A taste of the big stuff (real big stuff)

Hope god really are among us, give us strength and might to face this challenge, the half marathon of Penang Bridge. The truth, among the 5 runners I am the weakest, I was able to finish only 1 round in the psychiatric ward. If I am able to finish this half marathon it will prove that even weaklings can do it, achieve what they dream. So I now will take the hopes of a thousand, representing them and finish the run. (Please remember pussies of the ASS member are not among the ones I represent). Bless me my lord, bless are those who dare to challenge their limits.

Real sorry that I made myself look more noble my friends, I needed more purpose.
You are all great and wonderful for willing to take me on this ride. The darker side of the story is I join this marathon because it’s been sponsored by IMU (what luck). I feel it’s a waste not joining it, and a chance to take back at least some chunk of meat we fed the IMU beast.

Remember, it’s not the end that matters but the journey. So enjoy the show, update of the run will come soon.
Note: I been practicing in my Taman in Klang, soon I will run the 16 rounds together.

gynecology examination question

I apologize first for any grammar or spelling mistake, need to rely on my short term memory, so as time goes by my memory fades off fast. Need to do everthing quick so mistakes are inevitable, anyway hope this could be of some help.

Note: answer only provided to those questions whose answer are beyond comprehension. In simple language, weird answer for weird question.

1. A women with Stage 3b cervical carcinoma, came in with bilateral leg swelling and abdominal pain.
a. what is stage 3b

b. what causes her bilateral leg swelling and abdominal pain
pelvic nerve compression, lymph node involvement, severe tumour till it compress inferior vena cava, pelvic bone metastasize.

c. now discuss your management plan
bad prognosis tumour
discuss to family member years of survival
need to plan for palliative care, radiotherapy, chemotherapy, and surgery.
give her morphine

d. what complication develop from the treatment given in question c. .
complications of morphine
complications of chemotherapy
complications of surgery
complication of radiotherapy

2. A women having done anterior copoherography for her cyctocele with vaginal hysterectomy. 6 hours later having breathing difficulty and raise pulse rate.
a. 2 diagnosis as to what cause her breathing difficulty and raise pulse rate.
Respiratory causes: lung collapse, aspiration, pulmonary embolism
CVS causes: heart failure

b. 4 investigation for the above condition and their value of ding so.
Chest x-ray
Spiral CT
ECG
ABG, blood oxygen level.

Now 8 hours later while pulling out catather see urine leaking from the vagina
c. what causes the vagina leaking, reasons
vesico-vagino fistula
utero-urethra fistula
neurogenic bladder (this answer is acceptable, cause women can’t differentiate source of urine, so be creative)

d. how to treat the above problem.

4. women came in with preterm premature rupture of membrane, at 24 weeks of gestation. Examination review nothing except, uterus at 32 cm, fluid thrill positive. Had 2 previous miscarriage before
a. what investigation need to be done, explain reasons
ultrasound
MGTT
Rhesus and blood group
high vaginal swap

for normal delivery to progress, need intrauterine blood transfusion, deliver by cesarian section at 32 weeks of gestation
b. diagnosis:
rhesus incompatabilty
blood grp incompatabilty
isoimunization

c. further management plan for the mother after delivery
Tell the mother the problem.
Advice on contraception
Future pregnancy needs intensive management.
Note: giving anti-rhesus immunoglobulin is not indicated, previous miscarriage had sensitize mother.

4. A 47 years old women having diagnose with uterine fibroid, she weight 97 kg, presented with sever emenorrhagia for 6 months.
a. how to manage her
b. she now insists on having surgery, what 2 option did she have, and reason out.(reason base on trigger)
Now she presented with unilateral leg swelling, which is painful.
c. diagnosis
d. what is her risk factor
e. treatment

5. 19 year old, factory operator, came in for emergency contraception.
A. 2 important history to elicited
Menstrual cycle and period of amenorrhea
Multiple sexual partner
Previous medical problem
B. 2 methods of emergency contraception, precautions
Yuzpe’s method
IUCD
5 weeks later, she develop severe abdominal pain with per vaginal bleeding, she is fainting.
C. diagnosis
Ruptured ectopic pregnancy.
Acute dysmenorrheal
Miscarriage
Twisted ovarian cyst (any cause of gynecological acute abdomen)
D. treatment plan for the above question

A contribution by the former president of ASS.

Nature example of biological warfare

In the animal kingdom, the strong always prey over the weak. To some extend it is similar to our human society. Different creatures use different strategies to get their prey; the usual way is to be faster then the prey, like the usual lion chasing the deer. However some outsmart their prey, in this particular case this “amazing” creature done it by using biological “weapons”.
Ever heard about the komodo dragons, yes big large saurian lives in pockets of Indonesia’s islands. This creature are super clumsy, and as a small child I always wonder how this stupid creature kills, I always believe it is just some scavengers, like the T-rex, big with no grace. The cool fact about this creature it kills it’s pray by causing septicemia, an example of nature using biological weapons. Here is an extract form wikipedia:

“Komodo Dragons have not traditionally been considered venomous, but it has recently been suggested that they may produce weak venom. In addition to the possible venom, dragons also possess virulent bacteria in their saliva, of which more than 15 strains have been isolated. These bacteria cause septicemia in their victim; if an initial bite does not kill the prey animal and it escapes, it will commonly succumb within a week to the resulting infection. The lizard is able to locate its prey using its keen sense of smell, which can locate a dead or dying animal from a range of up to 9.5 kilometers (6 miles).The Komodo dragon appears to be immune to its resident bacteria.”

So good news to us, at least we Homo sapiens won’t be on its menu, we can always hope and depend on our so-call advanced medical therapies.

New home education program

Ever wonder what small children nowadays play? Yes, computer games.
Remember those puzzles solving game, where serious brainstorming is needed. Still I prefer the mindless shooting game more. It’s cool to be aggressive and vicious at some moment of your life.
But that is not the point, gone with all those stupid puzzle solving or first person shooter game. Nowadays computer games are more realistic then ever, which made it more “educational” than ever.
Ever played feeding frenzy, it is educational since it provides small children information on the various species of deep sea fishes. However it is also spreading the cruel fact of nature, survival of the fitness, which is the motto of some crazy Europeans to colonize other country, ended in the sufferings of millions, but that is history.
But I am here to introduce a new game, “fairy godmother”, ever play this one? Lovely fairy tale as background added some godfather series essence to spice it up, real interesting, and real fun.
So if mafia is involved into this fairytale land, what would happen? Hard to imagine, as a matter of fact it is not really hard. First start runs your family business, in this case selling potion, than end your rival using all sorts of method and plans (I prefer the second part of game). So if you play it super “rat” and “dirty” then u win your opponent in no time. Really “educational” right, it teaches younger generation to do business the dirty way, which is more important than anything taught in primary school. Better street smart than book smart.
I propose that future education should include this new home educational program. This is call fun and education together as one.
I just wonder when those programmers are creating some game about medical students. I will gladly provide them some info of my so call “interesting” life. This new game will be teaching new generation how “fun” it is to be medical student with the prospect of “encouraging” more people to enter the medical program