Standard Operating Procedures for Medical Assistants in Primary Healthcare

Diagnosed by ~YM~ On Oct 25th 2009

Standard Operating Procedure is the latest guidelines by Malaysia MOH for primary health caregivers. Encompasing general conditions from various fields such as ENT, Psychiatry, Obstetrics, Skin conditions, Infection and even general malaise, this guideline hope to educate the public as well in early detection, prevention of illness and promotion of health. Special thanks to Miss Ojie for her efforts in searching for this guideline and contribution.

CPG: Management of Type 2 Diabetes Mellitus

Diagnosed by ~YM~ On June 25th 2009

The latest(4th) edition of CPG for management of Diabetes Mellitus Type 2 is out! There's no need to seek or look for the old ones when the new ones is already here, with the management of all its macrovascular and microvascular complications. Are you up for it?

CPG: Schizophrenia

Diagnosed by ~YM~ On June 16th 2009

Schizophrenia Management in Adults is out! Let's strive to work ourselves up to learn more about it then! Malaysia Ministry of Health has put up a CPG for this, hoping doctors would be able to benefit from it and put it into practice.

H1N1: The Pandemic Begins

Diagnosed by ~YM~ On June 12th 2009

40 years since the last pandemic call has been made. 1968 was the year of Mexican flu, and the country of flu has breed another one, the H1N1 (Swine Flu). Would WHO take specific measurements to prevent the spread? Can they still advice travels just because they would not want to affect US tourism? How good can WHO be in containing the virus? Only time shall tell as the world is battling the unknown. We at Med PBL would try to spread the words of the swine flu for a better understanding of the Swine flu and its nature.Click on the title for the brochure for general reading of Swine Flu.

CPG: Management of Primary Open Angle Glaucoma (2008)

Diagnosed by ~YM~ On May 31st 2009

Glaucoma has been one of the leading cause of blindness worldwide. Perhaps it is time for us to take proper steps to ensure that it would not be a hindrance for Malaysians to enjoy the beauty of sight. This latest CPG is available via the sidebar downloads.

Consensus Guidelines on URTI 2009

Diagnosed by ~YM~ On May 11th 2009

Upper Respiratory Tract Infection (URTI) is a common condition in most primary care clinics throughout the world. In what may seem a trivial matter, it can lead to death if left untreated. Yet, despite the efforts done for a better medical outcome, there is still a wide abuse of antibiotics which may lead to unwanted complications. With this said, the Malaysian Society of Otorhinolaryngology Head Neck Surgery (MSO HNS) has come out with a consensus on how it should be managed.

Paediatric Protocols for Malaysian Hospitals

Diagnosed by ~YM~ 0 referrals
Here's the pdf version of the protocol for Pediatrics:

 MOH Paediatric Protocols for Malaysian Hospitals
by Hussain Imam Hj Muhammad Ismail, Ng Hoong Phak, Terrence Thomas


Format: PDF (~5MB)
Download Link:

The hard copy can be purchased from the distributor at RM15 as of date (23rd Nov 2009) at: Malaysian Paediatric Association
3rd Floor (Annexe Block),
National Cancer Society Building,
66, Jalan Raja Muda Aziz,
50300 Kuala Lumpur.

Tel: 603-2698 9966/ 26915379
Fax: 603- 26913446
Email: mpaeds@po.jaring.my
Website: www.mpaeds.org.my

Suggested retail price is RM17, thus you may see this book being sold at a higher price elsewhere, such as in Kamal Medical Bookstore where previously, students have to pay RM30 for the same book, and with the page containing the address to the distributor being torn off as it is situated nearby.

Hope this could be beneficial for all. :)
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Year 4 Semester 2 Examination Timetable 2009/2010 Draft 1

Diagnosed by ~YM~ 0 referrals
The 1st unreleased draft for the 2nd semester exam timetable is out. There may be changes in the timetable, but the 1st draft will give you a rough idea on hows the arrangement of the papers. Also thanks to Fense for his notification and effort to provide us with this valuable piece of information.

  
*click on image to enlarge*
 
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Paediatric Short case

Diagnosed by Jeffrey 3 referrals


These are some tips for my colleagues who will be taking their Paeds short case in 1 week time.

Paediatric short case will be conducted in the PPUKM paediatric department, which includes the wards, the NICU, the PHDU and PICU. Each student will have 2 cases under 2 different lecturers.

Common cases are : Thalassaemia, Respiratory cases, Cardio cases, Floppy baby, Developmental assessment, Nephrotic syndrome, Neonatal assessment ****(experience may differ)


The examiner will give you a short history, e.g. "This is a 3 year old girl with fever and cough for 3 days". You must know than what to look for in the general examination! If you are told the girl present with fever and cough, don't go talking about Osler nodes, leuconychia etc, which does not lead to the symptoms you are told! Be aware of what you are saying and suggesting.

Remember, WASH your hands before touching the baby. This is extremely important in Paeds.

One of the most popular question that leaves most of us dumbfounded is "Do a general examination". Therefore please practice this. For those who have no idea what you're suppose to look for general examination, all you have to do is ask, not the examiner, but your supervisor or friends now.

My supervisor's advice to me :Stay calm, don't panic, speak clearly and be systematic, think carefully before you say anything. This is important because in the stress of facing a full Prof, whatever we said will not pass through our gray matter, and we end up presenting rubbish to the Prof.

Paediatrics is not all about developmental assessment. Don't get so obsessed with it. I mean, don't just practice DA and forget the rest. Paeds are NEVER small adults.


Neonatal assessment is one exam question that makes us happy. We can say all sort of things like mongolian blue spots, milia, ebstein pearls, erythema toxicum, Harlequin color changes etc. But then,if we don't know why we look for all that, and why is it important to look for them, what's the use? The point is, don't look just for the sake of taking exam. Please know the importance of these skin changes in the neonate.


Good luck to all Paeds! Short case is never easy, do not take for granted that when you've studied all the books under the sun, you will pass. Your technique and application is important as well. All the best!!:)
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Downloads - Orthopedics

Diagnosed by ~YM~ 0 referrals
Alright, here's some material downloads for the Orthopedics. Special thanks to Jeffrey, who provided the misc materials, and Muhaimin, the leader of the posting who aid in the collection of seminar and other lecture materials. More is soon to come for this posting when other contributors are willing to aid us. :P

Introduction:

Materials:
  1. Misc:


    • Orthopedics - Dr. H. von Schroeder,Paul Kuzyk, Mark Shekhman, Adam Sidky,
      Anna Kulidjian
    • Using the 10-g Semmes–Weinstein Monofilament & 128 Hz tuning fork usage - American College of Physicians
    • Pressure Ulcer Prevention -National Pressure Ulcer Advisory Panel
    • Pressure Ulcer Treatment - National Pressure Ulcer Advisory Panel
    Download Link: Rapidshare| Sendspace | 4shared

Common Lecture:

Radiology Conference:


Seminar Materials:
  1. Fracture, Healing and Its Complications
    Download Link: Rapidshare| Sendspace | 4shared

  2. Arthroplasty
    Download Link: Rapidshare| Sendspace | 4shared

  3. Peripheral Nerve Injury
    Download Link: Rapidshare| Sendspace | 4shared

  4. Limping in Children
    Download Link: Rapidshare| Sendspace | 4shared

  5. Back Pain
    Download Link: Rapidshare| Sendspace | 4shared

  6. Wound Management
    Download Link: Rapidshare| Sendspace | 4shared

  7. Knee Injury
    Download Link: Rapidshare| Sendspace | 4shared

Medical Books Downloads:
McRae's PE, netter's Orthopedics, etc - Dr Pirates
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Downloads - Forensic

Diagnosed by ~YM~ 0 referrals
Below are the compilation of Forensic lectures for the session 09/10. We'll try to upload those that we could get, so it's really based on best effort possible. So, enjoy your lectures!! :)

Materials:

Lectures:
  1. Introduction of Forensic Pathology:
    Short Version (Without photos)
    Download Links: Rapidshare | Sendspace | 4shared | iFile.it
    Full (With all photos)
    Download Links: Rapidshare | iFile.it

  2. Forensic Postmortem and Certification of death
    Download Links: Rapidshare | Sendspace | 4shared | iFile.it

  3. Identifications
    Download Links: Rapidshare | Sendspace | 4shared | iFile.it

  4. Postmortem Changes
    Download Links: Rapidshare | Sendspace | 4shared | iFile.it

  5. Physical Evidence and Examination Scene of Death
    Download Links: Rapidshare | Sendspace | 4shared | iFile.it

  6. Death due to Road Traffic Accident
    Download Links: Rapidshare | Sendspace | 4shared | iFile.it

  7. Death due to Electrocution, Lightning and Bomb Blast
    Download Links: Rapidshare | Sendspace | 4shared | iFile.it

  8. Death due to Asphyxia and Drowning
    Download Links: Rapidshare | Sendspace | 4shared | iFile.it

  9. Death due to Firearm Injury
    Download Links: Rapidshare | Sendspace | 4shared | iFile.it

  10. Death due to Heat and Burn
    Download Links: Rapidshare | Sendspace | 4shared | iFile.it

  11. Death related to Sexual Assault
    Download Links: Rapidshare | Sendspace | 4shared | iFile.it

  12. Abortion, Infanticide and Maternal Death
    Download Links: Rapidshare | Sendspace | 4shared | iFile.it

  13. Death due to Natural Causes
    Download Links: Rapidshare | Sendspace | 4shared | iFile.it

  14. Forensic Aspect of Non-accidental Injury and Child Abuse
    Download Links: Rapidshare | Sendspace | 4shared | iFile.it

  15. Negligence and Anaesthetic Death
    Download Links: Rapidshare | Sendspace | 4shared | iFile.it

  16. Forensic Investigation of a Mass Disaster
    Download Links: Rapidshare | Sendspace | 4shared | iFile.it

  17. Toxicology
    Download Links: Rapidshare | Sendspace | 4shared | iFile.it

  18. Expert Witness and Court Procedures
    Download Links: Rapidshare | Sendspace | 4shared | iFile.it

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Year 4 Forensic Lectures 2009/2010

Diagnosed by ~YM~ 0 referrals
Here's the current Forensic Lecture schedule, along with the lecture title and venue. Do note that this is subjected to last minute changes, and this is the current schedule as of date. Any changes would be notified later on. Attendance is taken for the lectures, so do note, attend at your own risk. :)

*Click on image to enlarge and for clearer view*

Special thanks again to Siti Nurul Ain Jasmi and PERSIAP BBA Year 4 09/10 for their latest updates.
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Standard Operating Procedures (Medical Assistants in Primary Healthcare)

Diagnosed by ~YM~ 0 referrals
Standard Operating Procedures serve as guides to meet the standard of care and professionalism set out by the Ministry of Health, Malaysia. It also serves to enhance public awareness of such standards expected from health care providers in the community. Such awareness will hopefully encourage greater compliance to these guidelines by Assistant Medical Officers. It is in their best interest that they adhere, at all times, to the series of practice guidelines that have been prepared by the Ministry of Health.

Special thanks to Miss Ojie for her contribution in looking for this file! :P


Format: PDF
Download Link: Sendspace | Rapidshare | 4shared | iFiles

Contents:
  1. Surgical Conditions:
    • Foreign body in the ear
    • Foreign body in eye
    • foreign body in nose
    • Skin lumps
  2. Infections
    • Dengue Fever
    • HIV/AIDS
  3. Dermatological conditions
    • Warts
  4. Metabolic Disorders
    • Acute Hyperglycemia
    • Acute Hypoglycemia
  5. Psychiatric Conditions
    • Violent Psychiatric Patient
  6. Obstetric condition
    • Antepartum Hemorhhage
    • Postpartum Hemorrhage
    • Pre-eclampsia and Eclampsia
    • Puerperal Fever
  7. Symptoms
    • Chronic fatigue
    • Constipation in Adults
    • Ear Discharge
    • Hyperventilation
    • Loss of Weight
    • Edema in adults
    • Palitations
    • Tremors
  8. Others
    • Case brought in dead
    • CVD screening
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Downloads - Ophthalmology

Diagnosed by ~YM~ 0 referrals
Below are the compilation of efforts for the Ophthalmology posting. Sadly, there aren't any soft copy of lecture notes a a result of non-distribution. However, we'll try next time with the help of other groups in other posting if possible.

On the other hand, here's a copy of production from Medical PBL to aid in the fundoscopy techniques and findings. I admit there's quite a number of flaws in it, so I hope there would be reviewers who would kindly give your comments and suggestions to improve this "book."

*Update(28th June 2009): The revised 2nd edition is now available!

Fundoscopy Made Easy
2nd edition
Download Links:
Sendspace |Rapidshare | 4shared



Materials
  • Ophthalmology Case Write Up Template
    Download Links: Boxnet (Also in sidebar Downloads Section)
  • Welch-Allyn Guide to the Use of Diagnostic Tools for Ear and Eye Examination
    Download Links: Boxnet (Also in sidebar Downloads Section)
Medical Books

The case write up template for Ophthalmology can be downloaded from the sidebar. This template is in accordance with the one given to the representative posting.



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Update: Oct 15 (Newsletter style)

Diagnosed by ~YM~ 2 referrals
http://www.faqs.org/photo-dict/photofiles/list/374/1897scroll.jpg

Well, it's been some time since some real updates has been here, so here's the "newsletter" edition of what's going on around here.

  1. For the Year 3 medical students who had taken their exam more than a week ago, their results has just came out. To find out more, you can refer to the album created by PERSIAP Year 3 BBA. The list of names are available there. Sadly speaking, the infamous O&G posting renewed their feat in holding the most number of students failing the posting at around 56, if my count was right. Internal Medicine held at 20+, with Surgery 5-6 students and Medicine and Society also barely few.

    Here, I would like to congratulate those who passed, and reminded not to be complacent. There are always pitfalls in the path we are taking along this field. And for those who did not pass, do not despair. There is still hope during the repeat posting.

    There will be a post mortem for those who fail O&G and Internal Medicine tomorrow(16th Oct) at DK O&G Dept (9am) and Dept of Medicine(11am) respectively. Attendance is compulsory, but I'm not sure if anyone can come back on time since the results is just out today.
    (Update 16th Oct): The post-mortem has been postponed to a later date, thanks to Prof Zaleha.) - Source: Fadhli, PERSIAP YDP 2009/2010

  2. For the Year 4 medical students, our results slip should be available at the academic office by next Monday (19th Oct 2009). You should be able to collect it by then, least throwing away the worries and anxiety. And oh yes, there's no common lecture tomorrow, but SSM briefing at 3pm. It sounded compulsory, so I'd reckoned we should go to renew our memories on our SSM tasks.

  3. For the Year 4 Group 3 who's going for Ophthalmology posting next week onwards, the list grouping is out. You can refer to the notice borad at the Ophthalmology dept. Or you can click here.

  4. For the group in Orthopaedics posting, the cover for case write up can be obtained from the department office, where they put the case write ups. I've also uploaded my version (colored logo) with the same format for marks allocation by the sidebar download section.

    I'll be uploading some catalog about othoses and prosthesis soon, so keep a check here once in a while. Until then, so long.
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Jejunal Adenocarcinoma

Diagnosed by Jeffrey 4 referrals
Extremely rare place to be affected with adenocarcinoma, nevertheless it is possible. Small bowel is rarely affected by cancer, possibly due high mobility and peristaltic movement of the gut which propels any potential carcinogen forward.( Chandrasoma and Taylor)

Jejunal adenocarcinoma frequently presents with a gastritis like symptoms: upper abdominal pain, vomitting, food intolerance and abdominal distension. Taken together with its statistics, nobody would have thought about jejunal adenocarcinoma at its initial presentation.

A section of the jejunum showing a fungating mass measuring 4cmX3cm in the wall of jejunum. Biopsy reveals jejunal adenocarcinoma.( Lee and Polger: Jejunal Ca with metastasis to Liver)

The symptoms will progress to those of intestinal obstruction, such as billious projectile vomiting, severe abdominal distension, colicky abdominal pain and constant belching. Lost of weight and appettite which is present at this time is attributed to the obstruction, not to what obstruct it. At this point, surgeons will come into play and still, jejunal adenocarcinoma will be low in the list of differentials. Among the differentials are Colon adenocarcinoma(far more common), Gastric Ca, gallstones and jejunal volvulus.

Various imaging methods will be commenced. Unfortunately at early stage nothing much can be seen. At later stage, there may be metastatic lesions to the liver, reproductive organs and peritoneum. OGDS and Colonoscope detects nothing (do you wonder why?)
An upper GI series with small bowel follow-through was also performed in 1988 prior to the patient's surgery. This showed a 6 cm ulcerating and nodular mass in the proximal jejunum just distal to the ligament of Trietz (Lee and Polger: Jejunal Ca with metastasis to the liver)

Only at laparatomy can the biopsy and definitive diagnosis be made. At this point of time, the tumor might have caused adhesion among the loops of the small bowel, it might have spread to mesenteric nodes and even to the peritoneum and ovaries.


Biopsy of a part of the jejunal showing malignant gland-forming cells in the submucosa of the wall of the jejunum. Nucleus is darkly stained and cells are pleomorphic. (Ajay H Bhandarwar, Shivkumar S Utture, Sunderraj Ellur, Tanuj Shrivastava : Adenocarcinoma of the Jejunum Presenting with Intestinal Obstruction)

Chemotherapy will be commenced post-surgery. There is no specific chemo treatment for jejunal adenocarcinoma because it is so rare. Treatment for colon cancer is extrapolated to treat jejunal adenocarcinoma. One case report states that "the role of chemotherapy and radiotherapy in small bowel adenocarcinoma is not clearly defined"(Ajay H Bhandarwar, Shivkumar S Utture, Sunderraj Ellur, Tanuj Shrivastava: Adenocarcinoma of the Jejunum Presenting with Intestinal Obstruction)

Screening for jejunal adenocarcinoma is difficult. A case report suggest that Barium contrast studies have an accuracy of 83%. However, the method of choice suggested is Enteroclysis.

When the cancer is terminal, please warn the patients that there will be "magic" people out there who claim to be able to cure this disease. Money will be spent, only for the patient's condition to deteriorate.

The moral of the story is, although a disease is rare, please do not exclude it. As 1 of my Professor told me last time, "in practicing the art of medicine, never say never".

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