Sunday, August 9, 2015

Dari Buku 555 Elektif

Assalamualaikum uolss.

Hari ni sis cuma nak share apa yang sis belajar selama 4 minggu sis buat elektif kat PPUM. Actually ni sis cuma tulis balik laa apa yang sis sempat catat throughout attachment sis with the doctors over there. Takde lah banyak sangat, ada yang tak dan nak tulis, hoho. Semoga terhibur!! (Heh terhibur sangat lerww)

Gastro Clinic:

1. Causes of liver cirrhosis:
-wilson disease
-autoimmune hepatitis
-alcohol (common in europe)
-hepatitis B and C (common in Malaysia)
-hyperlipidaemia (camni ke spelling dia)
-cryptogenic liver disease (obesity, fatty liver, etc)

2. Pt with diabetes - we dont give metformin - can cause lactic acidosis and hence renal failure

3. Pt with cirrhosis
-ultrasound every 6 months - to pick up any focal lesion - ie cancer
-prescribe propanolol - prevent portal hypertension

4. What is statin - HMG CoA reductase inhibitor - how does it work - google sendiri laa hehs

5. Longstanding cardiac failure - can cause cardiac cirrhosis and liver congestion

Cardio Clinic:

1. Most common cause of valvular disease - chronic rheumatic disease

Infectious Disease Clinic:

-CD4 <200 p="">-opportunistic infection - other way to identify AIDS
-CD4 - use to guide treatment administration
-when CD4 <500 -="" initiate="" p="" treatment="">-sign of treatment failure - CD4 doesnot rise, viral load increase
-HAART - highly active antiretroviral therapy - reduce replication of virus, so when there is treatment failure, viral load increase

2. TB
-clinical signs and symptoms - fever, night sweates, weight loss, cough, haemoptysis
-CXR - hilar lymphadenopathy, lesion at apical (less aerated area), nodules, cavity (in malaysia, cavity in cxr is TB until proven otherwise), bats appearance
-ziel nielson stain (spelling camne ntah) - detect mycobacterium tuberculosis
-sputum, bronchoscopy

Gastro Clinic:

1. Fibroscan
-to detect early scarring
-prognostic kit for fibrosis developing into cirrhosis
-below 7.2 is good

2. HBsAg - surface antigen - after 6 months, if still have, consider chronic Hep B (Hep B cause inflammation leads to hepatocyte rupture and hence release liver enzyme and increase liver enzyme)

3. HBeAg - replication of Hep B

4. NASH - non alcoholic steatohepatitis - common metabolic liver disease, treat with Vitamin E

5. Fatty liver disease - can be normal, so thats why kena buat fibroscan or liver biopsy

6. Hep C has better prognosis than Hep B

7. Chrons disease consider as active when CRP > 0.6mg/dL

8. Spironolactone + furosemide for unresolved ascites due to portal hypertension

9. Side effects of steroids - DM, HT, osteoporosis, weight gain, cataract, osteopenia - easy bruising, cushing syndrome, dyslipidemia

10. Any meds for hypertension can cause hypokalemia

INR Clinic:

New anticoagulant such as dabigatran - can be used for AF, PE, DVT but not valvular heart disease

Diabetes Clinic:

1. Glycemic control
-HbA1C less than 7%

2. Non glycemic control
-BP < 140/90
-lipid (triglycerides <1 .7="">1) (LDL <2 .6="" p="">-Waist (<90cm cm="" for="" men="" p="" women="">
3. Pt with renal impairment - contraindicated to fasting - lead to dehydration

Gastro Clinic:

1. Portal hypertension -> increase blood flow to spleen -> splenomegaly -> hypersplenism -> thrombocytopenia and hence decrease platelets

2. Dialysis - haemodialysis and peritoneal dialysis ( google to learn more!)

3. End stage kidney failure - develop hyperuricemia and hence gout

4. Neuroendocrine tumour - also known as carcinoid tumour, new test to detect cromogranin-A

Endocrine Clinic:

1. Subclinical hypothyrodism - T4 normal, TSH is low

2. If allergic to carbimazole - give PTU (propylthiouracil)

3. Hypothyrodism a/w hyperlipidemia and hence heart disease

4. Acromegaly
-monitor IGF-1
-symptoms can resolves but monitor biochemically
-suppress IGF-1 with somatostatin analogue (octreotide)
-a/w colon cancer and hence do surveillance colonoscopy
-check by MRI - then undergo surgery (trans-sphenoidal surgery) if pituitary macroadenoma
-usually late diagnosis
-check visual field

5. Macroprolactinoma
- tx medically with dopamine agonist (bromocryptine,cabergoline)

6. Carbimazole is more effective than PTU
- side effect - agranulocytosis- dangerous sepsis, signs - fever, sore throat, mouth ulcer
- if pregnant, use PTU
- for 18 months treatment for hypothyrodisim

SLE Clinic:

1. Sjogren syndrome
-dry eyes, dry skin, vasculitis, lung
-anti-Ro and anti-La
-how do we dx: clinical sign symptoms, blood test, biopsy of the glands
-tx with azathioprine(steroid sparing agent)

2. Rheumatoid arthritis
-clinical signs - z deformity, distal wrist sublixation, etc etc
-blood test - anti CCP (most sensitive and specific), anti RF
-x-ray - bony erosion
-tx - metrotrexate

3. SLE
-a/w ankylosing spondylitis
-lupus nephritis - proteinuria, test with 24 h urine, 6 class in classification
-azathioprine side effects - anaemia, leukopenia, thrombocytopenia

Respiratory Clinic:

1. Tx for TB : RIPE - rifampicin, isoniazide, pyrazonamide, ethambutol

2. Bronchial artery embolisation - from femoral artery -> thoracic artery -> bronchial artery

3. Spontaneous pneumothorax - if both lungs failed to expand -> surgery

4. Brochiectasis - asthma-like symptoms, tramline appearance x ray, asthma doesnt hv xray changes

5. Aspergillosis - increase IgE, increase eosinophils

So itu je lah yang mampu sis re-write balik dalam blog from sis punya buku nota. Ada benda yang lain sis belajar takde dalam buku nota, contohnya identify etc etc kat badan patients.

Alright, tak sampai lagi dua minggu nak kena balik Ireland balik, berhuhuhu la sis.

Seeru 'ala barakatillah diriku :')



Hanis Amanina said...

baru lepas elective, fuh mencabar nak faham medical shortform

Norain Ishak said...

Hanis, memang ponnn

LOW, LOA ingat apebende la masa tu rupanya loss of weight, loss of appetite