PCL 11- AN EARLY ARRIVAL

LAST PCL: AN EARLY ARRIVAL

Name: Rohani

Age: 30 years old

Gender: Woman

Status: Married, children - Anisa (3), Kamal (5), G3P2

Occupation: Farmer (paddy)

Pregnant – 30 weeks

SYMPTOMS:

- Increased urinary frequency

- Back ache

- Lower abdominal cramp

CC: Abdominal cramps

When- about half hour, now more frequent

Quality- Increased

PAST HISTORY

- Carcinoma in situ

ON EXAMINATION

- Dilation cervix (2 cm)

DIFFERENTIAL DIAGNOSIS

- PREMATURE LABOUR

- UTI in pregnancy – LUKMAN

LEARNING ISSUES

1. Growth and Development of Fetus (Syukriah & Kieron)

2. Physiology of Pregnancy & Labour (Sam & Nicole)

a. What happen if preterm occur at each trimester?

b. Sign and Symptoms of labour

3. Causes & risk factor for preterm labour – (Rose & Deepak)

4. Complications of preterm labor - baby (Lukman)

5. Management of preterm labor (Fui Fui)

6. Psychosocial issue (Shamendri & Viran)

a. Family, possible loss of child

b. Access to health care, money, distance, transport, long term care, support for wife, bonding with child.

7. Health care delivery (maternal and child health), logistic (what if anything goes wrong) in Rural Area (David)

Some info

hey sam i think this might help you with your investigations and the differentiating between BPH and prostate cancer..
http://www.cancer.gov/cancertopics/factsheet/Detection/PSA
you might have already found it but if u ddnt here u go =)

PCL: Waterworks

PCL 10: Water Works
Name: Marzuki Mohammad
Age: 60
Occupation: train driver
Status: married
CC: Can’t micturate properly, incomplete VOIDING
Increase frequency of urine. Increase urgency


DDx: (do point for point against)
1. Urinary Tract Infection (Lukman*)
a. Lower and upper urinary tract symptoms
2. Bladder CALCULI (Shamendri)
3. Prostate Cancer (Syukriah)
4. Bladder Carcinoma (Fui Chen)
FYI
- Posterior Urethra valve (Everyone, especially Lukman*)
Learning Issue
BPH
- Anatomy (David Soon)
- Definition and Epidemiology (Nicole)
- Pathophysiology and Sign and symptoms (srilanka Male)
- Risk factors (Deesingh)
- Investigation(SAM)
o How to differentiate between Malignant and Benign tumours.
o Specificity and Sensitivity of PSA
- Treatment and management (Rose)
- Complication and Psychosocial (Kieron)*

• * Means disregarded

Week 11 Practical tasks

Heylooo People! :) Given below is the practical for week 11.

1. Pelvic diaphragm and perineal membrane

Kierron and Lukman

2. Viscera- Male reproductive system

Sam and Nicole

3. Viscera- Urinary bladder

Shamendri and Rose

4. Viscera- Urethra

Fui Chen and Viran

5. Male and female external genitalia

Deepak

6. Clinical/procedural anatomy

David

7. Radiology

Syukriah

-Shamendri!

PCL 9: Two Years and no baby
Patient: David & Jilian
C.C: No baby!
David
- Smoker (1 pack/day) & Drinker
-
Learning issues
1) Reproductive system related topics
a. Menstrual Cycle - Nicole
b. Spermatogenesis - Kieron
c. Oogenesis - Judge
2) Anatomy of the Reproductive system - FC
3) Management of infertility
a. Medical (e.g. IVF) – Syu syu
b. Psychosocial - Viran
c. Alternative options (e.g. adoption) -Sam
4) Causes & Risk factors of infertility – david
5) History Taking & Physical Examination – Rose, Shamzziii
6) Investigations – Deepak

ANATOMY Practical Week 9 - Pelvis II

1.1-1.4 - Nicole
1.5-1.7 - Lukman
1.8-1.11 - Viran
2.2-3.1 - Shamendri
3.2-3.5 - Sam
3.6-3.9 - Rose
4.1-4.3 - Fui Chen
5.1-6.1 - Keiron
6.2-6.5 - Syukriah
6.6-7.1 - Deepak
7.2-7.5 - David

PCL 8: It's a Boy

PCL 8: It’s a BOY ??
Patient details:
Name: Kamal
Age: 5 days-old
Gender: unknown?
CC: Ambiguous genitalia
Symptom: - Look unwell
- Vomiting
- Lethargy
- Losing weight

Learning Issues:
1) DDx
- Pseudohermaphrodism (Deep)
- Chromosomal abnormality: include Turner’s (Shammi)
- Congenital adrenal hyperplasia (Cangkul 2)
2) Androgen & testosterone
- Synthesis, secreted where, function? (Fui Fui, Syu Syu)
3) Embryology
- Development of sexual organs (Nicoley)
4) Anatomy & physiology of adrenal gland (Kan, Karen)
5) Investigations (Viran)
- Karyotyping
- Genetics
6) Management
- Of Psychosocial Issues (David) & ethical issues (Rose)

PCL 7

Hey people of Group I!
I hope everyone's enjoying their hols. Just a gentle reminder to UPLOAD YOUR PARTS FOR PCL so that I can compile it and send it to DR WONG CHEE PIAU. Please upload them by tonight yea (12 MIDNITE). Thank you for your attention. See y'all real soon =)

PCL 7: The Wedding

PCL 7: THE WEDDING
Patient’s Details
Name : Sumey
Gender : Female, Indian
Age : 28
Occupation : ??

CC : Loss of weight with palpitations
Associated:
• Tremors
• Eyes look different
• Glandular swelling (not sure where???)
• Loss of fat and muscle
• Increased appetite
• LOSS OF WEIGHT WITH NO LOSS OF APPETITE
Family Hx: Father had a MI
Social Hx:
• Likes to go travelling
• Drinks occasionally
• No smoking
DDx:
• Hyperthyroidism
• Malabsorption
• Diabetes
• STRESS
• Malignancy

LEARNING ISSUES:
1. DDx (4)
o Malabsorption- Shamendri
o Diabetes- Fui Chen
o STRESS- Kieron
o Malignancy (Abdominal) - David
2. Anatomy and physiology of thyroid gland (2)- Lukman and Samantha
3. Pathophysiology of hyperthyroidism (1)- Nicole
4. Signs and Symptoms (1)- Viran
5. Investigations (1)- Rose
6. Treatment and management (1)- Syukriah
7. Complications and Psychosocial (1)- Deep
PLEASE SEND TO DR WONG BY 16th September (12PM) cheepiau@gmail.com

DISCUSSION OF THE LAST PCL!!

about the negative feedback
receptor is not sensitive
there is no end product, so no negative feedback..

how cushing syndrome led to osteoporosis (increased cortisol)
proximal muscle weakness (increased cortisol)

HOW THESE HAPPEN?

discuss this..!!
Viran

PCL 6: NO MORE DIETS

Patient’s Details
Name : SITI
Gender : Female, Malay
Age : 43
Occupation : ??

CC : WEIGHT GAIN associated with:-
• Red (plethora/malar rash/alcoholic/sun burn/flushing) face - vasodilatation
• Round face
• Bruise
• Pimples
• Moustache (hirsutism) - due to androgen? Androgen comes from testosterone?
SYSTEMIC FEATURES – possibly due to hormone (steroids?)
PH : Hypertension (on medication?)
Social : Watching on diet

HORMONES
 Chemical messengers
 Travel in the blood
 Affect multiple organs
 Examples: insulin, sex hormones (testosterone), growth hormones, oxytoxin, progesterone, thyroxine, ADH, ACTH, cortisol, prolactin, TSH, FSH, LH, etc.

LEARNING ISSUE
1. Hormonal control – pituitary axis & non-pituitary axis glandsorgans
a. Negative-positive feedback (3)
2. Epidemiology
3. Cushing’s Syndrome (1) and Cushing’s Disease (1)
4. Differential Diagnosis (3) – PCOS, ….
5. Pathophysiology of hormonal control (2)
6. Investigation
7. Treatment and Management
8. Complications & Psychosocial

1. Endocrine system – endocrine control, negative-positive feedback mechanism
a. Pituitary axis
b. Non-pituitary axis (Nicole, Kieron, Deepak)
2. Pathophysiology of endocrine system- how does the endocrine system go wrong? (Viran, Shamendri)
3. Differential Diagnosis (Lukman, Sam)
a. PCOS
b. Etc.
4. Cushing Syndrome + Disease (4)
a. Definition + Epidemiology (Fui Chen)
b. Risk Factors & Causes
c. Signs & Symptoms (Syurkriah)
d. Investigations/Diagnosis
e. Treatment & Management (David)
f. Complications & Psychosocial (Rose)


PLEASE SEND TO DR WONG BY WEDNESDAY (12PM) cheepiau@gmail.com

Anatomy: Abdomen V

1.1 - 1.4 Viran
1.5 - 1.7 Fui Chen
2.1 - 2.5 Nicole
3.1 - 3.4 Shamendri
4.1 - 4.3 Lukman
4.4 - 4.5 Sam
5.1 - 5.4 Rose
5.5 - 5.9 Kieron
6.1 - 6.3 Deepak
6.4 - 6.5 Syukriah
6.6 - 6.7 David
7.1 - 7.4 Rose

WEEK 4: ABDOMEN IV

It's time for task delegation!!!! =)

1- Fui Chen (1.1-1.3) + Syukriah (1.4-1.6)

2- Sam (2.1-2.5) + David (2.6-2.7)

3- Rose

4- Kieron

5- Nicole

6- Luqman

7- Viran (7.1-7.4) + Deepak (7.5-7.7)

8- Shamendri

PCL Task (Updated)

PCL 3: Like Father
1) Polyps (Nicole, Rose & Lukman)
a. Patho
b. Signs and symptoms
c. Investigations
d. Treatment

2) Hemorrhoids (Sam & Kieron)
a. Patho
b. Signs and symptoms
c. Investigations
d. Treatment

3) Trauma (David & Deepak)
a. Patho
b. Signs and symptoms
c. Investigations
d. Treatment

4) Colorectal cancer (Syukriah, Fui Chen, Viran)
a. Epi
b. Patho
c. Signs and symptoms
d. Investigations
e. Treatment

5) Investigations for bleeding per rectal (Shamendri)

Practical III

Rose - 1
Lukman - 2
Fui Chen - 3
Deepak - 4
David - 5
Syukriah - 6
Kieron - 7
Shamendri - 8
Nicole - 9
Rose - 10
Sam - 11

Task Delegation

PCL 3: Like Father
1) Polyps (Nicole, Rose)
a. Patho
b. Signs and symptoms
c. Investigations
d. Treatment

2) Hemorrhoids (Sam & Kieron)
a. Patho
b. Signs and symptoms
c. Investigations
d. Treatment

3) Trauma (David & Deepak)
a. Patho
b. Signs and symptoms
c. Investigations
d. Treatment

4) Colorectal cancer (Syukriah, Fui Chen, Viran)
a. Epi
b. Patho
c. Signs and symptoms
d. Investigations
e. Treatment

5) Investigations for bleeding per rectal (Shamendri)

Deepak's Last Week Stuff

Goal of Treatment
 Bring the symptoms under control.
 Heal the esophagus.
 Manage or prevent complications.
 Maintain the symptoms of GERD in remission.
1st Line: Changes to Lifestyle
 Position
 Eating Manner
 Diet
 Weight Loss
 Smoking Cessation
 Simple Antacids (over-the-counter)
 Avoiding NSAIDS

2nd Line: Medical Intervention
CLASS MOA EXAMPLES DOSAGE
Alginate –containing Antacids Neutralise stomach acid,
forms foam raft. Ca, Mg, Al containing antacids As and when necessary (after meals)
H2 Antagonists Acid supression cimetidine, ranitidine, famotidine 30 minutes before meals
Proton Pump Inhibitors Reduce gastic acid production by up to 90% omeprazole, rabeprazole, lansoprazole, pantoprazole, esomeprazole Severe:
Twice daily & prolonged for years
Pro-Motility Drugs Stimulate muscles of GIT metoclopramide 30 minutes before meals,
at bedtime
3rd Line: Surgical Intervention
The operation used most often for GERD is called fundoplication. The top of the stomach is wrapped around the lower end of the oesophagus, tightening the oesophageal sphincter.
http://www.youtube.com/watch?v=9bnIuKiHdDE

By Deepak

Heptitis Investigations

Prior to ordering tests for hepatitis, the physician should consider the patient’s history, age, risk
factors, vaccination status and any available previous hepatitis test results.
It must be recognized that an established infection with one hepatitis virus does not exclude co- or superinfection with other hepatitis viruses or other agents such as cytomegalovirus or Epstein-Barr virus, although such dual infections are considered uncommon.
Other possibilities to be considered include hepatotoxic drugs including herbal medicines.
Risk factors for viral hepatitis include:
• Substance abuse (e.g. injection drug use, snorting cocaine)
• High-risk sexual activity (e.g. men who have sex with men, traumatic sex)
• Multiple sexual partners
• A sexual partner with viral hepatitis
• Travel to high-risk hepatitis endemic areas or exposure during a local outbreak
• Household contact with an infected person especially if personal items (e.g. razors, toothbrushes,
nail clippers) are shared
• Attendance at daycare
• History of a transfusion-dependent illness
• Needle-stick injury or other occupational exposure (e.g. healthcare workers)
• Receipt of blood products prior to 1990
• Newborn of infected mother
• Tattoos and body piercing
• Contaminated food or water (hepatitis A only)

Role of serology in hepatitis management
•Serology involves the study of seroactive substances for the purpose of diagnosis and
management of diseases
•Such substances may include antigens and antibodies.
•The presence and time of detection of these substances are essential in hepatological
Infectology

Hepatitis A
•Anti HAV:
▫Detectable at onset of symptoms (IgM)
▫Persists for lifetime hence not very useful clinically (IgG)
•IgManti HAV indicates recent infection. Could remain +ve4-6months post infection.

Hepatitis B
• Serologic markers include:
▫ Hep B surface antigen (HBsAg)
 Detectable in large quantities in serum
 Indicates acute infection and high infectivity
 Appears in blood late incubation period and disappears within 3-4 wks but may persist up to 6mths
▫ Anti HBs
 Indicates past infection with and immunity to HBV (if assoc. with anti HBc), presence of passive antibody from HBIG,or immune response from HBV vaccine
• Hep B core antigen (HBcAg)
• Anti HBc: of 2 types
▫ IgM
 Appears after about 2 mths and may persist till 7th mth.
 Indicates acute infection
▫ IgG
 Indicates chronic infection
• HBe Ag
▫ Circulating form of HBcAg
▫ A marker of viral replication and infectivity
▫ Appears transiently at onset of infection and lasts 1-3mths
▫ Associated with HBV replication and indicates high titre and infectivity of serum
• Anti-HBe
▫ Appears from 10th wek
▫ Presence in serum of HBsAg carrier suggests lower titre of HBV
• Most sensitive test is detection of HBV DNA in serum though not generally required for routine diagnosis
• HCV:
▫ Anti-HCV, for chronic infections
▫ Serum PCR
• HDV:
▫ Anti HDV (IgG & IgM)
• HEV:
▫ Anti HEV


Conclusion
• Viral hepatitis is a common cause of CLD in this environment.
• Healthworkers are particularly at risk of infection
• Understanding the basis for serological investigations of viral hepatitis improves diagnosis, management, prognostication as well as prevention of the disease and its complications.

Cholecystitis
• Inflammation of gall bladder
• Cholelithiasis
o Gall stones
o Formed in biliary tract
 Cholesterol
 Bile pigment
• Caused by cholesterol crystallization from gall bladder bile
o Cholesterol supersaturation of bile
o Crystallization promoting factors within bile
o Motility of gall bladder
• Bile pigment stones
o Black
o Brown
• Cholecystitis caused by obstruction to gall bladder emptying.
• Caused by obstruction of the cystic or common bile duct by a stone migrating from the gall bladder.
o Obstruction results in increased glandular secretion leading to progressive distension of the gall bladder.
• Symptoms
o Severe, steady pain in the epigastric region that then localises to the upper right quadrant.
o Pain gets worse with deep breaths
o The pain often radiates to the tip of the right scapula.
o Fever, sweating, chills
o Loss of appetite, abdominal bloating
o Jaundice

By Kieron

Gastroesophageal Reflux Disease

Gastroesophageal reflux is a normal physiologic phenomenon experienced intermittently by most people, particularly after a meal. Gastroesophageal reflux disease (GERD) occurs when the amount of gastric juice that refluxes into the esophagus exceeds the normal limit, causing symptoms with or without associated esophageal mucosal injury (ie, esophagitis).
Pathophysiology
The physiologic and anatomic factors that prevent the reflux of gastric juice from the stomach into the esophagus include the following:
• The lower esophageal sphincter (LES) must have a normal length and pressure and a normal number of episodes of transient relaxation (relaxation in the absence of swallowing).
• The gastroesophageal junction must be located in the abdomen so that the diaphragmatic crura can assist the action of the LES, thus functioning as an extrinsic sphincter. The presence of a hiatal hernia disrupts this synergistic action and can promote reflux (see image below).
•

Barium swallows indicating hiatal hernia.
• Esophageal clearance must be able to neutralize the acid refluxed through the LES. (Mechanical clearance is achieved with esophageal peristalsis. Chemical clearance is achieved with saliva.)
• The stomach must empty properly.
Abnormal gastroesophageal reflux is caused by the abnormalities of one or more of the following protective mechanisms:
• A functional (frequent transient LES relaxation) or mechanical (hypotensive LES) problem of the LES is the most common cause of gastroesophageal reflux disease (GERD).
• Certain foods (eg, coffee, alcohol), medications (eg, calcium channel blockers, nitrates, beta-blockers), or hormones (eg, progesterone) can decrease the pressure of the LES.
• Obesity is a contributing factor in gastroesophageal reflux disease (GERD), probably because of the increased intra-abdominal pressure.
From a therapeutic point of view, informing patients that gastric refluxate is made up not only of acid but also of duodenal contents (eg, bile, pancreatic secretions) is important.

By Shamendri

Investigations of Cholecystitis

History
EPIGASTRIC pain radiating to the RIGHT HYPOCHONDRIUM, may radiate to tip of scapula
Quality: Colicky --> Constant
Associated symptoms: Nausea, vomiting, fever

Physical Examination
Fever, tachycardia, jaundice
Maximal tenderness in right hypochondrium with guarding & rebound
+ve Murphy's sign

Investigations
Blood tests: FBC, ESR, bilirubin, alkaline phosphatase, serum aminotransferase
Urinalysis
Pregnancy test
Abdominal ultrasound
CT scan
Hepatobiliary scintigraphy

Summary of TREATMENT AND MANAGEMENT OF CHOLECYSTITIS
Medical care
• Bowel rest – no eat & drink
• IV hydration
• Nasogastric suction- keep stomach empty & reduce fluid accumulation in intestine
• Anti-emetics (list of drugs and their MOA)
• IV antibiotics (list of drugs and their MOA)
• IV analgesic (pain reliever) (list of drugs and their MOA)
• Daily stimulation of gallbladder contraction by IV CCK (cholecystokinin)

Surgery (cholecystectomy)
• Open surgery
• Laparoscopic

Abdomen II- Peritoneal Sac

1. Abdominal in relation to the Anterior Abdominal Wall - Sham & Rosy

2. Peritoneal Cavity & Reflections
Sam- (2.1-2.2)
Kieron- (2.3-2.4)
Fui Chen- (2.5-2.6)

3. GIT
Nicole - 3.1
Lukman - (3.2-3.4)

4. Nerves - David & Nicole

5. Vessels
Deepak (5.1 & 5.2)
Syukriah (5.3-5.4)

6 & 7 -Viran

SHARIFAH’S NIGHT OUT

Demography: Female, married, 58 yo, housewife, 3 grown up children (2 d 1 s), slightly overweight (BMI=25)
CC: Epigastric pain
Over indulgence, nausea
HPI: When- on and off, worse last four days, frequent on few days ago, severe pain
Where-Middle
Quality- radiated to R side of the chest (tenderness), severe
Quantity-on off, 3-7
Better-No
Worse-Lie down, food
Associated symptoms-fever, feel like vomiting
Belief-heart attack
Fam Hx: father cholecystectomy, parents died due to old age,
Past Med Hx:
Diet: always kenduri
Social smoker- 3-4 cigarettes/day
Medication: No
Allergy: No
Travel: to Kelantan
O&G: 10 years post menopausal
Investigation: FBC, Urinalysis normal, liver function, cholesterol level (raised 5-10%), ultrasound, endoscopy, ECG normal, cardiac enzyme, 37.2oc, HR 80/min, BP 140/90, RR 12, ESR slightly raised, bilirubin borderline, alkaline phosphotase raised mildly, blood glucose normal, amylase normal
Murphy’s sign-a bit painful
Differential Diagnosis:
1. Cholecystitis
2. Hepatitis
3. Pancreatitis
4. Gastritis
5. Gastroesophageal reflux
6. Stomach cancer
7. MI

Learning issues
1) Overview of the anatomy of the GIT (Sam, Nic)
2) Pathophysio of chole, hep and GERD. Signs & symptoms. What are these 3 things? (Shamzi-GERD, Kieron- Chole, Luk-Hep)
3) Treatment and management (Syukriah- Chole, David- Hep, Deepak- GERD)
4) Investigations (Rosy- Chole, FC-GERD, Vir-Hep) *PCL is a bit different nowadays, we have to cover all 3 diseases, so just check out on which one you’re doing!

PCL Week 1 Sem 4: Why am I overweight?
Bio: Sushila, Indian, mid 20s, female, accountant, smoker, overweight.
CC: Constant lethargy & fatigue.
Associated symptoms: -
Lifestyle: Constant dieter, smoker, leads a sedentary lifestyle, stressed? Low confidence & esteem.
Family history: Overweight, culture

Issues
1. Overweight & Obesity – Definition & Epidemiology (How common? Classifications?) (Lukman)
2. Differential: Hypothyroidism, Cushing’s (steroid consumption) (Shamzi)
3. BMI & Waist Circumference, Hip-waist ratio, indicators of overweight and obesity (Asians etc.) (Deepak)
4. Risk factors for overweight & obesity. (David)
5. Complications for overweight & obesity. (Viran)
6. Treatment and Management: Lifestyle change, diet change, Medication & surgery (CPG for obesity, www.ifnotdieting.com) (Nicole & Kieron)
7. Diets – Different types, Normal calorie allowance (Syukriah)
8. Recommended weight loss (per week), Maintenance, (Fui Fui)
9. How society perceives the overweight (and what is an ideal physique)? The patient (Sam & Rose)

FINAL PCL

PCL 13: Anne’s Holiday (woohoo!)
Patient details:
Name: Anne
Age: 42 or above
Occupation: Nurse (requires standing for long hours in the surgical ward)
Smoker: Yes
Concerns: Overweight, long hours in air
Chief Complaint: Pain in left leg, walking eventually became a problem
Quality: Annoying, excruciating pain, so painful you can even put your leg on the floor
Associated symptoms: Swelling in the left leg
Lifestyle: Lack of physical exercise
Differential Diagnosis:
• DVT
• Compartment syndrome (no trauma)
• Varicose veins
• Elephantitis
• Sickle cell anemia
Learning issues:
1) Types of blood disorders (Syukriah & Sam)
a. Inherited
b. Non-inherited
2) Epidemiology & Definition of DVT (Kieron)
3) Pathophysiology of DVT (Sham & David)
a. Encourage patients to walk after surgery (previously not encouraged)
4) Causes & Risk factors (smoker, previous surgery) leading to DVT (Nic)
a. Economy class syndrome? (What is it?)
5) Signs & symptoms of DVT (FC)
6) Diagnosis & Investigations (Deep)
7) Prevention, Management & Treatment (Viran & Rosie)
8) Prognosis & complications (Lukman)
That’s ALL for this Semester! 

Week 13 Anatomy Practical

Task Delegation
Guys, your task for this week! ~Jia you~
1.1 and 1.2 Kieron

1.3 Sam

2.0 Lukman

3.0 Deepak

4.0 Shamendri

5.0 (1.5 &1.6) Syukriah

5.0 (1.7) Nicole

6.0 Fui Chen

7.0 Rose

8.0 (1.15&1.16) David

8.0(1.17) Viran

PRACTICAL NECK II: ANTERIOR REGION OF NECK

2.1-2.2 SYUKRIAH

2.3 -3.1 NICOLE

3.2 - 3.3.3 FUI CHEN

3.4- 4.1 ROSE

4.2 KIERON

4.3 VIRAN

5.1 SAM

5.2 DAVID

6.1-6.2 DEEPAK

6.3 LUKMAN

6.4-6.5 SHAMENDRI

PCL topics

Learning IssuEEEEEEEESSSSSSS
Define types of veganism (David Soon)
- What can you suffer from?
- Can vegan cause anemia? O.o
What is anemia? (Deepak)
- How do you define it and classification
- What is the cause of iron deficiency in a male
Signs and symptoms (lookman)
Causes and risk factors of anaemia(Rose, viran)
- Can iron deficiency cause menstrual problems? Or the other way round?
Pathophysiology of anaemia (SAM)
- O2 transport
- Why is she tired and lethargic
Diagnosis and investigation (kieron, shami)
- Blood test, what is expected to be seeeeeeeeeeeeeen
Management, treatment and complication (fui chien, nicole)
- Diet
o Sources of iron
Psychosocial (syukriah)

Practical Task Delegation Week 11

Topics for Practical week 11.

1.0 Nose and paranasal sinuses

1.1- 1.2.3.1- Sam

1.2.4- 1.5- Deepak

2 Pharynx and Palate
2.1- 2.4.1- Rose

2.5- 2.8.1- Fui Chen

3.0 Larynx
3.1- 3.3.2- Lukman

3.4- 3.6.1- Viran

4.0 Mouth and Tongue
4.1- 4.3.1 Shamendri

4.3.2- 4.5.1- Kieron


5.0 Surface and clinical anatomy


5.1- 5.2.1- David

5.3- 5.4.1- Nicole

PCL 9 - COMPLICATIONS

Learning issues:
1) What is nephrotic syndrome? (ALISKIREN)
a. Diff. between nephritic & nephrotic
2) Epidemiology of nephrotic syndrome (ROSE)
3) Risk factor & causes (DAVID)
a. CIGUATERA poisoning
4) Physiology of the renal system (FC)
a. Creatinine clearance?
5) Pathophysiology (SRI LANKANs)
a. Nephrotic syndrome
b. how diabetes leads to nephrotic syndrome
6) Signs & symptoms (DEEPAK)
7) Diagnosis & investigation (NICOLE & SYUKRIAH)
8) Management & treatment of nephrotic syndrome (LOOKMAN & SAM)

have fun =P

http://www.universal-tao.com/article/urine_therapy.html

6.1-6.3

6.1 Pterygopalatine fossa:
Boundaries:
- Anteriorly (maxilla), laterally, infratemporal region
- Medially (palatine bone, extension of pterygomaxillary fissure)
- Posteriorly (pterygoid plates & greater wing of sphenoid)
Contents: maxillary artery & branches, maxillary nerve, pterygopalatine ganglion

6.2 Infratemporal region
Boundaries:
- Medial: Lateral pterygoid plate, PP fossa, superior constrictor, tensor/levator palati
- Lateral: Ramus of mandible, coronoid process
- Superior: Greater wing of sphenoid, squamous part of temporal, temporal region
- Inferior: carotid triangle
- Anterior: maxilla, inferior orbital fissure
- Posterior: carotid sheath, styloid process & deep styloid region
Contents: pterygoid muscles, temporalis tendon, maxillary vessels, V3, chorda tympani, otic ganglion

6.3 Deep styloid region
Boundaries:
- Lateral: Styloid process
- Medial: Posterolateral wall of pharnyx
- Anteriorly: Infratemporal region
- Posteriorly: Atlas & axis
- Superiorly: base of skull
- Inferiorly: Posterior belly of digastrics

Contents: Internal carotid artery, internal jugular vein, IX, X, XI, XII, sup. cervical ganglion

Anatomy Practical: Mandibular Regions

Activity 2.1.5

Crocodile's jaw is easily held in a closed position. Explain.

I have found some infos...hope it's useful!

Crocodiles' jaws are geared towards chomping down. This gives the animals extreme biting power. But the muscles that open the jaw are relatively weak and can easily be held closed. This is also applicable to human.

Probable answers:-

1. The mouth-closing muscles (temporalis, medial pterygoid and messeter) are well-developed.

2. More muscles for closing the mouth (3) than the muscle for opening the mouth (1). More strength/tension? So easier to be held closed?

Guys, I just giving out my idea....I am not sure about the answer.

(Rose, I told you that I read something about crocodile but its not for crocodile jaw! In fact it about "crocodile tears"- Frey's Syndrome!)

some useful stuff =)

http://thepointeedition.lww.com/product/isbn/9780781775250?focus=ebook

u can go to the above site and use the online e-book of moores if u guys want..
my username and password are
u/n: viran821
p/w: gandav21

also my email is viran821@gmail.com, pls email me ur parts and i shall compile everythin and post up on our group on sunday or monday..

Practical Task Distribution

1. BONES --ROSE

2. MUSCLES --SITI

3. VESSELS -- VIRAN (3.1 UNTIL 3.1.6)

3.2 UNTIL 4.1.1 ---NICOLE

4.2 UNTIL 4.2.5.1-- SHAMENDRI

4.3 UNTIL 4.3.3.4-- KIERON

5. JOINT -- DAVID

6. SPACES/SURFACES & CLINICAL (UNTIL 6.3.1)--SAM

6.4 UNTIL 6.4.5 --- DEEPAK

6.5 UNTIL 6.6.3 LUKMAN

7. RADIOLOGY --FUI CHEN

PCL 8: Confusion Reigns

Details of the PCL
Madam Leong
· 82 y.o
· Mental and physical health deterioration
· Had right knee replacement due to osteoarthritis
· Accelerated memory loss due to physical inactivity
· Absent minded
· Lives in nursing home currently
· John (only son) unable to visit and take care of her frequently
· Visited once a week
· More confused; cannot recognize son
· Stiff movements
· Needs help going to bathroom
· Urinates more frequently
· Painful when urinating
· Smells like urine sometimes
· Has urine incontinence
Important info:
· Absent minded
· Memory loss
· Stiff movement
· Urine incontinence/ frequency
· Pain during urination
· Brain problem???
Hypothesis
· Parkinson’s
· Alzheimer’s
· Senile
· Depression
· UTI (urinary tract infection)
Learning Issues
· Anatomy of the genitourinary system (female)- sites of frequent infection (1) David
· Definition and Microbiology (normal and abnormal flora) at and around the area of UTI (2) Fui Chen and Syukriah
· Pathogenesis and routes of infection (2) Kieron and Deepak
· Signs and symptoms- define the SS and why it occurs (2)- Lukman and Nicole
· Diagnosis and investigation- Viran
· Management and treatment plus Complications (as well as cognitive impairment) (2)Shamendri and Sam
· Social issues regarding the elderly and nursing homes- Rose

PCL 7- A Balancing Act

LEARNING ISSUES

1. Differential diagnosis? (Viran, Deepak)
2. What is hyponatraemia? (Lukman)
3. Physiology – water regulation and acid-base balance (kidneys) (2) (David, Nicole)
 Calculation
i. Plasma osmolarity
ii. Urine osmolarity
4. Underlying causes??(Sam)
5. Clinical signs & symptoms (Kieron)
6. Diagnosis (Investigation) (Rose)
7. Treatment and management (Syukriah)
 Intravenous drug therapy
8. Complications of hyponatraemia (Fui Chen)
9. Ethical and Law Issues (Shamendri)

I personally think that Prochaska DiClemente Cycle (for behaviour change) can be used to quit smoking!

How about you guys? Agree? Disagree?

How to QUIT smoking?

According to University of Texas MD Anderson Cancer Centre, research has shown these FIVE ways will help to quit smoking for good:

1. Pick a date to stop smoking.

- Before that day, get rid of all cigarettes, ashtrays, and lighters everywhere you smoke. Do not allow anyone to smoke in your home. Write down why you want to quit and keep this list as a reminder.

2. Get support from your family, friends, and coworkers.

- Studies have shown you will be more likely to quit if you have help. Let the people important to you know the date you will be quitting and ask them for their support. Ask them not to smoke around you or leave cigarettes out.

3. Find substitutes for smoking and vary your routine.

- When you get the urge to smoke, do something to take your mind off smoking.

a)Talk to a friend.

b)Go for a walk.

c)Go to a movie.

d)Reduce stress with exercise, meditation, hot baths, or reading.

e)Try sugar-free gum or candy to help handle your cravings.

f)Drink lots of water and juices.

g)You might want to try changing your daily routine as well.

h)Try drinking tea instead of coffee.

i)Eating your breakfast in a different place, or taking a different route to work.

4. Talk to your doctor or nurse about medicines to help you quit.

- Some people have withdrawal symptoms when they quit smoking. These symptoms can include depression, trouble sleeping, feeling irritable or restless, and trouble thinking clearly. There are medicines to help relieve these symptoms. Most medicines help you quit smoking by giving you small, steady doses of nicotine, the drug in cigarettes that causes addiction. Talk to your doctor or nurse to see if one of these medicines may be right for you:

• nicotine patch: worn on the skin and supplies a steady amount of nicotine to the body through the skin
• nicotine gum or lozenge: releases nicotine into the bloodstream through the lining in your mouth
• nicotine nasal spray: inhaled through your nose and passes into your bloodstream
• nicotine inhaler: inhaled through the mouth and absorbed in the mouth and throat
• bupropion: an antidepressant medicine that reduces nicotine withdrawal symptoms and the urge to smoke
• varenicline (Chantix): a medicine that reduces nicotine withdrawal symptoms and the pleasurable effects of smoking

5. Be prepared for relapse.

- Most people relapse, or start smoking again, within the first three months after quitting. Don't get discouraged if you relapse. Remember, many people try to quit several times before quitting for good. Think of what helped and didn't help the last time you tried to quit. Figuring these out before you try to quit again will increase your chances for success. Certain situations can increase your chances of smoking. These include drinking alcohol, being around other smokers, gaining weight, stress, or becoming depressed. Talk to your doctor or nurse for ways to cope with these situations.

Teen Smoking Prevention Programme

PCL Week 6: COPD

PCL Week 6:
Shamila: 45, single parent, struggling financially
CC: Dyspnoea, cold, cough, yellow sputum, fever
When: 2 weeks after daughter got discharged
Quality: yellow sputum  infection
Examination: dull percussion in left lower bases, crackles, wheeze on expiration, hyperresonant percussion, mild fever
Meds prescribed: Amoxycillin
Family Hx: mom had rheumatoid arthritis, dad (smoker) died of respiratory failure
Social Hx: smoking for >30 years
Differential diagnosis: asthma, exertion, infection, COPD, emphysema




Learning issues: COPD VISUAL AIDS OK???
- Differential diagnosis: asthma, exertion, infection, COPD, emphysema (KANNN + Shamendri)
- Incidence (local + overseas!) (Rose)
- What is COPD? Chronic bronchitis & emphysema, pink puffers, blue bloater (Deepak)
- Physiology (Karen)
- Pathophysiology of emphysema in smokers (Viran)
- Signs & symptoms (Fui Fui)
- Risk factors (Syukriah)
- Diagnosis & clinical examination: include lung function test (detail), JVP (Sam)
- Management & treatment (general only) (Nicole)
- Prevention & cessation of smoking (role play) (Dr. Gong + Group I)
- Complications (David)

PCL week 3 - Anna's Out of Breath

LEARNING ISSUES
1. Incidence of Prevalence of asthma Fui Chen
2. What is Asthma? DD for this case’s signs (hypersensitivity) Nicole

3. Anatomy of the Respiratory Tract Shamendri

4. Physiology of Respiration / Pathophysiology of Asthma and wheezing Deepak, Rose

5. Risk Factors and causes Keiron

6. Signs and Symptoms, and aggravating factors Lukman

7. Investigation and examination – lung function tests Viran

8. Treatment and management, Complications (Acute and Chronic)
Complementary and alternative medicine David, Syukriah, Sam (Role play of CAM)

Signs & symptoms of Hypertension

Most people with primary hypertension don't have any obvious symptoms at all, also the possible symptoms of hypertension vary quite a lot from person to person. These symptoms could also be symptoms of other health problems, however here are a few of the more common symptoms of hypertension to look out for.
1. One of the symptoms of hypertension is chronic headaches. When you get chronic headaches that last for days (rather than hours) you should immediately see a doctor and get your blood pressure checked.
2. Dizziness or Vertigo
3. Blurry or double vision.
4. Drowsiness
5. Nausea
6. Shortness of breath. Usually when this occurs people start to get a little concerned. Often by this time though the blood pressure has probably reached high enough levels to be dangerous as this is one of the last symptoms of hypertension you'll experience.
7. Heart palpitations
8. Fatigue - general tiredness
9. A flushed face
10. Nosebleeds
11. A strong need to urinate often (especially during the night)
12. Tinnitus (a ringing or buzzing in the ears)
If you have any combination of these symptoms, then you should get your blood pressure checked by a doctor.
Secondary Hypertension
If you have hypertension that is caused by another medical condition, it is calledsecondary hypertension. This can be caused by many of different illnesses. People with kidney disorders often have secondary hypertension. This is because the kidneys regulate the balance of salt and water in the body. If your kidneys cannot get rid of excess salt and water from the body, your blood pressure goes up. Kidney infections, a narrowing of the arteries that carry blood to the kidneys, and other kidney disorders can disturb the salt and water balance. Kidney problems are by no means the only medical condition that can cause secondary hypertension, there many other conditions the 'side' effects of which can cause hypertension. More info is on the 'causes of hypertension page'