funny how it looks

when you see an acidotic pH
bicarb also low: to may think its metabolic acidosis(can also look at lactate-to indicate sepsis)
but when you see the pCo2 is also high: co2 retention on the same time
-it is a mixed respiratory and metablic acidosis- occurs a lot a very sick patients

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basic breath sounds and heart sounds/murmurs

download here..hope this will be beneficial to refresh our memory.

click link below to download

breath sounds

heart sounds application

edited :)

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addition
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breath and heart sounds
(not sure whether it is the same with above or not...)

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Simple Acid-Base Disorders and Expected Compensation

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Contraindications to lumbar puncture

A lumbar puncture should not be performed in a patient with suspected meningococcemia when certain conditions are present. This is intended to minimize the risk for cerebral herniation or other adverse effect when there may be little additional information obtained from the CSF studies.

Contraindications to lumbar puncture:

(1) confident clinical diagnosis of meningococcal disease, with typical hemorrhagic rash

(2) drowsiness or impaired consciousness

  Glasgow coma scale <>

  deteriorating Glasgow coma scores

  signs of raised intracranial pressure

(3) focal neurologic signs

(4) signs of raised intracranial pressure, including marked instability in blood pressure and heart rate

(5) evidence of septic shock, with signs of poor perfusion

(6) infection at the planned lumbar puncture site

(7) moderate to severe bleeding disorder

Additional notes:

(1) A normal CT scan does not exclude a raised intracranial pressure.

(2) If lumbar puncture is not performed and the patient has not improved within 24 hours despite therapy, then reassess the need for lumbar puncture.

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Age Correction in Prematurely Born Infants

Premature infants are smaller and less developed than full term infants of the same postnatal age.
If the gestational age at birth is used to correct the postnatal age, then the development of the premature infant can be more meaningfully compared to normal infants.


corrected age in weeks
= (age in weeks since birth) - [40 - (weeks of gestation at birth)]


The age correction should be done for the first year.
Afterwards the correction has little if any benefit, and the chronological age can be used.

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2010 Rheumatoid Arthritis Classification Criteria

click image to enlarge

Application of these criteria provides a score of 0–10, with a score of >/= 6 being indicative of the presence of definite RA.

A patient with a score below 6 cannot be classified as having definite RA, but might fulfill the criteria at a later time point.

for details, you may need to read journal on "2010 Rheumatoid Arthritis Classification Criteria" by An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative

or

READ ONLINE HERE

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scabies

Treatment of scabies

topical medications:

1. topical benzyl benzoate lotion

• (25% for adults, 12.5% for children aged 3 to 12)
• 3 applications at 24-hour intervals

2. topical lindane (1%)

• 2 applications for 8 hours

3. topical permethrin 5% lotion

• single application, washed after 8 hours

4. crotamiton cream (eurax) repeat nightly for 3 to 5 nights

5. sulphur in calamine lotion: useful in pregnant or nursing mother and neonates

oral medication

• ivermectin
• 200ug/kg

Procedures

• apply the entire skin from neck below
• pay special attention to the groin, fingerwebs, toewebs

Adjuvant therapy

• antihistamine for relief of itch
• topical corticosteroids

Environment measures

• treatment of all close contacts even if asymptomatic
• wash all bed linens, towels and clothes that were worn in the 2 days before each application. use hot water.

source: if not mistaken it's from the dermato lecture

jh A111218

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addition pictures
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O&G : OBA

A 39 year old lawyer presents to Gynaecology clinic with a history of subfertility for the last 6 years and is keen to conceive. Ix revealed that she had anovulatory cycle and a normal semen analysis. What would be the most appropriate fertility treatment that you would offer for this patient?

A.Clomid to induce ovulation

B.GnRH injections to induce ovulation

C.Intrauterine insemination

D.IVF

E.Timed sexual intercourse

Key Points :
# subfertility --> male and female factors.
- male (semen - normal)
- female (ovulation / tubal / hypothalamic pituitary axis)
# 39 years old --> advanced maternal age.. reaching 40.. must do conception urgently
# keen to conceive --> need assisted conception
# most appropriate fertility treatment --> DEFINITIVE TX
- if Q asked most appropriate step --> not definitive..STEP

Choices :

1st : find the outlier (absolutely wrong!!!) --> timed sexual intercourse

2nd : find the "nampak sama tapi tak serupa"
- clomid : 1st line.. but need more time.. need to wait
- GnRH : 2nd line...still need to wait..need time..

so between IUI and IVF
best answer is IVF because it is "superior" (i'm not so sure)

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