7th Day of Elective

1st day of the new week, I was attached to a neurologist, Dr. Kho Lay Kun. Well, she is a very nice doctor. She taught me a lot of things. I followed her to visit around the wards to see patients. First case is a patient present with dysphagia, a bit of confusion, stroke. The brain screen showed that 70-80% of brain vessels had been damaged and there were silent infarcts, the patient will then treated as TIA (Transient Ischemic Attack). The patient went home, had another similar episode, but now present with unilateral stiffness of the limbs and some jerking. It is then confirmed to be seizure. Stroke is divided into 2 groups- Blockage and Hemorrhage. TIA is classified into the blockage group. When the vessels suddenly got clot up, the patient suddenly suffered from lack of oxygen in the brain. After a while, the vessels open up but some tissues already suffered from ischemic. I got to visit rehabilitation centre. There were physician helping patient to do exercises. I saw my secondary teacher with her husband there and a poor baby. The baby has one side cramp leg. Another interesting case is a woman came with loss of left supraclavicular fossa.She couldn’t elevate the left shoulder too. Chest X-ray was taken but showed no masses and ultrasound was taken and it showed muscle hypertrophy. What causes hypertrophy. 1st: Exercise too much (Unlikely because impossible only exercise one side of shoulder), 2nd: Recurring damages to the muscle, hypertrophy by repairing, 3rd: Abnormal growth of muscle (Tumour)-very rare disease. The woman said the disease is progressive. So, if it is a tumour, muscle tissue biopsy need to be taken to determine the malignancy of the tumour.I saw a case of tension vascular headache, epilepsy, adverse effect towards contrast used in colonoscopy, moderate Alzheimer's disease, epilepsy, etc. And, one more interesting thing that happened today is I got sent by Dr. Kho to Dr. Ching, neurosurgeon. At first, when Dr. Kho said I can follow the neurosurgeon to know more a bout the case, I felt very happy because for me, neurosurgeon is like damn pro and cool. However, when I saw him and just suddenly realized that the neurosurgeon is actually Dr. Ching.Lol, it scared the hell out of me. Well, fyi, Dr. Ching is the medical director here, he don't like medical students. He shouted at Natasha and Gaik Si before and he told Dr. Lim before that he didn't want to see us in his OT. Lol. But, there was nothing happened. He just asked me: What's your name? Where r u from? Are your parents doctors? Have you learnt CNS? I told him I just learn the basic and he shot me with questions. What are the 12 cranial nerves? Which 1 is sensory, which is motor? What are the branches of facial nerve? Haih...I couldn't answer most of them, swt! The case I saw in his room is a rare disease, known as Tolosa-Hunt Syndrome.In Tolosa-Hunt syndrome, inflammation of the cavernous sinus (behind the eyes) causes severe eye pain and irritation or damage of the nerves of the face.Tolosa-Hunt syndrome begins with severe pain behind or around one eye that comes on suddenly. The pain can be constant and intense. As the sinus inflammation increases and spreads, nerves in the face can be affected, producing symptoms such as drooping eyelid (ptosis) of the affected eye or numbness and tingling in the forehead. Difficulty controlling eye movements (ophthalmoplegia) and the pupil may cause sensitivity to light and double or blurred vision. If left untreated, vision loss is possible. I saw the patient's eyelids are dropped and had to be lifted up using celofon tape.It can be treated with steroid medication such as prednisone but some do have recurrence of the Tolosa-Hunt Syndrome. O ya,Dr. Kho also brought me to visit the library and relaxation centre, hehe!! Neurologist and neurosurgeon r really smart!


Lesson of the day:

Dr.Kho (Neurologist) said:

Medicine is not straightforward,
Sometimes you cannot find the definite diagnosis,and it stresses you up.
But don't worry, TRUST your judgement,
Let time to proof everything, closely monitor the progression of the disease.
Don't ever let patient's opinion to affect your decision,
For what we did we believe it's for the good of patients!!!




P/s: There was a war outbreak early in the morning, haih...