paediatrics 5th year

29 August 2012 (tomorrow) will be my end of posting examination ^_^ bismillahirrahmanirrahim... i want to do my VERY BEST in my final year, insyaallah..

http://aia.i4u.us/islam.shtml

auscultation of heart

4 areas: - aortic - pulmonary - tricuspid - mitral

http://www.stethographics.com/heart/main/sites.htm

pattern of resp muscles use

um, for the pattern of respiratory muscle use: Normally, the diaphragm does all the work of inspiration and the abdomen will move outward along with the chest wall as the diaphragm descends (Figure 35.3). Inward inspiratory motion of the abdomen is termed abdominal paradox and suggests diaphragmatic dysfunction (Figure 35.4). Inward inspiratory motion of the chest wall is suggestive of a decrease in lung compliance. Placing the palms of the hands on the chest and abdomen may help confirm the visual impression. Active use of the abdominal musculature during expiration is distinctly abnormal. Look to see if the strap muscles of the neck, the scalenes, and the sternocleidomastoids are contracting during inspiration causing an upward motion of the entire chest.

Use of accessory muscles is suggestive of increased inspiratory work of breathing. Extreme increases in inspiratory work of breathing may be reflected in accentuated swings of pleural pressure. Negative pleural pressure may be manifested by inspiratory retraction of the suprasternal or supraclavicular notches or the intercostal spaces. In the presence of notch retraction, pulsus paradoxus is frequently present and should always be measured.

http://clinicalmethods.blogspot.com/2011/08/chapter-35-overview-of-pulmonary-system.html, Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990; http://soundersleep.com/musclesOfRespiration.php

paradoxical thoracoabdominal breathing

we learnt that there will be a paradoxical thoracoabdominal breathing in a life threathening asthma (respiratory arrest eminent). this might help me a bit.

Figure 35.3Normal inspiration Descent of the diaphragm raises intra-abdominal pressure moving the abdomen outwards along with chest expansion. The sternum moves outward.

Figure 35.4Abnormal inspiratory findings In the hyperinflated patient with obstructive lung diseases the flattened diaphragm pulls in the lower ribs at end-inspiration (Hoover's sign). The sternum is pulled cephalad by the action of the strap muscles of the neck. The abdomen may be retracted by the passive transmission of intrathoracic pressure across the dysfunctional diaphragm.

http://clinicalmethods.blogspot.com/2011/08/chapter-35-overview-of-pulmonary-system.html, Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990

notes from japan

ok, dah lepas hari terakhir kat university of tokyo hospital. tinggal sabtu n ahad utk berjalan2 sekitar tokyo. tp jgn lupa, packing brg awal2, supaya x terlebih muatan jat airport nanti. unfortunately.....i am right now locked outside of my room..! trying to get some water at the kitchen but forgot to bring along my room key card..haha what a joke, in the middle of nite.of course my friend wouldn't get up from her sleep. even with calling and ringing the bell. i wud also do that if i were in her place. but alhamdulillah, my neighbour Mai woke up and invite me to her room. thanks, mai!! after all,please do forgive me ya Allah- if i spent my time wastefully. huhu nauzubillah. please note, ok bayah...be smart, be organized.of course u can change urself from time to time, insyaallah, with God's willing.

ok dah lepas sesi lepas geram.(pd diri sendiri)

sebenarnya aku d university of tokyo utk 3 minggu. 21may-13jun 2011..bersama groupmates- adibah, maisarah n sumayyah.

ni tinggal hari2 terakhir utk mnghabiskan masa di jepun. sungguh, byk yg ku belajar. kehidupan, mengawal emosi, jd professional, lebih berusaha, memahami org, bersangka baik dgn org, mcm2 lah. apa2 pun, kesimpulannya, kat mana2 pun atas dunia ni, semuanya milik Allah. kat mana2 pun, kita bleh ditarbiyyah, diajar dan diberi petunjuk oleh Tuhan.

setelah berakhir tahun 3, fakulti perubatan UiTM ada sesi 1 bulan utk 'program elektif'. kami diberi peluang utk buat attachment di mana2 hospital yg kami mahu, dalam apa2 bidang yg kami mahu, asalkan dalam bidang klinikal. ada 5 tempat utk sesiapa yg nak apply overseas.. siapa cepat dia dpt. 1 tempat utk 1 group, 1 group plak ada 5 org. kami perlu hantar sendiri surat permohonan n dapatkan jawapan drpd tmpat yg kami nak pergi.accomodation n ticket flight pun kena arranged.

sesungguhnya, byk dugaan n rintangan dlm proses applying to overseas tu. jutaan terima kasih pd supervisor: Mr Heo Chong Chin, a parasitology lecturer (forensic entomology), umairah, adibah, maisarah dan sumayyah.x dilupakan prof hafil, mr adli n the cardiothoracic team in Hospital Universiti Malaya.

Mr chin hantarkan permohonan kpd byk universiti, terutamanya ke jepun dan korea, sbb kami mmg ingin ke sana. akhirnya ada yg mmbalas jawapan.mmg x diduga. cardiothoracic department of university of tokyo hospital. tmpat idaman aku yg pernah aku fikir xmungkin aku boleh jejakkan kaki. namun kuasa Allah mengatasi segalanya.segala puji bg Nya.

selain dr tu, accomodation, flight, visa approval n semua yg penting2 tu diuruskan Mr Chin.beliau mmg seorang supervisor yg hebat n bertanggungjawab. smg Allah mmberikan apa yg terbaik buatnya.

ok, straight to our activities done here.

our supervisor here is Prof Minoru Ono, the head of dept. of cardiothoracic surgery (CTS). he is a very kind,professional, in mid-40's gentleman. His secretary is Mrs Yoshiko Koide, in 30's .

CTS terdiri drpd 4 groups, dibahagi2kan skop tugas mereka:
A-adult cardiac surgery (contoh:CABG, etc)
B-vessels(aneurysm, bentall's procedure, david's)
C-congenital heart disease(PDA, BT shunt)
V-heart transplant n Ventricular assisted devices

doktor2(sensei) kat sini sgt hebat dlm surgery, sopan, membantu n inspiring
meraka akan berikan jawapan bila ditnya, malah, prof2 turut check n betulkan case report kami.

secara general, pada hari isnin-jumaat:
1. join morning conference- prof n doktor akan bincang pasal kes2 d ward, n pembedahan yg bakal dilakukan. start 7.15am.depends on no. of cases, may be up to 9am.

2. observe surgery
kami perlu pakai pkaian yg dikhaskan utk student. suprisingly, there are colour codes for OR(oeration room). white-doctors, blue- nurses, green-anaesthetist,yellow- people from product company. kami student pakai bju belang2 kelabu hitam. comel jgak.

3. ward rounds
ada grand ward round bersama prof ono setiap selasa. semasa keberadaan kami
d sana, residents yg present case terpaksa bercakap dlm bhasa inggeris. "good exposure to them"-prof ono yg kata.. so kami ke general ward, ccu n picu.

4. join lecture student
kebetulan ada 5th year students yg buat rotation bersama kami, perlu tukar rotation setiap 2 mgu. 1st n 2nd week kami bertemu Yu Inaba, Kobayashi n Nonogaki. 3rd week kami bersama aki n kinoshita. they are good to be our friends=) tq.

5. buat report utk observed surgery . tp for selected cases je lah,
yg aku berkesempatan observe: LVD implantation(dura heart), Infrarenal AAA graft replacement, Supravalvar aortic stenosis in 7 months old boy, On pump CABG, ASD repair in 41y/o women.

yg groupmates aku observe(yg aku xberkesempatan): PDA ligation in ELBW baby, off pump CABG, aortic valve repair, thoracoscopy for lung Ca.

6.sesi interview bersama prof n dr
Prof Ono, kyo sensei, murakami sensei, saito sensei
they are truely inspiring cardiac surgeons!hope that one day i'll be like them, insyaallah..



alhamdulillah, semoga pengalaman ni menjadi satu jalan utk impian ku akn dtg, dan juga menjadi jalan utkku mendekatkan diri kpdNya..amin..

ok...otsukare samadeshita!(anda tlh berusaha kuat)
wassalam^o^

sampai ke hujung year 2

alhamdulillah test untuk module central nervous system dah dilalui. mggu depan physical and behavioral science.nak abis dah sem ni,....

10/5- PRO examanination. ni exam utk pre clinical years. mesti lulus utk melangkah ke tahun2 seterusnya. semoga Allah permudahkan, insyaAllah. strive for it!!^o^

24/5-20/6- ni minggu2 utk projek elektif. grup ku buat pasal kuda.

5/7- bermula tahun 3 perubatan. semoga diizinkan, ameen.

semoga sem ni- dpt beri pengajaran n terus beri ilmu ttg kehidupan buatku.
alhamdulillah.

HoLidaY

um, skrg ni cuti sem. sminggu je. hehe, xpelah, ni pun dah kira bersyukur sgt2. um, dpt rehatkan kepala otak ni. hrp2 dpt teruskan hidup utk jd lebih baik, dlm usaha melengkapkan diri sblm tiba detik bertemu Illahi..

teruskan usaha utk jd doktor.never say die before u try.

um, mmetik kata2 yg aku dpt dr email, yg mana aku mmg terkena...(huhu)
'Failures do what is tension relieving,while winners do what is goal achieving.'Dennis Waitley


wassalam..