tag:blogger.com,1999:blog-83115941977098476612024-03-12T21:42:23.003-07:00MEdICaL InFO~Learning Medicine is like a bless, cause It's one of a world's miracle, It's a knowledge of God~N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.comBlogger30125tag:blogger.com,1999:blog-8311594197709847661.post-57483569081638938872011-05-21T09:12:00.000-07:002011-05-21T09:19:32.923-07:00Lower Limb Amputation<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj41u7zEvJPPLTe3tsecc98eP8qjJQ6kKWPwcn47YOUIW4er-kYoNBI3UpidZuQSee-ri3lU61FpUbG9byy-2Tn3IRrnoxyyCEMVCBwU4jsLvBupM2B_HIxVUCxMv_GM_UIPOCwLevZxUo/s1600/1230552-1232101-1232102-1232233.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj41u7zEvJPPLTe3tsecc98eP8qjJQ6kKWPwcn47YOUIW4er-kYoNBI3UpidZuQSee-ri3lU61FpUbG9byy-2Tn3IRrnoxyyCEMVCBwU4jsLvBupM2B_HIxVUCxMv_GM_UIPOCwLevZxUo/s400/1230552-1232101-1232102-1232233.jpg" width="341" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
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</div><span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="color: #666666; line-height: 16px;">1</span><span class="Apple-style-span" style="line-height: 16px;">) <u><span class="Apple-style-span" style="color: #741b47;">Hemipelvectomy</span></u></span></span><br />
<span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="line-height: 16px;"> Also called hindquarter amputation, which involves the excision of part of the pelvic bone</span></span><br />
<span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="line-height: 16px;"></span><span class="Apple-style-span" style="line-height: 16px;"><br />
</span><span class="Apple-style-span" style="line-height: 16px;">2) <u><span class="Apple-style-span" style="color: purple;">Hip disarticulation</span></u> </span></span><br />
<span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="line-height: 16px;"> Which is the amputation of the limb at the hip level</span></span><br />
<span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="line-height: 16px;"></span><span class="Apple-style-span" style="line-height: 16px;"><br />
</span><span class="Apple-style-span" style="line-height: 16px;">3) <u><span class="Apple-style-span" style="color: #38761d;">Transfemoral amputation</span></u> <span class="Apple-style-span" style="color: red;">(Above Knee Amputation)</span></span></span><br />
<span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="line-height: 16px;"></span><span class="Apple-style-span" style="line-height: 16px;"><br />
</span><span class="Apple-style-span" style="line-height: 16px;">4) <u><span class="Apple-style-span" style="color: #274e13;">Knee disarticulation</span></u></span></span><br />
<span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="line-height: 16px;"></span><span class="Apple-style-span" style="line-height: 16px;"><br />
</span><span class="Apple-style-span" style="line-height: 16px;">5) <u><span class="Apple-style-span" style="color: blue;">Transtibial amputation</span></u> <span class="Apple-style-span" style="color: red;">(Below Knee Amputation)</span></span><span class="Apple-style-span" style="line-height: 16px;"> </span></span><br />
<span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="line-height: 16px;"></span><span class="Apple-style-span" style="line-height: 16px;"><br />
</span><span class="Apple-style-span" style="line-height: 16px;">6) <u><span class="Apple-style-span" style="color: blue;">Syme amputation</span></u> </span></span><br />
<span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="line-height: 16px;"> Amputation at the level of the ankle joint, where the heel pad is preserved to provide </span></span><br />
<span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="line-height: 16px;"> a platform for weight bearing</span></span><br />
<span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="line-height: 16px;"></span><span class="Apple-style-span" style="line-height: 16px;"><br />
</span><span class="Apple-style-span" style="line-height: 16px;">7) <u><span class="Apple-style-span" style="color: #783f04;">Amputation of the foot:</span></u> </span></span><br />
<span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="line-height: 16px;"> Amputation is performed at the mid-foot, it is called a <span class="Apple-style-span" style="color: red;">Chopart</span> </span></span><br />
<span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="line-height: 16px;"> Amputation near the metatarsal is called a <span class="Apple-style-span" style="color: red;">Lisfrance</span></span></span><br />
<span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="line-height: 16px;"> Amputation through the metatarsal bones is called a <span class="Apple-style-span" style="color: red;">Transmetatarsal amputation</span></span></span><br />
<span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="line-height: 16px;"> Amputation of toe(s) plus part of metatarsal bone(s) is called <span class="Apple-style-span" style="color: red;">Ray Amputation</span></span></span><br />
<br />
<span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="line-height: 16px;">8) <u><span class="Apple-style-span" style="color: #783f04;">Disarticulation of Toe(s)</span></u></span></span>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-82283959647014554732011-05-21T06:36:00.000-07:002011-05-21T06:39:30.939-07:00Algorithm Management of Diabetic Foot Patient<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqq2ivMV2YZGscczULQiFnwPSz-mlqvWLitWWdbF3CwZ6L7Vu0G9b6SNLBDCR7SRU2yBB6by6IlU6yZIu0iKvdhyphenhyphenXOrJXRBcf7XpzfI3FA0ePFPrwVyllUkY0yWolTFuTM35eFKfhq1gE/s1600/DFU.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjqq2ivMV2YZGscczULQiFnwPSz-mlqvWLitWWdbF3CwZ6L7Vu0G9b6SNLBDCR7SRU2yBB6by6IlU6yZIu0iKvdhyphenhyphenXOrJXRBcf7XpzfI3FA0ePFPrwVyllUkY0yWolTFuTM35eFKfhq1gE/s640/DFU.png" width="469" /></a></div><div class="separator" style="clear: both; text-align: left;">* cut & paste from Malaysian Diabetic Foot CPG</div>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-14355250820035782952011-05-21T02:53:00.000-07:002011-05-21T02:55:30.761-07:00Types of Brian Herniation<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyF4tDqBhZqHVVxfSmY043hFLatKVerVglPv3R-6DjDbLU6BcKZ8peFSsAh2gJygBdyIN8NMTMmuECSIZwQ9Iguj7PfvR94GdbG6uZgEbw6oLI8-X7cjKPC8Twr3-_XuNqV07ErNd4jHM/s1600/Edu.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyF4tDqBhZqHVVxfSmY043hFLatKVerVglPv3R-6DjDbLU6BcKZ8peFSsAh2gJygBdyIN8NMTMmuECSIZwQ9Iguj7PfvR94GdbG6uZgEbw6oLI8-X7cjKPC8Twr3-_XuNqV07ErNd4jHM/s320/Edu.png" width="294" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div class="separator" style="clear: both; text-align: left;"><span class="Apple-style-span" style="line-height: 14px;"><b><u><span class="Apple-style-span" style="font-family: inherit;">Supratentorial herniation</span></u></b></span></div><div style="text-align: left;"><span class="Apple-style-span" style="line-height: 14px;"><b><u><span class="Apple-style-span" style="font-family: inherit;"><br />
</span></u></b></span></div><div style="line-height: 14px; text-align: left;"><span class="Apple-style-span" style="font-family: inherit;">1-Uncal</span> </div><div style="line-height: 14px; text-align: left;"><span class="Apple-style-span" style="font-family: inherit;">2-Central (transtentorial) </span></div><div style="line-height: 14px; text-align: left;"><span class="Apple-style-span" style="font-family: inherit;">3-Cingulate (subfalcine) </span></div><div style="line-height: 14px; text-align: left;"><span class="Apple-style-span" style="font-family: inherit;">4 Transcalvarial </span></div><span class="text_exposed_show" style="display: inline;"><span class="Apple-style-span" style="font-family: inherit;"></span></span><br />
<div style="text-align: left;"><span class="Apple-style-span" style="line-height: 14px;"><b><u>Infratentorial herniation</u></b></span><br />
<span class="Apple-style-span" style="line-height: 14px;"><b><u><br />
</u></b></span></div><div style="text-align: left;"><span class="Apple-style-span" style="line-height: 14px;">5-Upward (upward cerebellar or upward transtentorial) </span></div><span class="text_exposed_show" style="display: inline;"><span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="line-height: 14px;"><div style="text-align: left;">6 Tonsillar (downward cerebellar)</div></span></span></span><br />
<div style="text-align: left;"><br />
</div>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-39829293416445160792011-05-20T21:47:00.000-07:002011-05-20T21:48:21.702-07:00Proper X-Ray of Fractured Bone Must Have?<span class="Apple-style-span" style="background-color: yellow;">* Rules of 2</span><br />
<br />
1) 2 View --> AP & Lateral View<br />
2) 2 Joints --> prox & distal<br />
3) 2 Limbs --> in children particularly<br />
4) 2 Injuries --> exclude injuries elsewhere<br />
5) 2 Occasion --> repeat 1/ 2 weeks laterN_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-17702219102823099882011-05-20T08:47:00.000-07:002011-05-20T08:50:58.582-07:00Obstetric Ultrasound<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><u><span class="Apple-style-span" style="color: blue; font-family: inherit;"><b>1<sup>st</sup> Trimester (10-14 weeks)</b></span></u></div><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><span class="Apple-style-span" style="font-family: inherit;">-<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span><b style="mso-bidi-font-weight: normal;">Viability<o:p></o:p></b></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><span class="Apple-style-span" style="font-family: inherit;">-<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span><b style="mso-bidi-font-weight: normal;">Dating scan</b> (CRL)/ REDD (if diff > 7)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><span class="Apple-style-span" style="font-family: inherit;">-<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span><b style="mso-bidi-font-weight: normal;">Gross anatomy</b> – anencephaly, cystic hygroma, bladder outflow obstruction<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><span class="Apple-style-span" style="font-family: inherit;">-<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span><b style="mso-bidi-font-weight: normal;">Multiple pregnancy</b> – chorionicity, amnionicity <o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="color: red;"><b><u>2<sup>nd</sup> Trimester (18-24 weeks)</u></b></span><u><o:p></o:p></u></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><span class="Apple-style-span" style="font-family: inherit;">-<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span><b style="mso-bidi-font-weight: normal;">Dating Scan</b> (Biparietal diameter/ Head circumference)/ REDD (if diff >14)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><span class="Apple-style-span" style="font-family: inherit;">-<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span><b style="mso-bidi-font-weight: normal;">Structural anatomy</b> – brain, face, heart, kidneys, abdomen, spine, hands, feet, genitalia, bladder<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><span class="Apple-style-span" style="font-family: inherit;">-<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span><b style="mso-bidi-font-weight: normal;">Fetal growth</b> – IUGR/PE/Oligo<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><span class="Apple-style-span" style="font-family: inherit;">-<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span><b style="mso-bidi-font-weight: normal;">Fetal Sex</b> – 99% accuracy <o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><span class="Apple-style-span" style="font-family: inherit;">-<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span><b style="mso-bidi-font-weight: normal;">Placental site</b> – recheck @ 34 weeks <o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><u><span class="Apple-style-span" style="font-family: inherit;"><b><span class="Apple-style-span" style="color: purple;">3<sup>rd</sup> Trimester </span></b><o:p></o:p></span></u></div><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><span class="Apple-style-span" style="font-family: inherit;">-<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> <b> </b></span><b>EFW</b>: FL, AC, BPD<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><span class="Apple-style-span" style="font-family: inherit;">-<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span>Fetal Progression, well being, presenting part<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><span class="Apple-style-span" style="font-family: inherit;">-<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span class="Apple-style-span" style="font-family: inherit;"><b>Placenta Location</b> (> 28 weeks) </span><span class="Apple-style-span" style="font-family: Constantia, serif; font-size: 10pt;"><o:p></o:p></span></div>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com2tag:blogger.com,1999:blog-8311594197709847661.post-58306206915397712542011-05-20T00:17:00.000-07:002011-05-20T00:50:41.911-07:00List Of Medical Problems in Preterm Baby<b>1) BRAIN</b><br />
- Interventricular Hemorrhage<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSkhU8WlHyFY8nSGLPr77RsuyBiEiwsn1l1pGUKGq23SWHTE91qtwAYDWXXYEUICZ5BjBcYqhk5YBaJipAPfcBVz4ySg9X8iVIqB7IrXvB9sZlhE-itNzxtRd_E43Qfh3VWHCObsVPYVQ/s1600/brain_slice_revealing_an_interventricular_hemorrhage.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="233" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSkhU8WlHyFY8nSGLPr77RsuyBiEiwsn1l1pGUKGq23SWHTE91qtwAYDWXXYEUICZ5BjBcYqhk5YBaJipAPfcBVz4ySg9X8iVIqB7IrXvB9sZlhE-itNzxtRd_E43Qfh3VWHCObsVPYVQ/s320/brain_slice_revealing_an_interventricular_hemorrhage.jpg" width="320" /></a></div><br />
<b>2) EYE</b><br />
- Retinopathy of Prematurity<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg48XpY4oInVp6ypgSTttKEbq-7W167pPYoyLDvPB76F4iCF7MeQ0iJvF7gglEgKxczSjBCBGOoqYuNfwaOr51JewzElqxf0p2f6W_ZrjapEp_aX91wWNQlQYugMukhQmB6lbWmBCN7i1w/s1600/Study-Gives-Hope-Preemies-With-Retinopathy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg48XpY4oInVp6ypgSTttKEbq-7W167pPYoyLDvPB76F4iCF7MeQ0iJvF7gglEgKxczSjBCBGOoqYuNfwaOr51JewzElqxf0p2f6W_ZrjapEp_aX91wWNQlQYugMukhQmB6lbWmBCN7i1w/s1600/Study-Gives-Hope-Preemies-With-Retinopathy.jpg" /></a></div><br />
<b>3) RESPI</b><br />
- ARDS<br />
- Pneumothorax<br />
- Bronchopulmonary Dysplasia<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgamHV24EMB46BTb97VAfuUJWG0mZKq1w98F4psDqoBfdQ1xr5ZZdiimEf_h9FszuOb071N4aWl6FBITpb58or6zHSabl7b0TZSlkuveRbJI7ZmMWAr5IHNv5yrlyg4yXV2Da_91WtLn-w/s1600/1505_1516_3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="254" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgamHV24EMB46BTb97VAfuUJWG0mZKq1w98F4psDqoBfdQ1xr5ZZdiimEf_h9FszuOb071N4aWl6FBITpb58or6zHSabl7b0TZSlkuveRbJI7ZmMWAr5IHNv5yrlyg4yXV2Da_91WtLn-w/s320/1505_1516_3.jpg" width="320" /></a></div><br />
<b>4) CVS</b><br />
- PDA<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYwUkumrVntIR1b86bpEdXFQzj9GocoszWKmmpawrOdkDlUCD5Lhr0t7XTZlpICsFzYjjhaOezF0xq-JmQGDs-D17wQNv8zO_bcolOwfRcbLbfYaLr-44SiP4pQAlMAR3rF0X6IkKgofg/s1600/350px-Patent_ductus_arteriosus.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="249" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYwUkumrVntIR1b86bpEdXFQzj9GocoszWKmmpawrOdkDlUCD5Lhr0t7XTZlpICsFzYjjhaOezF0xq-JmQGDs-D17wQNv8zO_bcolOwfRcbLbfYaLr-44SiP4pQAlMAR3rF0X6IkKgofg/s320/350px-Patent_ductus_arteriosus.jpg" width="320" /></a></div><br />
<b>5) GIT</b><br />
- GERD<br />
- Jaundice<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2hXUHFmMP7QWHeANEq0b_DyLopBZOmxqVVU9jmNOtTNEcCN6CP4ekE56IkvgCalLE56UjoJzIPPU7B4JTpO8UiAFe0B5Dm_azds8jx2K0a4iCK2M-8Y4caeQin6LckEUYYrxWhBKBKf4/s1600/Jaunduce_baby.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2hXUHFmMP7QWHeANEq0b_DyLopBZOmxqVVU9jmNOtTNEcCN6CP4ekE56IkvgCalLE56UjoJzIPPU7B4JTpO8UiAFe0B5Dm_azds8jx2K0a4iCK2M-8Y4caeQin6LckEUYYrxWhBKBKf4/s320/Jaunduce_baby.jpg" width="249" /></a></div><br />
<b>6) METABOLIC</b><br />
- Hypoglycemia<br />
- Hypothermia<br />
- Hypocalcemia<br />
- Malnutrition --> Need more<br />
- Anemia<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPJOhKNRba3lDARIXWZVBeq_C_kvomnOnFsmypXqmhnH65zrLaYlvbXd5YQaWmUDDkNUcDixSq7wT4GsK2u5MkEXMO1-59so8Ne-3972MzZjLXx3TJB5LepzSNncGBriFd10gqTFhWj7g/s1600/malnourished_child.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="310" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPJOhKNRba3lDARIXWZVBeq_C_kvomnOnFsmypXqmhnH65zrLaYlvbXd5YQaWmUDDkNUcDixSq7wT4GsK2u5MkEXMO1-59so8Ne-3972MzZjLXx3TJB5LepzSNncGBriFd10gqTFhWj7g/s320/malnourished_child.jpg" width="320" /></a></div><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOBgprM1NSWf2DmrUZUShTOKZfd38hgiu6qDoe80Ejjr0NQHhnmUy1G4KEq_XGCYBabRipNz6nhyphenhyphen6tAtMjXxU3JDFyF6kmZicvQXwlmIOdQ1SWZM6Zp5OOwYklauhCX2j7mq-arXKngoc/s1600/anemia1a.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="198" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOBgprM1NSWf2DmrUZUShTOKZfd38hgiu6qDoe80Ejjr0NQHhnmUy1G4KEq_XGCYBabRipNz6nhyphenhyphen6tAtMjXxU3JDFyF6kmZicvQXwlmIOdQ1SWZM6Zp5OOwYklauhCX2j7mq-arXKngoc/s320/anemia1a.gif" width="320" /></a></div><br />
<br />
<b>7) IMMUNOSUPRESSED</b><br />
- Risk of Infection<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0tOJDf6CfPe2jqsBxAB9nofJZmdMff_bZm4Ecvjwz-qcPT6Hw4b0SgavmQe2OuqXQI5GPv9bvnKlVAJJjzYsRDwtUjowvCB0kJ4t-APN87_o3vKI4vJsXrISaBmcKHfJjq9f1KXuBho8/s1600/cytomegalovirus.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="281" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0tOJDf6CfPe2jqsBxAB9nofJZmdMff_bZm4Ecvjwz-qcPT6Hw4b0SgavmQe2OuqXQI5GPv9bvnKlVAJJjzYsRDwtUjowvCB0kJ4t-APN87_o3vKI4vJsXrISaBmcKHfJjq9f1KXuBho8/s320/cytomegalovirus.jpg" width="320" /></a></div>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-66862581749085519732011-05-19T21:21:00.000-07:002011-05-19T21:22:47.043-07:00HyperKalemia VS HypoKalemia<span class="Apple-style-span" style="background-color: yellow;">* Normal Serum <b style="mso-bidi-font-weight: normal;"><span style="line-height: 115%;"><span class="Apple-style-span" style="font-family: inherit;">K<sup>+ </sup></span></span></b>: 3.5 - 5.0 mmol/L </span><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAuNVFAhTN8-fabc8j65f9DgvoRamS7geLcWiUaFWSsQfNiXOHMOrMxyBpultwUQU-QwBoxtD41iKlP4cDOxZ6m4bhZqAzM-3StOn3PPkfNKpo5LZ1NRn9XYwTa9s7THMdXDCc6eD5ols/s1600/Hyper_HypoK.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAuNVFAhTN8-fabc8j65f9DgvoRamS7geLcWiUaFWSsQfNiXOHMOrMxyBpultwUQU-QwBoxtD41iKlP4cDOxZ6m4bhZqAzM-3StOn3PPkfNKpo5LZ1NRn9XYwTa9s7THMdXDCc6eD5ols/s640/Hyper_HypoK.png" width="564" /></a></div>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com1tag:blogger.com,1999:blog-8311594197709847661.post-53720120563522034892011-05-19T10:52:00.000-07:002011-05-19T10:56:51.239-07:00Contraindication of Tocolytic Agent<u><b style="background-color: lime;">ABSOLUTE</b></u><br />
1) Cardiac disease<br />
2) Hyperthyroidism<br />
3) APH<br />
4) Chorioamnionitis<br />
5) Cervix Os > 5 cm<br />
6) IUD<br />
7) Fetal Anomaly<br />
8) Fetal Distress<br />
<br />
<u><b style="background-color: lime;">RELATIVE</b></u><br />
1) PE/ Chronic HPT<br />
2) DMN_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-44876222887468596212011-05-19T06:42:00.000-07:002011-05-19T06:42:23.733-07:00FIGO STAGING: Cervical CA, Ovarian CA, Endometrial CA* First need to remember this;<br />
Staging of Cervical CA by Clinical, Ovarian CA by Surgical & Endometrial CA by Histopathology<br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9daK8SvcnOPtuOOsLTv8si2J4eYZHMtJ_QftONJ2OTvMrIU1_5VmobuXVm7WyF9a3ZSlta2dj0N65g7iGn2u3RBRTVOQPq-gzdS2YsAQvm81zGRVbZi7uQRGnUBmEIGELhzYYoZYjFFU/s1600/Cervix.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="306" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9daK8SvcnOPtuOOsLTv8si2J4eYZHMtJ_QftONJ2OTvMrIU1_5VmobuXVm7WyF9a3ZSlta2dj0N65g7iGn2u3RBRTVOQPq-gzdS2YsAQvm81zGRVbZi7uQRGnUBmEIGELhzYYoZYjFFU/s320/Cervix.png" width="320" /></a></div><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjggSOqEKxNgHpstNhDghQI2dDxP2-6mrSeNy496EVxz7HKd-HKNSTAO4VttFHh5RYyno9gZtsD161TaO_JMSuQcK25XdU5qU0bKi72MdwphvfsYi3rySjPgdj93nESe1rMYVsNNrZHvqA/s1600/Ovary.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="306" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjggSOqEKxNgHpstNhDghQI2dDxP2-6mrSeNy496EVxz7HKd-HKNSTAO4VttFHh5RYyno9gZtsD161TaO_JMSuQcK25XdU5qU0bKi72MdwphvfsYi3rySjPgdj93nESe1rMYVsNNrZHvqA/s320/Ovary.png" width="320" /></a></div><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjYDV-iTVyoaZBNzF_GjI3s9ZC8xfV9an-GdkzruHeItjql50V4-AKK-dXSEPBxndZI5snJhCU1CwedQyVjTBsRedLtqbW1-65s6dHMg6jzmYZ-CyKYFZbfGJnXmA7ecMylnyiffBvFRg/s1600/Endometrial.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="306" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjYDV-iTVyoaZBNzF_GjI3s9ZC8xfV9an-GdkzruHeItjql50V4-AKK-dXSEPBxndZI5snJhCU1CwedQyVjTBsRedLtqbW1-65s6dHMg6jzmYZ-CyKYFZbfGJnXmA7ecMylnyiffBvFRg/s320/Endometrial.png" width="320" /></a></div><br />
<br />
-------------------------------------------------------------------------------------------------------------<br />
<span class="Apple-style-span" style="font-size: x-small;">In Gynae Malignancy, this 3 cancer are very important; thus need to have at least a basic idea of their staging, because this will determine the management & prognosis of the patient </span>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-25123886014189836222011-05-19T05:44:00.000-07:002011-05-19T11:15:53.421-07:00Common Gynae Complaint & its Differentials1) <span class="Apple-style-span" style="background-color: yellow;"><u>Dysmenorrhea</u> </span><br />
- <u>Primary</u><br />
- <u>Secondary</u><br />
1) <span class="Apple-style-span" style="color: red;">Endometriosis </span><br />
2) Fibroid<br />
3) Adenomyosis<br />
4) PID <br />
<br />
2) <u style="background-color: yellow;">Menorrhagia</u><br />
1) <span class="Apple-style-span" style="color: red;">Fibroid </span><br />
2) Adenomyosis<br />
3) Endometrial Polyps<br />
4) Endometrial Hyperplasia<br />
5) Endometrial CA<br />
6) Hyperthyroidism<br />
7) DUB <span class="Apple-style-span" style="font-size: x-small;">(dx of exclusion)</span><br />
<br />
3) <u style="background-color: yellow;">Bleeding Early Pregnancy</u><br />
1) Abortion<br />
2) Molar Pregnancy<br />
3) Ectopic Pregnancy<br />
<br />
4) <u style="background-color: yellow;">Amenorrhea </u><br />
- <u>Primary </u><br />
1) Kallman Syndrome<br />
2) Gonadal Dysgenesis: <span class="Apple-style-span" style="color: red;">Turner Syndrome</span>, Testicular Feminizing Syndrome<br />
3) Uterus: <span class="Apple-style-span" style="color: red;">Mullerian Agenesis </span><br />
4) Vagina Atresia, Imperforated Hymen<br />
5) <span class="Apple-style-span" style="color: red;">Any Chronic illness of Childhood</span> eg: Thallasemia, CF etc <br />
<br />
- <u>Secondary </u><br />
1) Pituitary: Exercise, Stress, Eating d/o, Sheehan Syndrome, HyperProlactinemia,<br />
Hyper/HypoThyroid<br />
2) <span class="Apple-style-span" style="color: red;">Pregnancy <span class="Apple-style-span" style="font-size: x-small;">(most common) </span></span><br />
3) Menopause<br />
4) <span class="Apple-style-span" style="color: red;">PCOS</span><br />
5) Uterus: Asherman's Syndrome<br />
<br />
5) <u style="background-color: yellow;">Post-Menopausal Bleed</u><br />
1) <span class="Apple-style-span" style="color: red;">Cervical CA</span><br />
2) <span class="Apple-style-span" style="color: red;">Endometrial CA</span><br />
3) Endometrial Hyperplasia +/- Ovarian CA (Hormonal Secreting)<br />
4) Endocervical Polyps<br />
5) Atrophic Vaginitis <span class="Apple-style-span" style="font-size: x-small;">(most common)</span><br />
6) Bleeding Early Pregnancy<br />
7) Blood Disorder<br />
<br />
6) <span class="Apple-style-span" style="background-color: yellow;"><u>Infertility/Subfertilty</u> </span><br />
1) Uterus : Fibroid, Endometriosis<br />
2) Tubal: PID (adhesion), Tubal Pregnancy<br />
3) Ovary: PCOS, POF<br />
4) Husband Related<br />
5) Unexplained Fertility<br />
<br />
* Selamat Belajar*N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-49436234597579662072011-05-16T10:49:00.000-07:002011-05-16T10:51:43.645-07:00Metabolic Syndrome<div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicNjZFGyWVEMz2Jk2e2gxNWeWCD1PfghjgaCCEorvfQQ8aQpx5-YUjR-EIAcvIkh-vbaPaZZbIuTXZe1SbhSvo2QDRXQGv5X3AfSPaue-hu_WVHBqvwwQMrWwnSOI2TjfWtJFdf5MWLgg/s1600/Met+Syndrome.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEicNjZFGyWVEMz2Jk2e2gxNWeWCD1PfghjgaCCEorvfQQ8aQpx5-YUjR-EIAcvIkh-vbaPaZZbIuTXZe1SbhSvo2QDRXQGv5X3AfSPaue-hu_WVHBqvwwQMrWwnSOI2TjfWtJFdf5MWLgg/s320/Met+Syndrome.png" width="310" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div class="separator" style="clear: both; text-align: justify;"><strike>-------------------------------------------------------------------------------------------------------------</strike></div><div class="separator" style="clear: both; text-align: justify;"><span class="Apple-style-span" style="font-size: x-small;">I always forget the criteria to diagnose Metabolic Syndrome as I thought it is not much important, but nowadays... the incidence of Metabolic Syndrome is keep increasing as as result of Obesity and some other factors.... So you guys please remember this, I'm sure your lecturer going to ask about this quite often...</span></div><div style="text-align: justify;"><br />
</div>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-78966076131378649662011-05-16T04:24:00.001-07:002011-05-16T04:31:27.698-07:00Digital Rectal Examination (DRE) : What to Examine?<ol><li><span class="Apple-style-span" style="font-family: inherit;">No Contraindication for DRE:- <span class="Apple-style-span" style="color: red;">Pt refuse/ any painful anal condition</span></span></li>
<li><span class="Apple-style-span" style="font-family: inherit;">Inspection of Anal region </span></li>
<li><span class="Apple-style-span" style="font-family: inherit;">Insert Finger & check for anal tone</span></li>
<li><span class="Apple-style-span" style="font-family: inherit;">Intraluminal Examination - <span class="Apple-style-span" style="color: red;">any mass, impacted feces etc</span></span></li>
<li><span class="Apple-style-span" style="font-family: inherit;">Extraluminal Examination ---> eg: <span class="Apple-style-span" style="color: red;">Prostate</span></span></li>
<li><span class="Apple-style-span" style="font-family: inherit;">Removal Finger --> <span class="Apple-style-span" style="color: red;">Any melenic stool/ blood</span> etc</span></li>
</ol><div><br />
</div><div><br />
</div><div> *<span class="Apple-style-span" style="background-color: white;"> <u><span class="Apple-style-span" style="color: #20124d;">Painful Anal Condition</span></u></span></div><div><ol><li>Anal Fissure</li>
<li>Anal Fistula</li>
<li>Prolapse/Thrombosed Hemorrhoid</li>
<li>Perianal Abscess </li>
</ol></div><span class="Apple-style-span" style="font-family: inherit;"><br />
<span class="Apple-style-span" style="font-size: x-small;">* learnt from Mr Nazli credit to him </span></span>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-85593502145525130922011-05-14T20:52:00.000-07:002011-05-14T23:03:07.725-07:00Hernia Examination<span class="Apple-style-span" style="background-color: yellow;">INTRODUCE</span> & Ask if any pain over the examination area<br />
<br />
<span class="Apple-style-span" style="background-color: yellow;">ON LYING SUPINE</span><br />
1) <u><span class="Apple-style-span" style="color: red;">Expose properly</span></u>: Up to knee<br />
<br />
2) <u><span class="Apple-style-span" style="color: red;">Inspect: Testes & Groin</span></u><br />
- Testicular swelling/ redness/ loss of wrinkle/ displacement of median raphe/ scar<br />
- Groin swelling/ redness/ scar<br />
<br />
3) <u><span class="Apple-style-span" style="color: red;">Coughing Pulse</span></u><br />
- with b/L groin palpation --> if +ve (EXPANSILE)<br />
- then without palpation --> see the flow of swelling<br />
<br />
4) <u><span class="Apple-style-span" style="color: red;">Demonstrate inguinal ligament line</span></u><br />
- show the swelling above & lateral to the inguinal line<br />
<br />
5) <u><span class="Apple-style-span" style="color: red;">Palpation: Testis & Groin</span></u><br />
- Is the Testis separable, can get above the swelling, & feel for the cord<br />
- Feel for tenderness, temperature, consistency, surface, margin, translumination, compressible<br />
- Don't forget to measure the size of swelling/ or just estimate <br />
<br />
<div><span class="Apple-style-span" style="background-color: yellow;">ON STANDING </span></div><div> - Ask patient to<span class="Apple-style-span" style="color: red;"> put the swelling back in</span> (REDUCIBLE) </div><div> - Upon standing, <span class="Apple-style-span" style="color: red;">occlude deep inguinal ring</span> (2FB above midpoint of ing ligament) </div><div> & ask patient to stand</div><div> - Ask <span class="Apple-style-span" style="color: red;">patient to cough</span> & then release your hand</div><div> - See again the flow of swelling ---> sausage shape/ go from inguinal to scrotum</div><div> - Here probably can see the shape more clearly & can measure the size more accurately </div><div><br />
</div><div><span class="Apple-style-span" style="background-color: yellow;">COMPLETE</span></div><div> - Do Abdominal & PR Examination : Any evidence of Increase Intraabdominal Pressure</div><div> - Examine the Lungs --> any Lung problem, chronic cough </div><div><br />
<br />
<br />
</div><div style="text-align: left;"><span style="background-color: white;">-------------------------------------------------------------------------------------------------------------</span></div><div style="text-align: left;"><div style="text-align: justify;"><span style="background-color: white; font-size: x-small;">Hernia Examination is very tricky, most of the problem student encounter is whether to examine patient on lying supine first or straight away ask patient to stand? the answer is it depends on patient position at the time, if patient is at the time lying supine & you test for coughing pulse & not really demonstrable, I think better you ask patient to stand straight away and start your examination from standing, but if the swelling very obvious o lying supine & coughing pulse is positive, you can just follow the examination flow I recommended here</span></div></div>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-81722672717615356312011-05-14T20:11:00.000-07:002011-05-14T20:11:33.622-07:00Cushing Syndrome* Clinical syndrome resulting from excess circulating glucocorticoid<br />
<br />
<u>Causes</u><br />
1) <span class="Apple-style-span" style="background-color: cyan;">Exogenous</span>: <span class="Apple-style-span" style="color: red;">Steroid Toxicit</span>y <span class="Apple-style-span" style="font-size: x-small;">(Tx for Nephrotic, SLE, JRA, IBD) </span><br />
2) Endogenous : Adrenal CA/Adenoma, CAH, Cushing disease, Ectopic-ACTH<br />
<br />
<u>Head-to-Toe Examination</u> ---> Mainly for Exogenous Cause (as a cause for CS)<br />
<br />
1)<span class="Apple-style-span" style="background-color: yellow;"> <u>General</u></span><br />
- Orange on stick appearance<br />
- Central Obesity<br />
- Hyperpigmentation (ACTH-dep)<br />
<br />
2)<span class="Apple-style-span" style="background-color: yellow;"><u> Face</u></span><br />
- Moon Face, Plethoric Face, Acne, Hirsuitism, Frontal balding (female)<br />
<br />
3)<span class="Apple-style-span" style="background-color: yellow;"><u> Eyes</u></span><br />
- Cataract, Papilloedema (funduscopy)<br />
<br />
5) <span class="Apple-style-span" style="background-color: yellow;"><u>Oral</u></span><br />
- Candidiasis<br />
<br />
4) <span class="Apple-style-span" style="background-color: yellow;"><u>Back</u></span><br />
- Dorsal fat pad, Vertebaral tenderness (osteoporosis)<br />
- Neck: Skin Infxn<br />
<br />
5) <span class="Apple-style-span" style="background-color: yellow;"><u>Arms</u></span><br />
- Bruises, Thin skin, Skin Infxn (folds area), prox m/s wasting<br />
- Test for Prox Myopathy<br />
<br />
6) <span class="Apple-style-span" style="background-color: yellow;"><u>Fingers</u></span><br />
- Bad ungual infection<br />
<br />
7)) <span class="Apple-style-span" style="background-color: yellow;"><u>Abdomen</u></span><br />
- Central Obesity, Striae (purple/red), Scar (any reason)<br />
- Palpate --> Epigastric tenderness (>> steroid usage --> PUD)<br />
- Check for Ascites<br />
<br />
8) <span class="Apple-style-span" style="background-color: yellow;"><u>Legs</u></span><br />
- Bruises, Thin skin, Thin limbs, Prox m/s wasting<br />
- Palpate for leg edema also<br />
- Test for Prox Myopathy<br />
<br />
9) <span class="Apple-style-span" style="background-color: yellow;"><u>Complete with</u></span><br />
- BP --> HPT<br />
- RBS/ Dipstick --> DM<br />
- Weight & Height --> Growth Failure<br />
- Ask Hx of Long Steroid Tx<br />
- Any Bony pain/ patho# --> Osteoporosis<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjy8UrskOMdQjm_EvVUNqPVinaCdOk1MJ8zn1Shxi4JO5MbIwfQwsWrXwOZkJyG9IX2623ZgEKZ9Y9vqFrvv7_D-iPQ7rfMheT8MmL9X1RKhk9SYyHIJ663TIgqC0rQfLjRwcGzSaRcoos/s1600/X2604-C-74.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjy8UrskOMdQjm_EvVUNqPVinaCdOk1MJ8zn1Shxi4JO5MbIwfQwsWrXwOZkJyG9IX2623ZgEKZ9Y9vqFrvv7_D-iPQ7rfMheT8MmL9X1RKhk9SYyHIJ663TIgqC0rQfLjRwcGzSaRcoos/s320/X2604-C-74.png" width="219" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Graphic presentation of Cushing Syndrome</td></tr>
</tbody></table>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-80181015635886272192011-05-14T19:20:00.000-07:002011-05-14T19:21:11.571-07:00Principle Management of AGN<span class="Apple-style-span" style="background-color: cyan;">* In General NO specific Tx for AGN. The Tx is SYMPTOMATIC only</span><br />
<br />
1) <u><span class="Apple-style-span" style="background-color: yellow;">Confirm Dx</span> of AGN (Send Ix)</u><br />
- BP (High) --> <span class="Apple-style-span" style="color: red;"><span class="Apple-style-span" style="font-size: x-small;">plot at BP centile</span> </span><br />
- UFEME & C+S --> <span class="Apple-style-span" style="color: red; font-size: x-small;">RBC</span><br />
- BUSE --> <span class="Apple-style-span" style="color: red; font-size: x-small;">Renal Fx</span><br />
- Ser C3(<span class="Apple-style-span" style="font-family: 'Wingdings 3'; font-size: 15px; line-height: 17px;">$</span><span class="Apple-style-span" style="font-size: 15px; line-height: 17px;"><span class="Apple-style-span" style="font-family: inherit;">)</span></span>, C4 (n)<br />
- ASOT (>200 IU/mL)/ Throat/Skin swab & culture<br />
- FBC; Hb, TWBC<br />
<br />
2) <u>10 days course of <span class="Apple-style-span" style="background-color: yellow;">Penicillin</span></u><br />
- Initially IV C. Pen 30 mg/kg QID (1mg = 1667U)<br />
- Then change to PO Pen V 7.5-15 mg/kg QID<br />
<br />
3) <u><span class="Apple-style-span" style="background-color: yellow;">Tx Edema</span></u> (d/t salt & water retention)<br />
- ROF & salt intake<br />
<br />
4) <span class="Apple-style-span" style="background-color: yellow;"><u>Tx Hypertension</u></span> <span class="Apple-style-span" style="color: purple;">(Diuretics/ AntiHPT)</span><br />
- T. Frusemide 1-2 mg/kg BD<br />
- T. Nifedipine 0.5-1 mg/kg BD<br />
<br />
5) <span class="Apple-style-span" style="background-color: yellow;"><u>Tx Fever with Anti-Pyretics</u></span><br />
- PCM 15 mg/kg 4HRly (max 4g/day)<br />
* 1 Tab = 500 mg<br />
<br />
6) <u style="background-color: yellow;">Monitoring</u><br />
- Strict<span class="Apple-style-span" style="color: red;"> I/O Charting</span> (plus urine colour)<br />
- <span class="Apple-style-span" style="color: red;">Nephrotic Charting</span> (daily albumin & BP target < 90th centile)<br />
- VSx 4HRly<br />
- <span class="Apple-style-span" style="color: red;">RP daily</span> ---> Renal failure<br />
<br />
7) <u style="background-color: yellow;">Monitor for Cx & Tx appropriately</u><br />
- <span class="Apple-style-span" style="color: blue;">HPT Encephalopathy</span> --><br />
<span class="Apple-style-span" style="font-size: x-small;"> c/o headace, vomiting, blurry vision, seizure, altered conscious</span><br />
<span class="Apple-style-span" style="font-size: x-small;"> * do Fundoscopy </span><br />
-<span class="Apple-style-span" style="color: blue;"> Acute Cardiac Failure</span><br />
- <span class="Apple-style-span" style="color: blue;">Acute Renal Failure</span> <span class="Apple-style-span" style="font-size: x-small;">(Oliguria < <span class="Apple-style-span" style="font-family: inherit;">300 mg/m<sup>2</sup>/day)</span></span><br />
<span class="Apple-style-span" style="font-family: inherit;"> - <span class="Apple-style-span" style="color: blue;">Progressive Glomerulonephritis</span> </span><br />
<span class="Apple-style-span" style="font-family: inherit;"> - <span class="Apple-style-span" style="color: blue;">Nephrotic Syndrome</span> <span class="Apple-style-span" style="font-size: x-small;">(Pro; nephrotic range 3+/ > 1g/</span></span><span class="Apple-style-span" style="font-size: x-small;">m<sup>2</sup>/day)</span><br />
<div class="MsoListParagraph" style="line-height: normal; margin-left: 0cm; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: Kalinga, sans-serif;"><br />
<span style="color: #3366ff;"><o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: normal; margin-left: 0cm; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span class="Apple-style-span" style="font-family: inherit;">8) <span class="Apple-style-span" style="background-color: yellow;"><u>Follow Up</u></span></span></div><div class="MsoListParagraph" style="line-height: normal; margin-left: 0cm; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span class="Apple-style-span" style="font-family: inherit;"> - For at least 1 year</span></div><div class="MsoListParagraph" style="line-height: normal; margin-left: 0cm; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span class="Apple-style-span" style="font-family: inherit;"> - Monitor BP every visit</span></div><div class="MsoListParagraph" style="line-height: normal; margin-left: 0cm; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span class="Apple-style-span" style="font-family: inherit;"> - UFEME & RP ---> asses recovery</span></div><div class="MsoListParagraph" style="line-height: normal; margin-left: 0cm; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span class="Apple-style-span" style="font-family: inherit;"> - repeat C3 6 weeks later if not normalised on the time of discharge </span></div><div class="MsoListParagraph" style="line-height: normal; margin-left: 0cm; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span class="Apple-style-span" style="font-family: inherit;"><br />
</span></div><div class="MsoListParagraph" style="line-height: normal; margin-left: 0cm; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span class="Apple-style-span" style="font-family: inherit;">9) <span class="Apple-style-span" style="background-color: yellow;"><u>Outcome</u></span></span></div><div class="MsoListParagraph" style="line-height: normal; margin-left: 0cm; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span class="Apple-style-span" style="font-family: inherit;"> - Short term: Excellent, mortality < 0.5%</span></div><div class="MsoListParagraph" style="line-height: normal; margin-left: 0cm; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span class="Apple-style-span" style="font-family: inherit;"> - Long term: 1.8% dev CKD; should referred to Paeds Nephrologist</span></div> N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-3631756365610690752011-05-14T10:10:00.000-07:002011-05-14T10:15:20.516-07:00Down's Syndrome Features<span class="Apple-style-span" style="color: blue; font-family: Georgia, serif; font-size: medium; line-height: 29px;">My CHILD HAS PROBLEM</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-d3IoUZ16LXecITY3ntZpQsGmkFPWZqcQoDH66dlowBLFP3u5w1hMnED5eDu58yGer_SJDkHaOmRl1Yp8dJA976y3FOjWuDJ-RI-k8xWN49toeo4E3ViShn8Sc1o9q_At5cL0BVPMnig/s1600/Down-Syndrome-Child-1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="195" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-d3IoUZ16LXecITY3ntZpQsGmkFPWZqcQoDH66dlowBLFP3u5w1hMnED5eDu58yGer_SJDkHaOmRl1Yp8dJA976y3FOjWuDJ-RI-k8xWN49toeo4E3ViShn8Sc1o9q_At5cL0BVPMnig/s320/Down-Syndrome-Child-1.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Glemer tak adik nie.... hehe...</td></tr>
</tbody></table><span class="Apple-style-span"><span style="font-family: inherit; line-height: 20px;"><span class="Apple-style-span" style="color: red;"><b>C</b></span></span><span class="Apple-style-span" style="color: #333333; font-family: inherit; line-height: 20px;">ongenital heart disease/ </span><b style="font-family: inherit; line-height: 20px;"><span class="Apple-style-span" style="color: red;">C</span></b><span class="Apple-style-span" style="color: #333333; font-family: inherit; line-height: 20px;">ataracts</span><br />
<span class="Apple-style-span" style="color: red; font-family: inherit; line-height: 20px;"><b>H</b></span><span class="Apple-style-span" style="color: #333333; font-family: inherit; line-height: 20px;">ypotonia/ </span><span class="Apple-style-span" style="color: red; font-family: inherit; line-height: 20px;"><b>H</b></span><span class="Apple-style-span" style="color: #333333; font-family: inherit; line-height: 20px;">ypothyroidism</span><br />
<span class="Apple-style-span"><span class="Apple-style-span" style="line-height: 20px;"><span class="Apple-style-span" style="color: red;"><b>I</b></span>ncurve</span><span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="line-height: 20px;"> <span class="Apple-style-span" style="color: #333333;">5th finger/ </span><span class="Apple-style-span" style="color: red;"><b>I</b></span><span class="Apple-style-span" style="color: #333333;">ncreased gap between 1st and 2nd toe</span></span></span></span><br />
<span class="Apple-style-span" style="color: red; font-family: inherit; line-height: 20px;"><b>L</b></span><span class="Apple-style-span" style="color: #333333; font-family: inherit; line-height: 20px;">eukemia risk x2/ </span><span class="Apple-style-span" style="color: red; font-family: inherit; line-height: 20px;"><b>L</b></span><span class="Apple-style-span" style="color: #333333; font-family: inherit; line-height: 20px;">ung problem</span><br />
<span class="Apple-style-span" style="color: red; font-family: inherit; line-height: 20px;"><b>D</b></span><span class="Apple-style-span" style="color: #333333; font-family: inherit; line-height: 20px;">uodenal atresia/ </span><span class="Apple-style-span" style="color: red; font-family: inherit; line-height: 20px;"><b>D</b></span><span class="Apple-style-span" style="color: #333333; font-family: inherit; line-height: 20px;">elayed development</span></span><br />
<span class="Apple-style-span" style="line-height: 20px;"><span class="Apple-style-span" style="color: red;"><b><br />
</b></span></span><br />
<span class="Apple-style-span" style="line-height: 20px;"><span class="Apple-style-span" style="color: red;"><b>H</b></span></span><span class="Apple-style-span" style="line-height: 20px;"><span class="Apple-style-span" style="color: #333333;">irshsprung's disease/ </span></span><span class="Apple-style-span" style="line-height: 20px;"><span class="Apple-style-span" style="color: red;"><b>H</b></span></span><span class="Apple-style-span" style="line-height: 20px;"><span class="Apple-style-span" style="color: #333333;">earing loss</span></span><br />
<span class="Apple-style-span" style="line-height: 20px;"><span class="Apple-style-span" style="font-family: inherit;"> <span class="Apple-style-span" style="color: red;"><b>A</b></span><span class="Apple-style-span" style="color: #333333;">lzheimer's disease/ </span><span class="Apple-style-span" style="color: red;"><b>A</b></span><span class="Apple-style-span" style="color: #333333;">lantoaxial instability</span><br />
<span class="Apple-style-span" style="color: red;"><b>S</b></span><span class="Apple-style-span" style="color: #333333;">quint/ </span><span class="Apple-style-span" style="color: red;"><b>S</b></span><span class="Apple-style-span" style="color: #333333;">hort neck</span></span></span><br />
<span class="Apple-style-span" style="line-height: 20px;"><span class="Apple-style-span" style="color: red;"><b><br />
</b></span></span><br />
<span class="Apple-style-span" style="line-height: 20px;"><span class="Apple-style-span" style="color: red;"><b>P</b></span></span><span class="Apple-style-span" style="line-height: 20px;"><span class="Apple-style-span" style="color: #333333;">rotruding tongue/ </span></span><span class="Apple-style-span" style="line-height: 20px;"><span class="Apple-style-span" style="color: red;"><b>P</b></span></span><span class="Apple-style-span" style="line-height: 20px;"><span class="Apple-style-span" style="color: #333333;">alm crease single </span></span><br />
<span class="Apple-style-span" style="line-height: 20px;"><span class="Apple-style-span" style="font-family: inherit;"> <span class="Apple-style-span" style="color: red;"><b>R</b></span><span class="Apple-style-span" style="color: #333333;">ound face/ </span><span class="Apple-style-span" style="color: red;"><b>R</b></span><span class="Apple-style-span" style="color: #333333;">olling eye (nystagmus)</span><br />
<span class="Apple-style-span" style="color: red;"><b>O</b></span><span class="Apple-style-span" style="color: #333333;">cciput flat/ </span><span class="Apple-style-span" style="color: red;"><b>O</b></span><span class="Apple-style-span" style="color: #333333;">blique eye fissure</span><br />
<span class="Apple-style-span" style="color: red;"><b>B</b></span><span class="Apple-style-span" style="color: #333333;">rushfield spot/ </span><span class="Apple-style-span" style="color: red;"><b>B</b></span><span class="Apple-style-span" style="color: #333333;">rachycephaly</span><br />
<span class="Apple-style-span" style="color: red;"><b>L</b></span><span class="Apple-style-span" style="color: #333333;">ow nasal bridge/ </span><span class="Apple-style-span" style="color: red;"><b>L</b></span><span class="Apple-style-span" style="color: #333333;">anguage problem</span><br />
<span class="Apple-style-span" style="color: red;"><b>E</b></span><span class="Apple-style-span" style="color: #333333;">picanthic fold/ </span><span class="Apple-style-span" style="color: red;"><b>E</b></span><span class="Apple-style-span" style="color: #333333;">ar folded & low set</span></span></span><br />
<span class="Apple-style-span" style="line-height: 20px;"><span class="Apple-style-span" style="font-family: inherit;"> <span class="Apple-style-span" style="color: red;"><b>M</b></span><span class="Apple-style-span" style="color: #333333;">ental retardation/ </span><span class="Apple-style-span" style="color: red;"><b>M</b></span><span class="Apple-style-span" style="color: #333333;">yoclonus</span></span></span><br />
<span class="Apple-style-span" style="color: blue; font-family: Georgia, serif; font-size: medium; line-height: 29px;"></span><br />
<span class="Apple-style-span" style="color: blue; font-family: Georgia, serif; font-size: medium; line-height: 29px;"> </span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnunfNJmklz1Ax-JLdVGTW5tWi88Et6SRxDJGedSOE2Qk6HvIZW9wLtNHMUvkukIhPE3ASNgLS20EI1v2_SZhFmW6mMQlpu5di8G0srqMcjSObkgnQlcJ-rORdltGg4dKFHex8kUP7D9I/s1600/down-syndrome-head-to-toe-defects.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="292" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnunfNJmklz1Ax-JLdVGTW5tWi88Et6SRxDJGedSOE2Qk6HvIZW9wLtNHMUvkukIhPE3ASNgLS20EI1v2_SZhFmW6mMQlpu5di8G0srqMcjSObkgnQlcJ-rORdltGg4dKFHex8kUP7D9I/s320/down-syndrome-head-to-toe-defects.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Down's Syndrome: H to T</td></tr>
</tbody></table><br />
<span class="Apple-style-span" style="color: blue; font-family: Georgia, serif; font-size: medium; line-height: 29px;"><br />
</span>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-59326527087509818502011-05-14T09:47:00.000-07:002011-05-14T09:49:04.913-07:00Major Depressive Disorder: Major Criteria<span class="Apple-style-span" style="color: #333333; font-family: Georgia, serif; font-size: x-small; line-height: 20px;"><span style="color: #3366ff; font-size: 17px;">SPACE DIGS:</span></span><span class="Apple-style-span" style="color: #333333; font-family: Georgia, serif; font-size: x-small; line-height: 20px;"><br />
</span><br />
<ul style="font-family: Georgia, serif; font-size: small; line-height: 20px;"><li><span style="color: #3366ff; font-size: 17px;">S</span><span class="Apple-style-span" style="color: #444444;">leep disruption</span></li>
<li><span style="color: #3366ff; font-size: 17px;">P</span><span class="Apple-style-span" style="color: #444444;">sychomotor retardation</span></li>
<li><span style="color: #3366ff; font-size: 17px;">A</span><span class="Apple-style-span" style="color: #444444;">ppetite/Weight change</span></li>
<li><span style="color: #3366ff; font-size: 17px;">C</span><span class="Apple-style-span" style="color: #444444;">oncentration loss</span></li>
<li><span style="color: #3366ff; font-size: 17px;">E</span><span class="Apple-style-span" style="color: #444444;">nergy loss</span></li>
<li><span style="color: #3366ff; font-size: 17px;">D</span><span class="Apple-style-span" style="color: #444444;">epressed mood</span></li>
<li style="color: #333333;"><span style="color: #3366ff; font-size: 17px;">I</span>nterest loss</li>
<li><span style="color: #3366ff; font-size: 17px;">G</span><span class="Apple-style-span" style="color: #444444;">uilt</span></li>
<li><span style="color: #3366ff; font-size: 17px;">S</span><span class="Apple-style-span" style="color: #444444;">uicidal tendencies</span></li>
</ul><div class="separator" style="clear: both; text-align: center;"></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJq14KDGUyBoL-8LbzLzYRDiUFTUXbqTjSu7F2eWEye-J1m7v88KrizEEI-aNkmppKzbbfLR4rGO8F5aYdKM_Zuhqq-JdRi9LWFxNN3cTR4vulL_sZtBFVrXkek4OUwi4l8UGgmt6QJbE/s1600/depression.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJq14KDGUyBoL-8LbzLzYRDiUFTUXbqTjSu7F2eWEye-J1m7v88KrizEEI-aNkmppKzbbfLR4rGO8F5aYdKM_Zuhqq-JdRi9LWFxNN3cTR4vulL_sZtBFVrXkek4OUwi4l8UGgmt6QJbE/s320/depression.jpg" width="213" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Depression: Common among medical student (lagi2 dah nak exam nie..huhu)</td></tr>
</tbody></table><div><span class="Apple-style-span" style="color: #444444; font-family: Georgia, serif; font-size: x-small;"><span class="Apple-style-span" style="line-height: 20px;"><br />
</span></span></div>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-44304427124408238312011-05-14T08:27:00.000-07:002011-05-14T08:37:03.339-07:00Principle Management of Nephrotic Syndrome<span class="Apple-style-span" style="color: #274e13; font-family: inherit;">1) <u>Confirm Diagnosis</u></span><br />
<span class="Apple-style-span" style="font-family: inherit;"> - Fulfill the criteria:<span class="Apple-style-span" style="background-color: white;"> </span></span><br />
<span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="color: red;"><span class="Apple-style-span" style="background-color: white;"> </span><span class="Apple-style-span" style="background-color: yellow;"> > 1g/m<sup>2</sup>/day urine protein, Albumin < 25g/L, Gen Edema</span></span></span><br />
<span class="Apple-style-span" style="font-family: inherit;"> - Exclude secondary causes ---> </span><br />
<span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="color: red;"> </span><span class="Apple-style-span" style="color: red;"> I</span><span class="Apple-style-span" style="color: red;">nfection (Hep B, HIV. Malaria), Malignancy (Lymphoma, Leukemia), CTD (SLE)</span></span><br />
<span class="Apple-style-span" style="font-family: inherit;"><span class="Apple-style-span" style="color: red;"><br />
</span></span><br />
<span class="Apple-style-span" style="color: #274e13; font-family: inherit;">2) <u>General Measures</u></span><br />
- Control Edema ---><br />
<span class="Apple-style-span" style="color: purple;"> Normal protein & less salt diet, +/- Frusemide with caution (ROF in Chronic Edema) </span><br />
- Asses Hemodynamic (Hypo/Hypervolemia) ---><br />
<span class="Apple-style-span" style="color: purple;"> Daily Nephrotic Chart & I/O Chart</span><br />
- Penicillin V Prophylaxis ---> <span class="Apple-style-span" style="color: purple;">Dose according to age</span><br />
<br />
<span class="Apple-style-span" style="color: #274e13;">3) <u>General Advice</u></span><br />
- Nature of disease --><br />
<span class="Apple-style-span" style="color: blue;"> Most will relaspe (85%-95%) - Consult Dr if Pro 2+ in 3 conseq days/ edema+</span><br />
<span class="Apple-style-span" style="color: blue;"> Mostly idiopathic, Not affect renal fx</span><br />
- Home dipstick monitoring --> <span class="Apple-style-span" style="color: blue;">Once daily at early morning </span><br />
- Tx option & its Cx --><br />
<span class="Apple-style-span" style="color: blue;">Long Term Steroid, Cushing's, Immunocompromised (avoid infectious contact)</span><br />
- Immunization : Pneumococcal Vaccine --><br />
<span class="Apple-style-span" style="color: blue;"> Give during remission </span><br />
<br />
<span class="Apple-style-span" style="color: #274e13;">4)<u> Specific Tx for Primary Nephrotic Syndrome </u></span><br />
- Long Term Corticosteroid or<br />
- Cyclophosphamide --><span class="Apple-style-span" style="color: orange;"> </span><span class="Apple-style-span" style="color: #783f04;">For frequent relapse/ Steroid dependent </span><br />
<span class="Apple-style-span" style="color: #783f04;"> </span><span class="Apple-style-span" style="color: #783f04;"> </span>- Steroid Resistant --> <span class="Apple-style-span" style="color: #783f04;">Renal biopsy (specific Tx depend on HPE) + supportive </span><br />
<br />
<span class="Apple-style-span" style="color: #274e13;">5) <u>Manage Cx of Nephrotic Syndrome/ Cx of the Tx</u> (if any)</span><br />
- Hypovolemia --> <span class="Apple-style-span" style="color: #741b47;">Tx: Human Albumin fast infusion</span><br />
- Spont Bacterial Peritonitis --><span class="Apple-style-span" style="color: #4c1130;"> Tx: IV C. Pen + 3rd Gen Cephalosporin</span><br />
- Thrombosis --><span class="Apple-style-span" style="color: #4c1130;"> Prophylaxis</span><br />
<br />
- Cushing's Syndrome --> <span class="Apple-style-span" style="color: #4c1130;">Tx: Taper down steroid/ change to Cyclophosphamide </span><br />
- Immunocompromised --><span class="Apple-style-span" style="color: #4c1130;"> </span><br />
<span class="Apple-style-span" style="color: #4c1130;"> Immunization, avoid infectious contact, fever come to hospital</span><br />
- Acute Adrenal Crisis --><span class="Apple-style-span" style="color: #4c1130;"> when udergone stress TX : HCT/ Prednisolone </span><br />
- Loosing protein --> Muscle Wasting<span class="Apple-style-span" style="color: #4c1130;"> Tx: advice on diet (high calorie) </span>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-28807021300951611672011-05-14T01:43:00.000-07:002011-05-14T01:46:59.691-07:00Salter-Harris Fracture Classification<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNxy8Lx1Q9WP5N54pNRoL-WieIMp2PsdKfslqlOanimw0YNBsE2l4dlUwhKvaSx0czaGChV_CQ5OeBwbDP1U_Jz7Sj5NV6soj9VX6F6U7aoxHTZfC3tzfHifZ7A4pISFeX0ZSrJ9ADjZU/s1600/100305Figure24SalterHarrisD.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjNxy8Lx1Q9WP5N54pNRoL-WieIMp2PsdKfslqlOanimw0YNBsE2l4dlUwhKvaSx0czaGChV_CQ5OeBwbDP1U_Jz7Sj5NV6soj9VX6F6U7aoxHTZfC3tzfHifZ7A4pISFeX0ZSrJ9ADjZU/s1600/100305Figure24SalterHarrisD.gif" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-left: 18.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><span style="color: #333333; font-family: Symbol;">*<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> <b> </b></span></span><span class="apple-style-span"><span style="color: #333333; font-family: Kalinga, sans-serif;"><b>Type I </b>- fracture through the physis (widened physis)</span></span><span style="color: #333333; font-family: Kalinga, sans-serif;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 18.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><span style="color: #333333; font-family: Symbol;">*<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> <b> </b></span></span><span class="apple-style-span"><span style="color: #333333; font-family: Kalinga, sans-serif;"><b>Type II</b> - fracture partway through the physis extending up into metaphysic</span></span><span style="color: #333333; font-family: Kalinga, sans-serif;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 18.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><span style="color: #333333; font-family: Symbol;">*<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> <b> </b></span></span><span class="apple-style-span"><span style="color: #333333; font-family: Kalinga, sans-serif;"><b>Type III </b>- fracture partway through the physis extending down into the epiphysis</span></span><span style="color: #333333; font-family: Kalinga, sans-serif;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 18.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><span style="color: #333333; font-family: Symbol;">*<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span><span class="apple-style-span"><span style="color: #333333; font-family: Kalinga, sans-serif;"><b>Type IV</b> - fracture through the metaphysis, physis, and epiphysis -- can lead to angulation deformities when healing</span></span><span style="color: #333333; font-family: Kalinga, sans-serif;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-left: 18.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><span class="apple-style-span"><span style="color: #333333; font-family: Symbol;">*<span style="font: normal normal normal 7pt/normal 'Times New Roman';"> </span></span></span><span class="apple-style-span"><span style="color: #333333; font-family: Kalinga, sans-serif;"><b>Type V</b> - crush injury to the physis</span><o:p></o:p></span></div>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-59175145020193779572011-05-13T23:42:00.000-07:002011-05-13T23:59:36.748-07:00The 5 Ts of Right to left shunt<h3 class="post-title" style="line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0.25em; padding-bottom: 4px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="line-height: 20px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: small; font-weight: normal;">The <span class="Apple-style-span" style="color: purple;">5 Ts</span></span></span></h3><div class="post-body" style="line-height: 1.6em; margin-bottom: 0.75em; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><div style="line-height: 1.6em; margin-bottom: 0.75em; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">1. <span class="Apple-style-span" style="color: purple;">T</span>runcus arteriosus <span class="Apple-style-span" style="color: red;">(1 vessel)</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">2.<span class="Apple-style-span" style="color: purple;"> T</span>ransposition of great arteries <span class="Apple-style-span" style="color: red;">(2 vessels transposed)</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">3. <span class="Apple-style-span" style="color: purple;">T</span>ricuspid atresia <span class="Apple-style-span" style="color: red;">(3 =Tri)</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">4. <span class="Apple-style-span" style="color: purple;">T</span>etralogy of fallot <span class="Apple-style-span" style="color: red;">(4 =Tetra)</span></span><br />
<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;">5. <span class="Apple-style-span" style="color: purple;">T</span>otal anomalous pulmonary venous return <span class="Apple-style-span" style="color: red;">(5 =5 words)</span></span></div></div>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-44780882774253053772011-05-13T23:34:00.000-07:002011-05-13T23:36:59.523-07:00Clubbing: Causes<span class="Apple-style-span" style="font-family: Arial; font-size: 14px; line-height: 22px;"><span class="Apple-style-span" style="color: #444444;">CLUBBING CAUSES:..................CLUBBING</span></span><br />
<ul style="font-family: Arial; font-size: 14px; line-height: 22px;"><li><span style="color: #3366ff; font-size: 18px;">C</span><span class="Apple-style-span" style="color: #444444;">yanotic heart disease</span></li>
<li><span style="color: #3366ff; font-size: 18px;">L</span><span class="Apple-style-span" style="color: #444444;">ung disease (hypoxia, lung cancer, bronchiectasis, cystic fibrosis)</span></li>
<li><span style="color: #3366ff; font-size: 18px;">U</span><span class="Apple-style-span" style="color: #444444;">C/Crohn's disease</span></li>
<li><span style="color: #3366ff; font-size: 18px;">B</span><span class="Apple-style-span" style="color: #444444;">iliary cirrhosis</span></li>
<li><span style="color: #3366ff; font-size: 18px;">B</span><span class="Apple-style-span" style="color: #444444;">irth defect (harmless)</span></li>
<li><span style="color: #3366ff; font-size: 18px;">I</span><span class="Apple-style-span" style="color: #444444;">nfective endocarditis</span></li>
<li><span style="color: #3366ff; font-size: 18px;">N</span><span class="Apple-style-span" style="color: #444444;">eoplasm (esp. Hodgkins)</span></li>
<li><span style="color: #3366ff; font-size: 18px;">G</span><span class="Apple-style-span" style="color: #444444;">I malabsorption</span></li>
</ul><div><span class="Apple-style-span" style="color: #444444; font-family: Arial;"><span class="Apple-style-span" style="font-size: 14px; line-height: 22px;"><br />
</span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjza8GUeLJ0PqsDtkhFnxxKdt0fDpxjcnjWvjyr978d00Od8upjcwSeL5zMqG-btft9yWOd8kwgVMvfJZm29ezySJainAB8vD4k35iLz3W2miBRUMuEAeOcdMDT0uaG-lilhfvO9e-yrFQ/s1600/clubbing2small.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjza8GUeLJ0PqsDtkhFnxxKdt0fDpxjcnjWvjyr978d00Od8upjcwSeL5zMqG-btft9yWOd8kwgVMvfJZm29ezySJainAB8vD4k35iLz3W2miBRUMuEAeOcdMDT0uaG-lilhfvO9e-yrFQ/s320/clubbing2small.JPG" width="320" /></a></div><div><span class="Apple-style-span" style="color: #444444; font-family: Arial;"><span class="Apple-style-span" style="font-size: 14px; line-height: 22px;"><br />
</span></span></div>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-82011450877881839772011-05-13T23:21:00.000-07:002011-05-13T23:31:44.417-07:00Sequence of Elevated Enzyme Post-MI<h3 class="post-title" style="font-family: Georgia, serif; font-weight: normal; line-height: 1.4em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0.25em; padding-bottom: 4px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span class="Apple-style-span" style="color: #333333; font-size: x-small; line-height: 20px;">"<span style="color: #3366ff; font-size: 17px;">C</span>-<span style="color: #3366ff; font-size: 17px;">AST</span>-<span style="font-size: 17px;"><span style="color: #3366ff;">L</span></span>e" </span><span class="Apple-style-span" style="color: #333333; font-size: small; line-height: 20px;">(CASTLE):</span></h3><div class="post-body" style="font-family: Georgia, serif; font-size: small; line-height: 1.6em; margin-bottom: 0.75em; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><div style="line-height: 1.6em; margin-bottom: 0.75em; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><ul><li><span style="color: red; font-size: 17px;">C</span><span class="Apple-style-span" style="color: #444444;">K-MB.... first</span></li>
<li><span style="color: red; font-size: 17px;">AST</span><span class="Apple-style-span" style="color: #444444;">......... second</span></li>
<li><span class="Apple-style-span" style="color: #333333;"><span style="color: red; font-size: 17px;">L</span>DH</span><span class="Apple-style-span" style="color: #444444;">......... third</span></li>
<li><span class="Apple-style-span" style="color: #444444;">*Also: can use the last 'E' for</span><span class="Apple-style-span" style="color: #333333;"> </span><span style="color: red; font-size: 17px;">E</span><span class="Apple-style-span" style="color: #444444;">SR.</span></li>
</ul></div></div>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-27835999677446987022011-05-11T08:53:00.000-07:002011-05-11T08:55:08.808-07:00Respiratory Failure<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBGRL2N773Ovo1PSclrN7S-AVFFk1cdNRqyPucw5zzcMRTUWn0feT-HsMLCsT-70wAmBo48ov4YyFlMukNj6Nw7-38XPYiPXc-bVvmU5vQWGU-caLLn7xluYPPMoQv-GtyCjDTw_TfoEQ/s1600/Resp+Failure.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBGRL2N773Ovo1PSclrN7S-AVFFk1cdNRqyPucw5zzcMRTUWn0feT-HsMLCsT-70wAmBo48ov4YyFlMukNj6Nw7-38XPYiPXc-bVvmU5vQWGU-caLLn7xluYPPMoQv-GtyCjDTw_TfoEQ/s320/Resp+Failure.jpg" width="320" /></a></div><br />
* mintak maaf kualiti gambar kurang memuaskan tapi yg penting still boleh baca kan....N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-8307215500913947282011-05-10T14:20:00.000-07:002011-05-10T17:53:33.582-07:00Carpal Tunnel Syndrome : Causes<div><span class="Apple-style-span" style="font-family: Arial; font-size: medium;"><span class="Apple-style-span" style="line-height: 22px;">Mnemonic is MEDIAN TRAP</span></span></div><ul style="font-family: Arial; font-size: 14px; line-height: 22px;"><li><span class="Apple-style-span" style="color: #444444;"><span style="font-size: 18px;">M</span>yxoedema</span></li>
<li><span class="Apple-style-span" style="color: #444444;"><span style="font-size: 18px;">E</span>dema premenstrually</span></li>
<li><span class="Apple-style-span" style="color: #444444;"><span style="font-size: 18px;">D</span>iabetes</span></li>
<li><span class="Apple-style-span" style="color: #444444;"><span style="font-size: 18px;">I</span>diopathic</span></li>
<li><span class="Apple-style-span" style="color: #444444;"><span style="font-size: 18px;">A</span>gromegaly</span></li>
<li><span class="Apple-style-span" style="color: #444444;"><span style="font-size: 18px;">N</span>eoplasm</span></li>
</ul><ul style="font-family: Arial; font-size: 14px; line-height: 22px;"><li><span class="Apple-style-span" style="color: #444444;"><span style="font-size: 18px;">T</span>rauma</span></li>
<li><span class="Apple-style-span" style="color: #444444;"><span style="font-size: 18px;">R</span>heumatoid arthritis</span></li>
<li><span class="Apple-style-span" style="color: #444444;"><span style="font-size: 18px;">A</span>myloidosis</span></li>
<li><span class="Apple-style-span" style="color: #444444;"><span style="font-size: 18px;">P</span>regnancy</span></li>
</ul><span class="Apple-style-span" style="font-family: Arial; font-size: 14px; line-height: 22px;"><ins style="border-bottom-style: none; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; display: inline-table; height: 60px; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px; position: relative; visibility: visible; width: 234px;"></ins></span>N_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0tag:blogger.com,1999:blog-8311594197709847661.post-90430472153626712712011-05-01T10:02:00.000-07:002011-05-01T10:09:19.441-07:00Management of GAD/ Panic Disorder/ Phobia<span class="Apple-style-span" style="background-color: yellow;">* Manage as OUTPATIENT </span><br />
<br />
<b>INVESTIGATION</b><br />
<span class="Apple-style-span" style="background-color: lime;">1) BIO </span>:<br />
TFT, RBS, FBC (Hb),<br />
Urine for Drugs,<br />
ECG<br />
<br />
<span class="Apple-style-span" style="background-color: lime;">2) PSYSCO</span>:<br />
Collaborative hx from relatives, colleague, employer etc (find the stressor)<br />
<br />
<b>TREATMENT</b><br />
<span class="Apple-style-span" style="background-color: yellow;">1) BIO</span><br />
<span class="Apple-style-span" style="color: #351c75;"> <u>SSRi (1st line)</u> </span>----> <span class="Apple-style-span" style="color: red; font-size: x-small;">(Panic 1/2 dose AD, GAD = dose MDD)</span><br />
T. Escitalopram (Lexapro) 10-20 mg OM<br />
T. Sertraline ( Zoloft) 50-200 mg OM<br />
T. Fluoxantine (Proxac) 10-20 mg OM ---> <span class="Apple-style-span" style="color: blue; font-size: x-small;">DOC OCD/ Social Phobia</span><br />
<span class="Apple-style-span" style="color: #351c75;"> </span><span class="Apple-style-span" style="color: #351c75;"><u>Anxiolytic (BDZ)</u></span><br />
<span class="Apple-style-span" style="color: #351c75;"> </span>GAD ---> T. Diazepam 5 mg OD <span class="Apple-style-span" style="color: blue; font-size: x-small;">(Long Acting)</span><br />
Panic ---> T. Alprazolam 0.25-0.5 mg PRN <span class="Apple-style-span" style="color: blue; font-size: x-small;">(Ultra short) ----> xcont > 2 weeks can cause dependent </span><br />
<span class="Apple-style-span" style="font-size: x-small;"><span class="Apple-style-span" style="color: blue;"> </span><span class="Apple-style-span" style="color: #351c75;"> </span></span><span class="Apple-style-span" style="color: #351c75;"><u>+/- Beta Blocker</u></span><br />
<span class="Apple-style-span" style="color: blue; font-size: x-small;"><br />
</span><br />
<span class="Apple-style-span" style="background-color: yellow;">2) PSYCHOSOCIAL</span><br />
<span class="Apple-style-span" style="color: #351c75;"> <u>PsychoEducation (pt & family)</u></span><br />
- Reassurance --> not going to die/ be crazy<br />
- Nature of d/s ---> stress --> +CNS & increase adrenaline ---> phy symptoms<br />
if no stress ---> no symptoms<br />
- Important to identify the stressor & anticipate<br />
<br />
<span class="Apple-style-span" style="background-color: white; color: #351c75;"> <u>CBT</u></span><br />
- Cognitive : Modify & correct misinterpretation (catastrophic thinking)<br />
eg: List down +ve VS -ve quality you have<br />
- Behaviour: Relax/Breathing technique<br />
Distraction technique<br />
Stress Mx: Share!!!<br />
Problem Solving (table)<br />
<br />
<span class="Apple-style-span" style="color: #351c75;"><u>PsychoTx (Dynamic)</u></span> ----> <span class="Apple-style-span" style="color: red; font-size: x-small;">only for PHOBIA</span><br />
- Systemic Desensitization (with relaxation)<br />
- Gradual Exposure<br />
- Flooding<br />
<br />
<span class="Apple-style-span" style="background-color: yellow;">3) SPIRITUAL</span><br />
- Pray & Read Quran ----> can find piece (go back to your God)<br />
- Good deeds that you have ---> utilize it<br />
- I will pray for my patientN_MAMhttp://www.blogger.com/profile/15350158721429978895noreply@blogger.com0