tag:blogger.com,1999:blog-45240602205251901402024-03-19T05:56:05.463-07:00ONNizuka MDONNizukahttp://www.blogger.com/profile/01002168409385777548noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-4524060220525190140.post-20574313320986313412010-09-08T11:58:00.000-07:002010-09-08T12:32:14.753-07:00Case 1 - Acute Pancreatitis48 years old/Malay/Male/P9G9<br /><br />No known Medical Illness, Admission from A&E department<br /><br />C/O - epigastric pain radiated to the back for 2/7<br /> - very severe pain, patient roll on the floor d/t abdominal pain<br /> - worsening today<br /> - no other complaint<br /><br />PE - vital sign (hypotension, normocardia, LG fever)<br /> - Alert, conscious, in pain, increasing sweating<br /> - Chest examination and CNS examination - NAD<br /><br /><span style="font-weight: bold;">Per Abdomen examination</span><br /><br />RHC and epigastric tenderness with guarding (the only physical findings)<br />no organomegally<br /><br /><span style="font-weight: bold;">Differential Diagnosis</span><br />Acute Pancreatitis<span style="font-weight: bold;"><br /></span>Perforated Peptic Ulcer<br />Acute Myocardial infarction<br />Acute cholecystitis<br /><br /><span style="font-weight: bold;">Investigations (yang penting dan related)</span><br />FBC, VBG, CXR, blood glucose, ECG all normal<br />Sr amylase - 1372 iu/L<br /><br /><span style="font-style: italic;">Presentation to dr was done on the day of patient's adm</span><span style="font-style: italic;">ission<br />Questions that dr asked were;</span><br /><span style="font-style: italic;">1. State your differential diagnosis (stated above - all accepted)<br />2. What are the investigations? (as stated above - all accepted)<br />3. What is your provisional diagnosis, why? (acute pancreatitis - diagnostic criterias includes<br /> abdominal pain radiated to the back, increase sr amylase >3 times normal (53-123) or CT scan showing signs of acute pancreatitis)<br /><br />Homework given</span><br /><span style="font-style: italic;">- What would you expect in this patient CT scan<br />- Anatomy of pancreas and blood supply (sup pancreaticoduodenal, inf pancreaticoduodenal and splenic arteries)<br /><br /><br /></span><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://academic.kellogg.edu/herbrandsonc/bio201_mckinley/f20-13at_pancreas_c.jpg"><img style="cursor: pointer; width: 578px; height: 453px;" src="http://academic.kellogg.edu/herbrandsonc/bio201_mckinley/f20-13at_pancreas_c.jpg" alt="" border="0" /></a><br /><span style="font-style: italic;"><br /><br />- Define acute pancreatitis, chronic pancreatits and acute on chronic pancreatitis<br />- Aetilogy of Acute Pancreatitis (I GET SMASHED - mneumonic)<br />- How ethanol cause acute pancreatits (state the hypothesis)</span><br /><span style="font-style: italic;">- Pathogenesis of Acute Pancreatitis (how gall stone cause pancreatitis)</span><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://static.howstuffworks.com/gif/adam/images/en/pancreatitis-indication-picture.jpg"><img style="cursor: pointer; width: 400px; height: 320px;" src="http://static.howstuffworks.com/gif/adam/images/en/pancreatitis-indication-picture.jpg" alt="" border="0" /></a><br /><span style="font-style: italic;"><br />- Parameters of Ranson's Scoring (mortality rate based on the scores)<br />- Management in this patient (this patient already Nil by Mouth, on Analgesic and strict IO chart)<br /></span><br /><span>Reliable information<br />1. http://en.wikipedia.org/wiki/Pancreatitis<br />2. Bailey and Love, Short Practice of Surgery</span><span style="font-style: italic;"><br /></span>ONNizukahttp://www.blogger.com/profile/01002168409385777548noreply@blogger.com1tag:blogger.com,1999:blog-4524060220525190140.post-13516719654815736762010-09-08T11:44:00.000-07:002010-09-08T11:58:19.958-07:00IntroductionMy 2nd posting after Paeds posting adalah Surgery posting. This is the posting I've been waiting for!!! yalah, minat betul kat surgeri ni kan, eventhough I have no idea where to start<br /><br />Benda yang jadi stress dalam surgeri Posting adalah Log Book requirement... 50 short cases, 5 long cases, 5 major and minor OT, 12 on calls, 5 ward rounds, 5 OGDS, 5 ERCP and 5 Colonoscopy plus 5 x attendance to Surgeri Clinics, 2 times to Paeds surgeri clinics, and all the procedures all in 6 weeks time.... tapi ada kebaikan juga buat log book macam ni, at least pada orang yang malas cam aku nih...<br /><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhP6bkVD-D_1EOfJTOajyW2684M1WKRJ8HUml047URQrvHwGdBn0iEMCqQLaHcDcc5-DyYXroK8LOYAiees2GN8p5fxBN-rdwuKw_qHqSc9KYfq2ymvbRZNtbcyqH-Vyuy021pMkLk6Pd3u/s1600/GraysGrossKidneyInAbdomen.gif"><img style="cursor: pointer; width: 243px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhP6bkVD-D_1EOfJTOajyW2684M1WKRJ8HUml047URQrvHwGdBn0iEMCqQLaHcDcc5-DyYXroK8LOYAiees2GN8p5fxBN-rdwuKw_qHqSc9KYfq2ymvbRZNtbcyqH-Vyuy021pMkLk6Pd3u/s320/GraysGrossKidneyInAbdomen.gif" alt="" id="BLOGGER_PHOTO_ID_5514618647334323634" border="0" /></a><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://anatomy.med.umich.edu/atlas/images/abdo_wall_gifs/a55.gif"><img style="cursor: pointer; width: 296px; height: 296px;" src="http://anatomy.med.umich.edu/atlas/images/abdo_wall_gifs/a55.gif" alt="" border="0" /></a><br /><br /><br /><span style="font-style: italic;">hmmm, nak bezakan picture ngan cadaver pun dah susah, inikan pulak orang hidup...<br /><br /></span>Basic knowledge is important bila masuk surgeri team nih, yalah kan, Anatomy and Physiology kena kuat betul...setiap kali sebelum OT, kena baca anatomy dulu siap2, kalau x jadi stress coz gambaran anatomy kat manusia hidup lain ngan cadaver ataupun gambar dalam Atlas, semua dipenuhi blood field.<br /><br />but on the bright side, exam agak OK coz xde long case nor short case, cuma Esei and if I'm not mistaken some MCQsONNizukahttp://www.blogger.com/profile/01002168409385777548noreply@blogger.com0tag:blogger.com,1999:blog-4524060220525190140.post-88120809748650640212010-09-08T11:06:00.000-07:002010-09-08T11:42:28.078-07:00IntroductionThis is my first posting untuk memulakan sesi terbaru Fasa III tahun 4 medical kat USM. its a lil bit tough as kitorang x pernah diexpose dari segi Klinikal (Physical examination) kat Paeds patient nih. By the way, paediatric patient encompassed of patient yang berumur 0 - 4 weeks (Neonates), less than 1 year (infant), 1-2 years (toddler), 2-5 years (young child), school age and teenager<br /><br />And here in USM, Log book untuk Paediatric xlah se-stress posting department laen (e.g Surgery), requirement pun agak basic je and depends with masing2 punya supervisor. Untuk 4th year med student, korang akan diassign ke 3 team = 6 Selatan - Team A (Neuro, Nephro and GI) and Day-care, Team B (Respi, CVS) and Infectious team, and Team NICU (kat ward NICU and 6U)<br /><br />Untuk buku pulak, I recommend buku "Handbook of Hospital Paediatrics" or "Paediatrics Protocol" (local author) and buku Nelson Paediatrics (Tebal punya). I wouldn't recommend buku "Illustrated Textbook of Paediatrics" aka Sunflower cause penerangan xdetail langsung (cuba bayangkan penerangan Acute Renal Failure 1 paragraph je tulis....)<br /><br /><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjapMlqNyyvoNA4Fzlt_pdQyEu8wuKgRy0VjIhzrvcOYiSM9iU8lAc7qTWYbdntrhiDrfNEPyCfxoOwowqE3_CcT7A15A-EnrsAUVhrW3Ln2ZFUxvQYSDApkZKGqLJKSB8sVWzblGfFiOwh/s1600/29062010102.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 320px; height: 240px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjapMlqNyyvoNA4Fzlt_pdQyEu8wuKgRy0VjIhzrvcOYiSM9iU8lAc7qTWYbdntrhiDrfNEPyCfxoOwowqE3_CcT7A15A-EnrsAUVhrW3Ln2ZFUxvQYSDApkZKGqLJKSB8sVWzblGfFiOwh/s320/29062010102.jpg" alt="" id="BLOGGER_PHOTO_ID_5514613546921590754" border="0" /></a><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEL1RC7ddlA5PIHn1NSBcEY11yDiynenQjTtl31ZVu1yepTwJsxLbuVwzisUuWasTUOkhMTny5FGLk1oXKuLXMOUe2VGpPXyuaa4GlRGoEd3WZNwJN7jafbQOmtpYG3Z0N9N_P9v3oWlMa/s1600/nelson.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 243px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEL1RC7ddlA5PIHn1NSBcEY11yDiynenQjTtl31ZVu1yepTwJsxLbuVwzisUuWasTUOkhMTny5FGLk1oXKuLXMOUe2VGpPXyuaa4GlRGoEd3WZNwJN7jafbQOmtpYG3Z0N9N_P9v3oWlMa/s320/nelson.jpg" alt="" id="BLOGGER_PHOTO_ID_5514613750415913170" border="0" /></a><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgS0xLKY0kTb0L3kpE-95MWrXmPdevYQp7ejduV-HFUxo1_BRYrWgQlqgJ87mtR5UOVft5J_I0Qdh60U4RA2QDEEu4F8AM4YMEBrP3MmUEf4iGEU-PhRnl3iagQ_C-V8e3ghUc5cV889m6p/s1600/pedilustr.png"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 154px; height: 209px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgS0xLKY0kTb0L3kpE-95MWrXmPdevYQp7ejduV-HFUxo1_BRYrWgQlqgJ87mtR5UOVft5J_I0Qdh60U4RA2QDEEu4F8AM4YMEBrP3MmUEf4iGEU-PhRnl3iagQ_C-V8e3ghUc5cV889m6p/s320/pedilustr.png" alt="" id="BLOGGER_PHOTO_ID_5514614438008740322" border="0" /></a><br />Untuk tips pulak, if possible, cover all patient in your respective team. Exam akan ada MCQ and long-case (exam posting) . Untuk long case, patient akan diambil dari ward 6 U dan 6 S sahaja. most of us dapat common case like AGE, Febrile Fits, Bronchiolitis dan Pneumonia, tapi ada gak dapat case relapse SLE, complex Cyanotic Congenital Heart Disease and AML.<br /><br /><br />So, kesimpulannya, korang pergi clerk satu patient, let say Pneumonia, then balik baca all about Pneumonia from definition up to the management. kira tengok patient then balik baca about the patient, macam tu je, InsyaAllah boleh ok dah untuk exam. Drug doses xpayah nak hafal unless common drugs cam Prednisolone for Nephrotic dllONNizukahttp://www.blogger.com/profile/01002168409385777548noreply@blogger.com0tag:blogger.com,1999:blog-4524060220525190140.post-19386736030417591232008-10-01T02:55:00.000-07:002008-10-01T02:58:59.947-07:00HaemoptysisHaemoptysis, coughing up blood atau batuk berdarah merupakan salah satu symptom yang patut diberi perhatian jugak<br /><br />Walaupun benda ni simple je patophysiology nya, tapi kena tau gak r pokoknya<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjoS7TbsolmcsCMfHsyin858J2I2KQ3jPx6-K3RNXo1VuL_Zlz6f8dX5JFk4wmduXDqO9OQKGbKi6MejFljNh25SY6zmNJjzT7cqvukcu4xPgpeufOehCJ21PTnqrqGICXviXpBhepZWf34/s1600-h/fig102+copy.jpg"><img dragover="true" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjoS7TbsolmcsCMfHsyin858J2I2KQ3jPx6-K3RNXo1VuL_Zlz6f8dX5JFk4wmduXDqO9OQKGbKi6MejFljNh25SY6zmNJjzT7cqvukcu4xPgpeufOehCJ21PTnqrqGICXviXpBhepZWf34/s320/fig102+copy.jpg" alt="" id="BLOGGER_PHOTO_ID_5252122678627506050" border="0" /></a><br /><br /><br />Chemical substance yang paling utama dalam proses haemoptysis n ialah Tissue Necrotizing Factor(TNF)<br />so, secara basicnya, disebabkan mechanism penghasilannya berbeza, kita tengok differential diagnoses nya dulu<br /><br />1. Bronchial carcinoma - ni senang je sebenarnya, asalkan nama belakang die carcinoma atau sarcoma, mesti refer pada malignancy atau cancer. so, yang kita tahu, secara general, malignant tumour, antonim pada benign mostly present with haemorrhage and necrosis (nota Foundation Block untuk bebudak medic USM). there you go, ada TNF, ada necrosis of blood vessel or tissue and leads pada haemorrhage, dan the only waya darah nak kuar is via coughing reflex, then, disebabkan itu, ada r haemoptysis, kan mudah?<br /><br />2. Chronic pneumonia and Tuberculosis - ni pun sama, bila dah nama chronic, mesti involve macrophage, iaitu cell yang terlibat dalam chronic inflammation. Macrophage ni plak selalunya secretes TNF sebagai chemical mediators untuk inflammatory proses. there you go again, ada TNF, maybe blood vessel wall turut cedera and akhirnya necrosis, then macam biasa r, akan ada haemoptysis<br /><br />3. Chronic bronchitis and bronchiectasis - selalunya disease ni, iaitu dilation of air sacs, particularly at bronchial level. so, bila dilation berlaku, mucus and semua particle akan prone untuk masuk kedalam and ke tempat yang dilated tu. so, senang cerita, katakan particle yang masuk tu bakteria, so, katakan lagi sekali bakteria tu menyebabkan chronic inflammatory process, then macrophage pun involve la kan. jadi, akan ada r TNF dan abes cerita<br /><br />4. Pulmonary Embolism - obstruction of pulmonary cappilary oleh embolus akan menyebabkan bahagian depan embolus tu xdapat bekalan darah coz dah di obstruct. so, lack of blood supply akan jadi lack of nutrient, dan menyebabkan tissue injury, yet akhirnya, TNF memainkan peranan dan blood vessel yang xdapat blood supply akan mengalami irreversible cell injury, atau necrosis, then, sambung sendiri crianya OK?<br /><br />unlike haematemesis, atau muntah darah, haemoptysis selalunya menyebabkan minor blood loss je dan xkan leads pada hypovolemic shock, tu je<br />any comment, pembetulan or suggestion? dialu-alukanONNizukahttp://www.blogger.com/profile/01002168409385777548noreply@blogger.com1tag:blogger.com,1999:blog-4524060220525190140.post-17185361446827683702008-10-01T02:04:00.000-07:002008-10-01T02:22:53.694-07:00Give up study? nak motivation?Almost semua daripada kita, especially masa nga study pernah mengalami satu perasaan yang dinamakan putus asa untuk teruskan perjuangan<br />Tak kira la pasal apa kita give up, contohnya, banyak sangat nak kena cover, susah sangat certain subjek tu, masalah dalaman, batin, masalah keluarga dan lain-lain<br /><br />Aku just nak share beberapa tips yang memang aku gunakan sekiranya aku menghadapi masalah macam tu<br /><br />1.Remember your parents - Kalau aku, aku selalu akan jadikan parents aku sebagai satu motivasi untuk aku terus berjuang. Yaloh, just fikir macam ni, korang di hantar ke sesebuah sekolah, institusi pengajian etc dengan satu tanggungjawab, untuk study. yalah, aku bet, sebelum parents korang balik lepas hantar korang ke sesebuah tempat pengajian, korang mesti ada janji kat diorang yang korang akan belajar bersungguh-sungguh kan? Well, menda tu jadi cam satu amanah and tanggungjawab yang besar giler dan memang susah nak ditanggung.just imagine, 2 perkataan je pun, "BELAJAR BERSUNGGUH-SUNGGUH". macam aku, kadang-kadang aku lupa gak janji aku kat diorang, yaloh, kadang-kadang aku ponteng kelas, xstudy, men game dan lain-lain. so, secara basicnya, memang susah nak tunaikan janji tu tapi at least kita kena try accomplish menda tu, r paling2 minimum pun<br /><br />2. Ingat masa depan - Well, masa depan hampir 90% bergantung pada akademik.Kecundang sekarang, kecundang r korang selama-lamanya. so, jangan jadi camtu, semua orang nakkan masa depan yang cerah, xde pun yang xnak. so, the only way is to study betul-betul. Mudah cakap, susah nak buat<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpurZwHg4lkg6ojBq6iD8smuxLDLvwXTaY7DdjoxPhIshvzpmflGBnqGOyvgNUfqoraDbEjk-yWghWHCONoKKYn8tSd3gj7RR65zPyZuxNgNlQby2h8QJjjQ9Hd2Y-drkI7l34nOcTeGhO/s1600-h/bull+copy.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpurZwHg4lkg6ojBq6iD8smuxLDLvwXTaY7DdjoxPhIshvzpmflGBnqGOyvgNUfqoraDbEjk-yWghWHCONoKKYn8tSd3gj7RR65zPyZuxNgNlQby2h8QJjjQ9Hd2Y-drkI7l34nOcTeGhO/s320/bull+copy.jpg" alt="" id="BLOGGER_PHOTO_ID_5252113296800715650" border="0" /></a><br /><br />3. Matlamat - Setkan satu matlamat cthnya masa u<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqBNfAj-s0oZIyAhByB36t0lwIoGJoeIfIY_qbtu_RQ0uIFIl4z6FI-kaKfT4gW1mOuqEHjWDjsonXaSlJtS4I9cRCiPJdGzT-cHM9s_ASdsK6TK0hziMbHcbrpOmNaWwZ_kbdv-GO3W9x/s1600-h/aim+copy.jpg"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqBNfAj-s0oZIyAhByB36t0lwIoGJoeIfIY_qbtu_RQ0uIFIl4z6FI-kaKfT4gW1mOuqEHjWDjsonXaSlJtS4I9cRCiPJdGzT-cHM9s_ASdsK6TK0hziMbHcbrpOmNaWwZ_kbdv-GO3W9x/s320/aim+copy.jpg" alt="" id="BLOGGER_PHOTO_ID_5252112957534763394" border="0" /></a>mur korang 24 tahun, korang mesti dah ada ijazah, Korang mesti dah jadi jutawan masa umur 30 tahun. Menda ni jangan dijadikan angan2 semata-mata, tapi usaha tu kena betul-betul dilaksanakan untuk capai sesuatu target tu<br /><br />So, harap menda ni boleh sedikit sebanyak membantu korang yang da start lemah semangat, tu jeONNizukahttp://www.blogger.com/profile/01002168409385777548noreply@blogger.com2