Gerak Khas Attachment: Day 11

*Refer glossary or Prof. Google if encounter difficulties*

Ok. I'm back after 2 days off. I came a bit late today, was not hoping for any blood sampling procedure. I headed to that friendly HO cubicle, and he asked me, "tak ambik darah ke hari ni?". I don't know whether that question is sarcastic or is he just saying. Anyway, the ward admission rhythm is not regular lately. There's a lot of patient admitting despite day after tomorrow is active day.

I followed the HO round on his cubicle then 5 new USIM students come to us and observing. That HO asked the student why they followed us. That HO is actually known to be the least 'terror' HO than others. Nevertheless, I think that HO is a very much talented but maybe in other discipline, orthopedic maybe? That students went to follow a MO in other cubicle.

Me myself joining another MO for rounds. But before that, a HO asked me for a favor. She asked me to do blood sampling for patient in sub-acute cubicle. There were three patients to do blood sampling, which two of them is elderly. The first be the mak cik that needs PT/INR sampling. I tried that once but failed. That mak cik is fairly overweight. Then I gave up and tell the patient to wait for another doctor to come. Then I tried to take blood from a young female patient which is presented with fever TRO leptospirosis, malaria. Again, I failed. I gave up and tell her the exact same thing I told that mak cik.

I followed the round as usual and the MO asked me what is the common cause of psychosis. Namely, SOL, drug usage, electrolyte imbalance. I also asked to read about dementia too. After that, another specialist came to the ward for rounds. We joined him, and remember about the RVD pt with PCP? He said, if immunocompressed pt come with pneumonia, suspect CAP first. But this time we need to cover everything (CAP, HAP, atypical pneumonia, PCP and other fungal pneumonia) since his CXR is worsening. We also learned that insensible water loss in Malaysia is higher than that of country in the west by 300 cc, which usually have insensible water loss of 500 cc.

The specialists asked us about bronchiactesis, its common cause.

a) Infectious

- PTB

- pertussis

- persistant penumonia

b) Non-infectious

- Aspergillosis

- Kartagener's syndrome

For bronchiactesis, the most important treatment is to do chest physiotherapy. Because the bronchial is always inflamed that we need to clear that lungs from purulent sputum.

Thalassemia patient although not very much common but comprising of the most challenging problem. These patients having blood transfusion as contraindication unless you know the serum ferritin level. In case of accidental ordering of blood transfusion, iron overload is the case. In iron overload, the most common site for iron deposition are;

a) Pitutary gland

b) Heart > hemosiderosis in heart

c) Liver > cirrhosis

d) Pancreas

e) Adrenal gland

We see a male patient with UTI, which is less common but if encountered, suspect renal stones, vesico-ureteric reflex or other organic causes rather than microbial causes. The other patient was admitted for cellulitis, was ambulated well previously. But after admission, he can't even walk. So the specialist explained to us about deconditioning of Geriatrics. It is a condition where the patient feel comfortable enough of the environment in the hospital that he wouldn't even care to walk or taking care of himself. So, counsel the patient to make sure he is still conditioned to continue his life independently. That's all for day 11, folks!

Glossary

PT/INR- prothrombin time/international normalized ratio

TRO- to rule out

SOL- space occupying eison

RVD- retro-venereal disease

PCP- pneumocystis carinii pneumonia

CAP- community acquired pneumonia

HAP- hospital acquired penumonia

CXR- chest x-ray

PTB- pulmonary tuberculosis

UTI- urinary tract infection