The return of TB

Due to our government's generousity in accepting foreign workers without proper screening, TB has returned to Malaysia! Welcome back, old friend(or foe?)

Return of disease linked to foreign workers

Because i foresee that our government will continue to be generous for many years to come, I think its essential for us to equip ourself with the knowledge about our old friend here.

As usual, basic sciences are essential
1) What is Tuberculosis
2) Describe the etiologic agent
3) Clinical features
4) How is it transmitted
5) What investigations need to be done
6) What other organism or disease that can mimic tuberculosis
7) Complications of tuberculosis
8) Pott's paraplegia-what is it?
9) What are the regimens for anti TB drug? how long it should be given? Based on what do we decide the exact duration?

Nodules of the limbs

Foot

Elbow joint

An easy one here.

A 73 year old man who is known to have chronic renal disease presented to PPUKM with multiple painful nodules on the upper and lower limbs for 1 year duration.

1) Describe the nodules(sorry for the bad image quality, my Hp camera only 2 megapixel)

2) What are your differentials? What do you think is the most likely diagnosis? What makes you say so?

3) What investigation do you want to do? What to expect?

4) The best way to diagnose this condition is clinically. How do you do that?

4) How do you manage this patient?

The power of Blogging?

Could it be coincidence, or had someone actually saw my previous post and took action?

The sink in the previous post is now this.

Very neat and clean, isn't it? Hope it can be maintained like that:)

This proves YM wrong...its NOT a SSM project of growing aspergillus

Next time I saw anything dirty i will blog...it will become clean in a matter of hours:)

Blogs works wonders :D

Medical Students are survivors

You know, i am sometimes quite amazed at the perseverance and strength of medical students in life. They can survive anything and can live in any adverse conditions.





Medical students, i think, are trained to practice "hygienic medicine" but not hygiene itself. I don't like to do this at all, but below is a picture of a washing basin from one medical student's quarters.(identity dirahsiakan)

Note the growth of fungi (presumbly, Aspergillus. niger?). I have noticed this for weeks and am observing for some actions. Medical students can live in this condition! Who said medical students cannot survive adverse conditions?

Full proof of 2 things

1) Medical students are survivors(Salute!)

2)I am not a survivor because i will kill all those aspergillus niger when I cannot tahan the sight of it anymore.

Vote for Kuan Yew!

Our friend Kuan yew is running for the President post.......oops salah. :P
ACtually he is contesting in a Postcard competition and he needs all the votes you can give.

Vote for his beautiful photo! You won't regret.

KUan yew rocks:D

CEPAT!!!

PPD-Approaching a Difficult Patient

Usually a patient refuses to be clerked for one(or more) of the reasons stated below

1) Too many medical students clerked them before you

2) Bad experience with another medical personnel

3)their idea that it is useless talking about their pain to medical students who can do nothing about it. They want to see the Senior Consultant.

4) They are stressed about their condition and would rather not talk about it

5) they have seen medical students being reprimanded by a doctor( Registrars or Consultants) and lost confidence

6) Medical students appear not so confident

7) They may be in pain at the time u ask them.

Sometimes, these type of patients have very rare conditions(e.g. Ventricular Bigemini) that makes it all more necessary for you to clerk them. So how to approach? Here's a few tips.

1) Always approach patient by 1st asking them "How are you today?""How do you feel today?". This will give the patient a good impression. They know you care for them. This question also sometimes makes the patient tell you their current (acute) problem. If they do, say to them"I see...but what happens in the first place when you are admitted?" Most of the time they will tell you everything :)

2)While the PPD style "Selamat pagi encik, saya So&So, pelajar perubatan tahun 3" introduction may work well for some patients, most of the time it will not especially if the student looks timid. Patients will not have confidence to confide their problem to you. Therefore, always look confident. Don't hug your clipboard or notebook or whatever while introducing yourself to your patients. Because even for me it reflects that you are afraid. Put your clipboard on the table, walk to the patient, shake hands and introduce yourself, confidently and politely.

If your supervisor had asked u to clerk the patient, all the better. Say " Saya pelajar di bawah Dr So and So, saya nak tahu keadaan puan/encik untuk dilaporkan kepada beliau". 100% success.

3) The patient may reject you because they are occupied with something else at that time. In this case, make an appointment. Ask to clerk them after tea, after lunch etc. Usually patient may agree.

4) Some patients refused to be clerked because sometimes, medical students take a long time to clerk and they felt bored. Therefore, give them a time limit. Tell them " Pakcik, saya nak minta masa 15 minit untuk pakcik beritahu saya keadaan pakcik, boleh tak?". Make sure you adhere to time limit and if you exceed, please apologise. Normally the patient will not scold you. It is also a good practice for long case because in long case you only have 10 to 15 minutes to take full history.

5)Always visit the patient till he is discharged. Treat him like a human being.

Lastly, even if you are not clerking a patient, always flash a smile at them. A smile can bring lots of comfort, especially to the sick. Don't do catwalk in the ward and act as if the patients are not there. Your whitecoat is not a nice dress to be in for catwalk. After all, you will never know when you have to clerk those patients, and having been friendly and warm to them, it will make your job much more easier.

Goodluck!

?what you should know by now

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 convenientI=inflammatory condition such as pericarditis and pleuritisS=sick sinus syndrome, in old people where there is idiopathic fibrosis of the sinoatrial nodeM=Medications such as verapamil, levothyrosineA=atherosclerosis of the vessels leading to ischaemiaR=Rheumatic heart diseaseT=thyrotoxicosisC=congenital heart diseaseH=systemic hypertensionA=alcoholP=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..