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...
Posted by medik-ukm on Tuesday, July 06, 2010
General ECG Changes suggestive of acute MI1. New left ventricular strain pattern2. New Left Bundle Branch Block3. Q Waves (.04 sec and 1/3 height of R Wave)Unless isolated in Lead III 4. T Wave inversionUnless 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 ...
Posted by medik-ukm on Saturday, July 03, 2010
sorry because the picture not clear..
emmzesyra.blogspot....
Posted by medik-ukm on Saturday, July 03, 2010
Functions of cerebellum3 parts:1) vestibulocerebellum-maintain balance-controls eye movement2) spinocerebellum- enhance muscle tone-coordinate skilled voluntary movement3) 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·...
Posted by jh on Saturday, July 03, 2010
source: CP...
Posted by medik-ukm on Saturday, July 03, 2010
STAGES OF CHRONIC KIDNEY DISEASESTAGES OF DIABETIC NEPHROPATHYplease refer to other way to stage diabetic nephropathybased on clinical practice guideline.Learning Issue : How to calculate GFR?Cockcroft-Gault EquationA 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...
Posted by medik-ukm on Saturday, July 03, 2010
GOLD = Global Initiative for Chronic Obstructive Lung Disease;COPD = chronic obstructive pulmonary disease;FEV1 = forced expiratory volume in one second;FVC = forced vital capacity. A115...
Posted by jh on Saturday, July 03, 2010
sorry to say that this mnemonic sounds bad, but it aids the memory. :p Fluid overload (not respond to diuretics) Uraemia (with encephalopathy) periCarditishyperKalaemia (which not controlled by conservative measures) MEtabolic acidosis (which is severe)credit to Dr Yeo...
Posted by medik-ukm on Saturday, July 03, 2010
bad things about B-blocker
1)masking effect of hypoglycemia
2) slowing recovery of hypoglycemia
3) aggravate symptoms of peripheral vascular disease (cold extremities)
4) cause dyslipidemia
5) increase incidence of new onset DM
6) erectile dysfunction
7) night mares
B-blocker is contraindicated:
1) obstructive airway disease
2) severe peripheral vascular disease
3) 2nd and 3rd heart block
complications of alcohol
1) alcohol dementia
2) wernicke encephalopathy
3) korsakoff psychosis
4) hepatic encaphalopathy
5) alcohol dilated cardiomyopathy
6) fatty liver
7) liver cirrhosis
8)hepatocelullar carcinoma
9) thiamine deficiency
10) macrocytic anemia
11) coagulopathy
12)portal hypertension
13) subacute combine peripheral neuropathy
14) pancreatitis, pancreas carcinoma
15) decompernsated heart...
Posted by medik-ukm on Friday, July 02, 2010
IS IT ASTHMA?LEVELS OF ASTHMA CONTROLASTHMA SEVERITYASTHMA EXARCEBATIONA115...
Posted by medik-ukm on Friday, July 02, 2010
60 years old Malay female who was diagnosed to have hypertension and diabetis mellitus for 30 years presented to casualty with shortness of breath.Look at her age and time of diagnosis for DM and HPT. You should realize that this is a known case of young hypertension. She was diagnosed to have hypertension at age of 30.Remember to ask about :1) How she was diagnosed at that time?2) What was her symptoms at that time?3) Exclude secondary causes - what investigation?4) Where she was diagnosed? Some small clinic may not investigate for secondary hypertension which means that they did not treat the underlying cause of hypertension. Private hospital...
