5th rotation in 5th year

2^nd last day of dermatology round @ KAUH~with Dr Firas (course coordinator)

Shiny morning, I was assigned to be with one of my friend (Sameh) to take the history & do physical examination at 2^nd room. Owh, it’s about post-surgical nevus case.

As soon as we complete our duty, Dr walked into our room and asked me, "Duktura Nur, what's your finding in this patient?"

Gulp, suddenly I felt palpitation. Dub dub.. "TSAD:Type-Papule, Shape-pink, non scaly, well defined margin, linear arrangement, distribution-left thumb". (One breath, fuh..relief!)

Sameh gave me 'thumbs up', Good!

As a course coordinator, he's so strict about attendance and time. For each round or seminar that u don't attend either u may have any excused letter or not, u'have to do extra on-call on Saturday. Instead of that, his kind of teaching make us learn more, make us thinking & of course admitting in sort of the details that we don’t know if being asked.

"If u're not sure, just say 'I don’t know, its better than guessing without evidence'…. 'Go read the books!' –Dr Firas.

Sumi whispered, 'oo..how if we just put 'I don’t know' in the mini-osce exam, as we're not sure about our answer'. Our laugh burst out! & I uttered, 'quoted by Dr Firas, uh?' huhu..

Moral of the story>u should know everything.. go read the books everyday! (am I?? grrr~)

On my last day at Amirah Basmah Dermatology Clinic, we met a new interesting case.. a rare case which is 'Darier's disease' or keratosis follicularis. What's that??

It's a rare progressive genetic disease (autosomal dominant of keratinization), that fertility tends to be low. The diagnosis is confirmed by doing genetic test.

Erm, how's the patient presentation?? Well, it may appears in mid-teens (but this patient is about 30s), the rash aggravated by over-exposure to the sun, heat and humidity. We could see small pinkish or brownish papules with a greasy scale. These may coalesce into warty plaques in a sebarrhoeic distribution, usually at sterna, interscapular areas, behind the ears and may be generalized to other sites. The abnormalities is remains for life (poor them), often causing embarrassment, distinct odor and discomfort.

We also should inspect her back of hands (looking for plane warts), punctuate keratoses on palms & soles, cobblestone-like irregularities of mucous membrane of mouth, and also a distinctive nail dystrophy. (In this patient, positive finding only seen at her nail~whitish ridges run longitudinally to the free edge of the nails, apart from pinkish-brownish papules around her neck sterna area).

So sorry to her..she looks so anxious and depressed. If it's about genetic, nothing that could we do (I think), as it's already stated in Luh Mahfuz. Being in the clinics, meeting many sorts of people, make me thinking, Allah is The Almighty, who is able to do anything.. nothing, nobody could stop Him. Only just a little crash at the so-called tiny chromosome, the patient got this, that just appeared around 3 months ago.

End of my Dermatology rotation~Insya Allah the exam will be on end of January, clustered with Ophthalmology (what's so special about end of January??..wink wink).

After all, let's revise Al-Baqarah, 155-157.

"And certainly, We shall test you with something of fear, hunger, loss of wealth, lives and fruits, but give glad tidings to As-Sâbirun (the patient).

Who, when afflicted with calamity, say: "Truly! To Allâh we belong and truly, to Him we shall return (Innalillahi wa inna ilaihi raji3un)."

Such are they on who are blessings from their Lord, and mercy. Such are the rightly guided.