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
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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
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