Tuesday, February 21, 2012


I am not good at words but I am begging for two things:

1)Please read this: the least love and care I can give
2)Please spread the words and let us all pray for the safety of all Muslims. Everywhere. Any time.

it is not just that

May peace be upon us all

I had just finished my theory papers. Only written OSCE is left. 

I would not want to comment on the past. Let it be it. And I hope people wouldn't make their comments as well. Bluntly. No one knows what someone else's answers are. You hardly knows her/his condition for you to comment as you please.

Let's take an example. A student left the examination hall half an hour earlier. What is our first impression? "hebat tul dia ni. mesti boleh jawab". Indeed, nothing is wrong about that. Baguslah, bersangka baik. The problem may arise if you delivered such comment to him/her. Because in reality, it may not be just that. Perhaps that student really had no answer so he/she decided to leave early? Don't you think such comments would hurt him/her even more? 

If I were in such situation, I am hardly bothered to such comments because I had had worse insults. Nevertheless, I had met someone who broke into tears because of such comments. She had been through a lot just to cope with her own feelings and frustration of not being able to do well and when people added such remarks, she could not take it any more. 

This entry is not to blame anyone but I just hope we all know that our words had a lot of power in it. 

Pesan buat diri: kata-kata yang baik itu dapat membantu membentuk hikmah

*It is not okay to be just okay. You are let alive so that you will live your best!*

Wednesday, February 15, 2012

striving only at words :'(


It had been a while since I did some babbling here. Lately, I had been using :'( a lot. Exam mood I suppose:)

Today marked the end of clinical assessment for the session(if I pass) and also, I met my supervisor officially for the last time. He asked a lot questions regarding our exams, the questions which were introduced to us, how are we doing and etc... In short, he cared. That is not the issue. Throughout the conversation, I realized one thing: my supervisors had been giving me a lot and lots and lots of info but somehow, I couldn't do well in the exams? Too bad. The cases that I got for both of my short and long cases had all been discussed in great length during teaching, yet I told the examiners nonsense? Ridiculous. Somehow this made me realised that I am not being serious in my studies. Am I? I am not giving enough attention, not striving hard enough, did not give my maximum effort and yet I acted like I had done my very best. I am such a great liar T.T

I am not sure if I repeated the same mistakes in the previous postings. I am too afraid to admit that (a true cowardy). Frankly speaking, to pass has become so trivial to me(a part of me think it is good to fail~). Still, this is not the end of my journey. Let's strive and hopefully this will be depicted in my actions.

"Usaha dan tawakal. InsyaAllah"
"Best of luck!"

Ucapkanlah sesuka hatimu. Suarakan mengikut kehendakmu. Biarpun kata-katamu itu tidak bermanfaat lagi menyakitkan. Sesungguhnya aku punya Allah yang Maha Mendengar:)

Friday, February 10, 2012

~aku bukan parasit~ #004 Short case examination

May peace be upon us all

As promised, my supervisor's tips for the coming short case. *This may be incomplete and perhaps I mixed up some of my thoughts and understanding. Disclaimer: pleaese don't blame anyone is none of this is happening*

Firstly, you need to be able to know the diagnosis before you start examining. What? HOW? hehe. Not entirely true. What it really means is that you need to come up with your differentials based on the question alone. As the Dr says: typical cases. You then examine, get the signs, then it fits into a pattern-which confirms your thought and then you got your provisional and differentials:) In other words, it is the retrograde of your learning process. When we are learning, we get the signs, and then "oh, this must be this or that". Then we get to learn the etiology, pathophysiology, etc. honestly, I hardly do this. Seriously melalut? Let's move on. 

If you got hands examination, it is often scleroderma, RA, PsA. So if your question is "examine the hand", your differentials are at least these three. See? You have the differentials already. How to differentiate? You know better than me :) *A little bit on PsA: Look for pitting of the nails, sublingual hyperkeratotic, onycholysis, total nail dystrophy, psoriatic plaques(at the extensor surfaces[hand and legs], behind the ear, along the hairlines, periumbilicus).

Q: Examine the pulse. This is either AF or collapsing pulse. If this question, unlike CVS examination, palpate the pulse for 1 minute(you might miss slow AF if you palpate for only 15-30 secs). Your differentials: causes of collapsing pulse(5): AR/MR is common, A-V fistula, PDA, rupture of sinus valsalva. (other causes(including bounding pulse): APAMBATAF; aortic regurg; PDA; AV Fistula; MR; Beri-beri; Anemia; Thyrotoxicosis; Atherosclerotic aorta; Fever-bacterial endocarditis), causes of AF(refer the workshop :P)

Q: Inspect and proceed/ Look and proceed. The differentials: Cushingoid features[moon face], Parkinson[expressionless], thyroid[goitre or thyroid eye disease], *stroke[maybe unlikely for undergrad, the clue is Ryle's tube and reduced nasolabial fold]. It is going to be something obvious enough to be noted by undergraduates :D.

**if thyroid[if you notice goitre/neck lump], proceed to the neck first[due to time constraint]. After that only you proceed to the thyroid function status. Hands-fine tremor(kembangkan jari/spread the fingers), sweating, warm, AF; eye-lid lag, lid retraction, chemosis, ophthalmoplegia; reflex(don't forget!)- in hypothyroid=delayed relaxation --> ankle jerk!(don't know why) read this.;CVS and respiratory may have findings if patient is in failure but maybe not enough time for that.Note that presence of clubbing/thyroid eye ds/ pretibial myxedema is specific for Grave's ds. 

Skin: Psoriasis. Any other possibilities? Ulcer- unlikely bcoz they often in Surgery or Orthopaedics.

CVS: murmur-most common MR, VSD(can be in someone who is 40-50 years old), AR, TR(raised JVP but not tachypnoeic. Possible- AS, prosthetic valve(often have murmur as well- soft/ejection systolic murmur-this is normal, only if loud or diastolic murmur=the valve is failing). Uncommon: MS, ASD. CCF is even more uncommon because treated CCF does not have much finding and acute patient is not stable enough for exams. *just in case: CCF= raised JVP+tachypnoea


  1. Pleural effusion (stony though you may still unable to diff btwn stony and dull dullness+reduced/absent breath sound/vocal fremitus)
  2. Consolidation: (dullness+ increased vocal fremitus) - consolidation only have two possible causes - infection and malignancy. 
  3. Collapse: may present in patient who has had lobectomy/pneumonectomy[any lateral scar?]
  4. Generalised coarse creps: think of bronchiectasis
  5. Only generalised fine creps/scattered: fibrosis
**according to Dr, bronchiectasis and fibrosis are very easy to get because they are under regular follow-up, so can contact them any time. 
also, please give full diagnosis. Eg: AEBA/AECOPD secondary to pneumonia. 

-polycystic kidney ds(look for fistula[run your hand over the pt's arm]/nephrectomy scar[very lateral])
**ballotable kidney: bilateral-PCKD, unilateral-renal cell Ca/obstructive uropathy/PCKD with one kidney removed already.
**transplanted kidney: unlikely for undergrad. Just in case, there is J-shaped/curved scar at the inguinal region with mass underneath. 

Neuro: (upper limb/lower limb/cranial nerve[not common but possible; facial nerve{VII} or eye{III, IV, VI}])
-stroke: Ryle's tube, facial asymmetry
-if one sided lesion+aphasia/dyspasia: consider stroke
-if both lower limb: spinal cord lesion (LMNL)

**don't forget peripheral neuropathy

footnote: This list is not comprehensive. Let us all learn to become a good doctor rather than just passing the exam. May Allah grant His blessings to those who strive and leave the rest to Him.

no man's burden

May peace be upon us all

One of my dreams: to be no man's burden.

I doubt that I will ever make that comes true. For two main reasons:

  1. I am not perfect. Mudah je.
  2. Saya ni satu tanggungjawab bagi orang lain(bukan nk ckp tanggungjawab tu beban, tp boleh jadi). Terutamanya ayah. Mek. Abang. Kakak. Keluarga. Saudara. Kawan. Musuh? Ringkasnya, semua orang. InsyaAllah, kalau ada umur dan rezeki, orang itu.

 Kenapa plk? Sbb kn kta ni diwajibkan utk memelihara diri n ahli keluarga dari api neraka. Memelihara agama. Dan agama itu bukanlah tertakluk kepada ibadah khusus semata-mata. Pergaulan yang baik=ibadah. Nasihat, menyampaikan ilmu=ibadah. Marah terhadap kemungkaran=ibadah. Ringkasnya, semua pun ibadah apabila diniatkan kerana Allah dan menepati syariat.

Mungkin kita selalu lupa, diri kita ni, aset bagi mak ayah. Some kind of secret tunnels of deeds and sins. Why? Coz our parents are responsible to teach and guide us the right way. If we do good deeds, they got the pahala. When we commit sins, they have their share as well. Xkesian ke?

 Kita pilih jalan hidup kita, well, it's our business. Of course it is but our life is part of somebody else's life as well. Someone I love and care about told me this: "nape kakak nk jd Doktor? Asyik sibuk je…kn da susah nk jmpa…". It comes from a naïve and innocent girl. Deep in my heart, I felt guilty, thinking that I had spent too much of my life for myself and that caused less time spent with her. Perhaps other people thought of the same thing(T.T) Allahua'lam. Diri ini cuma boleh berdoa moga si kecil ini dan mereka yang kusayangi akan faham dan moga Allah terus berikan kekuatan untuk meneruskan langkah.

Contohnya, Kalau anak dara nk kuar malam slalu, kan mak risau? Meskipun ad keperluan, still risau kn? Kenape nk risau? Yela, kn kat luar tu byk lelaki yg kurang beriman, nanti kang jadi mangsa rompak, rogol, bunuh, etc. Nape mak nk fikir negatif? Bukannya keluar sorang pun, dengan kawan. Everything is possible dear. This is a quote often used to encourage us to do something but it can happen in a negative way too. So, mcm mana nk elakkan dari berlaku? Cegah. Prevention is better than cure=) Jadi xyah keluar. Bukan nak cakap keluar tu haram, tapi kalau xbawa manfaat buat apa? Fikirkan keutamaannya. Perlu ke x? manfaat vs bahaya/risiko. Contohnya dunia perubatan. Seringkali war-warkan gaya hidup sihat. Makanan yg seimbang. Bersenam. Kenapa? CEGAH penyakit. Xsume penyakit ada ubat/penawar(di saat ini, benar Allah janjikan setiap sesuatu ada ubatnya kecuali mati). Kalau nak bagi ubat pun, Dr akan sentiasa pertimbangkan kebaikan dan kesan sampingannya. Dr dan kita berikhtiar, Allah tentukan. Kita usaha untuk beramal, moga Allah kurniakan rahmat-Nya. Mak ayah nasihat, kita dengar ke tidak? Agama tetapkan batasnya, kita patuh atau rempuh? Allah tunjukkan dua jalan, yg mudah atau sukar yg didaki?

Tu baru bahaya di dunia. Api neraka? Lagi x tertanggung. Diri kita sendiri pun xpasti terselamat, janganlah menambah beban org lain. Mestila kita xnk ayah/abang/suami kita diazab kerana dosa kita kan? No man's burden. I want to be one.

kekalkanlah status kita sebagai hamba di dunia ini, moga kita merdeka buat selamanya di akhirat kelak. 

Selalu, kta terlupa, atau xsedar, atau terlepas pandang yg ramai org kisahkan kita.

Kita xsolat, org ingatkan. Mungkin ad yg tegur direct. Atau ad yg ajak solat jemaah. Or perhaps just some hint: Ganjaran bagi mereka yg menunaikan solat, Akibat meninggalkan solat, dll. Well, everyone have their on way. At least, they CARE. Jadi, jgn marah xsemena-mena.

Isy, xmasuk tjuk pun. Sbnrny nk ckp, kta ni sentiasa terlibat dgn org lain.siyes melalut

What comes around goes around. 

Terkesan dgn video nih tp tuan punya dia xbg reupload, so juz share link je. 

*p/s: Atas Nama Cinta? benarkah cinta itu? muhasabah diri T.T

Thursday, February 9, 2012

xpercaya lagi?


Terdetik nk tulis entry kali ni lepas dgr kuliah tafsir Ustaz Zahazan(surah ar-Rahman) yg mana ustaz ada sebut org Islam ni mesti ada dasar/prinsip aqidah yg kukuh. Satu masalah yg pernah(atau mungkin masih) melanda umat Islam ialah ketiadaan prinsip yg teguh. Contohnya, apabila ke bumi Barat, minum arak. Apabila ditanya mengapa, jawabnya "bila masuk kandang lembu menguak, masuk kandang kambing mengembek"...

Betul tu~ penting utk kita pelihara aqidah. Islam ini salah satu cirinya thabat n murunah(Tetap/tegas dan fleksibel. maksudnya tetap dari segi hukum namun fleksibel dari segi pelaksanaannya). Contoh plg mudah: Solat itu hukumnya wajib, sehingga orang sakit pun masih wajib tapi ada keringanan(rukhsah) bagi yg musafir/terhad pergerakannya akibat sakit. Ataupun tayamum apabila ketiadaan air. Ataupun sutera yg diharamkan bagi lelaki tp dibenarkan sekiranya menghidap penyakit kulit(seperti kisah Abdul Rahman bin Auf r.a : ttg pemakaian sutera bg lelaki, klik sini).

Sy mgkin bukan ahli utk membincangkan isu ni jd cuma nk berkongsi skit pengalaman masa gi Persidangan Pelajar Antarabangsa dua tahun lepas. Dalam program tuh, peserta dibahagikan kepada kumpulan kecil yg terdapat peserta dari pelbagai negara n salah satu ahli kumpulan saya ni ada seorg BBC(British-born Chinese). Dia ni sgt ramah dgn org lain(brdasarkan pemerhatian saya), tp xpernah tegur sy(dlm masa seminggu spnjg program tu) kecuali masa first-time jumpa(ice breaking). Saya pun xdela nk terasa sangat, lgpun ramai je org lain yg boleh nk borak2.
  But then, on our last group meeting, I just tried to break the silence. So I asked him, "what made you chose medicine?"- biasala kn- soalan cliche... n so he gave quite a lengthy answer(which was quite unexpected) and worth giving a thought too. Onwards, we had quite a nice discussion and towards the end I made a statement(ni la msg yg ingin disampaikan sebenarnya): "I thought you didn't like me because you were so friendly with others but you hardly talk to me and in a way, I thought you are a cold and arrogant person because of that(saje nk provoke skit :P)"
 n he gave me this surprising answer(but I am somehow relieved): "No, it's not that I dislike you but I am just afraid to approach you. Because you are a Muslim and I don't know what to talk about. I'm afraid I'd say things that might offend you." 
I answered:" why did you think that way?"
BBC: "coz I have seen Muslims in my place(London) and they are not like Muslims- they drink alcohol, went to pub and etc...(dia ni xpernah jmpa Muslim 24/7 kot)... so when I met you, I am surprised and I didn't know much about Islam- what I should or should not say. It's not because I don't like you"

jadinya, lebih kurg cmtula... bukannya nk menunjukkan Islamophobia- tak langsung, they are actually respecting us, tp sebenarnya Islam ni yg memelihara kita dari banyak segi. Cuba bayangkan kalau org2 nih anggap sy ni cm peserta lain, sesuka hati je nk peluk, laga pipi, etc, kn bahaya tuh?  Benarlah, Islam tidak memerlukan kita tapi kita yg memerlukan Islam.

59.Hai Nabi, katakanlah kepada isteri-isterimu, anak-anak perempuanmu dan isteri-isteri orang mukmin: "Hendaklah mereka mengulurkan jilbabnya[1232] ke seluruh tubuh mereka." Yang demikian itu supaya mereka lebih mudah untuk dikenal, karena itu mereka tidak di ganggu. Dan Allah adalah Maha Pengampun lagi Maha Penyayang. (Surah al-Ahzab, 33:59)

Maka nikmat Tuhan kamu yang manakah yang kamu dustakan?

*diri ini masih lagi mencari diri sendiri n mengejar hidayah-Nya. Ya Allah yg memegang hati-hati, tetapkanlah  hati kami dalam agama-Mu dan dalam ketaatan kepada-Mu

btw, suka entry ni (klik saya!)

Friday, February 3, 2012

winter is coming?

Greetings, may peace be upon us all.

This entry has nothing to do with winter as I love the weather in Malaysia as it is :D Such title is because I want to talk about the coldness that I felt is building up in me. I am not sure whether I am being super sensitive but I think as days passed by, I am being colder than ever. I blatantly say whatever I wanted to, regardless of the effects of those words. I hardly care about my expression when it can really hurt the people around me.

I am not saying this as if I deliberately do all this stuff. No, I did not. However, when I looked back to the things I had done for the day, these are what I feel. I am not sure if I had been this way for long but I had just realized it or I just somehow 'developed' these bad attitudes. Either way, I still hated this and I hate to hate myself. If ever, I hurt you with any of these, please tell me so I can improve. Please don't let me be in this pathetic circumstances forever. Please help me to stop hurting you T.T. I hope I would be like the Spring which often brings hope, joy and happiness to everyone!

*teringat mek ckp: "Europe is a really good place for vacation but I could only live there for few days/weeks. Living there for good certainly won't be my choice. The winter is just too cold. I would always choose Malaysia. Negara yg makmur:)"

Oh, tanah airku!

cantikkan? =)

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