"CREST" syndrome

one of variant of scleroderma (other variants: eosinophilic fasciitis,Thibierge-Weissenbach syndrome)

• Calcinosis
• Raynaud's phenomenon
• oEsophageal dysmotility
• Sclerodactyly
• Telangiectasia

Diagnosis criteria for SLE

Any 4 of 11 criteria:

1. Malar rash
2. Discoid rash
3. Photosensivity
4. Oral ulcers
5. Arthritis - nonerosive arthritis
6. Serositis - Pleuritis,pericarditis
7. Renal impairment - proteinuria, cellular casts
8. Neurological involvement -seizures,psychosis
9. Haematological involvement - haemolytic anaemia, leukopenia, thrombocytopenia
10. Antinuclear antibody - 95%
11. Immunological disorder - positive LE cell, anti-DNA antibody, false-positive syphilitic serology

innocent murmur of baby :)

features of an innocent murmur - 4S
Soft
Systolic,
aSymptomatic
left Sternal edge

Addison's disease

Addison :

Autoimmune

DIC (meningococcus)

Destruction

Iatrogenic

Sarcodosis,granulomatous eg. TB histiomycosis

hypOtension/ hypOnatremia
Nelson's syndrome (post adrelectomy,increased ACTH)

SEs of TCAs

TCA SE is Anti-HAM!!
antiH- istamine(sedation
antiA - adrenergic properties- CVS SEs : orthostatic hypotension (most life
                 threatening),tachycardia,arrhythmias
antiM- muscarinic effects -dry mouth,constipation,urinary retention,blurred vision,tachycardia

others- weight gain
         - lethal in overdose (!!one week supply of the drugs can be lethal in overdose,so assess your patient suicide risk 1st!)
         - major COMPLICATIONS- 3C = convulsions,coma,cardiotoxicity

mainstay of treatment of TCA overdose is IV sodium bicarbonate. 

kurma during bulan puasa

A brief history was taken before patient entered into OT..:)

A 55 years old Malay women,known case of HPT under OPD,she complaint of generalized and pain for the last 2 days.

Pain is sudden onset ,started from lower abdomen,colicky in nature,on & off and associated with nausea and vomitting,diarrhea.

Diarrhea-stool was brownish mixed with mucus,no malaena,no fresh bleed.

No hemetemesis,no fever,PU normal,LOA,LOW(can't quantified)

PMH-HPT,gastritis for past 1 year.

DH-has been taking NSAIDs on last 2 days to relieve pain.

FHX no history of malignancy.

Xray taken prior to operation:air under diaphragm(pneumoperitoneum)--suggesting perforation of bowel

During operation,surgeons found there's perforation on the sigmoid colon.

surprisingly,during the sanitation of the abdominal cavity,they saw something strange retained in the abdominal cavity.probably,these small seed-like thing makes the perforation in sigmoid colon.

everyone gathered around the kidney dish and try to figure it out...what the hell is this??

After few days, i walked to patient : "mak cik ah,apa makcik makan sebelum ini sampai biji2 tinggal dalam perut?"broken malay again but she understood anyway..:)

"saya makan kurma masa buka puasa...saya makan dengan biji la..."

"oh,jangan makan biji leh,makcik makan banyak actually kan?"...she smiled to me..well,she will be alright since she can smile back to me.=)

Wow,this is so weird still... = =

machine cutter!

• This was taken during my A&E elective postingA philipino worker accidentally inserted his hand into the meat cutter machine during his work.He entered A&E department with a great pain on his palm and just covered by a thin clothes.he has a opened injury on his palmar surface of his hand.i think there's a complete transection of the flexor tendon of his palm.basically patient can't do a grip action, incomplete flexion, and stiffness of the joints.

Flexor tendons have 5 different zones in the hand, as follows:

• Zone I contains only the FDP tendon and extends from the insertion of the FDP to the insertion of the FDS tendon.
• Zone II is the area once referred to as "no man's land." It is defined as the area extending from the insertion of the FDS tendon to the proximal end of the A1 pulley.
• Zone III is the zone of lumbrical origin in the palm.
• Zone IV is in the carpal tunnel
• Zone V is proximal to the carpal tunnel in the forearm.
  (information from http://emedicine.medscape.com/article/1238823-overview#a04)
  
  
  i believe this patient had the laceration in between zone of lumbrical origin in the palm.
  
  
  
  

schizophrenia

5As of negative symptoms:

1. anhedonia
2. affec(flat)
3. alogia (poverty of speech)
4. avolition(apathy)
5. attention(poor)

Rheumatoid Arthritis of Russian Mama

these were taken during my last elective posting in therapy department

"can i take photos of your hands?"broken Russian language...

"kanyeshna"(sure!)..and she smiled to me:)

you name it,she got it...

ESRF

Conservative management of ESRF(end stage renal failure)

• Anemia- erythropoeitin
• Bone disease-calcium,vitamin D
• Cardiac failure-diuretic,antihypertensice
• Diet-low protein
• Electrolytes-potassium(resornium,dialysis)
• Fluid restriction

Major depression Episode

1. Sleep
2. interest
3. Guilt
4. Energy
5. Concentration
6. Appetite
7. Psychomotor activity
8. Suicidal Ideation

Lithium

Lithium SEs: 

1. Weight gain
2.  Tremor
3. GI disturbance
4. Fatigue
5. Arrythmias
6. seizures
7. Goitre/hypothyroidism
8. leucocytosis
9. coma
10. polyuria
11. polydipsia
12. alopecia
13. metallic taste

1.