much ado about nothing

cartoonfat, originally uploaded by oyclubsnap2.

It seems that clinics are playing merry hell with my blog life! every time an exam comes up, i drop everything in the name of sanity and head straight for the library to do a good bit of *catching up* (mugging doesn't quite technically describe my endeavor heh.)

Anyway, theres goes the end of another 2 months in internal med. i took the clinical test in AH and was rewarded by an AMI (long case), a plural effusion and lastly a murmur due to aortic SCLEROSIS (both short cases.)

the first case was easy enough, i was able to adequately get a decent history and diagnose the gentlemen concerned. i guess i must have impressed the consultant because he was all smiles at the end of my presentation. subsequently he allowed me to do my physical examination of the next case unobserved and gave me the A++ option of presenting freely rather than to stick to protocol after i had finished. I decided to go for the gold and went for the advanced option and was still managing to hold up quite well until the time came for the third and last case...the last case of aortic sclerosis, aortic bloody sclerosis...

this time i was majorly stumped. i had ascultated a PSM in the 2nd RIGHT intercostal space. it was a grade 3 murmur and it didn't seem to radiate anywhere. It was accentuated on expiration and it had the "wushing" quality of a mitral regurgitation.... damn. so i was considering 3 differentials, MR, TR or even a VSD. i had already pushed the possibilty of an AS out of my mind because there wasn't any carotid bruits nor was there evidence of pulsus tardus. so anyway... long story short, i completely missed the diagnosis, what a letdown.

oh well. at least the tutor was sympathetic when he realised that i hadn't thought of aortic sclerosis - which for the uninitated folks out there, is differentiated from aortic stenosis, on precisely the same grounds as my case, by a LACK OF BRUIT! nice information to take home heh.

In other news, hols have started after a marathon 4 months of tough clinics! haha one week of holidaying bliss awaits! whilst i'll admit its already wednesday night, and ive already wasted half my hols, i can only hope that the 2nd half will be better. (this so totally brings out the blind optimist in me. heh)

the first day of hols started with a marathon dota session of 7 hours (owned as usual but never you mind...) and a really lovely session eating mooncakes at pearlly's place. Nat, siying, claris and pearlly cooked this most amazing salad and japanese soba!

i have to get the recipe from them some day! *hint hint! nat! hand over thy recipe yah!* We were also entertained by mark with a surprising medley of medical RAPs from the usually benign and really guai mark! Next, siying decided to give mark and me a a quick session on salsa 101 which proved to be really refreshing. im now proud to say that while i still have 2 left feet...i can at least do salsa basic step!

fast forwarding to today, i ran into wai jia in the library who really inspired me with her book which she published for charity. Its a really good read and her illustrations put mine to absolute shame! (see mine in comparison? bleagh!) and her treatment of watercolours totally captivated me with her rich tonal palette! All in all, for a good cause, please DO approach our darling wai jia, m1, with a minimum of 20 dollars in your hand and walk away with an autographed copy of a book of gold, written by a heart of gold. :)

anyway, time to go! haha some long entry this has been.

btw. for all the naysayers (ie i say im fat, and you still say nay.. *heh*) i HAVE gotten fat alright! couldn't even complete my usual 5km run with sunder and weesoon. looks like i'll be leaving off the big 'n tasty burgers from our friendly M for sometime. dammit! i love unhealthy processed food!