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)