Diabetic Neuropathy

Ok...i know exam is over,results are out. But i would like to share these article as a revision for one of the most important disease in Medicine, diabetes.

Diabetes can affect all 3 division of the nervous system: sensory,motor and autonomic nervous system. The most common early presentation of diabetic neuropathy will be numbness of the extremities commonly described as "gloves and socks" numbness. It is a form of peripheral neuropathy and because of that, it affects all dermatomes. Therefore, during examination of diabetic foot to look for numbness one need not test according to dermatomes. Sensation is loss for both pain and light touch and for some reason, temperature sensation is not affected. Loss of proprioception is also an early sign, however, patient often does not notice this because the dominating or main problem to the patient is often sensory loss. The patient may also complaint of gait instability. Therefore, this sign must be elicited by the examining doctor.

In the motor division, neuropathy can take 3 forms : Acute painful neuropathy, diabetic amyotrophy and mononeuropathy. Acute painful neuropathy cause burning pain in lower limbs, typically at night. In severe cases even light touch can become intolerable. It can be precipitated by drugs such as itraconazole, commonly used to treat fungal infection in diabetic patients. Diabetic amyotrophy cause painful,marked wasting of the quadriceps femoris muscle. In extreme cases it cause absent knee jerk reflex. Diabetic mononeuropathy refer to involvement of only 1 nerve. The most common mononeuropathy is the carpal tunnel syndrome. Diabetes can also affect the cranial nerves, especially cranial nerve VII and III, causing diploplia. If more than 1 nerve is affected, the condition is called mononeuritis multiplex.

Autonomic neuropathy manifest in form of postural hypotension,atonic bladder with urinary retention, diarrhea etc.In long standing uncontrolled diabetes, gastroparesis can happen leading to uncontrollable nausea and vomiting mimicking intestinal obstruction. Diabetic patient often complain of syncope, lethargy, dizziness. Note that sometimes, these signs can be a side effect of the oral hypoglycaemic agent, e.g. diarrhea may be caused by Metformin.

Malaysian style of easing a traffic congestion...

...is to create a congestion somewhere else!

http://thestar.com.my/metro/story.asp?file=/2009/2/28/southneast/3349285&sec=southneast

Malaysian style of easing a traffic congestion...

Short cases

Examination is over and its time for celebration:)

These are the short cases that i gather, thanks to Koh Ging....any addition to this list please leave a comment or e mail me at jeffsylee@yahoo.com...thanx

Examine the respi system
1) Rheumatoid arthritis with lobectomy
2)Lung Cancer
3) Pleural effusion
4) Bronchiectasis due to agammaglobinaemia

Examine the cardiovascular system
1) Mitral regurgitation pansystolic murmur
2) atrial fibrillaion

Examine the Neurological system
1) Upper limb CVA
2) Lower limb for ___?


Examine the neck for Graves disease

Examine the GI system for hepatosplenomegaly due to beta -thalassaemia


please leave a comment or e mail me for any further information or correction...Thank you so much

Review for In a page: examination for common uncommon disorders found in the ward

As some of you might know, i've already started writing about the examination methods of various "uncommon" disorders sometimes found in the ward and long and short case exams. These include rheumatoid arthritis, Cushings, Parkinson, Myasthenia Gravis,diabetic foot etc.

After "testing" the writing with my friends, i find that not only the techniques but also the method of presentation is important. Therefore, to upgrade the booklet, i humbly request some help from our coursemates for input about the presentation format for any "uncommon" disease found in the ward.Anyone who want to help me write, all the better. We can do this during our holidays. I know its a bit too much to do that during the holidays, but, this booklet will be useful for our juniors and for us in the fifth year.

The newer version that i'm thinking of will also include common questions asked in short and long cases. for this, i need as much input as possible.

No help is too small. Constructive critism will be very much appreciated and destructive critism will be forgiven. I hope we can do this together, because as far as i see, no books from UKM students are in the market yet.(there is at least 1 from UNIMAS)

comments and suggestions can be dropped here or at medicalpblukm.blogspot.com. I appreciate all that is given very much. thank you

Brilliant students of Malaysia today

Today, i read something in the star that really amuse me. A Science stream student taking Biology,Chemistry and Physics, felt disappointed because he/she couldn't take an additional paper, Science.

I AM a Form 5 student who will be sitting for my SPM examination this year. Initially, 40 of my classmates and I planned to take both Science and Ekonomi Asas, but now we are unable to do so.
This is because, as according to our teachers, the Science and Physics paper are slotted at the same time and date, and similarly the Ekonomi Asas and Biology papers.
Being Science stream students, Physics and Biology are compulsory. After studying Science and Ekonomi Asas for more than a year, it is very disappointing that we are unable to take these subjects.
Last year, there were no clashes. And I wish to stress that we checked the 2008 timetable before choosing our subjects. We were even advised by the seniors, and we were not told earlier that problems like these would arise.
Education Ministry, please do something. Do not let our efforts go to waste

Personally, i would tell the Education Ministry not to let your effort go into waste, but at the same time i would like to tell you not to let your TIME go into waste. Why do you want to take Science when you have already studied Physics, Chemistry and Biology in depth? What happen if you got A1 for science and C4 for Physics, Chemistry and biology? Will the A1 help you?
And reading this letter, this student have no aim in life. He/she still doesn't know what he/she wanted to do after school.

And do everybody know how this type of student is produced? Read the next article.



MY daughter is in Year One. She is very shy and worries a lot. She cries every morning without fail as she always has something to worry about.
During the first few days of school, she was scared and my husband and I took leave to be with her. We tried to help her to adapt to the new environment.
Today, I received a phone call from her school asking me to take her home as she had fever. When I arrived at her school, her class teacher told me that when she checked my daughter’s forehead, it did not seem like she had any fever.
I knew my daughter was lying to me because she was afraid to attend Chinese class. I was very disappointed and angry with her.

My daughter has a full week with tuition classes in different subjects. This year, she has one extra tuition class – Bahasa Malaysia.

Am I putting too much pressure on her? I want my daughter to be happy. She’s just six-plus, and she worries so much. I’m worried that she may have a breakdown one day.

Imagine a year one student who just got into school, who havent got used to the new environment and life, is forced to have, in her mother's word, a FULL WEEK WITH TUITION CLASSES IN DIFFERENT SUBJECTS,WITH ONE BAHASA MALAYSIA EXTRA TUITION CLASS THIS YEAR.

I couldn't imagine the mental torment that poor child must be suffering. If i am her, i would have hated school soo much. I would lost interest in school.
If i survive, i would grow up and wonder what i did in my childhood. In my form 5, i would try to take Physics, Bio and Chem and also Science because i've already went to tuition for that. And i will be angry with the Education ministry when the time for Chem coincide with Science.

Then when i'm older and have a child, my child would ask me what i did when i was younger. I would proudly tell her ," in 1 week, i went to 20 different tuition classes,3 tuition everyday." Then my child would ask me what games i played during my childhood, what enjoyable things i've done and what cheeky things i've done during my childhood. I tried to think, but couldn't thing of any, the most interesting thing in my childhood is when i got my 1st Casio 350 scientific calculator.

In short, my life will be just, black and white. There's no colours to it at all.


This is what happen today. In my 13 years of formal education, i only go to 1 tuition class, that is in form 6, but i didn't think it helped because its exactly the same with what is being taught at school. So to parents who is so eager to sent their children off to tuition hoping they will score 30A1s in their SPM, forget it la......Spend more time with your children, encourage them to study on their own like what my mum did....then SPM wont be a problem.

As for the student, no need to go to any "famous" tuition classes. No need to take Science when you've already taken the 3 science subjects. USE YOUR BRAIN before you do anything la......don't take subjects in spm just to make your result look great ok......If you want to take, take EKonomi asas is ok, Perdagangan etc. That will show that you are good in both fields, but still it doesnt show how holistic you are right?

cooling down:)

sorry for being a bit harsh in the previous post...feel disappointed and disheartened to hear such comment going around.

So, like prof Hashim said, we must noe the normal physiology b4 repairing the abnormal. Rite now my problem is hearing comments i don't like. I couldn't possibly keep people's mouth shut. But i can turn on a deaf ear! So, now i just ignore and do what i think is right.

Hopefully this is a right thing to do. hopefully.