Archive for the ‘ Posting (Elective) ’ Category

Medical Department (17 Ogos – 28 Ogos)

List of Cases

1) Acute Pulmonary Edema (APO) 2ry to Anemia , acute on Chronic Renal Failure (CRF) 2ry to traditional medication

2) Decompensated 2ry to non-compliance of fluid restriction

3) Lt Parietal Hemorrhage transformation of an infarct w/ Rt sided Hemiplegia

4) Decompensated Congestive Cardiac Failure (CCF) w/ fast Atrial Fibrillation (AF) precipitated by anemia , possible underlying IHD , myelofibrosis , unlikely autoimmune hepatitis probably due liver congestion

5) meningitis

6) Dengue w/out warning sign

7) Unstable angina (USA) , Atrial Fibrillation(AF) -rate controlled , ischaemic stroke

8 ) Anterocutaneous fistula at previous appendicectomy wound , prolapse & retracted loop ileostomy , treated as IBD by surgery , malnutrition , dermatitis over scrotal gluteal cleft

9) Spontaneous Pneumothorax

10) Myeloblastic Anemia

11) Neuroglycopenis sepsis

12) Acute Coronary Syndrom (ACS)

13) Chronic Kidney Disease (CKD) , Pneumonia , AGE , DM , HPT , normochromic normocystic anemia 2ry to CKD

14) Pseudomonas Sepsis , acute on Chronic Renal Failure (CRF) , Hx Upper GastroIntestinal Bleeding (UGIB) 2ry to ? bleed Peptic Ulcer Disease (PUD) , Myeloproliferative Disorder , IHD , HPT , DM , Hyperlipidemia , Gout

15) Lt sided HPT bleed , aspiration pneumonia

16) Lt ischemic Stroke

17) Acute Pulmonary Oedema (APO) 2ry to Hypotensive Emergency , Fluid Overload 2ry ESRF , DM , HPT

18) Congestive Cardiac Failure (CCF) w/ Community-acquired Pneumonia (CAP)

19) Community-Acquired Pneumonia TRO of Pulmonary Tuberculosis (PTB)

20) Dengue w/ warning sign + hepatitis

Dokumentation in Medical Ward

HISTORY

1) Chief C/O :

-63 malay man

-KCO COPD on Hospital Jerantut follow up

-defaulted follow up and medication

2) Hx of Presenting Illness

-chronic smoker >40 years (1pack / day)

-C/O shortness of breathing (SOB) , progressively worsened over 1/52

-worsened today

-has been having chronic cough over 1 year duration

-sputum whitish

-x hemoptysis

-fever on & off 1 year

-got lost of weight (+LOW)

-no lost of appetite (-LOA)

-no sore throat / RN / abd pain / diarrhea / vomit

-was never investigated for Pulmonary Tuberculosis (PTB)

3) Medication Hx

-not on any medication

4) Allergies Hx

-Bactrium / sulphur-base medication

5) Social Hx

-ex english teacher

-chronic smoker

-non alcohol

Physical Exam

1) General Exam

-tachypneic

-CRT < 2 sec

-GCS full

-speaking in phrases

-BP =102/74

-PR = 113

-Temp = 36.5

-dxt = 8.0 mmol/L

-SPO2 on nasal prong

=82 on admittance (pneumothorax unfixed)

=96-97 post chest tube (pneumothorax fixed)

2) Head & Neck

-no virchow’s LN

3) CVS

-Dual Rhythm No Murmur (DRNM)

4) Respiratory

-reduced A/E on lf side (crept / ronchi) = airway block

-no A/E on rt side =airway o.k

-percussion hyperresonant on rt side = got air

5) Abdomen

-soft / non tender

-no hepatosplenomegaly

Diagnosis

-rt pneumothorax ? 2ry to Pulmonary Tuberculosis (PTB) / Malignancy

Management

-put in chest tube

-maintainance – IVD 3 pints N/S over 24 hours

-put on nasal prong

-nebs combivent hounty

-IV hydrocort 0.5 mg stat was given at ED

-IV Rocephin 2 g stat then 1 g OD

-T-Azithromycin 500 mg OD x 3/7

-stat IV Aminophylline 500 mg in 1 pint HS over 1 day

-T. Nuelin SR 250 mg BD CM

-IV Pethidine 50 mg stat + IV Maxalon 10 mg stat given in ED prior to chest tube

-stat on suction in ward 10-20 cmH2O in ward

-HO on call to review , inform MO if patient unwell

-FBC

-RP

-LFT

-ABG post chest tube on nasal prong

-Alpha-fetoprotein

-LDH

-CA 19.9

-CA 125

-ESR

-Sputum AFB x 3

-Mantoux test

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Obstetric & Gynecology Department (6 Ogos-14 Ogos)


DOCUMENTATION IN OBSTETRIC

History Taking in Obstetric

1)Name / Age / Gravidity & Parity (G1P1 = first pregnancy)

2)Last Menstrual Period (LMP) / Expected Due Date (EDD) / Period of Amenorrhea (POA)

-sure of date (SOD) by previous scan

3)Presenting Complaint

-abdominal pain

-contraction / min

-leaking liquor (LL) / show (blood) / Fever

-Fetal Movement

4)Past Pregnancy Problem

-booking BP / hP for hypertension

-Meal Glucose Tolerance Test (MGTT) done for diabetes

5)Past Medical Problem / Surgical Problem

-Diabetes / Hypertension / Asthma

-Any Surgery

-family history (fHx) of above diseases

-any allergy of food or medication

6)Past Obstetric Hx

-process (spontaneous vaginal delivery (SVD) / Induced Vaginal Delivery (IVD) / Caeserian Delivery (CD)

-baby weight & sex

-baby status (Full Term (FT) / Preterm (PT)

7)Medication

-prescribed or recreational

General Examination

-Lung clear & same of both lungs

-CVS duorythms no murmur (DRNM)

Abdominal Exam

-cephalic or breech presentation

-fetal head over 5

Vaginal Exam

-cervix opening (1-10)

-fetal head engage

Spaculum Exam

-PreVaginal (PV) discharge

-colour of fluid

-pooling of fluid (rupture of membrane)

-Sign and Symptom of Urinary Tract Infection (S&S for UTI)

USS Scan Exam

-Head Circumference (HC)

-Abdominal Circumference (AC)

-Fetal Length (FL)

-Amount of amniotic fluid

-expected age due size

Physical Exam

-stable / alert / comfortable

-pink (healthy)

Social History

-occupation

Management

-strict FKC (Fetal Kick Chart)

-follow up (CTO) for any contraction / LL / show

-follow up (CTO) for BP / CTG / USS Scan

PROCEDURE IN OBSTETRIC

BASIC

1)Vaginal Exam

2)Abdominal Exam

3)Speculum Exam

4)CardioTocoGraph(CTG)

5)Artificial Rupture of Membrane (ARM)

Delivery

1)Spontaneous Vaginal

2)Vacuum Vaginal

3)Caeserian Section

Complication

1)Common Complication

2)Premature Rupture of Membrane (PROM)

3)Pre-Eclampsia

4)Breech Birth

5)Shoulder Dystocia Birth Injury

6)Preterm Labour

Orthopedic Department (20 Jul-3 Ogos)

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Basic Procedure for Ortho Medical Students

1) Vena Puncture

2) Intravenous Cannulation

3) Closed Bladder Drainage (CBD) Insertion

4) Wound Debridement

5) Closed Manual Reduction (CMR) and Casting (POP)

6) X-Ray Interpretation

7) Toilet & Suturing for Surgical Laceration Wound

8] Internal Fixation of Fractures

9) Excision Biopsy of Lesion

10) Intrepretation of Common Records / Charts (ECG, input/output charts, head charts, medication charts)

11) Ankle Block (Local Anesthesia)

12) Vacuum Dressing

13) Amputation