ECG changes in MI

General ECG Changes suggestive of acute MI

1. New left ventricular strain pattern

2. New Left Bundle Branch Block

3. Q Waves (.04 sec and 1/3 height of R Wave)

Unless isolated in Lead III

4. T Wave inversion

Unless isolated to Lead III or Lead V1

5. ST-T elevation (more than 1mm in limb or precordial leads)

6. ST depression in Lead V1, Lead V2 (Posterior MI)

7. Hyperacute T Waves (over 50% of preceding R)

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Brain in the CT scan

sorry because the picture not clear..

emmzesyra.blogspot.com

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Cerebellum: Knowing their functions then knowing their dysfunctions

Functions of cerebellum

3 parts:

1) vestibulocerebellum

-maintain balance

-controls eye movement

2) spinocerebellum

- enhance muscle tone

-coordinate skilled voluntary movement

3) cerebrocerebellum

-plan and initiate voluntary activity

-provide input cortical motor area

Cerebellar dysfunction

· Ataxia (unsteady widebased, limp on side of lesion, cannot walk in straight line)

· Scanning speech (dysarthria- cannot coordinate skilled voluntary movement)

· Dysmetria/ past pointing (unable to plan and initiate voluntary activity. Usually had problem to past his/her finger initially but still can reach at the end of process)

· Intentional tremor

· Unable to stop movement promptly- rebound phenomenon

· Dysdiadochokinesia

· Ipsilateral hypotonia

· Cerebellar nystagmus

· Pendular jerk

· Romberg’s test usually negative, positive when lesion at dorsal column tract

Function of basal nuclei:

5 components:

1. Caudate nuclei

2. Putamen

3. Globus pallidus

4. Subthalamic nucleus

5. Substantia nigra

Roles:

1. Inhibit muscle tone throughout body

2. Select and maintain purposeful motor activity

3. Suppress useless/unwanted pattern of movement

4. Coordinate slow, sustained movement

Dysfunction causes:

1. Hyperkinesia

· Chorea- rapid involuntary movement

· Athetosis- continous slow writhing movement(dance-like)

· Ballism/hemiballism- involuntary movement that are flailing, intense, violent

2. Hypokinesia

· Akinesia - difficult initiate movement

- Reduce spontaneous movement

· Bradykinesia - slowness of movement

Disease due to basal ganglia dysfunction:

1. Huntington’s disease

· Hyperkinetic due to loss of GABAergic pathway

· Autosomal dominat (chr 4)

· Early: jerk trajectory of hand when reaching to touch spot

· Later: hyperkinetic choreiform

· Slurred speech

· Progressive dementia

· Death 10-25 years after onset

2. Parkinson disease

· Both hyperkinetic (rigidity and tremor) and hypokinetic (akinesia and bradykinesia)

· Sporadic idiopathic/ familial

· Loss of dopaminergic neuron and dopamine receptors in basal ganglia

source: lecture note second year by Prof Ruszymah

*alert: this info can be ask during short or long cases (in case dpt parkinson and cerebellar disorder)

~emmzesyra~

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diabetic nephropathy staging

source: CPG

JH

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Chronic Kidney Disease VS Diabetic Nephropathy

STAGES OF CHRONIC KIDNEY DISEASE

STAGES OF DIABETIC NEPHROPATHY

please refer to other way to stage diabetic nephropathy
based on clinical practice guideline.

Learning Issue : How to calculate GFR?

Cockcroft-Gault Equation

A commonly used surrogate marker for estimate of creatinine clearance is the Cockcroft-Gault formula, which in turn estimates GFR:It is named after the scientists who first published the formula, and it employs serum creatinine measurements and a patient's weight to predict the creatinine clearance. The formula, as originally published, is:

When serum creatinine is measured in µmol/L:


Where Constant is 1.23 for men and 1.04 for women.

One interesting feature of the Cockcroft and Gault equation is that it shows how dependent the estimation of CCr is based on age. The age term is (140 - age). This means that a 20-year-old person (140-20 = 120) will have twice the creatinine clearance as an 80-year old (140-80 = 60) for the same level of serum creatinine (120 is twice as great as 60). The C-G equation also shows that a woman will have a 15% lower creatinine clearance than a man at the same level of serum creatinine

Thanks to Dr Ngiu for asking us to compare between CKD and diabetic nephropathy.

A115262

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GOLD Staging System for COPD Severity

GOLD = Global Initiative for Chronic Obstructive Lung Disease;
COPD = chronic obstructive pulmonary disease;
FEV1 = forced expiratory volume in one second;
FVC = forced vital capacity.

A115262

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indication for dialysis (the mnemonic)

sorry to say that this mnemonic sounds bad, but it aids the memory. :p

Fluid overload (not respond to diuretics)

Uraemia (with encephalopathy)

periCarditis

hyperKalaemia (which not controlled by conservative measures)

MEtabolic acidosis (which is severe)

credit to Dr Yeoh

JH

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