Medical PBL

Case Files 9 - Hypertension in Pregnancy, or was it?

2011-11-27T11:46:00.001+08:00

Case submitted by Dr Jefrrey Lee on 15th Nov 2011

This is an extremely rare case. just would like to share it for academic purpose.

A 38 year old primigravida at 22 weeks POA was referred from MCH for stabilisation of severe hypertension in pregnancy

(BP=220/120 on 2 separate occasions).

No previous known history of hypertension but there is a family history of hypertension.
She is asymptomatic for preeclampsia, urine protein trace.
Routine PET workup taken shows that she is extremely hyperkalaemic (serum potassium =8.9).
Creatinine and other PET workup was normal and ECG does not show any changes suggestive of hyperkalaemia.
She was given cocktail, serum potassium improved to 4.5 but again increase to 7.8 a day later. - Sample was not lysed.
ABG was taken shows a compensating metabolic acidosis. She was otherwise asymptomatic with normal urine output.

The diagnosis is beyond our level as it is made by the Physician. But it is worthwhile to consider this when we cannot explain why a patient remain hypertensive, with asymptomatic hyperkalaemia and metabolic acidosis.

Ready for the diagnosis? --> Gordon's syndrome or type II pseudohypoaldosteronism. Nice to know, nice to forget too : )

Case Files 8 - Oh My Urine - SOLVED

2011-11-26T14:52:00.000+08:00

An elderly bed bound lady in her early 70's, was found to have urine as of such in her CBD bag.

Given that this is the first time the patient developed this condition,
1) What would your differential diagnoses be?

Purple Urine Bag Syndrome - Although the name suggests more of urine discoloration, most of the time, the catheter and the bag are more markedly stained by the pigment.
Porphyria - less likely, but still possible

2) What do you think are the risk factors for such condition?

Before we identify the risk factors, it is prudent to know how it is formed. Tryptophan in the food gets metabolized in the intestines into indoles. Enterohepatic circulation converts it into indoxyl suplhate which is then detoxified by the liver into indoxyl. These are excreted into the urine, which would be metabolized by colonizing bacteria(in alkaline environment) in the CBD into indigo (blue) and indirubin (red). The blue and red pigments when mixed, of course, gives you the purple hue from where the name originated from.

Risk factors, of course are bedridden female elderly, alkaline urine, chronic constipation(to allow tryptophan metabolism and enterohepatic circulation metabolism to occur), long standing indwelling catheter(for colonization of bacteria in the CBD).

3) How do you treat this condition, should there be a need?

There are many advocates for different treatment, including:
i) Urinary sanitization - by replacing the indwelling urine catheter and ensuring proper catheter hygiene, the urine condition will slowly but surely to improve
ii) Constipation management - Since constipation is a risk factor, it is prudent to help the patients to move their bowels, hence preventing or reducing the formation of indoxyl.
iii) A short course of antibiotics - Treatment of the UTI can be done, although it should not be the sole treatment. The above mentioned methods should also be practiced, otherwise there would still be recurrent infection!

CPG: MAnagement of Pulmonary Arterial Hypertension + Management of Breast Cancer

2011-11-12T09:24:00.000+08:00

Here/s the latest 2 Clinical Practice Guidelines. I'm pretty sure that the Management of Breast Cancer was recently uploaded as I would have noticed it by then if it was issued online last year. Nevertheless, feel free to update yourself with the last guidelines regarding Management of Breast Cancer and Pulmonary Arterial Hypertension.

Management of Breast Cancer (2nd Edition) - 2010
Download Links: Box.net | Mediafire

Management of Pulmonary Arterial Hypertension - 2011
Download Links: Box.net | Mediafire

For a view of the whole collection of Malaysia CPG's available in Medical PBL (Trust me, we do have quite a collection), kindly do refer to: ==> HERE

CPG: Management of Dyslipidemia, 4th edition - 2011 + Guidelines for Insulin Therapy

2011-10-23T12:02:00.001+08:00

The latest guidelines to the management of dyslipidemia is out. Do check out the guidelines if you're interested in it. :)

Management of Dyslipidemia - 2011
Download Links: Box.net | Mediafire

And also, the guidelines for Insulin Therapy, a complementary to the latest CPG for management of Diabetes Mellitus, by Malaysian endocrine and Metabolic Society(MEMS) with MOH, in view of the rising trend of insulin users among diabetic patients.

Insulin Therapy Guidelines 2011
- Practical Guide for Insulin Therapy
  Download Links: Box.net | Mediafire
- Quick Reference for Insulin Therapy
  Download Links: Box.net | Mediafire

For a view of other CPG's, kindly do refer to: ==> HERE

Malaysia Clinical Practice Guidelines and Consensus (Last update: Oct 23rd, 2011)

2011-10-13T14:00:00.002+08:00

Below is the subsection for the available CPG in Malaysia. All CPG are valid for 4-5 years unless stated otherwise. Older CPG are stored for archiving and reference purposes and should not be held liable for any differences in management.

For search purposes, it is recommended to use the browser's search function, "Find" through this list of CPG's. For example, Firefox or Chrome users can use the function "Ctrl" + "F" and type in the keywords in the designated search box. This will lead to the targeted keywords/ text on this list.

Pharmacological Guidelines

Malaysia National Antibiotics Guidelines 2008
Download Links: Box.net | Mediafire
Insulin Therapy Guidelines 2011
- Practical Guide for Insulin Therapy
  Download Links: Box.net | Mediafire
- Quick Reference for Insulin Therapy
  Download Links: Box.net | Mediafire

Cardiovascular CPG:

Management of Unstable Angina/ Non-STEMI (2nd Edition) - 2011
Download Links: Box.net | Mediafire
Prevention of Cardiovascular Disease in Women - 2008 (1st Edition)
Download Links: Box.net | Mediafire
Management of Hypertension (3rd edition) - 2008
Download Links: Box.net | Mediafire
Management of Heart Failure - 2007
Download Links: Box.net | Mediafire
Management of Acute STEMI - 2007 (2nd Edition)
Download Links: Box.net | Mediafire
Management of Ischemic Stroke - 2006
Download Links: Box.net | Mediafire
Management of Unstable Angina/ Non-STEMI - 2002
Download Links: Box.net | Mediafire

Respiratory CPG:

Management of Pulmonary Arterial Hypertension - 2011
Download Links: Box.net | Mediafire
Management of Chronic Obstructive Pulmonary Disease (2nd Edition) - 2009
Download Links: Box.net | Mediafire
Treatment of Tobacco Use and Dependence - 2003
Download Links: Box.net | Mediafire
Management of Adult Asthma -Revised 2002
Download Links: Box.net | Mediafire

Hematology CPG:

Management of Transfusion Dependent Thalassaemia - 2009
Download Links: Box.net | Mediafire
Management of Anemia in Pregnancy and Chronic Kidney Disease (?Draft) - 2007
Download Links: Box.net | Mediafire
Management of Immune Thrombocytopenic Purpura - 2006
Download Links: Box.net | Mediafire
Diagnosis and Management Chronic Myeloproliferative Disorders - 2004
Download Links: Box.net | Mediafire

Nephrology CPG:

Management of Chronic Kidney Disease in Adults - 2011
Download Links: Box.net | Mediafire
Diabetic Nephropathy - 2004
Download Links: Box.net | Mediafire

Endocrine/ Metabolism Disorder CPG:

Management of Dyslipidemia - 2011
Download Links: Box.net | Mediafire
Management of Type 2 Diabetes Mellitus (4th Edition) - 2009
Download Links: Box.net | Mediafire
Management of Diabetic Foot - 2004
Download Links: Box.net | Mediafire
Management of Dyslipidemia - 2004 (The previous 2003 was a draft)
Download Links: Box.net | Mediafire
Management of Obesity - 2003
Download Links: Box.net | Mediafire
Consensus Statement on Androgenetic Alopecia - 2003
Download Links: Box.net | Mediafire

Infection CPG:

Management of Dengue Infection in Adults (Revised 2nd Edition) - 2010
Download Links: Box.net | Mediafire
Management of HIV Infection in Pregnant Women - 2008
Download Links: Box.net | Mediafire
Management of HIV Infection in Children - 2008
Download Links: Box.net | Mediafire
Management of Dengue Fever in Children - 2004
Download Links: Box.net | Mediafire
Adult Vaccination - 2003
Download Links: Box.net | Mediafire
Childhood Immunisation - 2004
Download Links: Box.net | Mediafire
Control and Management of Tuberculosis 2nd Edition - 2002
Download Links: Box.net | Mediafire

Neurology CPG:

Consensus Guidelines on the Management of Epilepsy- 2010
Download Links: Box.net | Mediafire

Vascular CPG:

Management of Acute Variceal Bleeding - 2007
Download Links: Box.net | Mediafire
Management of Non-Variceal Upper Gastrointestinal Bleeding - 2003
Download Links: Box.net | Mediafire
Management of Venous Tromboembolism - 2003
Download Links: Box.net | Mediafire

Orthopedics & Rheumatology CPG:

Management of Gout - 2008
Download Links: Box.net | Mediafire
Management of Osteoporosis - 2006
Download Links: Box.net | Mediafire
Management of Osteoarthritis - 2002
Download Links: Box.net | Mediafire

Ophthalmology CPG:

Screening of Diabetic Retinopathy - 2011
Download Links: Box.net | Mediafire
Management of Primary Open Angle Glaucoma - 2008
Download Links: Box.net | Mediafire
Management of Post-Operative Infectious Endophthalmitis - 2006
Download Links: Box.net | Mediafire

Otorhinolaryngology (ENT) CPG:

Consensus Guidelines on URTI - 2009
Download Links: Box.net | Mediafire
Management of Sore Throat - 2003
Download Links: Box.net | Mediafire

Women's Health CPG:

Hormone Therapy During Menopause in Malaysian Women - 2010 Download Links: Box.net | Mediafire
Management of Anemia in Pregnancy and Chronic Kidney Disease (?Draft) - 2007 Download Download Links: Box.net | Mediafire
Management of Menorrhagia - 2004
Download Links: Box.net | Mediafire

Pediatrics CPG:

Retinopathy of Prematurity - 2005
Download Links: Box.net | Mediafire
Withholding and Withdrawing of Life Support in Children - 2005
Download Links: Box.net | Mediafire
Rational Antibiotic Utilisation in Selected Paediatric Conditions - 2004
Download Links: Box.net | Mediafire
Management of Jaundice in Healthy Newborns - 2003
Download Links: Box.net | Mediafire
Management of Postnatal Corticosteroids For The Prevention of Chronic Lung Disease In Preterm Infants - 2003
Download Links: Box.net | Mediafire
Management of Febrile Fits - 2000
Download Links: Box.net | Mediafire

Mental Health CPG:

Management of Schizophrenia in Adults - 2009
Download Links: Box.net | Mediafire
Management of Dementia (2nd Edition) - 2009
Download Links: Box.net | Mediafire
Management of Attention Deficit Hyperactive Disorder in Children and Adolescent - 2008
Download Links: Box.net | Mediafire
Management of Major Depressive Disorder - 2007
Download Links: Box.net | Mediafire
Malaysia Consensus Statement for the Treatment of Bipolar - 2007
Download Links: Box.net | Mediafire

Cancer CPG:

Management of Breast Cancer (2nd Edition) - 2010
Download Links: Box.net | Mediafire
Management of Cancer Pain- 2010
Download Links: Box.net | Mediafire
Management of Cervical Cancer - 2003
Download Links: Box.net | Mediafire
Management of Breast Cancer- 2002
Download Links: Box.net | Mediafire

Gearing for MD Professionals

2011-10-11T11:55:00.000+08:00

Preparations are never too early, but they can always be too late. In view of this, this section is created to aid future medical students, in particular UKM medical students and other Uni students sitting for similar exams to gear for their professionals. We do hope that this would be of great help, as some of these here are recollection of the past years question. We do hope that those who are still there would be able to continue to contribute to this site to expand the question banks for the benefit of the rest.

Professionals:
MD UKM Professionals Exam 2010 - A joint recollection --> Downloads: Box.net
MD UKM Professionals Exam 2011 - A joint recollection --> Downloads: Box.net

Surgery:
Year 3 Exams 2009-2010 --> Downloads: Box.net

O&G:
Year 3 Exams Sem 1 2009-2010 --> Downloads: Box.net
Year 3 Exams Sem 2 2009-2010 --> Downloads: Box.net

JKM:
Year 3 Exams Sem 1 2010-2011 --> Downloads: Box.net

Internal Medicine:
Year 3 Exams Sem 2 2009-2010 --> Downloads: Box.net
Year 3 Exams Sem 1 2010-2011 --> Downloads: Box.net

Year 4 Full Set Sem 2 Questions 2010-2011 --> Downloads: Box.net

Triad (ENT, Ophthalmology, Anesthesiology):
Dr Aida Ophthalmology OSCE Slides --> Downloads: Box.net
Ophthalmology Revision Questions --> Downloads: Box.net
ENT Revision Questions --> Downloads: Box.net
Year 4 Exams Sem 1 2009-2010 --> Downloads: Box.net
Year 4 Exams Sem 2 2009-2010 --> Downloads: Box.net
Year 4 Exams Sem 1 2010-2011 --> Downloads: Box.net
Year 4 Exams Sem 2 2010-2011 --> Downloads: Box.net

Psychiatry:
Year 4 Exams Sem 1 2009-2010 --> Downloads: Box.net
Year 4 Exams Sem 1 2010-2011 --> Downloads: Box.net
Year 4 Exams Sem 2 2010-2011 --> Downloads: Box.net

Orthopedics:
Year 4 Exams Sem 1 2009-2010 --> Downloads: Box.net

Year 4 Exams Sem 1 2010-2011 --> Downloads: Box.net
Year 4 Exams Sem 2 2010-2011 --> Downloads: Box.net

Pediatrics:
Pediatrics Long Case Template
(Seizures/ Epilepsy, Cerebral Palsy, Asthma, Thalassemia, Diabetes, Spina Bifida
Download Links: Box.net
Year 4 Exams Sem 1 2009-2010 --> Downloads: Box.net
Year 4 Exams Sem 2 2009-2010 --> Downloads: Box.net
Year 4 Exams Sem 1 2010-2011 --> Downloads: Box.net

CPG: Screening of Diabetic Retinopathy

2011-10-06T21:40:00.000+08:00

The new Clinical Practice Guidelines for Screening for Diabetic Retinopathy is out. So, there's no longer any reason not to refer to the eye specialist for diabetes eye problems right? :P

To download this file, kindly proceed to the CPG Downloads Section at: ==> HERE

CPG: Management of Chronic Kidney Disease in Adults

2011-09-14T14:30:00.001+08:00

The new Clinical Practice Guidelines for Management of Chronic Kidney Disease in Adults is out. For a soft copy of this CPG, you can head to MOH web or the link below to the CPG download section on this site.

To download this file, kindly proceed to the CPG Downloads Section at: ==> HERE

Malaysia National Antibiotics Guidelines 2008

2011-08-31T10:22:00.000+08:00

Just in case if anyone is looking for the Malaysia National Antibiotics Guidelines, here's the 2008 edition. Hope it could benefit all, while we await the latest guideline! :)

I've also included it in the "Malaysia Clinical Practice Guidelines and Consensus" Section.

Malaysia National Antibiotics Guidelines 2008

Download Links: Box.net | Mediafire

CPG: Management of Unstable Angina and Non-STEMI

2011-08-02T19:43:00.000+08:00

The latest clinical practice guidelines for management of unstable angina and non-STEMI is out. Hope this benefits all of us who's going to be working in Malaysia particularly.

To download this file, kindly proceed to the CPG Downloads Section at: ==> HERE

Case Files 4 - Emergency/ Int Med: Dying From Within

2011-07-01T19:59:00.000+08:00

Case Submission by Dr Jeffrey Lee (July 1st, 2011)

A 17 years old teenage boy was admitted to the wards after allegedly ingested 2 cups of Paraquat. Upon admission, he was vomiting profusely and multiple oral ulcers were seen upon inspection.

On investigation, his creatinine levels were raised from 168 μmol/ L on admission to 694 μmol/ L and >1000 μmol/ L over a week. The chest radiograph shows progressive changes suggestive of massive fibrosis.

Some questions to ponder:

What is your immediate management of this patient should you be the House Officer attending to this patient?
Give your full medical diagnosis of this patient from the information given.
What are the other signs and symptoms you should look out for?
What are the other complications you should be cautious of?
What are the investigations need to be done, particularly for monitoring purpose?

Upon admission, a nasogastric tube was inserted and NG Fuller's earth and Mist Alba was administered STAT with adequate hydration till diarrhea. Activated charcoal was also administered and the boy was being considered for peritoneal dialysis should his blood urea raises to a critical level.

A new protocol from the Sarawak General Hospital advocates the use of immunosuppressive agents. The agent recommended was IV Cyclophosphamide and pulse therapy of Dexamethasone. These agents presumably modulate the immunoresponse and have a reno-protective effect. These therapy was commenced on this patient. While the renal function improved with 2 or 3 cycles of immunosuppresion, the lung could not be saved as fibrosis has started to set in.

Further questions:

What are the dosage of the treatment given?
What are the indications for the use of immunosuppresive agents? Should we use them for all paraquat poisoning?

Medical Case Files & Submissions

2011-06-21T02:16:00.000+08:00

Many moons ago, there once was an idea to form a section on medical case files in MedPBL. Due to the lack of manpower, the effort did not materialize much, with only 3 cases in the bank. Now that MedPBL has consolidate further over a few years time, it is time to bring back this idea back into the fray.

Currently, MedPBL accepts any form of medical cases for discussions and learning, be it from the cases you encounter on daily basis, or some interesting ones elsewhere. From Medicine, Surgery downright to Orthopedics, we do accept all sorts of cases from the fields of Modern Medicine (I'm sorry, as homeopathy is out of my scope of knowledge and moderation indeed).

Hence, wherever you are in this world, from within or out of Malaysia, we are willing to share your case. Of course, the identity of the patient shall not be revealed, and we will credit the sender appropriately. If you prefer to use a pseudonym instead, we would also be glad to help you with that.

Don't worry, all we need is a fresh case, with some description at the very least. Further discussion can be worked out later. :)

To have a view at the current case files: Medical Case Files

To submit your medical cases: Medical Cases Submission

*P.S: I have allocate a tab on top for this section.

The 2010 ACR - EULAR Classification Criteria for Rheumatoid Arthritis

2011-05-16T01:08:00.006+08:00

I'm sure many would have known of the ACR-EULAR criteria for Rheumatoid Arthritis as of 2010. (below)

Here is some pointer of what to take note of before someone overexcitedly applies the criteria everywhere.

There must be at least one joint with definite clinical synovitis. It is stated in the criteria but often overlooked, even by young doctors/ Masters students. Hence, you don't simply overuse ultrasound to diagnose synovitis unless you're unsure of your clinical skills (which I had doubts of you being able to interpret the ultrasound by then)
This is a new case of possible RA. Previously treated RA will stay as RA, hence you can't use this criteria to undiagnose patients with RA.
Other causes of synovitis has been ruled out(not caused by other disease, such as infective synovitis, etc.

Essentially, the 4 criterias used are:

Joints Involved, the types (Large/Small) and number: (0-5)
Serology (Low-positive/High-positive/Negative) of rheumatoid factor/ anti-citrulinated peptide antibody (0-3)
Acute Phase Reactants (Normal/ Abnormal ) ESR/ CRP (0-1)
Duration of Symptoms (More / Less than 6 Weeks) : (0-1)

A score of 6/10 or more identifies patients with rheumatoid arthritis, but a score of less than 6 does not rule out rheumatoid arthritis. Hence, reassessment can be done as appropriate as the score may be cumulatively fulfilled over time.

*Click on image to enlarge*

Downloads: Special Study Module

2011-05-15T12:02:00.003+08:00

Here's the materials for SSM (for the year 2010) should you need them.

Calculating Sample Size for SSM Research - by Assoc Prof (M) Dr Azmi Mohd Tamil (2008) Internal Link to Page : Click Here
SSM Abstract Guidelines 2010 & Poster Presentation Tips
Download Link: Box.net
SSM Logo (in png format)
Download Link: Box.net
Examples of SSM Posters 2010
Download Link: Box.net
Examples of SSM Presentation Slides 2010
Download Link: Box.net
Dr Amir Abbas Keynote for 2nd MUASRM 2010
Download Link: Box.net
MIB Conference Abstract Guidelines 2010
Download Link: Box.net

For those SSM commitee who needs the logo/ letterhead in .psd format, you can kindly email me at the contact stated in this blog. I'll send over via email if I'm available. Thanks. :)

Saturday Teach-In Palliative Medicine - May 14th, 2011

2011-05-09T13:02:00.000+08:00

Title:	Saturday Teach-In Palliative Medicine
Date:	14-May-2011
Category:	Palliative Medicine
Description:	Medical Academies of Malaysia, Jalan Tun Razak, Kuala Lumpur.


Download: Flyer - PDF (683 KB) Registration Form - PDF (100 KB)

Source: Saturday Teach-In, Academy of Medicine of Malaysia

Sarawak Handbook of Medical Emergencies, 3rd edition

2011-05-09T11:48:00.002+08:00

This handbook features a few difference compared to its predecessor (2nd edition). Among the few noted differences were:

There are additions and updates of the chapters whenever possible.
New updated values according to international/ local consensus & guidelines
Legitimate and larger fonts, making it more comfortable to the eyes.
Glossy paper quality, making it seems nicer (although you might have trouble highlighting the book)
Better presentations for the charts and tables.
An index at the back of the book, making referencing easier.
Last but not least, the cover is different.

This handbook can be purchased from the bookshop below at RM42 as of date (10th May 2011) at:

Syarikat Kamal134, Jalan Pahang, Setapak
53000 Kuala Lumpur.
TEL: 603-4021 9915, 4021 0575
FAX: 603-4024 6415
Email: kmedical@tm.nt.my

Map:

View Larger Map

If you're hoping that someone would send it to your place, you can request for one of the handbooks for delivery to your footstep, from:

Medicine for MRCP and Medical Students: 3rd edition Sarawak Handbook of Medical Emergencies

Until then, this post is to inform you that it's out now! You may want to grab hold of this latest edition before starting your housemanship.(2nd edition was in 2005) :P

Introduction to Year 5 Clinical Posting

2011-04-29T04:24:00.009+08:00

Well, this is going to be the final year, hopefully. Hence, this is a crucial year, as it determines whether if you're going to make the cut, or stay back (TCA) for another 6 months. Finally, here's the introduction index for any advice pertaining the final year in clinical posting.

General:

More will be updated soon. :)

A Not-So-Brief Guide on Professionals Exam (UKM)

2011-04-29T01:28:00.003+08:00

I would not be able to give the breakdown of each component of the exams as it may vary every year. However, here's a general rundown of what you should be expecting:

Continuous Assessment

This aspect is important as you are required to pass each posting in final year to qualify for the professionals. So, make sure you have satisfactory attendance, satisfactory logbook requirements and perform adequately to pass your mini CEx.
If I am not mistaken, there is no contributory marks to your professional exams, although your performance in each posting may be evaluated and graded, and this would appear in one of your transcript when you pass your professionals. However, this would not matter much, unless you're already on track for an Honours since Year 1. :P

Theory Papers: (50% of total)

You would most likely have:
- 2 sets (60 questions each set) of OBA + EMI
- 2 sets(around 10 questions each set) of KFQ.
The format may vary every year, but should there be separate sets of paper (eg, 2 set of OBA+EMI), you would expect division of the postings into the 2 papers. For example, the 1st set may have Internal Medicine, Family Medicine, Emergency Medicine, Psychiatry, Pediatrics ++, while the 2nd set would then feature questions from O&G, Surgery, ENT, etc. However, there may be the occasional crossovers, so don't forget everything!

Clinicals: (50% of total)

The clinical evaluation consists of 3 components, namely unmanned OSCE(20%), long case (30%), and manned OSCE ala short cases (50%)
Unmanned OSCE is basically what many would have called OSPE. You are given some photos/ radioimaging/ items and you are required to answer them. There could also be simple statistic questions from JKM. You will be asked about everything under the moon in this test, which would have 20 stations.
You have 1 Long Case, which you are to spend 45 minutes with a patient (with a nurse as chaperone and aid). During this allotted time, you are supposed to take a history of the chief complaints and other co-existing problems, do a targeted physical examination and simple bedside tests (waist circumference, urine dipstick, Dextrostix, blood pressure, etc + ask for weight/height), depending on your case.
After the 45 minutes is over, you will be brought to a table just outside of the examiners room. A timer will be set for 15 minutes. During this time, you are supposed to organize your train of thoughts, that is, to plan your investigations and management. Once the time is over, you will have to enter the examiners room and spend approximately 30 minutes there. There will be 2 examiners from 2 different posting (1 from the field of your long case and another from a related field as a buffer). From there, you will have to present and discuss about your case. You may need to return to the patient's room to show your physical examination to the examiners.
The cases are from the 4 main postings, namely Internal Medicine, Surgery, Pediatrics and Obs & Gyne. However, the patients may have problems related to your minor postings, and they should not be neglected! Most of the time, the patients are well-trained and able to converse well, and their problem list may not exceed 4. However, there could be some occasional outliers which may not conform to the norms.
You have 4 manned OSCE ala short cases(10 minutes each). The cases would be from:
1. Internal Medicine
2. Surgery/ Orthopedics (Ratio of cases are 2:3, or 1:2)
3. Obs & Gyne
4. Misc: Pediatrics/ Psychiatry/ ENT/ Ophthalmology/ Emergency Medicine (BLS/ATLS)
Most of the time, you are expected to do a physical examination within 7 minutes, which can be brief and targeted if you're running out of time. The extra 3 minutes will be for answering the questions posed by the examiners. Certain stations may require you to do procedures or counseling instead. For example, the O&G station may ask you to do a urinary catheterization or ERPOC, or GDM counseling. Yes, this may seem unfair, but it also shows that you need to be prepared for anything.

As of 2011, the requirement to pass the professionals would be:

Score more than 50% in your clinical exam
Score more than 50% in your overall exam (clinical + theory)

By now, I hope that you have a rough idea on how the professionals exam works. Don't worry if you don't get it now. All you need to do is to do your part in learning all you can in your final year. Learn how to investigate and manage a case. Learn how to present a case. Learn how to do a proper PE. Learn how to teach your juniors. Yes, you will now have juniors under your wings, and by teaching them, you'll also be able to train your presentation skills( if they don't understand you, it means you have a long way to go.. :P) and your confidence. Learn how to juggle your time between wards and study.

So, here I am wishing you all the best for the march in March. (Pardon the pun) :)

Related Article:

FIfth and Final Year

Back to Introduction to Year 5 Clinical Postings

Fifth and Final Year

2011-04-26T15:48:00.006+08:00

The blog's rather quiet. I think everyone is still euphoric, the aftershock of passing the professional exam.
With the new grouping of final year students released, many of us had been asked "Is starting with this posting good? What to do? etc etc"
The only thing I can tell you is no matter what posting you kick off with, there's nothing you can do to change it. So just go and do it. ^^

But of course, there are some tips that can make end-of-the-world year more enjoyable. Here are some tips, which is fully my personal opinion. May vary according to individuals.

1) Does the initial and end posting matter?
Theoretically, yes. Imagine you ending the year with things like O&G and Paeds instead of Family Medicine. Sounds scary huh? But in reality, no. Whatever posting you are in, you need to be on your toes. Just work hard. If you end your year by being complacent, you are doomed to misery during your study month. Of course, some posting are more tedious than others, but if you are not on your toes, easy things becomes hell.

2) Is it stressful?
You are in medical school and you expect it not to be stressful in your final year? Of course its stressful! And tiring in some postings where you have to rush againts time to "cover bed" and study! The key is how you manage your stress. Take Saturdays when you're not on call to do what you like. Forget about wards...you can think about wards and studies any other day.

3) Is there a lot to read?
Well.... gone were the times when reading is the main thing in your life. You need to practice, especially the long cases. Of course you must read, but don't imprison yourself in the room 24 hours a day. Spend the day time practicing, spend the night time studying. Its time for targeted reading, meaning reading only the important stuff. Things like syringomyelia and dystrophia myotonica can be forgotten, but not Cerebrovascular accident.

4)How to practice?
Get a fully committed partner. Sounds gay but yes, do it. Do 1 long case every other day. The days in between, just do short cases. Make sure you know your subject before going into it. Don't trust your partner's knowledge, after your discussion u need to countercheck and re-read to reinforce your knowledge, and correct misconceptions.

5) I could not remember what I read. How?
Nobody can say that they remember everything they read, unless they try expressing it out. Try to express out what you read. Most of the time, remembering is not the problem. Its how you apply it. Thus, ask yourself, how will I be asked about this stuff in the long case?

6) Should I start reading now?
Except if reading is your enjoynment, I suggest you to treasure your free time now. :P

7)What are we expected to do?
You are a final year, you are expected to know everything, at least in principle. Do not be disheartened when you are humiliated in front of juniors, its part and parcel. Patch up your mistakes and do better.

8) So many stuffs, how to remember??
Personally, for those who know me, I remember my stuff because I tried to make other people understand it through teaching. Once people understand what I'm saying, it means I understood it too. The knowledge will stick to you like jejunum to ileum. But that does not mean I don't need to revise, it just makes my revision faster, and I know which part that I am unclear with and clarify it.

9) I am not you, I don't know how to teach.
Absolute nonsense. You are final year, if you don't know, who knows? -_-" If you don't want to teach, refuse study group, than there's only one way for you, isn't it? Study and talk alone. It will be extremely depressing.

10) What is Long Case, short case?
Long case format is: 45 minutes for you to clerk and examine and do simple bedside test, with the patient.
After that, you are not allowed to talk or examine the patient anymore. You have 15 minutes on your own to reorganize your thought and plan management.
After that, 30 minutes with 2 lecturers. They may bring you to see the patient, ask you to perform examination.
Cases are from Major postings: Internal Medicine, O&G, Paediatrics,Surgery. (the chief complain)
Psychiatry and Orthopaedics are NOT major postings.
Although the Chief complain is from the major postings, the patient might have some other problems in ENT, Psychiatry, etc.
Do not expect that your patient have only 1 problem. Its normally a cocktail of problems.
Don't worry about uncooperative or blur patients. The patients are extremely "well trained"

Short case: virtually anything under the sun can be tested, from Urinary catheter insertion to performing ERPOC. One station even asked you to call the consultant to report a case. -_-"
4 stations : 1 Internal Medicine, 1 Surgery or 0rthopaedics in ratio of 1:3, 1 O&G(the most creative department) and 1 Miscellaneous( includes Psychiatry, Paediatrics, ENT, Opthalmology)
10 minutes each station.

I summarise in the following
At the end of final year, students should be able to
1) have a thick face
2) Dare to ask, dare to answer, dare to do wrong, dare to correct self.
3) perform Hx taking, PE and give outline of Mx confidently and more importantly, correctly.
4) Manage emergencies
5) Pass professional exam in March.

Good luck and enjoy your fifth year in medical school!^^ Its definitely not final, yet.

Related articles:

A not-so-brief guide to professional exams (UKM)

Back to Introduction toYear 5 clinical postings.

Downloads - Internal Medicine 2

2011-01-19T19:03:00.005+08:00

Link to Year 3 Int Med materials

Therapeutic Seminars

Stroke Seminar
Download Links: | Box.net | Mediafire |
Chronic Kidney Disease Seminar
Download Links: | Box.net | Mediafire |
Respiratory Seminar
Download Links: | Box.net | Mediafire |
Diet for Hypertension Seminar
Download Links: | Box.net | Mediafire |
Diet Therapy for Chronic Kidney Disease
Download Links: | Box.net | Mediafire |
Rheumatology Seminar
Download Links: | Box.net | Mediafire |
Cardiology Seminar
Download Links: | Box.net | Mediafire |
Gastroenterology SeminarDownload Links: | Box.net | Mediafire |
HIV Seminar
Download Links: | Box.net | Mediafire |

Extra Materials:

Food Exchange List (Microsoft Words docx)
Download Links: | Box.net | Mediafire |
Food Pyramid Diet Adequacy (Microsoft Words docx)
Download Links: | Box.net | Mediafire |

Pediatrics 2

2011-01-07T22:54:00.000+08:00

*Last Update - 7th Jan 2011*
Alright, here's some material downloads for the Pediatrics.It's not much different from the Pediatrics Downloads in Year 4, but I would like to separate them for indexing purposes. Here is where I'll include any new materials from our Year 5 2010/2011 postings. Special thanks to Jeffrey Lee for his contributions to start this post. :)

Link to Year 4 Pediatrics Downloads

In view of smaller storage space and to keep in line with technology. all powerpoint files would be uploaded in pptx format. Any inconvenience is notably regretted. Thank You.

Materials:
Skills Lab materials (from e-Spin, Pediatrics Section)
Download Links: Box.net | Mediafire

Intraosseous Infusion
Barlow- Ortolani maneuver
NG Tube Insertion
Checklist for Umbilical Venous Catheter
Checklist for Lumbar Puncture

1st Posting:

Child Abuse
Download Link: Sendspace | 4shared | Mediafire | Box.net |
PBL: Renal Diseases in Peds
Download Links: Sendspace | 4shared | Mediafire | Box.net |

2nd Posting

Seminar:
1. Acute Emergency in Pediatrics (Credits to Kai Xian for the file)
  Download Link: Sendspace | 4shared | Mediafire | Box.net |
2. Prematurity (Credits to Sam Jo Ee for the file)
  Download Link: Sendspace | 4shared | Mediafire | Box.net |
3. Neonatal Infections (16th Aug 2010)
  Download Link: Sendspace | 4shared | Mediafire | Box.net |
4. Pediatrics Cardiac Cases (24th Aug 2010)
  Download Link: Sendspace | 4shared | Mediafire | Box.net |
5. Poisoning and Injuries in Children (15th Sept 2010)
  Download Link: Sendspace | 4shared | Mediafire | Box.net |

PBL:
1. Stridor (30th July 2010)
  Download Links: Sendspace | 4shared | Mediafire | Box.net |
2. Renal Problems (13th Aug 2010)
  Download Links: Sendspace | 4shared | Mediafire | Box.net |
3. The Comatose Child (19th Aug 2010)
  Download Links: Sendspace | 4shared | Mediafire | Box.net |

3rd Posting:

Seminar and PBL:
1. Poisoning and Injuries in Children (credits to Kanit for the file)
  Download Links: Sendspace | 4Shared | Mediafire | Box.net |
2. Pediatric Cardiac Cases (credits to Kanit for the file)
  Download Link: Sendspace | 4Shared | Mediafire | Box.net |
3. Acute Lymphoblastic Leukemia (credits to Kanit for the file)
  Download Link: Sendspace | 4Shared | Mediafire | Box.net |
4. PBL: Renal Problems (credits to Kanit for the file)
  Download Links: Sendspace | 4shared | Mediafire | Box.net |

5th Posting:

Seminar & PBL:
1. Acute Lymphoblastic Leukemia (credits to Su Yan for the file)
  Download Links: | 4shared | Mediafire | Box.net |

Interesting Reads:

Normal Growth for Babies -by Jeffrey (10th Oct 2010)

Downloads - Dermatology

2010-12-30T20:34:00.000+08:00

Below are the compilation of lecture notes and other materials for Dermatology, indexed for easier referencing. Thank you for all your efforts to share the materials below. :)

*The lectures are meant for internal distribution. Certain lecturers had mentioned this, hence we'd put encryption for the files requested by the lecturers. The password is our dean's first name
(6 characters).

Lecture Notes:

Diagnosis of Skin Disorders (7th May 2010)
File Size: ~ 20 MB
Download Links: Mediafire| Box.net| iFile
Eczema (7th May 2010)
File Size: ~ 10 MB
Download Links: Mediafire| Box.net | iFile
Psoriasis (22nd May 2010)
File Size: ~ 19 MB
Download Links: Mediafire| Box.net| iFile
Adverse Cutaneous Drug Reaction (22nd May 2010)
File Size: ~ 4 MB
Download Links: Mediafire| Box.net| iFile
Bullous Skin Disorder (22nd May 2010)
File Size: ~ 11 MB
Download Links: Mediafire| Box.net| iFile
Papulosquamous Disorders (22nd May 2010)
File Size: ~ 4 MB
Download Links: Mediafire| Box.net| iFile
Common Skin Infections (22nd May 2010)
File Size: ~ 7 MB
Download Links: Mediafire| Box.net| iFile
Skin tumor (22nd May 2010)
File Size: ~ 11 MB
Download Links:Mediafire| Box.net| iFile
Sexually Transmitted Infection (22nd May 2010)
File Size: ~ 2 MB
Download Links: Mediafire| Box.net| iFile
Leprosy (22nd May 2010)
File Size: ~ 2 MB
Download Links: Mediafire| Box.net| iFile

Extras (HKL):

Management of Common Skin Diseases
File Size: ~ 4MB
Download Links: Mediafire| Box.net| iFile
Picture Quiz in Dermatology
File Size: ~ 27MB
Download Links: Mediafire| iFile

Downloads - Surgery 2 (Updated Dec 29th, 2010)

2010-12-29T21:02:00.002+08:00

Alright, here's some material downloads for the Surgery.It's not much different from the Surgery Downloads in Year 3, apart from the fact that I'd wish to separate them for easier indexing. Here is where I'll include any new materials from our Year 5 2010/2011 postings. Hope that we'll be getting materials from other postings as well. :)

*There are empty ones without any links, as we weren't given the ppt by the group. We do hope that there will be kind fellow unimates who would help to contribute to the list. :)

Link to Year 3 Surgery Posting Downloads
*All links are internal unless stated otherwise (in italics & bracket)
Group 4's Seminar Material

ABC in Abdominal Trauma Dec 29th, 2010(credits to Jeffrey) - RECOMMENDED READ
Download Link: | Mediafire | Box.net |

Seminar Materials

Acute AbdomenDownload Link: Sendspace | 4shared | Mediafire | Box.net |
Overview on Upper GI BleedingDownload Link: Sendspace | 4shared | Mediafire | Box.net |
ABC in Chest Trauma
Download Link: Sendspace | 4shared | Mediafire | Box.net |
Management of Patients With Obstructive Jaundice
Download Link: Sendspace | 4shared | Mediafire | Box.net |
Common Vascular Condition
Download Link: Sendspace | 4Shared | Mediafire | Box.net
Common Urological ConditionDownload Link: Sendspace | 4shared | Mediafire | Box.net |
ABC in Abdominal Trauma
Download Link: Sendspace | 4shared | Mediafire | Box.net |
Common Peadiatrics Condition
Download Link: Sendspace | 4shared | Mediafire | Box.net |
Common Neurological Condition/ Head Injury
Download Link: Sendspace | 4shared | Mediafire | Box.net |
Common Conditions in Breast and Thyroid Diseases
Download Link: Sendspace | 4shared | Mediafire | Box.net |
Overview on Lower GI Bleed (by Mr Imtiaz)
Download Link: Sendspace | 4shared | Mediafire | Box.net |
Skin Cancer
Download Link: Sendspace | 4shared | Mediafire | Box.net |
Burns and Tissue Reconstruction (~20+ MB)
Download Link: Sendspace | 4shared | Mediafire | Box.net |
Breast and Thyroid Imaging
Download Link: Sendspace | 4shared | Mediafire | Box.net |

Extra Reads

Acute Pancreatitis (reading as recommended by Izzati Rani & Masyitah Md Radzi)
- Treatment Strategy for Acute Pancreatitis
  J Hepatobiliary Pancreat Sci (2010) 17:79–86
  Download Link: Box.net
- The Atlanta Classification of acute pancreatitis revisited
  Download Link: Box.net
Short Case: Stoma Examination (Medik UKM)

SPA Briefing for Future Medical House Officers from UKM

2010-12-27T23:31:00.000+08:00

Below are the downloads of the files I have obtained from Chai Peng as I was not well today. Here's the requested files given by the SPA. Most of it is in BM, which of course, would be of no problem for Malaysians.

Borang BMD (pdf)
Download Links : Box.net | Mediafire
Medical Act & CPC lecture (pptx)
Download Links : Box.net | Mediafire
Taklimat Tahun Akhir Pelajar Perubatan UKM 2010/2011 (pptx)
(Briefing for UKM Final Year Medical Students 2010/2011)
Download Links : Box.net | Mediafire

Downloads - Emergency Medicine (Updated Dec 26th, 2010)

2010-12-17T23:26:00.002+08:00

Concept Lectures:

Principles in Emergency Medicine (~30+ MB)
Download Links : Mediafire
Principles in Pre-Hospital Care
Download Links : Box.net | Mediafire
Disaster Preparation and Management
Download Links : Box.net | Mediafire
Radio Communication Practice
Download Links : Box.net | Mediafire
Medicolegal Issues in Emergency Medicine
Download Links : Box.net | Mediafire

Seminar:

Shock in Emergency Department
Download Links: Box.net | Mediafire

Extras:

Must- Have Algorithm for ACLS (2005), consists of:
- Pulseless Arrest
- Tachycardia with Pulses
- Bradycardia
- Suspected Stroke
- Suspected Chest Ischemia
Download Links: Box.net | Mediafire