Friday, March 20, 2009

urology clinic

OMG!Saye terlekat kat slide 1 after name n tajuk for my fyp..sangat malas..
asek berfcebook je..hahaha..nyway tadi kan i was in urology clinic(morning) and vascular clinic(afternoon).
Macam last week kan for urology clinic memang cases yang u jumpe kan mmg renal stones je..kalau tak renal stones, benign prostatic hypertrophy...
But today kan i saw few interesting cases and mr.d was quite nice to me..ngeee...

1. Okay my 1st patient was a lady presented with 1 episode of painless frank haematuria. No urinary symptoms at all. And that was the first and the only episode she had. She's not on any anti-coagulants or anti platelet and was not having any trauma prior to that. She never smoke and never been to Middle East country. She never had any kidney problems before yada yada yada yada yada. And u know rule of thumb kan, painless frank haematuria in adults population is a bladder cancer until proven otherwise.So eventho macik ni dh asymptomatic she still need few investigations to outrule bladder cancer..Oh yang sangat menarik hati about this patient kan sebab she was a bit weary cite sal arwah husband die meninggal sebab leukemia that she believed her husband got it from appendicectomy.. And the haematuria tu die pecaye its one of the side effects of Losartan. Sekian.

2. My 2nd patient was a 3y.o kid referred by GP query undescended testis. I took the history from the parents and lepas tu examine that kid. He was really a good kid and he let me examine at his private area. And on examination I told Mr.D that he had bilateral undescended testes..hahahaha..i was so confident with my findings(while trying my bst to impress him) and Mr D pon examine budak tu..From his inspection pon die cakap that kid ade testis.hahaha.. cUme a bit retractile. Hahaha and pastu die suruh examine lagi sekali baru ade..rupenye sebab salah examination technique...die jadi cresmateric reflex and mende tu pon retract dalam tu.hahahaa

3. This is actually Elaine's patient. A 25y.o lady presented with colicky pain in RUQ radiating to her back.Mind u this is a urology clinic. After the perfect history presented by Elaine, Mr.D asked us,
"So cathy, what is ur differential diagnosis here?"
"This is a true colicky pain so i think it must be renal calculi"
Mr. D(buat muke x puas hati and cakap " Now Connor how about u?what do u think?"
"renal calculus?"
Mr.D buat muke x puas hati lagi and asked me,
"Now Miss Jeffery.What do u think is wrong with her?"
"Owh.I dont know. Her history doesnt really fit in this clinic but because its colicky i have to go with Connor and Cathy"
"Elaine how about u doc?"
And yes. The answer is gallstone. What gallstone is doing in urology clinic like?hahaha..mmg history die typical gallstone thats y i was saying that the history doesnt fit this clinic but sebab last week dh kene marah sebab die cakap all true colicky pain is renal stone until proven otherwise..haishhhh..ahhahaha..tah pape jer..

4 & 5. Hydrocoele.. Satu tu straight forward je..bleh transluminate..patient tu 42y.o datang ngan wife die...Yang satu tu 21y.o gentleman with a history of 3days painless swelling of his right t****s. And Mr.D was asking us,
"with this history, whats ur differential diagnosis doc?" (while pointing his hand to me)
"No.Cmon!" (then pointing his hand towards cathy and connor and both of them gave him the same answer..
Pastu die cakap SALAH!.Its testicular neoplasm until proven otherwise. Sebab patient tu young..Then we examined him..Patient tu 21 y.o kot?and kiteorg sume examine and mesti r die rs segan kan..huhu..owh and turned out it is hydrocoele sebab die boleh transluminate..hahahhaa.and it did fluctuates as well..muahaha..gelak2 kat Mr.D.hahaha

6. Connor punyer patient. 31y.o gentleman presented with painless testicular swelling for yrs..Never brought to his attention sampai la recently when its getting bigger..And on examination mmg macam cancer la kan..Mr.D pon cakap la most probably this is a neoplastic lesion. Pastu patient tu tanye mr.D what do u mean by neoplstic?
Then Mr.D cakap it is a growth.Then patient tu cakap,
"Owh so i have a tumour since my puberty?J***s i never realize it."
Muke patient tu x cuak langsung pon!!Siap masa keluar die cakap Good Luck Doc kat Mr.D..huhu...

7. 72 y.o gentleman referred to urology clinic due to elevated level of PSA. PSA die 28. On rectal examination, prostate die macam ade neoplastic characteristic..So Mr.D cakap die kene dtg buat transrectal prostate biopsy..Die xcakap kt patient tu mende tu suspect cancer pon die cume cakap kene buat transrectal and blood..huhu..

And in the Vascular Clinic,
I saw 2 AV Fistula patient and a patient with hyperpigmented skin secondary to cyclosporin..She has polycystic kidney disease and had twice renal transplant but both failed..rejected by her body..and she is living with her left kidney..kesian kan?huhu..
And satu patient lagi referred due to bilateral cold leg worst on cold weather..dengar history ni i cam cmon la...logik kot cold weather mmg la sejuk..peripheral pulses die normal n present.

P/s : Im thinking of making this blog private. Cam takut sket dh skang.huhu..


Wahidah said... make sure i leh read ur blog tau..kalo tk ciap..i babap u nanti aina..:P

crack-cracker said...

huh!!np nak wat blog nie jadi private ye..mmm..nanti tak dapat baca la ye...mmm

sakiinah said...

just make sure u invite me on your private blog ;P

p/s: saye pun takot jugak tiba2 dpt attacking comment flm blog baru huhu