Revision~Clinical Surgery~

Sekarang sy kt dept.surgery lagi pas OBG!! i really love it..hoyehh!!! (^_^)

Hari nie..doktor yg incharge kmi adalah Dr.Srinivas...suka! he is 2nd year Postgraduate doc actually..
hmm..sy suka sume doc surgery especially the one n only lady surgeon, Dr.Preety..as the name applied, she is very preety, n smart too!..hiiiii..
Surgery is cooler...for a cool people! haha..adakahh??

emm..Lepas tgk surgery mastectomy *removal of lump in the breast* ~~sowiee kmi pening sket nk translet ke bhs melayu..cakap campur2..tp kmi try! huu..~~

kami seramai 4 org diarah kan pi amek case patient yang ada pembengkakkan di leher...ke leher yg membengkak eh?? cam pelik je bunyinyaa..uwaaa!! bahasa melayu ku!! swelling in the neck sbnrnye..*ok, give up!huu*

#Lebih kurang camnilah rupa swelling tue...eh..eh..makcik lupa cukur misai ke?? hee
( ini bukan gambar sebenar)#

hmm..disebabkan sy adalah x pi yg last clinical posting sbb collapse cam katak penyek time ward round...jadi sy dipaksa amek case n present kali ni..apelaa naseb badann..x bek la diorg wat sy cmni..x aci! yang minggu lepas sy dh amek..sy bkn sngaja xmo dtg..blablablabla....T_T


Sadapp u faizah!

Ok..ok..revision start!

HISTORY TAKING

Here, there is a female patient,Mrs.Vijayalakshmi with age of 38 years old, married,live in Vijayanagar, Bangalore and working as a labour.

Chief Complaint

Patient came to the hospital yesterday with a complaint of swelling in the centre of neck since 2 years back and also pain since 2 years ago.

On History of Presenting Illness

Patient is apparently normal until she got a complaint of swelling in the midline isthmus of thyroid gland, below the cricoid cartilage since 2 years back. It is a single swelling, oval in shape, gradually increasing in size starting from groundnut size to this current condition which is chicken egg in size without any discharge. Associated with that swelling, mild tolerable pain was presented on and off which is more during swallowing and reduced while taking rest. Patient have loss of weight, but does not have fever, injury in the neck or any trauma, chronic cough, tremor, dyspnoe, palpitation and diplopia.

*Don't forget to ask about negative history! it is important to make provisional diagnosis just based on history wise*

*paling-paling penting..anda harus menyediakan otak anda untuk berfikir n list kan differential diagnosis mengatasi kelajuan cahaya! hehe

*Berdasarkan history about the position,onset, duration, rate of growth and whether assoc. with pain or not, beberapa kemungkinan diagnosis boleh disenaraikan;

#Think about probability of Tuberculous lymph nodes also#
# If discharge present situated in the lower 3rd of the neck near the anterior border of the sternomastoid, it maybe Brachial fistula or Thyroglossal fistula#

1) Position- midline( Ludwing's angina, Thyroglossal cyst, subhyoid bursitis, retrosternal goitre), lateral n painless (Brachial cyst, cystic hygroma,dermoid cyst, cold abscess)

2) onset, duration & pain - Sudden increase with pain ( haemorrhage inside the goitre, Inflammation, malignant disease in late stage, Hashimoto Thyroiditis), fast growing swelling(Anaplastic carcinoma),growth very slowly n static for quite sometimes and painless(simple goitre, Carotid body tumor), growth slowly for year( multinodular, solitary n colloidal goitre, papillary n follicular carcinoma of the thyroid)
*Thyroglossal cyst may present since birth*

Past History

Patient was known doesn't have hypertension, Diabetis Mellitus, Tuberculosis, epilepsy, no any drug intake and never had undergo any surgery before.

Menstrual History

Normal

# Jangan lupa tnye menstrual history, if there is a female patient..this is to rule out if patient have oligomenorrhea or ammenorhea..-this is symptom of hyperthyroidism.

Family History

There is no significant history detected.

Personal History

Patient is a vegetarian diet with good appetite, sleep is disturbed, micturation is normal but having a loose stool. She is non-smoker, not chewing tobacco or betel nut and non- alcoholic intake.

#Personal history penting to rule out the etiology of the disease if let say hyperthyroidism or hypothyroidsm was suspected#

General Physical examination

Patient is sitting comfortably during examination. She is moderately built, well nourish, cooperative and concius with time, place and person.

Vital sign
Pulse rate: 60bpm
Resp.rate: 24/min
BP : 110/80 mmHg

Patient found to have bilateral lymphadenopthy of inguinal lymph nodes but absent of pallor, icterus, clubbing, koilonychia and edema.

Systemic examination
There is no abnormalities detected in CNS, CVS, Respiratory, GIT and Reproductive system.

Local examination
1) On inspection- There is single swelling, oval in shape around 5cm x 3cm in size, situated in the midline isthmus of thyroid gland below the cricoid cartilage. During swallowing, the swelling moves upwards on deglutition but doesn't moves upwards with protrusion of tongue.

2) On Palpation- There is multiple swelling and bosselated with firm in consistency. The swelling is localised and mobile.

3) On percussion- not done

4) On auscultation- systolic bruit was heard.

Provisional Diagnosis

Bilateral multinodular goitre.

Doctor on duty: Fuhh...siap dah case sheet..owhh ye anak-anak..jangan lupa wat general examination ok! look for sign pula n Thyroid function test for confirmation. Doktor sy kata"To be a good n excellent clinician or physician, aramm seh..u should be able to make diagnosis accurately n fast during physical examination and without depending on lab investigation."

Pisang emas dibawa belayar,
Masak sebiji diatas peti,
Just nak share ape yang diajar,
Supaya ley dingat sampailah mati.

*Hoho..perosak bahasa*