Late onset of Hypogonadism

This is an article by Prof Zul regarding Hypogonadism.......interesting read :)

Shrinking willies

What i'm planning next week

1) Go labour room observe vagina.....NO!! i mean observe delivery
2) Go medicine ward, slaughter anyone who want to be slaughtered in short case
3) Go watch madagascar II
4) ?go back melaka for a day or 2
5) Go......go.......aiya where else a.....go.....whatever la..

Gender Poser

Gender uncertainty....looks like there's many things which need research......Paktorlogist sekalian...please take note haha

Gender Poser

Sorry, this have nothing to do with Medicine..Just to pen my thoughts..

Yoga is Haram for muslims, says NFC

So i don't know what the fuss is. everyone is politicking this issue to make it sound as if Hinduism is banned in malaysia.

Why in the blue hell the non muslims must worry about this ban? Why they keep criticising the ban? The ban only applies for muslims. Any objections, should come from muslims la! I don't see why the non muslims should go on critisising one of the highest muslim authority in malaysia! Dont be so kepoh la.....they ban that's their problem....tak kena mengena with you all one!

National Fatwa council say that yoga should not be practiced by the muslims......only the muslims...understand? That's their law, we should respect although we may not agree with their reasons. After all, again i would like to reiterate, it only applies to muslim!! Non muslim want to practice yoga, go on practicing till become dhalsim oso nobody will disturb you!

Sometimes, i think that somehow, people of malaysia really DO forget the Federal Constitution. or maybe the newer generation don't know about Article 153 of the federal Constitution....Maybe should make Pengajian Am compulsary for form 1 students onwards. After all, i learn more useful things from 1 year of Pengajian Am compared to 5 years of Sejarah

For the sake of unity, stop the squabble la.....Do not question something you don't know...
small small matter want to make big big....nothing better to do ah?

Does size matter?

Important for life ok!:D

Concerns about the size of genital organs are often unwarranted.
MOST humans are concerned about the size of objects. For many, big is beautiful up to a point after which, it may become ugly. For others, small is beautiful again up to a point after which, it becomes unacceptable. Only a few of us have no views on size.
As it is with inanimate objects, so it is with the human body. Many adults are concerned about the size of their genital organs, particularly its relationship to sexual performance and satisfaction.
The paucity of information in the public domain, the gaps in consumers’ medical knowledge, misinformation and advertisements in the print and electronic media and the reluctance of many doctors and health care professionals in discussing such matters have contributed to misperceptions.
Men’s size
The male is fascinated with the penis from an early age. As boys become adults, many become convinced that it would be better if the penis is just a bit longer. Information from friends and advertisements reinforce the perception that there is a relationship between penile length and manhood.
Most females cannot understand this fascination or obsession. There are reports that chance remarks about small penile size, particularly in the bedroom, have led to impotence (erectile dysfunction).
When a male sees his penis, it is at an angle, which makes it appear to be shorter than it really is. But when he sees another male’s penis, there is no such foreshortening effect, so it appears that the other’s penis is longer.
One should remember the facts about penile size. Wessells and his colleagues reviewed publications on penile length in 1996. The average length of a flaccid penis, measured from the base to the tip, is 8.85 to 10.7cm while that of an erect penis is 12.89 to 15.5cm. During an erection, the shorter flaccid penile length of a male will increase more than that of another with a longer flaccid length.
It should be remembered that the vagina can accommodate any penile size as it is distensible because of its capacity to increase in length if an object is introduced gradually. There is no relationship between race, height and penile size. Neither is there a relationship between penile size and sexual performance and satisfaction. Some men have bigger penises than others, just as some men are taller or of bigger build than others but penile size is no indicator of virility.
Concerns about sizes
If one is unhappy about his penis size, it is advisable to consult a general practitioner or urologist. In most instances, reassurance that the penis size is normal is all that is necessary.
Many people advertise their claims of methods of increasing penis size. The expert opinions on the methods are:
Pills or patches – a complete waste of time
Penile enlargement exercises – probably futile
Penile suction devices – probably of little use
Penile enlargement surgery – uncertain value with risk of bleeding, infections and deformity. Surgery may lead to the flaccid penis appearing longer but it makes no difference to the size at erection. There are reports of some modest improvement in length with penis stretchers (expanders). Some men may want to reduce the penis size. Although this can be done, there are risks of bleeding, infection and deformity. A urologist should always be consulted prior to the use of devices or surgery.
Female size
The vulva is the visible part of the female genital organs. It includes the clitoris, labia and urethral opening. It is not uncommon for women to be concerned about the size of their vulva and vagina as it plays a major role in their sexuality. A common myth is that a large vagina is associated with excess sex. This is incorrect as the frequency of sex has no impact on vulval and/or vaginal size.
Braun and Kitzinger in their publication Culture, Health and Sexuality put it succinctly: “With the construction of women’s genitals as problematic, the ‘private’ female body becomes a site for potential improvement. Socio-cultural accounts of vaginal size in the West construct a tight (but not too tight) vagina as desirable, and a ‘loose’ vagina as undesirable. In women talk, we found a curious pattern: women identified the cultural desirability of a tight vagina, and noted negative uses to which this is put (such as the positioning of women with ‘loose’ vaginas as promiscuous).
“However, when women described their personal concerns about vaginal size, these were couched in terms of anxiety about being too tight. We argue that constructions of vaginal size are problematic because they create another site of bodily concern for women, and are used to control and abuse women. We suggest that they also reflect a disregard of women’s sexual pleasure, and a lack of familiarity with the functions of the vagina.”
Weber and his colleagues studied the relation of vaginal anatomy to sexual function and concluded: “Vaginal anatomy measured by introital calibre, length and vulvo-vaginal atrophy does not correlate well with sexual function, particularly symptoms of dyspareunia (painful intercourse) and vaginal dryness.”
If a woman has not given birth, there is no way that her vulva or vagina is too big. However, childbirth affects vulval and vaginal size. The more babies delivered vaginally, the more likely the size will be increased. This is because the vaginal muscles and its supporting tissues are damaged during childbirth, particularly when labour is prolonged or difficult.
The increase in vulval and vaginal size can be prevented by adherence to pelvic floor exercises for six months after delivery. This involves tightening up the pelvic floor muscles, like trying to stop passing urine, holding the contraction for 10 to 15 seconds, relaxing for 10 to 15 seconds, repeating the contracting and relaxing for five to 10 minutes and doing the exercises three to four times a day.
Too big
The effects of too big a vagina include less than satisfactory vaginal intercourse for the female and/or male, air and/or water getting into the vagina and descent (prolapse) of the vagina, uterus and other pelvic organs in later life.
There are different treatment methods. Intensive pelvic floor exercises described above for six months will lead to improvement. Working at vaginal muscle developers for some time can also improve matters. A pelvic floor repair done by a gynaecologist brings together and tightens the weakened pelvic floor muscles and tissues.
Many women are concerned that the vulval lips (labia) are too large, too long or protrude unequally. If there are such concerns, a gynaecological consultation will be helpful. In most instances, reassurance that one is normal is all that is necessary. If there is a genuine abnormality, it can be corrected surgically.
Sometimes, a female may feel that her vulva and vagina are too small. They are statistically very rarely correct. A small vulva and vagina may be the result of surgery to the vulva and vagina. Too small a vagina can occur when there is a vaginal septum, which may lead to a double barrel-shaped vagina. The symptoms include inability to insert a tampon, pain on vaginal intercourse or total inability to have intercourse.
The vast majority of women with these symptoms have a normal sized vagina. However, many of them suffer from sustained contraction of the vaginal muscles whenever there is an approach to the genital organs (vaginismus). An internal examination will provide the answer to questions about smallness. A vaginal septum is easily treated surgically. The treatment of vaginismus is challenging and requires an expenditure of time and effort by both patient and doctor. If the vulva and vagina are genuinely small, it can be corrected surgically.
Whenever there are concerns about the size of the genital organs, it is advisable to consult a doctor. To do otherwise is risky and to have an untrained person do the job is to court disaster.

Important Must Knows

Cardiology
Presentation of cardiac pathology
Angina-types
Angina-MI difference
STEMI and NSTEMI and how to differentiate them
Complications of MI
Principle of management of MI and Angina
CCF-at least know the 3 most common cause i.e. MI,dilated cardiomyopathy and systemic hypertension, others such as congenital heart disease, valvular heart disease and cor pulmonale is additional
Types of CCF
Effect of CCF on CXR and ECG
Complications of CCF
Heart block-ECG changes(may be asked in long case)
Atrial Fibrillation-causes, effect and management. For causes, i use the mnemonic I SMART CHAP, there are other mnemonics such as CVS HaRUS CePat etc...use whichever 1 convenient

I=inflammatory condition such as pericarditis and pleuritis
S=sick sinus syndrome, in old people where there is idiopathic fibrosis of the sinoatrial node
M=Medications such as verapamil, levothyrosine
A=atherosclerosis of the vessels leading to ischaemia
R=Rheumatic heart disease
T=thyrotoxicosis
C=congenital heart disease
H=systemic hypertension
A=alcohol
P=pulmonary causes e.g. pulmonary embolism and pneumonia

Infective endocarditis- Memorise the Duke criteria inside out,aetiologic agent and appropriate antibiotics is extremely important.many neglect this
Rheumatic heart disease-The bacteria involve, involve what valve, what is the extracardiac features(Duckett Jones criteria)

Dont forget the drugs used to treat cardiac disorders.

I think this is enough to cope for now kua.....respi, neuro and gastro and others next time tell la..

SFI did it,again:)

Being an alumni of SFI, i felt proud that again, SFI have made it to the news again, after a while:)
Congratulations to the team and Mdm Cheong! You're the best! : )

BOYS DO MALACCA PROUD AT THIRD ASIAN YOUTH FESTIVAL

Neurology

Neuro examination is always considered hard, with its many localising signs to remember. However, it is not that hard if you've practiced well in the 8 weeks

I'm lazy to write about neuro exam here, because there;s too many of them. If you want to learn, learn it from your supervisor, seniors, or our colleagues who have done their medicine previous semester. They should be able to guide.

But the most common mistake made is the use of the word normal. e.g. "the muscle power is normal" or "reflexes are normal". This is really contraindicated in short or long case, as the word normal denotes nothing but ignorance. Muscle power must always be expressed in "5/5" form,5 is maximum and 0 is minimum. Reflexes is expressed in +,++,+++, or ++++ with ++ and +++ considered normal.

If demonstration is needed feel free to ask. :)

Respiratory Examination

Respiratory examination need to be done fast because it involve examination of the chest and the back.



Important points to ponder

1) NEVER FORGET the RESPIRATORY RATE. --> common killer in short cases

2)Do the asterixis properly. Do not look like you have never done it before.

3) Hypertrophic pulmonary osteoarthropathy is peculiar to chronic pulmonary disease. So, in the exam, say HPO instead of clubbing, which is not specific, as it may be caused by some gastro and cardiac problems.

4)BCG scar --> impress some lecturers with this inspection, annoy others with it.

5) face, don't forget Horner's,nasal polyp, nasal septal deviation,central cyanosis, pharyngitis etc.

6) Neck--> Trachea(be gentle) and lymph nodes(do it fast, don't waste time here)

7) Trunk--> examine front and back except when told otherwise. Chest expansion, do properly. Ur thumbs should go away from each other when the patient INSPIRATE. Make sure ur thumbs are opposed when the patient expirate. To do this, cekik the patient chest during expiration. Ask any previous medicine posting ppl to demonstrate this.
Vocal fremitus is described as equal bilaterally, reduced on what site. DOnt say vocal fremitus is normal.
Percuss at least 8 spots on the chest including the base, which is in the MID axillary line.
Auscultate all ZONES, not lobe. There are 3 zones of the lung, while there is 3 and 2 lobes. Always describe breath sound as being vesicular(normal), bronchial(lobar pneumonia) etc. Do not say breath sound is normal. If crepitation is present, describe it. Pan inspiratory or mid inspiratory, coarse of fine and at which zone. E.g. bibasal mid inspiratory fine crepitation.

dont forget pedal edema :)

Gastrointestinal and Abdominal Examination

I'm not going into detail step because i'm sure everyone can do GIT examination. What i'll do is highlight the signs which may be present but frequently overlooked

Hands- Koilonychia, leuconychia, Plummer's nail(partial detachment of the nail from nail bed
Dupuytren's-alcoholism, excess use of the hand as in carpenter,NOT a sign of chronic liver
disease
Asterixis-->always forgotten
scratch marks-obstructive jaundice causing pruritus
jaundice, anaemia
mouth-leucoplakia, erythroplakia,stomatitis, glossitis, Pigmentation as in peautz jegher polyposis,
neck-virchow nodes and troisier's sign
chest-differentiate between venous stars,spider naevi and campbell de morgan's spots
abdomen inspection- cullen's and grey turner(discoloration)
abdomen palpation-sister mary joseph nodule, differentiate from fat hypertrophy in chronic insulin injection
Auscultation-renal bruit, differentiate from portal hypertension bruit by compression(portal vein bruit disappear on compression)

Signs that can be elicited for fun, but not compulsory:
Murphy's sign-> who dunno dis can go hang themself
Boas sign-> who dunno dis can also go hang themself
Rovsing sign-->erm...here we go again.who dunno dis can go hang themself
Psoas sign--> in acute appendicitis, attempt to extend a flexed knee will result in right iliac fossa pain
Cartnet sign--> if the pain is visceral, palpation of the abdomen after the patient sitted 45 degree with arm cross over the chest will not cause pain, because the pain is inside, not the abdominal wall.
The sign of hippocrates--> if gastric outlet obstruction, after warning the patient what is about to happen, the patient is rocked from side to side with the stethoscope diaphragm on the stomach. If there is GOO, succusion splash is heard.