Short Case weh

Just like what I've explained in the previous post,each student will get 2 cases.This short case is done during our final week which is now lah,8th week of posting.

So,today,since morning,I started to experience these catecholamine effects,diarrhoea pagi2.Haha.Normal homeostasis la kan,plus in d morning,our stress hormone is also increased (cortisol).Haha..so mmg rasa la badan x sedap suma.

We gathered in d Ward 4A.We arrived there early,at about 8 a.m although my turn will be at 8.50 a.m.And one by one student left us in the tutorial room.Suddenly,my name n other 3 students were called n we followed this kakak to HDU (OMG !!! ) HDU is High Dependency Unit.Haha..meaning....acute/severe cases will be there.

So..

I went in..

And my 1st case was wt Prof Kanaheswari (if I'm not mistaken,this is her real name)
Question-
1)Do general examination n proceed with Respiratory examination.

Answer (by me,of coz!)
1)Can i do running commentary,Prof?

A: Yes,it;s up to you.

Running commentary :
This is a baby boy(aged 7 months old),who is lying supine comfortably on the bed with nasal prong and nasogastric tube in situ.There is also brannula on the right hand.There is no pallor or jaundice.The respiratory rate was 36 breaths/minute.So,he is not tachypnoeic.However,there is marked xiphoid recession with mild intercostal and subcostal recession.No nasal flaring.Pulse rate is 80 beats/min,with regular rhythm and good volume (at 1st I couldn't appreciate the pulse at radial site,then I proceeded wt brachial pulse n I still couldn't find and Prof tried to palpate over the radial site and asked me to do the same thing).Luckily after that,it was palpable.Neves gila kot weh.Present pun cam stop2 though x lah gagap2.N then,I thought that the baby had NO hyperinflated chest,but Prof asked me to find other things on general examination.And i didn't comment whether there chest was hyperinflated/not.I was afraid that I might cook sign.Haish (salah dah kat situ,after that I think mayb ada la kan,dah prof suruh tgk again).Xpa,belajar dr kesalahan.Then,proceed wt respi examination.Trus ke chest expansion,which was equal bilaterally.(thoracoabdominal breathing cm besa,cuma xiphoid recession dia sgtlah obvious).Then on percussion,the chest is (bygkn aku tgh present again,so that explains why sometimes 'was' n 'is') hyperresonant all over the lungs.On auscultation,apex beat is palpable at the left 4th intercostal space,at the mid-clavicular line.(OMG,normal cardiac dullness aku x check lah weh).Salah lagi.There is also presence of bibasal coarse crepitations and expiratory rhonchi which was generalized all over the lungs .Then,prof took the stethoscope and listened to his lungs.Prof then said,"Listen again".(Oh,aku dah cuak).I took the stet again n listened,Ohh..rupa2nya coarse creps also present over the upper zones but more prominent bibasally.Haish.Neves ni sungguh mengacau.then,summarize n give provisional diagnosis.

Diagnoses : Bronchiolitis,Pneumonia (if severe can get hyperresonant though usually there'll b dullness on percussion).

2nd case :
Do newborn screening for the baby on the right side.(there were 2 babies)
So..bla..bla..bla..xlarat taip...

Buatla yg mana igt,baby tu looked normal though a lil bit plethoric lah.Tp aku lupa plak ballot kidneys and check anus tu imperforate or x.Then dr asked apa lg nak buat n aku ckpla those two.Pastu dr allowed me to ballot kidneys only.

Conclusion : Newborn screening is normal.

P/s : xtau lah kalau salah or different from 3 other students td.Harap2 LULUS lah weh.Plis lulus,aku mau bercuti ! :)