Causes of short stature

Short stature is a diagnosis which will give you clue during clinical examination especially during inspection.
added with other sign . It will help on your diagnosis.

Short stature can be divided into proportional and disproportional
proportional
Growth hormone deficiency
systemic disease
constitutional delay
familial

disproportional
Turner syndrome
Achondroplasia
Osteogenesis imperfecta
Congenital hypothyroidism (normally low IQ)


Achondroplasia  is a common cause of dwarfism. It occurs as a sporadic mutation in approximately 75% of cases (associated with advanced paternal age) or may be inherited as an autosomal dominant genetic disorder.

Osteogenesis imperfecta is a congenital bone disorder.It happened  because of a deficiency of Type-I collagen

books for sale

The above books is one of my precious books collection. I wish to sell it for better usage of the books rather  than keeping them in my book rack. The first books is essential paediatrics (third edition) sold at RM70. second books is scott an aid to surgery sold at RM40 and last books is paediatric problem in tropical countries sold at RM 40. If buying both paediatric books I will sold at total of 100.If buy 3 books sold at RM140. Additional photocopy books for paeds and O and G will be given with each purchased.

Interested please e mail me at fangpenang@gmail.com. I accept cash on delivery on Penang Island. thanks.

Osteoporosis general management and myth

A talk by enocrinologist from netherland named prof Socrates papapoulas regarding osteoporosis. He outlined biphosphonates and Hrt (forfemale) is the option for osteoporosis. Bisphosphonates better in the sense of risk of breast ca for Hrt. He outlined the risk factor for osteoporosis such as smoking, alcoholic , low BMI, low calcium intake, advancing age, race and etc. he stress the important of vit D (800micro grame) per day. Regarding the myth of atypical fracture and slower healing of hip fracture by biphosphonates, evidence proves that it is unrelated for biphosphonates vs placebo. Regarding the long term uses of biphosphonates for osteoporosis, he stated that for 5years treatment with biphosphonates, it will remain for the next 5 year. Evidence proves that no increased fracture risk compared 5 year biphospphonates and 5 year placebo and 10 year biphosphonates in FLEX study for alendronates.another study for Iv zoledronic acid annually showed similar results. It also critised orthopods not using biphosphonates for hip fracture pt. It stated a old people with fracture needs treatment for osteoporosis without checking Bone mineral density as it is proven by fracture.

Intensive Talk with Prof Falagas

Summary:
Bacteria develop multiple resistance to antibiotic
By:
1)producing B-lactamase
2)overexpression efflux pump to release extra antibiotic
3)antibiotic modify enzyme
4)ribosomal mutation
Thus appear all superbug such as ESBL, carbapenemase producing klebsiella etc
Pt infected with ESBL +ve had relative risk 1.85 of mortality compared to normal bugs
Treatment of commonest bugs in ICU –Acinetobacter spp.
Recommended to do C+S with MIC
Therapy promptly early
Start therapy right at beginning
Modification therapy as nessasary (de-escalation) early
Tigercycline- a new agt
It evades tetracycline efflux pump and ribosomal protective mechanism
Bacteriostatic
That is limitation no good blood level for therapeutic
Varied response to acinetobacter
Imipenem –launch with 4g/day
Recommend 2g/d as reduce seizure
Not enough as moderate susceptible organism need 1g qid .
Recommended for high MIC acinetobacter to give prolong infusion meropenem 1 g tds as long as 3 hr compared with 30min normally given.
Study proved similar dose with prolong infusion better outcome
Colistin monotherapy
Got 52% isolates for acinetobacter were polymycin only susceptible
The rest need colistin and one other antibiotic (rec add carbapenem)
As highest % of survival
Benault et al. showed Obesity highest rate septic shock
Partly related with leptin def
DM
FOsfamycin-good for Klebsiella spp and pseudomonas spp.
Another talk by gastro
If NDM1 may give fosfamycin + carbapenem.
UGIB
Commonest cause H. pylori followed by NSAID, Antiplatelet
Risk of UGIB-age, multiple co-morbidity and H/O peptic ulcer
If pt got cardiovascular problem, may restart antipltelet after 4-5 days of peptic ulcer

Neurology examination (basic fundamental)

Student, house officer, medical officer hates the most ! neurology system. Coz, no particular song lyrics to sing ! all other system got same chores to sing.-Inspection, palpation, percussion and auscultation.

To me, neurology famous song would be look and proceed + investigator.
The rule no 1- when ask to look at the face, please do look for upper and lower limb grossly also ! This is what i called LOOK thoroughtLY !

Rule no 2-Pretend yourself as a wireman,
rule of thumb - for neuro, first ,level of lesion-brain, cerebellum, brain stem, spinal cord, anterior horn , peripheral nerve or muscle.
After that second question- left or right brain or level of lesion
lAST-cause of the lesion
Then bingo- You are PASSED.

rule no 3- don't panic- apply for all

Rule no 4- common thing come first-apply for ALL physical examination.

Rule no 5- use your rule no2 rule then give the diagnosis with statement like this is a 40 year old (middle-aged) gentleman with left hemiparesis which is due to right cerebral infarct. etc..
Bingo, you are passed then just answer all the question.......to get better marks.


Good luck, the next will be cranial nerve. If you like the blog, pls do CLICK on google ads on top or side to show APPreciation! Your appreciation is my best inspiration!

undergraduate exam tips

Medical Students ask me the tips of passing clinical exam. The answer is stay calm, then perform what you practice everyday. My prof used to tell us if should practice at least 400 times before went for exam .If you failed, then you should also pretend to practice 400-500 times.

Tips no 1 , be systematic. For abdomen, CVS and respiratory. All following the normal song sequence, - Inspection, palpation, percussion and auscultation. For CVS, percussion part can be skipped. Every medical students worried about neuro. Actually neuro also got own sequence. First,inspection, then tone , power and reflex for motor. Then sensory, the last cerebellar system. for upper limb AND lower limb problem. for cranial nerve, just follow the sequence from 2nd to 12th nerve.

tip no 2, don;t panic. If panic, practice 1000 times, also may Failed. TAKE A DEEP breath and made it a norm routine for you.

Tip no 3, know the topics needed to know for undergraduate!
eg for 3 rd year
CVS- valvular disease-mitral regurgitation, aortic regurgitation, aortic stenosis. Mitral stenosis a bit rare. Prosthetic valve normally mechanical.
Respiratory-bronchiectasis,idiopathic pulmonary fibrosis, pleural effusion, pneumonia
abdomen -polycystic kidney disease, hepatomegaly, splenomegaly, hepatosplenomegaly. Pls memorise the causes of hepato, splenomegaly and hepatosplenomegaly.

Tip no4., Do not cause pain for patient! Pt cry or shout. 100 % failed !

Tip no 5, listen to examiner command, do not argue with examiner or else.......


Last, good luck for the candidates. Take exam as a challenge. Failing exam may make you a better Dr. Trust me about that ! all the top Dr failed their exam before.
It not means you should fail to be good ! it just means failing is nothing . It just a system to access the knowledge and coping !

cognition after carotid endarterectomy or stenting

A neurology 77 published a interesting report regarding the topic above.
divided in 2 arms -one for CEA ( carotid endarterectomy) , another CAS (carotid artery stenting)
the NIHSS (NIH stroke scale) assessed at baseline and 1 daY postprocedure. Modifie RANKIN SCALE at baseline, 1 and 6 month. Cognition assessed in the week before procedure and 6 months later.Pt also assessed for mood using Beck depression inventory II.
MRI with DWI performed 1 to 3 days before and 3 days thereafter to assessnew ischemic lesion.]

Result:significant decrease in cogntion sumscore after CAS from baseline to 6 month
NO significant decrease score after CEA.
The mean difference between changes was not statistically significant.
the worst cogntion functioning inpt treated with CAS consistent with higher rate NEW ischemic DWI lesion after CAS