Posted by FaDhLi on Saturday, December 25, 2010
another way to remember prerequisites is via mnemonic
F-O-R-C-E-P-Sfind it yourselves :D
advantages of vacuum compared to forceps*cervix at least 9cm (forceps must 10cm)
*less trauma to mother
*can be used in any position (forcep must direct OA or direct OP)
INFORMED CONSENT
Posted by medik-ukm on Thursday, December 23, 2010
Please examine this elderly lady who complained of something coming out from her vagina.
- Introduce, establish rapport, ask permission, position the patient (super duper mark in this)
- If the question asked to examine the perineum, go straight to the perineum by asking the patient to lie down in dorsal position and lift up her cloth while we cover her anterior abdomen with a blanket. Otherwise, do a general examination, or else you would miss the causes, differentials and the complications of prolapse (ie, chronic cough, cachexia to suggest malignancy)
- Inspect the perineum. Observe for atrophic changes in the labia majora, and any scars suggestive of trauma. Another sign of atrophic changes is that the labia minora is no longer concealed as we can see in non menopausal women. The pubic hair distribution should also be commented upon. Look hard for any PV discharge or color changes suggestive of inflammation due to infection or ischemia (due to kinking of blood supply particularly the vein)
- Ask the patient if she had any vaginal pessary inside her vagina. Ask permission to remove it. Observe if there is any protrusion coming out and comment on that protrusion. If there is none, ask patient to cough. You should be able to see some urine dribbling down if the patient had stress or mixed incontinence due to the prolapse. Then, ask the patient to bear down or any other way which would make the prolapse to come out (ie standing).
- Now that the prolapse is out, examine the anterior part of the prolapse. Comment on the dryness, discoloration, ulcer, pus. Look at the urethra opening. If there is any swelling posterior to it, it is the urethrocele. The mass had linear streak it is the bladder rugae lined by the anterior vagina mucosa. The fold behind it is the border between the vagina and the bladder...
- Proceed downward and you can see the cervix opening. Determine if the cervix is parous or not (ie, parous will have streak while nulliparous will just had a dot opening) or any peduculated mass, discharge, abnormal looking.
- Try to look at the posterior part but you should be able to see it clearer later.
- Palpate the uterus and determine the degree of prolapse. it is second degree if not all uterus is coming out (ie you cannot get above it while palpating the uterus upwards) or if you can get above it means that the whole uterus had prolapsed and hence the third degree prolapse.
- Ask patient to be in the simms speculum (like the simms speculum itself the patient head is flexed and the hip is also flexed to make a C position). Now using a simms speculum and a sponge holder with gauze inserted, move the posterior wall of the vagina back and use the sponge holder to manipulate the front. Comment on the surface of the prolapsed mucosa (ie, ulcer, skin changes, infection, pus). Move the speculum downward a bit until you see a prolapse from posterior vagina. If the prolapse is higher up it is the enterocele and if it is lower down it is the rectocele. Also, comment on the surface.
- Do a rectovaginal exam by inserting the index finger into the vagina (ie like a VE) and the middle finger into the anus. You Should be able to gauge the thickness of both hence the size of her perineal body. The thinner the perineal body is, the weaker the supporting muscle it attaches too.
- Finish the examination by reintroducing the prolapse back into the vagina and reapply the pesssary. The pessary should be compressed and inserted upwards towards the umbilicus before released inside the vagina (ie the anatomical pelvic passage) remember to gauge the size of the pessary (by measuring tape)and clean it with antiseptic prior to reinsertion.
Other systems to examine:
p/s the is controversy over doing a pap smear or not because of the dry cervix)
1. Respiratory
2. Abdomen
3. Lower limb
4. Connective tissue defect like ehlers danhlos...
by,
A!!$!$! =p
Read more »
Posted by FaDhLi on Wednesday, December 15, 2010
CTG shown changing in baseline from 140bpm to 110bpm (bradycardia).
What are your actions?
Posted by FaDhLi on Monday, December 13, 2010
EFW 3.6 kg
or
EFW 4.2 kg
answer : click read more below
Posted by FaDhLi on Thursday, December 09, 2010
ask the patient whether they comply to take hematinics and other pills regularly everyday during antenatal period.
If yes, they may be compliance to COCP.
If no, may be you should suggest for another method.
source : wardround yellow team
Posted by FaDhLi on Thursday, December 09, 2010
no symptoms and signs of impending eclampsia
reflex - if hyperreflexia, keep in ward!
normal PE chart
normal vital signs
no protenuria
normal uric acid level
dont forget to re-admit for induction of labor at 38/52 weeks
source : wardround yellow team
Posted by FaDhLi on Saturday, December 04, 2010
in exam, you will definitely have to use pinard stethoscope to listen to fetal heart
no daptone for you (as far as i know)
you are not just have to listen, but you also have to count the fetal heart rate
read more below
Posted by FaDhLi on Friday, November 26, 2010
this is just updated information from medscape.
before you practice this update information, you should clarify it with lecturer, especially anaesthetist.
read the info below.
Posted by FaDhLi on Thursday, November 04, 2010
upper motor neuron and lower motor neuron
compare both.
read below.
Posted by FaDhLi on Thursday, November 04, 2010
DEFINITION FEVER
elevation of body temperature that exceeds the normal daily variation and occurs in conjunction with an increase in the hypothalamic set point—for example, from 37C to 39C (shift of the set point from “normothermic” to febrile levels)
CHILLS
a sensation of coldness
RIGORS
exaggerated shivering
how all of these related?
fever comes with abnormally high body temperature, but why the patient can has chills and rigors (or shivering)?
read more below
Posted by medik-ukm on Wednesday, November 03, 2010
heart rate
respiratory rate
blood pressure
temperature
pain score
i'm not very sure whether pain score is still the vital sign, but in 2008, KKM add in the 5th vital sign which is PAIN SCORE.
Posted by medik-ukm on Friday, October 22, 2010
Question
Why you cannot give dextrose to hyperemesis gravidarum patient?
Answer
Dextrose containing solutions should be avoided as they increase the body’s requirements for thiamine and thus increase the chance of precipitating Wernicke encephalopathy in a woman who is already thiamine deficient
thanks to Izzati Rani
===============================
additional information from wong yee ming
Dextrose infusion can always be considered if the patient is too hypoglycemic and could not tolerate orally. All we need is to supplement them with thiamine (IV thiamine can be given), preferably before dextrose infusion, although it's just to appease the myth that thiamine should be given before dextrose infusion. It's all based on clinical judgment, and no clear cut answer.
Posted by medik-ukm on Tuesday, October 19, 2010
[5 x (height in centimetre)] - 400
however, in exam, please mentioned that you will compare the result with PEF chart.
thanks to hanim
Posted by medik-ukm on Monday, October 18, 2010
|||suggested steps for informed consent for colonoscopy|||
ONE
Introduce; build rapport; greet
TWO
Explain what the patient have; possible diagnosis, based on the trigger given
THREE
Explain what is colonoscopy
FOUR
Indication for colonoscopy
PR Bleed
unexplained alter bowel habit
family history of cancer
IBD
FIVE
Procedure of colonoscopy
Bowel prep (explain how to bowel prep)
Register on the date
change cloth
Enema
LA / GA bring partner to ensure safety after the procedure because patient may still be in sedative state
Position left lateral
Insert per rectal
Insert air may cause abdominal discomfort, flatulence
Insert camera
Biopsy may be taken depending on findings
SIX
Possible findings during colonoscopy
bleeding
mass
ulcer
inflammation
SEVEN
Complication of colonoscopy
Bleeding
Perforation
Pain
EIGHT
Benefit
Diagnostic
Therapeutic
NINE
Let patient ask
TEN
If patient refuse, give alternative (patient has right to refuse; DONT FORCE)
alternative --> barium enema
Posted by medik-ukm on Monday, October 18, 2010
Describe the salient features. (5 marks)
Increased radiolucency right hemithorax
Trachea shifted to the left
Loss of vascular markings
Mediastinal shift
Collapsed right lung
What is the diagnosis. (3 marks)
Right Tension Pneumothorax
What is the immediate treatment? (2marks)
Needle thoracocentesis at right 2nd ICS midclavicular line
Posted by medik-ukm on Saturday, October 16, 2010
MOCK OSCE SURGERY
Demonstrate the method of male catheter bladder
SUGGESTION ANSWER
Introduce and greet
Explain to patient and obtain consent
Ensure privacy
ASEPTIC TECHNIQUE!
Prepare equipments
Wash hand and wear sterile glove.
Clean and drape
Squirt local anaesthetic gel into urethra
Hold penis upward position
Insert catheter gently
Check the drainage of urine; press bladder if no urine drained
Inflate balloon with amount of water (not normal saline!!! why not normal saline?) as stated on the catheter
Pull back catheter until resistance encountered
Connect catheter to urine bag
Posted by medik-ukm on Saturday, October 16, 2010
EXAMPLE OSCE SURGERY
A 68 years old female is admitted to the ward.
Clinically she is dehydrated and requires intravenous hydration.
You are the house officer in charge.
Please demonstrate the insertion of peripheral venous cannula.
||||||||||||||||||||||||||||||||||
SUGGESTION ANSWER
Introduce and greet
Explain to patient and obtain oral consent
Select appropriate site (where?)
Apply tourniquet
Clean with alcohol swab
Venepuncture made comfirmed by ‘flashback’
Advanced the cannula 2-3 mm into vein
Sheath advance into vein and needle withdrawn
Tourniquet released
Cannula secured with adhesive tape
Flush with saline prior to use to ensure cannula is in-situ
Posted by medik-ukm on Saturday, October 16, 2010
Medical students MUST know how to instruct patient on the technique of using Peak Expiratory Flow.
I dont know whether it can come out in exam, but i'm sure you will have to instruct the patient some other day, maybe when you become a houseman.
Sorry if there are any mistakes in the information below.
ONE
Your mouth must be empty.
For best results, you should stand.
If you are unable to stand, sit-up straight.
TWO
Set the peak flow meter to zero at the bottom of the meter.
THREE
Hold in your hand with your thumb and forefinger on the grips and the mouthpiece facing toward you.
Younger children may opt to hold the device with both thumbs underneath and fingers on the grips.
Avoid blocking the vent holes as much as possible and do not allow fingers to interfere with the Peak Indicator.
FOUR
Take as deep a breath as possible filling your lungs completely with air.
FIVE
Place your mouth on the mouthpiece, past your teeth and form a tight seal with your lips.
Place your tongue below the mouthpiece.
Make sure your tongue is not blocking the opening at any time.
SIX
Blow, or exhale, the air out into the meter as strongly (HARD!) and quickly (FAST!) as you can in a single blow.
This will cause the indicator to move and indicate your peak flow.
Do not spit or cough into the device. If this occurs, repeat this step again.
SEVEN
Reset peak indicator.
(some people say do not reset because the device will automatically point to only the best reading effort)
EIGHT
Repeat the whole test another two times more for a total of three maneuvers.
NINE
Once you have completed three maneuvers, record your best effort
(DO NOT TAKE THE AVERAGE!)
TEN
You have to know what is normal reading for you.
There is normogram based on age, height and weight. (find out yourself)
There is also a PEF chart. (find out yourself)
Is there any formula for the normogram? i cant find it~
Posted by medik-ukm on Saturday, October 16, 2010
Posted by medik-ukm on Thursday, October 14, 2010
Abdominal Pain or Tenderness
Persistent Vomiting
Clinical Fluid Accumulation (pleural effusion/ascites)
Mucosal Bleed
Restlessness or Lethargy
Tender Enlarged Liver
Increase in HCT concurrent with rapid decrease in platelet
Posted by medik-ukm on Monday, October 11, 2010
Stage 1slight reticular (slight granular) decrease in transparency of the lung, no certain difference to normal findings.
Stage 2Soft decrease in transparency with an aerobronchogram, which overlaps the heart (= always a sign of an alveolar lung reaction!)
Stage 3like stage 2, but with gradual stronger decrease in transparency, as well as a blurry diaphragm and heart.
Stage 4White lung: practically homogenic lung opacity
Synopsis of the changes in Stages I - IV.source :
http://www.kinderradiologie-online.de/radiology/20021110223558.shtml#a1
Posted by medik-ukm on Monday, October 11, 2010
The parameters assessed by inspection or auscultation of the upper and lower chest and nares on a scale of 0, 1 or 2 using this system are :
Chest movement
Synchronized vs. minimal lag or sinking of the upper chest as the abdomen rises. In the most extreme instances, a seesaw-like movement of the chest and abdomen is observed and would be given a score of 2.
Intercostal retractions
Retraction between the ribs is rated as none, minimal or marked.
Xiphoid retractions
Similarly retraction below the xiphoid process are rated as none, minimal or marked.
Nasal flaring
There should be no nasal flaring. Minimal flaring is scored 1 and marked flaring is scored 2.
Expiratory grunting
Grunting that is audible with a stethoscope is scored 1, and grunting that is audible without using a stethoscope is scored 2.
As you can see on the slide, the higher the score, the more severe the respiratory distress.
Posted by medik-ukm on Monday, October 11, 2010
Posted by medik-ukm on Monday, October 11, 2010
Explaining what a febrile seizure is.
A seizure occurring in association with fever in children between 3 months and 6 years of age, in whom there is no evidence of intracranial pathology or metabolic derangement
A febrile convulsion is not epilepsy. No regular medication is needed.
Children suffer no pain or discomfort during a fit.
Children usually have fewer febrile seizures as they get older and most seizures stop completely by the age of six.
Reassured with prognosis
Population risk of febrile seizure is 2.7% to 3.1%
Risk of recurrence of febrile seizure after first seizure is 27% to 32%
Risk of epilepsy after simple febrile seizures 1.5% to 2.4%
No evidence that any child has ever died as a result of simple febrile seizure
No evidence of permanent neurological deficits following febrile seizure
Children who have febrile convulsions normally grow up healthy and do not have any permanent damage from seizures.
Control the fever if their child has a febrile illness
Take of clothing and tepid sponging
Antipyretic e.g. syrup or suppository Paracetamol 15mg/kg 6 hourly. It is indicated for patient’s comfort, but has not been shown to reduce the recurrence rate rate of febrile seizure. carefully check the label for the correct dose
What to do to if their child has a further febrile seizure
Do not panic. Remain calm.
Note the time of onset of the fit and how long it lasted
Ensure the child is safe by placing them on the floor and removing any objects that he could hit against.
Loosen the child’s clothing especially around the neck
Place the child in recovery position (left lateral with head lower than the body)
Wipe any vomitus or secretion from the mouth
Do not insert any object into the mouth
Do not give any fluid or drugs orally
Stay near the child until the seizure is over and comfort the child as he is recovering
Ambulance should be called if :
seizure has lasted 5-10 or more minutes and shows no signs of stopping
parents are very worried and anxious
source : wardround in Hospital Slim River
Read more »
Posted by medik-ukm on Monday, August 09, 2010
Sail Sign
1) Elbow X-ray
-suggest an occult frature
-with some imagination, we can see the shape of a spinnaker (sail)
-it rise from the displacement of the fat pad around the elbow joint
-in children : suggest supracondylar fracture of the humerus
-in adult : suggest radial head fracture
2)Chest X-ray
-in adult : suggest left lower lobe collapse (cannot see left diaphragm margin)
-in children : at the mediastinum suggest thymus-->sharply demarcated triangle radiopacity (disappear on inspiration)
A114954
Posted by alvisto on Monday, July 26, 2010
There are 2 conditions which can cause this :
1. Somogyi Effect
2. Dawn Phenomenon
1. Somogyi Effect
- Also known as "rebound hyperglycemia"
- Usually due to:
- missed night meals despite taking insulin regularly
- a person who takes long-acting insulin without supper
- night/ long-acting insulin dose too high
- Relative Insulin Excess-> Early morning (2-3am) hypoglycemia -> Body's counter-regulatory mechanism activated -> Hormones (cortisol, glucagon, epinephrine) released to counter insulin effect -> Morning Hyperglycemia
2. Dawn Phenomenon
- Can occur in normal person
- Exaggerated response in diabetics
- In a normal human physiology, counter-regulatory hormones (cortisol, glucagon, epinephrine) are released during early morning hours to sustain blood glucose level without food. These hormones also antagonize insulin effect, hence there is a relative higher insulin resistance during the night.
- In patients with Type I diabetics esp, insulin production is low, hence there is an exaggerated Dawn phenomenon --> morning hyperglycemia
- It typically occurs (more often) in Type I diabetic patients during puberty or pregnancy due to marked production of counter-regulatory hormones (cortisol, glucagon, epinephrine, growth hormone), thus also causing exaggerated Dawn phenomenon.
How to differentiate then ?
Check blood sugar levels (Dextrostix) around 2 - 3 a.m. for several nights.
- If the blood sugar level is low at 2 a.m. to 3 a.m., suspect Somogyi effect (Rebound phenomenon).
- If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's most likely Dawn phenomenon.
(which is even more likely if the patient is a type I diabetic at early onset of puberty/ pregnancy, although Somogyi effect must be ruled out first)
How to prevent/treat ?
Somogyi effect
- Have regular meals and never skip them.
- Have a light snack (preferably protein) before bedtime.
- Go to bed with a glucose level slightly higher than usual.
- Bring your diabetic logbook (with your result of early morning 2am-3am blood glucose) while consulting your physician, in case your insulin dose may require adjustments.
Dawn Phenomenon
- Exercise later in the day. It may have more glucose-lowering effect throughout the night.
- Limit bedtime carbohydrates and try more of a protein/fat type of snack (nuts, peanut butter, cheese, or meat).
- Talk with your doctor of a possible medication adjustment (usually insulin) to control the higher fasting readings (common in DM Type I at onset of puberty).
- Eat breakfast to limit the dawn phenomenon’s effect. By eating, your body will signal the counterregulatory hormones to turn off. -> peliknya...
Why bother ?
Good blood glucose control is essential for diabetic patients. The adjustment of medication (insulin) dose depends on which is the culprit, as one needs to lower the blood glucose prior to bedtime (Dawn phenomenon) or increase the blood glucose level prior to bedtime (Somogyi effect).
Therefore, if the patient is having persistent morning hyperglycemia despite increased insulin dose, suspect Chronic Somogyi.
Thanks to Dr.Ngiu for asking us weeks ago.
Source : Wikipedia, 2 other internet sources (by Alvis Lee) -
July 26th, 2010
Edited by Wong Yee Ming -
May 15th, 2011
Read more »
Posted by medik-ukm on Monday, July 19, 2010
Infection: Inoculation of pathogen into normally sterile tissue
Systemic inflammatory response is triggered by ischaemc, inflammation, trauma, infection to protect the host from the damaging effect of insult. However, the response can be overexaggerated when the damage and insult is too great.
Systemic inflammatory response syndrome (SIRS) criteria---> 2 or more of the following:
- Temp: <36 or >38
- HR: > 90 bpm
- RR: > 20/ min
- WCC: >12 X 10^9/L or <4X10^9/L
- MAP: <65 mmHg (Systolic BP < 90 mmHg/ Diastolic BP < 60mmHg)
Sepsis: SIRS with the presence of infection (documented).
Severe sepsis : SIRS with organ dysfunction (SOFA criteria)
Septic shock : Sepsis-induced hypotension despite fluid resuscitation
Sepsis Organ Failure Assessment (SOFA) criteria
Goal in treating sepsis :
1. MAP > 65 mmHg (To maintain BP > 90/60 mmHg)
2. ScvO2 > 70%
3. CVP: 8-12mmHg
4. Urine output > 0.5ml/kg/h
Recap MAP calculation:
MAP : (systolic - diastolic)1/3 + diastolic
A114954
Edited by: Wong Yee Ming
Posted by medik-ukm on Monday, July 19, 2010
Rule Out Stroke In Emergency Room (ROSIER scale)
The aim of this assessment tool is to enable medical and nursing staff to differentiate patients with stroke and stroke mimics.
* Stroke is likely if total scores are > 0. Scores of completely excluded.
The ROSIER scale is not suitable for patients with suspected TIA with no neurological signs when seen. Please use the ABCD2 assessment for patients with suspected TIA. This assessment assists in the identification of patients with a high or low risk of early disabling stroke.
High risk TIA patients (scoring 5 or more on ABCD2 score) should be:-
�� Seen within 24 hours of the event at the TIA clinic (patients referred to the TIA clinic at the RVI need a TIA clinic referral form completed)
or
�� Out of hours (e.g. at weekends), contact the on-call Stroke Consultant and admit for review,
urgent investigation and initiation of secondary prevention.
Any patient with more than one episode in the last week is at a greater than 30% risk of stroke within a week and should be admitted to EAU for investigation and review by a Consultant Stroke Physician.
This ABCD2 scale is not a substitute for a full medical assessment.
The modified Rankin Scale (mRS) is widely used to assess global outcome after stroke.
A114954
Posted by medik-ukm on Friday, July 16, 2010
Please download more details BTS guideline info
HERE.
Thanks to Dr Ngiu for teaching us on British Thoracic Society (BTS) guidelines for investigation of unilateral pleural effusion.
A115262
Posted by medik-ukm on Thursday, July 15, 2010
Posted by alvisto on Thursday, July 15, 2010
1st one is Modified Ranking Score, to assess the functional status of a stroke patient (refer to previous post)
2nd one is NIHSS (National Institute of Heatlh Stroke Scale)
- a 15-item neurologic examination stroke scale used to evaluate the effect of acute cerebral infarction
- valid for predicting lesion size and can serve as a measure of stroke severity.
- to be a predictor of both short and long term outcome of stroke patients.
- serves as a data collection tool for planning patient care and provides a common language for information exchanges among healthcare providers. (comment author : Ya meh, tak dengar pun...)
Summary of what's in this complicated form of NIHSS
- Level of consciousness
- Best Gaze
- Visual
- Facial Palsy
- Motor Arm
- Motor Leg
- Limb Ataxia
- Sensory
- Best language
- Dysarthria
- Extinction and inattention (neglect)
For those who's interested, here's the link to the form
http://www.ninds.nih.gov/doctors/NIH_Stroke_Scale.pdf
Thanks to Dr. Ngiu for asking us this.
Read more »
Posted by alvisto on Thursday, July 15, 2010
CASE :Young male teenager presented with 1 week history of progressively worsening vision of his left eye. He claims that he cannot see well with that eye. He has fever and headache as well. He has severe facial acne.
Cranial nerve examination noted left sided external and internal opthalmoplegia,and loss of sensation over the left forehead. Other neurological examination is normal. What can be your diagnosis?
DISCUSSION :All the 3rd, 4th and 6th cranial nerves, together with opthalmic branch (V1) and maxillary branch (V2) run forward in the lateral wall of cavernous sinus.
V2 (maxillary branch of trigeminal nerve) leaves the mid-portion of cavernous sinus to exit the skull through foramen rotundum.
V3 （mandibular branch) langsung not in the lateral wall of cavernous sinus at all. Exits the skull through foramen ovale as soon as it leaves the trigeminal ganglion.
So,
Retrocavernous sinus -> 3 branches of CNV, CNIII, CNIV & CNVI
Posterior portion of cavernous sinus -> CNV1, CNV2, CNIII, CNIV & CNVI
Anterior portion of cavernous sinus -> CNV1, CNIII, CNIV & CNVI
Questions :1. What is the most likely diagnosis ?Lesions at the left anterior portion of cavernous sinus, which is most probably due to left cavernous sinus thrombosis secondary to facial acne.
2. What is internal and external opthalmoplegia ?Internal -> paralysis affecting only the sphincter muscle of the pupil and the ciliary muscle
External -> paralysis affecting one or more of the extrinsic eye muscles
Total opthalmoplegia -> Internal + External
3. Differential diagnosis ?
- Pituitary Tumour (Pituitary gland is situated between the left and right cavernous sinus)
- Intracavernous carotid artery aneurysm
- Cavernous-carotid arteriovenous fistula
- Metastases (eg, nasopharyngeal carcinoma extension)
- Meningioma
- Sphenoidal sinusitis
4. What other condition can present with similar conditions ?Lesions at superior orbital fissure -> Trauma, Tolosa-Hunt Syndrome (idiopathic granulomatous disease)
Reason : After cavernous sinus, CN3,4,6 and V1 bersama-sama enter superior orbital fissure. That's all.
5. Why facial acne cause Cavernous sinus thrombosis ?Facial acne -> Acne pecah -> Kebetulan acne burst at the place of danger area of the face -> bacteria enters Facial Vein -> ophthalmic vein connects facial vein and cavernous sinus, and because these connections are valveless, retrograde infections can spread from facial vein to cavernous sinus -> Thrombophlebitis of the cavernous sinus -> haha !
6. Other signs/symptoms of cavernous sinus thrombosis ?- Swollen eyelids, chemosis and proptosis
- Papilloedema
- Usually involves both eye
7. Name 1 condition very similar to cavernous sinus thrombosis ? State the difference.Orbital cellulitis. Jawapan dekat Dhingra pg 191.
Summary : Cavernous sinus thrombosis is more acute, involve both eyes.
8. How to confirm cavernous sinus thrombosis ?CT scan
9. Other source of cavernous sinus thrombosis ?Dhingra pg 191.
Please correct me if I am wrong, some of these questions is I sendiri fikir punya. Thanks.
Source : Red book of neuro examination, Dhingra, OxfordThanks to Dr. Yeoh for asking us this interesting case through facebook. It's very rare but it happens in Teluk Intan.
Read more »
Posted by medik-ukm on Tuesday, July 13, 2010
Thanks Dr Ngiu for asking us this question.
A115262
Posted by medik-ukm on Tuesday, July 06, 2010
| RED (admit hospital) | YELLOW (FM specialist or OnG speacialist) |
| *Eclampsia *PE- ↑BP with urine alb 1+/symptomatic/ BP> 160/110mmHg *heart problem with symptoms(palpitation n dyspnea *dyspnea on light activities *uncontrolled GDM or urine ketone≥ 1+ *pervaginal bleed *AbN fetal HR ^FHR≤110bpm after 26w ^FHR≥160bpm after 34w *symptomatic anemia *premature contraction *PROM *severe asthmatic attack | *HIV +ve *Hep B +ve *BP 140-160/90-110 mmHg with –ve urine alb *GDM *post date >7days |
| GREEN (MO) | WHITE |
| *rhesus –ve *mother wt <45kg *current medical prob (psy or OKU) *past gynae surgery *on drugs abuse, alcoholism, or smoker *recurrent miscarriage ≥3x *past obs hx: ^LSCS or instrumental delivery ^Hx of PIH,PE,E,GDM ^Baby birth wt <2.5 or >4.0 kg ^retained placenta or PPH ^stillbirth *twin pregnancy *urine alb 1+ *wt >80kg or increase wt >2kg/week *AbN lie at ≥36w *head not engaged at ≥38w for primid | White I (hospital) *primid *age <18 and > 40 year old *grandmultipara *gap between birth <2 years or > 5years *mother prob (ht <145cm, ibu tunggal) White II(home/alternative birth centre) *gravid 2-5 *no past obs hx, no medical prob, no cx after delivery. *ht >145cm *mother age >18, < 40 year old *married mother with good family support *POA >37 w and < 41w *estimated birth wt >2.5-3.5kg |
source: buku merah (buku f/up antenatal)
114289
another way to remember prerequisites is via mnemonic
Stage 1
Stage 2
Stage 3
Stage 4
Synopsis of the changes in Stages I - IV.
