Here comes the smack down, oppa limeuu style

Give him some chance la. Maybe he can do well in pre U? U never know.

How about do something nearer lor.......pharmacy or nursing also can lar......work in the hospital what.. LOL

In that case one can choose to work as cleaner in hospital. Dun even need a diploma lol

i have never seen b and c students at spm become a students in a proper pre-u...

have you?....

however, i have seen them become a students at some 'foundation' programme for russian med schools....

Makes much more sense right now for it to be first line for BP in certain cases as well as CCF.

I remember our lecturers told us that sartans and prils are pretty similar, although there are different side effects due to presence/breakdown of bradykinin.

However, I do remember somewhere that sartans work differently something along the lines of losartan binds loosely whereas cadesartan binds tighter?

TBH only one. A friend of mine got only 2As and the rest B and C in SPM, but managed to get TER 96% for SAM. But to be fair he was sick during SPM. But nevertheless, nothing is impossible. And the fact that you haven't encountered one doesn't mean it doesn't exist

But of course he has to work extra hard from now. If his pre u result is still not satisfactory, then I will discourage him from joining the medical fraternity as well.

Btw anyone sitting for mrcp part 1 in Jan? I have a list of must know facts. Let me know if u need it.

This post has been edited by hypermax: Dec 20 2012, 04:33 PM

the first choice is always ACEI due to the cost, sartans are still relatively new are much pricier and are only used when ACEI are not effective (in the private settings it may be another story though). but both should never be used together.

technically ARBs are more effective as it binds directly to the receptors hence angiotensin 2 have no where to bind and get degraded. In the case of enzyme inhibition there's bound to be some ACE escaping the effects of ACEI. but in real life scenarios it may differ.

This post has been edited by zstan: Dec 20 2012, 04:43 PM

In clinical practice, first line is almost always ace-I. Arb is used when patient cant tolerate ace-i, usually due to dry cough (accumulation of bradykinnin in the lungs). Of course in some cases, double blockade is used (combination of both Arb and ace-i).

Pharmacy and nursing aren't 'backups' for med. Both are noble professions which requires same amount of dedication and they all have their own difficulties. Don't enter the courses just because it seems like a 'backup plan' in case you don't get into med. Get in for the right reasons.

yes to everything but I don't know how relevant are those info to practical clinical scenarios. TBH i haven't seen any AT1r antag prescribed on the wards, yet. (or maybe I just missed them)

---

Added on December 20, 2012, 4:49 pmWas wondering if there are other criteria (other than the issue of dry cough/intolerance of ACEI) needed to prescribe arbs. I haven't came across dual ACEI-arb usage, so I found this along the way:

http://www.ccjm.org/content/76/12/693.full

This post has been edited by onelove89: Dec 20 2012, 04:49 PM

its really not recommended... there's always other choices of BP lowering drugs.. combination of these 2 will result in declining renal function. the electrolyte imbalance will also be more severe if combined.

http://www.jfponline.com/pages.asp?aid=7183

why so mean, you dont even know me.
im not fully prepared during my trial.
teachers dont finish sylllabus and so on (last minute study before exam).
but im giving my 100 percent for my real spm.
i know my capabilities.
i cant say anything right.
just wait for spm result in march and i will prove you are wrong.
i even dont hangout anymore with my socalledhipster* friend because they do stupid things and they dont realize how tough life is if you want to succeed.

Now that's what I call confidence!
All the best!

Good for you that you're confident. But seriously, there is much more to being a doctor than you think. Can you answer me what a doctor does besides diagnosis and prescribing/delivering appropriate medicines/ procedures?

Not being your wet blanket but please do survey other careers as well, you're young and there is still much more to think about. Please note that committing this early to medicine is not necessarily good, I sometimes doubt myself in less time than I think that I'm going to have to be responsible for a person's health. It may seem very managable in paper but when you start to see things in the healthcare setting, by gosh, it is a whole new philosophical lession.

Who knows, when you're exploring you might discover some hidden gems as well! (IMHO, all professions are noble as you earn an honest living)

Also, my path post-SPM was A-levels then to University. I wasn't the brightest student in my high school but I did fairly well with Maths and Science subjects. Did fairly well in my A-levels and was lucky to be granted an acceptance letter to uni. I did 3 science and a maths for A-levels. Physics and/or biology (have not heard any that does not need chemistry) is/are not needed in all universities but to be safe, just take it if you can handle it to be safe. Do survey which universities you're planning to apply to before choosing the subjects.

is it abt good heart, communication skills, tolerance, patience?

hmm, but dont worry i will reconsider abt doing medicine after done my a levels.
if i get good result and feels i can cope with being a doctor i will continue with it.
btw thanks for all the replies

it's a good thing to have confidence. Don't get us wrong. We aren't just being mean and trying to put you off or discourage anyone trying to get into med. Some of us here are real doctors and some of us are medical students. We say so because we know what you will be venturing into, and how tough it is from there onwards. Limeuu isn't being mean, he's just being realistic, and he's speaking from his experience.

Back then, I too was very sure med was the only path for me. Why? because the only reasons I had was 'I wanted to help others' and 'I can do it because I'm (sort of) top in class'. Oh how I crashed and burned. =P Even in my foundation program in OZ, they keep stressing that we should find an alternative to med. There were SO SO many out there trying to do med, including those who are just in the middle of the bell curve. I'm glad I didn't get in the first time. Get your reasons right. It's more than just 'I want to help others' or 'I KNOW this is my future career.' That isn't enough to get you any where.

Oh, and also, D_s_X's first question can give you an idea of how much you know about doctors/medicine. Do tell us what do you think about that.

Also with your trial results, well, for the time being it's not really enough to get you a scholarship, unless your SPM results prove us wrong. cheers.

It is not recommended, but some nephro consultants do use such combination in selected cases. I am not sure of the indication as my haven't done my nephro rotation as MO. Will try to find out more about this.

http://care.diabetesjournals.org/content/26/8/2268.long
this one says that it's renoprotective. Others say that they don't do much (in terms of renoprotection)

But it'll be great to see what the consultants say about the combination.

In a nutshell, it is part of it. Syd G has said it is also about medico-legal obligations, professional and personal life boundries and et cetra. Your life will be dominated by medicine. In my limited years of training, having a good heart, tolerance, patience can only bring you so far, there are many unpredictable circumstances where those won't be able to help you with your judgement but in fact, might cloud it. It is not the cleanest profession where everything is either right or wrong. There is much time to explore! I hope that you'll get good results in SPM and A-levels and so on, however, if you don't; plenty of other options as careers where your good heart can be put to good use as well, don't fret! Like I said, every profession is noble if you do it with the right heart.

P/S: re:if i get good result and feels i can cope with being a doctor i will continue with it.

You seem to be able to know your limits, one of the things I have been taught to be a good doctor =)

not sure if this is the right place
but i'm going to finish med school soon

need to fill housemanship form and interview just around the corner

any idea good place for housemanship?
not GH....i hate big hospital cos many medical student (like myself) and more importantly fierce consultant

any tips very much appreciated

well if you want to opt for 'smaller' hospitals you can always apply places like pahang, kelantan, terengganu, perak etc.