🔪Surgical Posting

# 🔪Surgical Posting ## :pushpin: Introduction 1. Surgical posting mengajar kita utk jd lebih berdisiplin 2. Surgery ada: i. **BST** - 2 kali seminggu, biasanya Dr suruh present mcm long case ii. **Seminar** - buat ppt slide ikut topic masing2 iii. **Case discussion** - sama je mcm seminar iv. **Case write up** - ada 2 (satu kene submit minggu ke-4, satu lagi kene submit minggu ke-8) 3. Kita kene tahu surgeon2 sgt sibuk 4. So biasanya BST, seminar, case discussion semua akan banyak banyak kali tangguh 5. Jadi kene appoint org utk ==**contact Dr seminggu sebelum**== BST, seminar, CD 6. Physical examination blh belajar sendiri & tanya senior, tak payah tunggu BST ## :pushpin: Surgical Posting System Basically dlm surgery kita kene pergi 4 tempat: i. Ward ii. Clinic iii. Endoscope room iv. OT :::spoiler SASMEC <table style="width:100%"> <tr> <th>Ward round</th> <td> <ul> <li>kene bahagi ikut team:</li> <ul> <li>Team A → colorectal</li> <li>Team B → hepatobiliary, breast, thyroid</li> <li>Team C → vascular</li> </ul> <li>biasanya akan start ward round MO dulu pukul 7.30am, ward round dgn specialist biasanya start lambat sikit</li> <li>wajib ikut ward round dgn specialist setiap hari</li> <li> kalau blh ikutlah jgk ward round dgn MO</li> </ul> </td> </tr> <tr> <th>Endoscope & OT</th> <td> <ul> <li>tgk jadual scope & OT sehari sebelum utk tahu patient mana yg akan masuk scope/OT hari esoknya</li> <li>wajib clerk dulu patient sebelum masuk endoscope atau OT</li> <li>minta izin dgn Dr kalau nk scrub in dlm OT</li> </ul> </td> </tr> <tr> <th>Clinic</th> <td> <ul> <li>clinic surgical kt semua hospital nama dia SOPD (surgical outpatinet department)</li> <li>setiap team A, B, C ada jadual yg berbeza utk clinic</li> <li>kat SASMEC kene clerk pt dulu sebelum masuk bilik Dr</li> <li>clerk pt kt dlm consultation room kt SOPD</li> <li>bila nombor pt yg kita dh clerk kene panggil, ikut pt masuk bilik Dr and minta izin kt Dr utk present pt</li> </ul> </td> </tr> </table> ::: :::spoiler HTAA * Kat HTAA takde Dr yg pantau kita, maka atas diri masing2 utk jd berdisiplin atau tak <table style="width:100%"> <tr> <th>Ward round</th> <td> <ul> <li>biasanya ramai HO and tak dgr sgt apa yg diorg present</li> </ul> </td> </tr> <tr> <th>Endoscope & OT</th> <td> <ul> <li>tgk jadual scope & OT sehari sebelum utk tahu patient mana yg akan masuk scope/OT hari esoknya</li> <li>kt HTAA tak wajib clerk pt tp seeloknya clerk dulu sbb takut kene soal dgn surgeon</li> <li>ape2 pon perkenalkan diri & minta izin dgn surgeon sebelum join scope/OT </li> </ul> </td> </tr> <tr> <th>Clinic</th> <td> <ul> <li>SOPD kt HTAA pon ada jadual </li> <li>kalau nk tgk case breast & thyroid, pergilah SOPD hari Rabu pukul 2.00pm</li> <li>biasanya kitorg tak clerk pt pon, terus je masuk bilik Dr</li> <li>biasanya Dr2 indian baik & willing utk ajar students</li> </ul> </td> </tr> </table> ::: :::spoiler HOSHAS * Kt HOSHAS specialist yg akan ajar student UIA ialah **Mr Ussof Eskaandar** * Mr Ussof sgt sgt baik orangnya & dia bercakap sgt sopan dan lembut, tp dia sgt sibuk <table style="width:100%"> <tr> <th>Ward round</th> <td> <ul> <li>ward round kt HOSHAS ada HO tp tak ramai mcm kt HTAA</li> <li>biasanya akan start ward round MO dulu</li> <li>ward round MO kt HOSHAS sgt beneficial sbb MO diorg rajin mengajar HO, kita pon blh belajar sekali</li> <li>ward round dgn specialist biasanya start lambat sikit</li> </ul> </td> </tr> <tr> <th>Endoscope & OT</th> <td> <ul> <li>mcm biasa, tgk jadual sehari sebelum, biasanya kitorg whatsapp Mr Ussof utk tahu jadual OT</li> <li>kalau blh masuk lah endoscope & OT yg ada Mr Ussof sbb Mr rajin mengajar student</li> </ul> </td> </tr> <tr> <th>Clinic</th> <td> <ul> <li>clinic pon sama tgk jadual, tanya Mr Ussof hari apa dia ada kt clinic </li> <li> HOSHAS pon mcm HTAA tak payah clerk pt, terus je masuk bilik Dr</li> <li>join clinic dgn Mr Ussof sgt best sbb kita blh tgk byk PE & Mr akan ajar byk benda </li> <li>clinic dgn senior MO pon best sbb diorg akan bg student buat PE kt patient (ni ikut MO jgk lah)</li> </ul> </td> </tr> </table> ::: ## :pushpin: Logbook 1. Ada mcm2 benda kene buat & isi dlm logbook 2. Minimum requirement utk logbook blh tgk dlm buku Manual for Surgery Posting 3. Logbook ni yg penting kt belakang sekali kene terus mintak sign Dr lps dh present: i. **Dua case presentation** yg diberi markah (yg ni lecturer/specialist je yg blh bg markah) ii. Seminar & case discussion 4. Surgery kene at least 8 kali oncall ## :pushpin: Physical Examination 1. Abdominal examination (termasuk per rectal examination) 2. Breast examination 3. Thyroid examination 4. Hernia examination 5. Peripheral vascular examination (arterial & venous) 6. Lump & bump examination 7. Stoma examination :::success :bulb: **Semua org wajib buat [per rectal examination](https://hackmd.io/@aishahk/H1uc4RsFj?utm_source=preview-mode&utm_medium=rec)** ::: #### Special Test 1. Hernia - occlusion test 2. Breast - fixation test 4. Lipoma - slip test 5. Scrotal swelling - transillumination test 6. Kidney - renal punch *ada byk lg special test lain, bacalah sendiri ## :pushpin: History Taking **Aim:** able to take a complete history of patients 1. Patient's biodata (name, age, gender) 2. Chief complain 3. HOPI (kalau bleeding kene tanya symptoms of anemia, kalau jaundice kene tanya symptoms of obstructive jaundice, etc) 4. Systemic review (fever, SOB, cough, numbness, nausea & vomiting, any related metastatic symptoms) 5. Past medical & surgical history 6. Drugs & sumpplements history (insulin oral or injection, anticoagulants, antihypertensive) 7. Family history (malignancy, same illness) 8. Social history (smoking, drinking, occupation, recreational drugs) 9. Gynaecological & obstetric history (menstrual cycle, hormonal contraceptives, previous pregnancy) :::spoiler 4 Cardinal signs of obstructive jaundice 1. Yellow discolouration of skin & sclera 2. Tea-coloured urine 3. Pale-coloured stool 4. Pruritus ::: :::spoiler 4 Cardinal signs of intestinal obstruction 1. Abdominal distention 2. Abdominal pain 3. Constipation 4. Nausea & vomiting ::: :::spoiler 5 Cardinal signs of inflammation 1. Pain 2. Redness 3. Heat 4. Swelling 5. Loss of function ::: :::spoiler 4 Cardinal signs of anaemia 1. SOB 2. Palpitation 3. Dizziness 4. Lethargy ::: :::spoiler Constitutional symptoms 1. Significant loss of weight 2. Loss of appetite 3. Fatigue ::: ## :pushpin: Topics Should Be Covered #### Main: 1. Abdomen (hernia, intestinal obstruction, appendicitis, peptic ulcer, colon cancer) 2. Gallstone (choledocolithiasis, cholecystitis, cholangitis) 3. Breast (breast cancer, fibroadenoma) 4. Thyroid (MNG, thyroid cancer) 5. Vascular (arterial, venous) #### Others: 1. Liver diseases (liver abscess, liver cancer) 2. Urology (renal stone, pyelonephritis, pyonephrosis, renal cell carcinoma, BPH) 3. Esophageal diseases (bleeding esophageal varices, esophageal cancer) 4. Neurosurgical diseases (intracranial hemorrhage, brain tumour) #### Common chief complain: 1. Abdominal pain - kene baca ddx abdo pain utk each 9 region of abdomen 2. Jaundice 3. Bleeding - per rectal bleed, hematemesis, bleeding ulcer of the lower limb 4. Hematuria 5. Lump - breast lump, hernia, neck lump p/s: kalau nak selamat cover je semua topic yg dia bg dlm buku manual surgery ## :pushpin: What We Should Concern 1. ==**Risk factors**== for each disease 2. Differentiate symptoms of ==**benign vs malignant**== 3. Kene tahu ==**classifications, law, staging**== of diseases <table style="width:100%"> <tr> <th>Diseases</th> <th>Classification/Law/Score</th> </tr> <tr> <td>Peptic ulcer</td> <td>Forrest classification</td> </tr> <tr> <td>Hemorrhoid</td> <td>Goligher's classification</td> </tr> <tr> <td>Breast lump</td> <td>BIRADS</td> </tr> <tr> <td>Thyroid</td> <td>TIRADS, Bethesda</td> </tr> <tr> <td>Palpable gallblabber</td> <td>Couvoisier’s law</td> </tr> <tr> <td>Constipation</td> <td><a href="https://hackmd.io/@aishahk/Hy1XS0oFs">Rome IV criteria of constipation</a></td> </tr> <tr> <td>UGIB</td> <td>Rockall score</td> </tr> </table> *ada byk lg classification lain, bacalah sendiri *surgeon suka kalau kita tahu classification2 ni ## :pushpin: Surgical Materials in Ward 1. Cannula - peripheral, central, needle colour & size 2. Chest tube - baca pasal *'underwater seal'* 3. Types of urinary catheter - two way, three way 4. Types of drainage tube - Sengstaken-Blakemore, Minnesota 5. Types of drainage bag 6. Types of dressing ## :pushpin: Pantang Larang dlm Surgical Posting 1. Hari2 (Isnin - Jumaat) kene dtg ward sebelum pukul 7.30am kalau kat SASMEC 2. Hari2 kene join ward round 3. Kalau tak dtg kene provide MC 5. Kene kenal siapa consultant, specialist, MO utk setiap team A, B, C 6. Jaga pemakaian & attitude :::danger :bangbang: **Jgn menipu attendance** :bangbang: ::: ## :pushpin: Reference ### Textbooks: 1. Browse's Introduction to the Symptoms & Signs of Surgical Disease :+1::+1::+1: ![](https://i.imgur.com/62HscMM.jpg =x200) 2. Essential Surgery (Elsevier) :+1::+1: ![](https://i.imgur.com/FNd2dD5.jpg =x200) 3. Bailey & Love's Short Practice of Surgery :+1: ![](https://i.imgur.com/1KJOgmF.jpg =x200) 4. Principles & Practice of Surgery ![](https://i.imgur.com/3sqU72s.jpg =x200) :::info :+1: = recommended :+1::+1::+1: = highly recommended ::: ### Notes Compilation: 1. Medbear Surgery Notes ![](https://i.imgur.com/C9ONbY5.jpg =x150) 2. Dr Chan Preparation Handbook ![](https://i.imgur.com/ixzww6x.jpg =x200) 3. Notes from our seniors i. [Farah Imanina Notes](https://drive.google.com/drive/folders/1yydNl93MK79lwWSjUXBuHn4EX5mtut5j) ii. [Shamail Notes](https://drive.google.com/drive/folders/1w3dbIwcBLk9FV0i7YE9PWEu3bVqS9rwr) :::warning :warning: Jgn sebut Medbear/buku Dr Chan/notes compilation yg lain dpn surgeon sbb notes ni bukan mainstream reference mcm textbooks :warning: ::: ## :pushpin: Additional Resources #### Youtube 1. Prof Ikhwan Sani from HUSM i. Hernia PE {%youtube TCeJlUqe-6k %} ii. Breast PE {%youtube onY-M3j0WMg %} iii. Thyroid PE Part 1 {%youtube XoVaOpFxStw %} Thyroid PE Part 2 {%youtube 0XZrmeHeFRc %} Thyroid PE Part 3 {%youtube vMupKzbxki4 %} iv. Per Rectal Examination {%youtube TCeJlUqe-6k %} v. Venous PE {%youtube DmtlrzvO4Oc %} vi. Stoma PE {%youtube onY-M3j0WMg %} 2. [Geeky Medics YT Channel](https://www.youtube.com/@geekymedics) 3. [Rhesus Medicine](https://www.youtube.com/@RhesusMedicine) 4. [Zero To Finals](https://www.youtube.com/@ZeroToFinals) #### Website 1. UpToDate 2. [MSD Manual Professional Version](https://www.msdmanuals.com/professional) 3. [TeachMeSurgery](https://teachmesurgery.com/subjects/) p/s: Tips ni drpd perspective Aishah K, lain org mungkin lain perspective. Semoga bermanfaat & goodluck for surgery posting &#128522