set of premises. This may consist of numbers, words or images, particularly as measurements or observations of a set of variables.
• data is the input one enters into the system. eg weight : 50kg, 70kg. weight is the variable, the number is the data.

8. what are the modifiable risk factor? e.g for hypertension

• ….

family medicine
1. emergency contraception
2. acute myocardial infarction
3. differences between asthma and coad

nak jadi cikgu
hari ni bercakap sampai takde suara
kering tekak
tanya bdak2 skolah smk ubai soalan2 ttg kesihatan
berebut2 nak jawab nak dapatkan hadiah
bagus betul bdak2 ni

selalunye kering tekak
bile menjerit masa sports tournament je
tp hari ini dalam sejarah
suara habis sebab bercakap banyak
bdak2 pun ralit mendengar
seronok nak mengajar…

Thalassaemia screening
- just use fbc
- look for level of mch, not mchc
- if less than 28pg, blood is taken for full blood picture

-send to histopath lab

-if hypochromic microcytic present

-have to examined further to confirm dx: haemoglobin electrophoresis

patutnya mende ni takyah pk pun
tapi
bes jgk kalau ikutkan la
kalau tak pass famili med
bleh buat 3 minggu remedial utk ong
3 minggu utk family med
huhuhu
bes jgk buat family med
tp 3 minggu je dalam ong cukup ke?

minat nak jd internal medicine specialist
walaupun biasa je
takleh kumpul duit byk pun
glamer pun takde
tp bidang ni la aku rasa bes skali
minat
skg masuk famili med
rasa nak jd famili med specialist plak
keje kat klinik kesihatan
hihihi

dr samsul la ni
bg cadangan mcm ni
dah ter pk pk
to fail or not to fail fam med…..
hmm…..

What is the objective of oxygen therapy?
The objective of oxygen therapy is to give the patient as much oxygen as is required to return the PaO2 to what is normal for the particular patient to achieve a better tissue perfusion.

What are the types of oxygen therapy?
1. Fixed (independent of patients’ factor)
    e.g venturi mask

2. Variable (depend on patients’ factor, FiO2,..)
   e.g nasal cannula, simple face mask, tracheostomy mask, incubator, head box….

How to deliver 100% oxygen?
By using bag-valve-mask resuscitator, when no air leak from the mask, and no air enter the mask from outside, then 100% oxygen can be delivered.