MY SLIDESHARE

notes:

This is not my own link. I copy and paste it here from a websites called HOUSE OFFICER WORKSHOP MALAYSIA to share with you all. You can directly go to the websites and download other books here.

notes:

This is not my own link. I copy and paste it here from a websites called HOUSE OFFICER WORKSHOP MALAYSIA to share with you all. You can directly go to the websites and download other books here.

Hope this helps to guide you through the course somehow. I find it quite useful and helps me a lot during my posting as a medical student in the hospital.

notes:

This is not my own link. I copy and paste it here from a websites called HOUSE OFFICER WORKSHOP MALAYSIA to share with you all. You can directly go to the websites and download other books here.

Orthopaedic is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.

This is a useful book for your guidance in this posting. It helps me and my friends a lot. 

notes:

This is not my own link. I copy and paste it here from a websites called HOUSE OFFICER WORKSHOP MALAYSIA to share with you all. You can directly go to the websites and download other books here.

Fuhhh, I just told you guys that I don't want stroke patient this morning right? Turn out I went to see my patient and suddenly my patient that I got is a stroke patient. WOW. What a case... I almost broke into tears and I became very nervous. Thank God, Liyana was there helping me out to prepare for the case. She did all the research while I try to memorise and smoothing my CNS physical examination flows.

Nina was there too and helping me out with the physical examination. I'm blessed to have friends like them. My subgroup-mates also  very supportive and wish me luck with the patient.

I went to Mahsuri ward at 2.00 pm and starting to clerk the patient. Then I receive a message from Dr. Ong that I need to clerk Bed 15 instead Bed 2. I asked her for confirmation, and she said Bed 15 for me. Mann..

I called my friend and I told her our case had been swapped - giving her hints that she need to read about CNS examination and ischaemic stroke 2ry to cardioembolism instead CVS case. 

The CNS CASE

The patient was a 65 year old malay gentleman but seems old from his age. He has underlying Chronic Rheumatoid Heart Disease, Chronic Kidney Disease and Gouty Arthritis.
He came due to left upper and lower limb muscle weakness.

My case - The CVS patient

My patient was well cooperate and very friendly. 1 hour was not enough for me to clerk and did my examination (suprisingly!). 1 hour given to me was always enough before this, I wonder if changing my style by first listening to all the patient had to say is better than while listening I should jotted down everything and arrange it all together. Hmm. The latter seems better for me. 

My patient was a 43 year old, malay gentleman working as hawker and live in Melor, Kota Bharu. He is a smoker with history of 21 pack years for more than 30 years. He stopped smoking last month.

Patient is a known case of hypertension and also hypercholesterolnemia. He was diagnose with hypertension since 2 years ago and not compliance to medication. His hypercholesterolnemia was diagnosed last month and claimed compliance to medication.

His main complaint was chest discomfort, breathlessness and lethargy. Then nothing. Aiyoo. There was  5 days history admission to CCU  recently (last month) due to almost similar presentation but worsen than the current one. He was not aware of the diagnosis. But listening to his description about the symptoms is more likely like acute myocardial infarction or acute heart failure.

Upon physical examination, Apex beat was not displace (5th intercostal space, mid-clavicular line), there was thrills present at left sternal edge. Pansystolic murmur was heard best heard by diaphragm at mitral area and radiated to axilla - bloody hell it was mitral regurgitation! And I was so pleased with myself that I can finally differentiate the type of murmur. Bibasal crepitation was heard and there was no sacral and pedal edema. 

My differential diagnosis were Acute Coronory Syndrome and also Heart Failure. Dr. Ong asked me about the investigation I would done and management for Acute Coronary Syndrome Disease. She gave me good mark, Alhamdullilah !

Investigation I would carry out :

1) FBC - looking for any infections from total white count and looking for anemia from Hb level.

2) Coagulation Test

3) Renal profiles

4) Liver Function Test

5) Cardiac Biomarkers - Troponin & CKMB

6) ECG - ST elevation in Myocardial Infarction

7) Chest X-Ray - to look for any cardiomegaly or other underlying disease

8) Echocardiogram - To see the LVEF status, cardiac wall, cardiac contractility and to confirm mitral regurgitation

Management:

1) Airway

2) Breathing

3) Circulation

4) Give oxygen if patient still breathlessness

5) Primary PCI

6) Anti-fibrinolytic such as streptokinase or ateplase

7) Anti hypertensive drug - Frusemide

8) Educate patient

💕 READ HOW TO DIFFERENTIATE MURMURS 💕

Having difficulty in differentiating type of murmurs while auscultate a patient? Don't worry, you're not the only one ! Me too having the same problem since I was a 3rd year medical student. During that time, I was at Hospital Tanah Merah and I did not came across any patient with murmur. Cases were limited as it is a district hospital. All severe cases will be referred to Hospital Kota Bharu. So, I'm here now in Kota Bharu as a 4th year medical student. So many patient with interesting physical findings and most of them have murmur! YAY.

So here some tips I learnt from my prof and also from hospital specialist. One of my prof blog about it - A Simplified Approach to Cardiac Murmurs For Medical Students. And it is very helpful for me and makes my life easier. A bit confused in beginning but later you'll be okay. 

From the blog:

The basic principles are:

• if the murmur coincides with the first heart sound, it is a systolic murmur.

• If it doesn't coincide with the first heart sound, it is a diastolic murmur.

 

SOURCE : MY NOTES FOR USMLE

Schizophrenia is a serious brain disorder that distorts the way a person thinks, acts, expresses emotions, perceives reality, and relates to others. People with schizophrenia -- the most chronic and disabling of the major mental illnesses -- often have problems functioning in society, at work, at school, and in relationships. Schizophrenia can leave its sufferer frightened and withdrawn. It is a life-long disease that cannot be cured but can be controlled with proper treatment.

Contrary to popular belief, schizophrenia is not a split or multiple 

personality. Schizophrenia is a psychosis, a type of mental illness in which a person cannot tell what is real from what is imagined. At times, people with psychotic disorders lose touch with reality. The world may seem like a jumble of confusing thoughts, images, and sounds. The behavior of people with schizophrenia may be very strange and even shocking. A sudden change in personality and behavior, which occurs when schizophrenia sufferers lose touch with reality, is called a psychotic episode.

Anyone can get schizophrenia. It is diagnosed all over the world and in all races and cultures. While it can occur at any age, schizophrenia typically first appears in the teenage years or early 20s. The disorder affects men and women equally, although symptoms generally appear earlier in men (in their teens or 20s) than in women (in their 20s or early 30s). Earlier onset of symptoms has been linked to a more severe course of illness. Children over the age of 5 can develop schizophrenia, but it is very rare before adolescence.

At one time, doctors classified schizophrenia based on distinct subtypes:

Positive Symptoms of Schizophrenia

• Delusions: Delusions are strange beliefs that are not based in reality and that the person refuses to give up, even when presented with factual information. For example, the person suffering from delusions may believe that people can hear his or her thoughts, that he or she is God or the devil, or that people are putting thoughts into his or her head or plotting against them.
• Hallucinations: These involve perceiving sensations that aren't real, such as seeing things that aren't there, hearing voices, smelling strange odors, having a "funny" taste in your mouth, and feeling sensations on your skin even though nothing is touching your body. Hearing voices is the most common hallucinationin people with schizophrenia. The voices may comment on the person's behavior, insult the person, or give commands.
• Catatonia (a condition in which the person becomes physically fixed in a single position for a very long time).

• Talking in sentences that do not make sense or using nonsense words, making it difficult for the person to communicate or engage in conversation
• Shifting quickly from one thought to the next
• Moving slowly
• Being unable to make decisions
• Writing excessively but without meaning
• Forgetting or losing things
• Repeating movements or gestures, such as pacing or walking in circles
• Having problems making sense of everyday sights, sounds, and feelings

Is It Schizophrenia?

Making the Diagnosis

• Delusions (false beliefs that the person won’t give up, even when they get proof that they’re not true)
• Hallucinations (hearing or seeing things that aren’t there)
• Disorganized speech and behavior
• Catatonic or coma-like daze
• Bizarre or hyperactive behavior

WANT TO SEE OTHER SEMINAR PRESENTATION ?

 

SOURCE : MY NOTES FOR USMLE

 

credit: pinterest

credit: pinterest

credit: pinterest