Posted by FaDhLi on Saturday, December 25, 2010
another way to remember prerequisites is via mnemonicF-O-R-C-E-P-Sfind it yourselves :Dadvantages 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 CONS...
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...
Posted by FaDhLi on Wednesday, December 15, 2010
CTG shown changing in baseline from 140bpm to 110bpm (bradycardia).What are your actio...
Posted by FaDhLi on Monday, December 13, 2010
EFW 3.6 kgor EFW 4.2 kganswer : click read more be...
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 t...
Posted by FaDhLi on Thursday, December 09, 2010
no symptoms and signs of impending eclampsiareflex - if hyperreflexia, keep in ward!normal PE chartnormal vital signsno protenurianormal uric acid leveldont forget to re-admit for induction of labor at 38/52 weekssource : wardround yellow t...
Posted by FaDhLi on Saturday, December 04, 2010
in exam, you will definitely have to use pinard stethoscope to listen to fetal heartno daptone for you (as far as i know)you are not just have to listen, but you also have to count the fetal heart rateread more be...
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 belo...
Posted by FaDhLi on Thursday, November 04, 2010
upper motor neuron and lower motor neuroncompare both.read bel...
Posted by FaDhLi on Thursday, November 04, 2010
DEFINITION FEVERelevation 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)CHILLSa sensation of coldnessRIGORSexaggerated shiveringhow all of these related?fever comes with abnormally high body temperature, but why the patient can has chills and rigors (or shivering)?read more be...
Posted by medik-ukm on Wednesday, November 03, 2010
heart raterespiratory rateblood pressuretemperaturepain scorei'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 SCO...
Posted by medik-ukm on Friday, October 22, 2010
QuestionWhy you cannot give dextrose to hyperemesis gravidarum patient?AnswerDextrose 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 deficientthanks to Izzati Rani===============================additional information from wong yee mingDextrose 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 answ...
Posted by medik-ukm on Tuesday, October 19, 2010
[5 x (height in centimetre)] - 400however, in exam, please mentioned that you will compare the result with PEF chart.thanks to ha...
Posted by medik-ukm on Monday, October 18, 2010
|||suggested steps for informed consent for colonoscopy|||ONEIntroduce; build rapport; greetTWOExplain what the patient have; possible diagnosis, based on the trigger givenTHREEExplain what is colonoscopyFOURIndication for colonoscopyPR Bleedunexplained alter bowel habitfamily history of cancerIBDFIVEProcedure of colonoscopyBowel prep (explain how to bowel prep)Register on the datechange clothEnemaLA / GA bring partner to ensure safety after the procedure because patient may still be in sedative state Position left lateralInsert per rectalInsert air may cause abdominal discomfort, flatulenceInsert cameraBiopsy may be taken depending on findingsSIXPossible findings during colonoscopybleedingmassulcerinflammationSEVENComplication of colonoscopyBleedingPerforationPainEIGHTBenefitDiagnosticTherapeuticNINELet...
Posted by medik-ukm on Monday, October 18, 2010
Describe the salient features. (5 marks)Increased radiolucency right hemithoraxTrachea shifted to the leftLoss of vascular markingsMediastinal shiftCollapsed right lung What is the diagnosis. (3 marks)Right Tension PneumothoraxWhat is the immediate treatment? (2marks)Needle thoracocentesis at right 2nd ICS midclavicular line ...
Posted by medik-ukm on Saturday, October 16, 2010
MOCK OSCE SURGERYDemonstrate the method of male catheter bladderSUGGESTION ANSWERIntroduce and greetExplain to patient and obtain consentEnsure privacyASEPTIC TECHNIQUE!Prepare equipmentsWash hand and wear sterile glove.Clean and drapeSquirt local anaesthetic gel into urethraHold penis upward positionInsert catheter gentlyCheck the drainage of urine; press bladder if no urine drainedInflate balloon with amount of water (not normal saline!!! why not normal saline?) as stated on the catheterPull back catheter until resistance encounteredConnect 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 greetExplain to patient and obtain oral consentSelect appropriate site (where?)Apply tourniquetClean with alcohol swabVenepuncture made comfirmed by ‘flashback’Advanced the cannula 2-3 mm into veinSheath advance into vein and needle withdrawnTourniquet releasedCannula secured with adhesive tapeFlush 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.ONEYour mouth must be empty.For best results, you should stand.If you are unable to stand, sit-up straight.TWOSet the peak flow meter to zero at the bottom of the meter.THREEHold 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.FOURTake as deep a...
Posted by medik-ukm on Saturday, October 16, 2010
source : Diarrhea Case Report Form, Hospital Slim River.||||||||||||||||||||||||||||||||||||||||||||||bonus information :World Gastroenterology Organisation Practice Guideline of Acute Diarrhea Mac 2...
Posted by medik-ukm on Thursday, October 14, 2010
Abdominal Pain or TendernessPersistent VomitingClinical Fluid Accumulation (pleural effusion/ascites)Mucosal BleedRestlessness or LethargyTender Enlarged LiverIncrease in HCT concurrent with rapid decrease in plate...
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 opacitySynopsis of the changes in Stages I - IV.source : http://www.kinderradiologie-online.de/radiology/20021110223558.shtml...
Posted by medik-ukm on Monday, October 11, 2010
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Posted by medik-ukm on Monday, October 11, 2010
Download here :Multiupload : http://www.multiupload.com/RX9F53YQ6ARapidshare : http://www.multiupload.com/RS_RX9F53YQ6AMegaupload : http://www.multiupload.com/MU_RX9F53YQ6ADepositfile : http://www.multiupload.com/DF_RX9F53YQ6AHotfile : http://www.multiupload.com/HF_RX9F53YQ6AZhare : http://www.multiupload.com/ZS_RX9F53YQ6AUploading : http://www.multiupload.com/UP_RX9F53YQ6ASource : Bailey and Love, Surg...
Posted by medik-ukm on Monday, October 11, 2010
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Posted by medik-ukm on Monday, August 09, 2010
Sail Sign1) 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 fracture2)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)A114...
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...
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...
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...
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.A115...
Posted by medik-ukm on Thursday, July 15, 2010
~emmzesy...
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-...
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...
Posted by medik-ukm on Tuesday, July 13, 2010
Thanks Dr Ngiu for asking us this question.A115...
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...
