live attenuated vaccines

BOYs Love The CRIME

B= BCG
O=OPV
Y=YELLOW FEVERLove= LIVE ATTENUATED
The= TYPHOID
C=CHICKEN POX
R=RUBELLA
I=INFLUENZA
M=MUMPS,MEASLES
E=EPIDEMIC TYPHUS

Possible causes of pyrexia of unknown origin (PUO)

"IMAGINE"

INFECTIONS:-Bacterial:bacillary endocarditis and septicemia,collection of pus(subphrenic,intrahepatic,etc)
Viral:hep bprotozoal:malaria,amoeba,spirochaetes
specific: TB,typhoid..

MALIGNANCY:-kidney nd liver,pancreas,lymphoma(hodgkin nd non hodgkin)..

AUTOIMMUNE DZS: SLE , PAN, rhumatoid arthritis..

GRANULOMAS: sarcoid,crohn dz...

IATROGENIC: Drug fever

NURSES,Doctors and all paramedical : factitious fever

ETC: remember that the cause is more often a rare manifestation of a common disease than a common manifestation of rare disease

The causes of Gastro Intestinal Bleeding

The simple things to remember:

ABCDEFGHI:
Angiodysplasia
Bowel cancer
Colitis
Diverticulitis/ Duodenal ulcer
Epitaxis/ Esophageal (cancer, esophagitis, varices)
Fistula (anal, aortaenteric)
Gastric (cancer, ulcer, gastritis)
Hemorrhoids
Infectious diarrhoea/ IBD/ Ischemic bowel

The types of Hypoxia...

1. Anoxic hypoxia or Diffusion hypoxia
Anoxic hypoxia also called as diffusion hypoxia is essentially due to the deficency of oxygen being absorbed by the lungs. This is either due to a decrease in the inspired concentration of oxygen in the air which can result in suffocation.
Another reason is due to a defect in the absorption of oxygen by the lungs due to some pathology or defect at the alveolo cappilary membrane of the lungs, where the real gas exchange takes place.

2. Anaemic hypoxia
Another among the 4 Types of Hypoxia is the Anemic hypoxia. This is due to decreases oxygen binding capacity of the lungs, most commonly due to a decrease in the hemoglobin concentration. Hemoglobin is the main carrier of oxygen in the circulation throughout the body. Hence, if hemoglobin is less, the supply of oxygen to the tissues is decreased.

3. Stagnant hypoxia
The next among the 4 Types of Hypoxia is stagnant hypoxia. This is due to decrease in the flow of blood, that carries the oxygen. For example as in Cardiac arrest or in circulatory shock, the decreased supply of oxygen due to cessation or slowing down of blood circulation causes hypoxia to the body tissues.

4. Histotoxic hypoxia
The last among the 4 Types of Hypoxia is the histotoxic hypoxia. this occurs due to defect in the extraction of oxygen from the circulation by the body tissues. An example of histotoxic hypoxia is cyanide poisoning

Strawberries of medicine.. hehe

Strawberry tongue
- Scarlett fever(white followed by red),Kawasaki's disease .
Strawberry vagina/cervix
- Trichomoniasis .
Strawberry Gingivitis
- Pathognomic of wegner's granulomatosis .
Strawberry Gallbladder
- Diffuse cholesterolosis .
Strawberry Hemangioma/nevus
-Birth marks .
Strawberry picker's Palsy
-peroneal nerve compression .

PATHOGNOMIC SIGNS

1. COPD (Chronic Obstructive Pulmonary Disease)
- Barrel-Chested
2. Pneumonia
- Greenish Rusty Sputum
3. Pernicious Anemia
- Beefy Red Tongue (Schilling’s Test)
4. Kawasaki Dieases
- Strawberry Tongue
5. Typhoid
- Rose Spot
6. Tetany
- Chvostek Sign (Muscle Twitching Face)
- Trosseau’s Sign (Jerky Mov’ts)
7. Pancreatitis
- Cullen Sign (Bluish discoloration preumbilical area)
8. Appendicitis
- McBurney’s Point (rebound tenderness)
- Rovsing Sign (RLQ pain w/ palpation in LLQ)
- Psoas Sign(pain on lying down putting pressure on MB pt)
9. Thrombophlebitis
- Homan’s Sign
10. Hepatitis
- Icteric Sclera (yellowish discoloration of sclera)
11. Meningitis
- Burdzinski Sign (Pain on nape)
- Karnig Sign (pain on leg/ knee area)
12. Pyloric Stenosis
- Olive-Shaped Mass
13. Hyperthyroidism
- Exopthalmus
14. Addison’s Disease.
- Bronze-like skin
15. Cushing Syndrome
- Boffalo Hump
16. Cholera
- Rice Watery Stool
17. SLE
- Butterfly Rashes
18. Leprosy
- Leoning Face (contracted face)
19. Bulimia Nervosa
- Chipmunk Face
20. Liver Cirrhosis
- Spider Angioma
21. Asthma
- Wheezing Inspiration
22. Hyperpituitarism
- CAROTENEMIA (Discoloration of skin)
- XANTHAMIA
23. Down Syndrome
- Single Crease on Palm
24.TOF
- Ventricular Septal Defect , Pulmonary Stenosis
Overriding of Aorta , Right Ventricular Hypertrophy
25.Cataract
- Blurry Vision / Hizzy Vision
26.Glucoma
- Tunnel-like Vision
27. PTB
- Low grade fever in a ternoon
28. Cholecystitis
- Murphy’s Sign (pain RUQ)
29. Myasthemia Gravis (MG)
– Ptosis (inability to open upper eyelids)
30. Dengue
- Petechiae
31. Parkinson’s Diease.
- Pill Rolling Tremors
32. Measles
- Koplick’s Spot

at semporna

it's been 2 month passed already....
if want to came some place peacefully, just come to semporna. Even there is no many places that interesting but the beauty of the ocean already catch my heart. Not now but since i'm was a kid. I really like to come to the beach because the scenery just so beautiful for me.

this picture was been taken while me and my three liltle brother's enjoying our breakfast at 9 am i guess. At the same time, there is a group of fisherman have collected the fish and the crabes that they have been catches i think since early in the morning. when i looked closer the fishes and the crab's was so big. Daebakk!! But i can't take the picture so closed because i'm so afraid to go near of them.. not so friendly of me.

After the breakfast, my daddy give us suprise. "ALL OF U, GO PREPARE BECAUSE WE HAVE TO SEE THE OCEAN AND THE ISLAND TOO" wow!!!. DAEBAKK!! Hahahahaha. My first time to get on the boat and seriously, i'm feel so dizzy but it's amazzing experiance.

the simulator question 1

A 40 year old man arrives at the ER accompanied by his family. He is complaining of palpitations after working outside for several hours. The assessment is as follow:

SKIN: Pale, warm and dry
CVS: Strongperipheral pulses and a BP of 125/80
CNS: Fully intact
RESP: RR is 22, no resp. difficulties, lungs CTA
The monitor shows narrow complex SVT with HR of 180
_____________________________________________________________________________________

1. You place oxygen at 2 litre by nasal phronge on the patient and start an IV. The
monitor continues to show a narrow complex SVT.

What is your next intervention?
- attempts vagal maneuvers.

2. You have performed vagal maneuvers and there is no change in the patient heart
rate and rhythm. What is your next step?
- give adenosine 6mg rapid IV push. If no conversion, give 12mg rapid IV push.

3. You give 6mg Adenosine rapid IV push with no effect. 12mg adenosine rapid IV
push is then given. The patient develops severe chest pain and his vital sign
are: HR220, BP (not obtainable), and weak pulse. The patient also has LOC change.
Your next step should be.
- perform immediate synchronized cardioversion.

4. After synchronized cardioversion is unsuccessful, the pt. continues to
deteriorate. The patient is now unconscious with pusleless ventricular
tachycardia. Below is what you see on the monitor:

What is your first intervention.
- give one unsynchronized schock (120-200 J)

5. The patient does not respond to the defibrillation. He remain unconscious in
ventricular tachycardia. What is your next intervention.
- Gives 5 cycles of CPR.

6. After completing 5 cycles of CPR, your rhythm check indicates a second shock.
You shock a second time, and the patient rhythm does not change. You resume CPR.
While completing the cycle of CPR what else shold be done?
- Give Epinephrine 1mg IV push(repeat every 3-5 minutes),
- Vasopressin 40 U IV push to replace the 1st or 2nd of epinephrine.

7. You have given the epinephrine or vasopressin and completed the 5 cycles of CPR.
A rhythm check reveals no change. You attempts at third defibrillation.
What will be your defibrillation setting?
- 120-200 Joules.

8. The third schock does not change the rhythm and you restart CPR (5 cycles). You
have schock, have given vasopressors (epinephrine and/or vasopressin), you have
have continued with effective CPR. What medication should be considered at this
points?
- Amiodarone

9. What is the correct dosing for amiodarone in the Pulseless Arrest Algorithm?
- 300mg IV once. Then consider an additional 150mg IV once.

10. Lidocaine can be used instead of amiodarone as an anti-arrhythm for pulseless
arrest. What is the proper dosing of lidocaine?
- 1 to 1.5 mg/kg 1st dose, then 0.5 to 0.75 mg/kg IV.

11. You give amiodarone 300mg 1st dose and the patient convert to a Normal Sinus
Rhythm. You are instructed to start an amiodarone drip for the postresuscitation
maintenance theraphy. What is the maximum cumulative dose for amiodarone in a
24 gour period?
- 2.2 grams.

12. The patient has been stabilized and intubated, but does not respond to verbal
commands. He is transported to the hospital's ICU. Since the patient is not
responsive what would be the most importants intervention in the post- cardiac
arrest phase.
- induced theraputic hypothermia.

ACLS

There's is one website that i found and maybe it will be usefull to me so please take a note... This is the question :

1. Success of any resuscitation attempt is built on:
- High quality CPR
- Defibrillation when required by the patient ECG rhythm

2. The most important algorithm to know for adult resuscitation is:
- Pulseless arrest

3. The systematic approach with a person in cardiac arrest should include the BLS survey and the ACLS survey (True)

4. While conducting the BLS survey, you should do all of the following things including:
- check patient responsiveness
- active EMS
- get an AED

5. According to new 2010 Guidelines, which of the following is the correct order for the patient sudden cardiac arrest?
- Give 30 compressions, open airway, check breathing, attach AED as soon as
possible.

6. After providing a schock with an AED you should:
- Start CPR, beginning with chest compressions.

7. During CPR after an advanced airway is in place, which of the following is true:
- one breath every 6 to 8 second should be given.

8. The most important intervention with witnessed sudden cardiac arrest is:
- defibrillation.

9. Typically, suctioning attempts in ACLS situation should be:
- 10 second or less.

pada bulan december.....

sejak bermulanya cuti aku dan terakhir kalinya bergelar sebagai seorang pelatih penolong pegawai perubatan, perasaan aku bercampur baur... perasaan sedih pun ada kerana terpaksa meninggalkan negeri kedah yang selama 3 tahun ini tempat aku menimba ilmu, bersuka cita dan berduka cita bersama-sama dengan 141 rakan-rakan seperjuangan serta perasaan yang sangat gembira kerana dapat kembali ke sabah untuk bersama-sama dengan keluarga tercinta.

4hb dec 2011, 3.00 am
disebabkan tidur terlalu lewat sangat kerana masing-masing sibuk dengan mengemas barang-barang untuk dibawa balik bersama-sama ke sabah. Dengan beg bagasi yang sememangnya sangat berat untuk dibawa ditambahkan lagi dengan beg sandang yang kecil molek menyukarkan lagi pergerakan pulang. Bila aku bangun, aku sedar yang teman sebelah katil aku sudah tiada, semua barang-barang telah diangkut dan dibawa ke depan pintu pagar untuk menanti bas kolej datang untuk membawa kawan-kawan pergi ke lapangan terbang bayan lepas pulau pinang (main hentam je bab xtau airport mana dorg pegi tpi semestinya mesti pulau pinang). Kenapa lapangan terbang di penang?? sebab, hanya yang asal dari kota kinabalu, keningau, tambunan, ranau dan sebagainya akan naik dari penang. Jadi, macam mana yang tinggal sandakan dan tawau pula macam aku ini..?? kami kena naik kapal terbang di lapangan terbang alor star je. Pada waktu itu, aku dengan dua orang rumet aku yang tinggal iaitu E dan D telah melambai kawan-kawan kami yang baru sahaja bergerak menuju ke penang. Nak nangis pun ada juga. Nampaknya, tinggal kami bertiga untuk menyiapkan diri kami masing-masing untuk balik juga...