We're now on Facebook as well!
Med PBL is now on Facebook apart from Twitter. Help to promote us by going to the FB page and click on "Like". :)
Prof Izham Interactive Teaching is Back!
A tribute to Prof Izham, a prominent clinical professor whose teaching and lessons had benefited many. The aforementioned site would be reviving materials from the famous profizham.org site.
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3CPG of Infectious Disease: Melioidosis and Leptospirosis
Here are the latest addition of CPG's in MedPBL's collection.
- Guidelines for Clinical and Public Health Management of Melioidosis in Pahang - 2011
Download Links: Box.net | Mediafire
- Guidelines for the Diagnosis, Management, Prevention and Control of Leptospirosis in Malaysia - 2011
Download Links: Box.net | Mediafire
Case Files 9 - Hypertension in Pregnancy, or was it?
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 : )
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
- 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).
- 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
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.
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
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
- Insulin Therapy Guidelines 2011
Malaysia Clinical Practice Guidelines and Consensus (Last update: Feb 22nd, 2011)
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
- 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
- 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
- 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
- Guidelines for the Diagnosis, Management, Prevention and Control of Leptospirosis in Malaysia - 2011 Download Links: Box.net | Mediafire
- Guidelines for Clinical and Public Health Management of Melioidosis in Pahang - 2011
Download Links: Box.net | Mediafire - 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 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
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
- 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
- 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
- Consensus Guidelines on URTI - 2009
Download Links: Box.net | Mediafire - Management of Sore Throat - 2003
Download Links: Box.net | Mediafire
- 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
- 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
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: Management of Chronic Kidney Disease in Adults
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.
Malaysia National Antibiotics Guidelines 2008
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.
