Sunday, May 24, 2009
Today is 24th May (sunday)... 7 days to go
well.. 7 days to go.. status:
MEDICINE: CVS, RS, CNS, Rheumato, Endo, Hemato, Gastro-entero
SURGERY: upper+lower GI, thyroid, breast, hepatobiliary, pancreas.
GP: currently going thru past years paper
yet to finish:
- look thru past years MCQ
- infectious disease
- lumbs and bumps, vascular
- emergency medicine
- orthopaedics revision
***********************************************************************************
in the mean time, lets enjoy the video clips by Zi Avi from S'rwk..
ENJOY! :)
*********************************************
Friday, May 22, 2009
new jersey 2009/2010
well...the new spain jersey looks so 'superman-ish'.. i dont like it..
same goes to england new jersey..its too immaculate for me.. too lazy to design ke? i guess the reason behind this simple design maybe becoz they r trying to emulate the 1966 england world cup winning jersey.. they think that they can win if they wear jersey of a champion.. oh puh-leeesss....
1 week gone.. 1 week more!
huhu... time really pass u very quickly.. its already 1 week.. 9 more days or so away from exam.. hmm..
so hows my progress?
i have started studying medicine, more or less covered these:
- cvs
- respi
- neuro
- some, GI, some hemato, some rheumato
surgery this weekend
GP? omg!!! what about GP??!!! damn!!!!!!! got to go...
*************** ******** ************ *********
so hows my progress?
i have started studying medicine, more or less covered these:
- cvs
- respi
- neuro
- some, GI, some hemato, some rheumato
surgery this weekend
GP? omg!!! what about GP??!!! damn!!!!!!! got to go...
*************** ******** ************ *********
acer predator pc
spec:
Intel Core 2 Extreme and Core 2 Quad processors
Nvidia's nForce 780i chipset
up to 8GB of 1066MHz DDR 2 memory
three Nvidia GeForce 9800 GTX graphics cards in Tri-SLI mode.
1kW power supply
7.1-channel HD audio with EAX 4.0 support
Creative SoundBlaster X-Fi card
multi-format memory card reader
3.5mm audio sockets
quartet of USB 2.0 ports
four more USB ports round the back
a six-pin Firewire connector
two Gigabit Ethernet ports
six more audio jacks
wow..... i want one ....
http://www.acer.com/predator/
*******************************
Thursday, May 21, 2009
ASTHMA guidelines GINA 2008
Things you should know about asthma
what is asthma?
- asthma is chronic inflammatory disorder of airways characterized by bronchial hyperresponsiveness leading to widespread bronchoconstriction.
-asthma is reversible
REMEMBER: airway narrowing and airway hyper-responsiveness
Factors which cause asthma
- host factors - atopy
- environment factor - allergen, infection, air pollution, smoking, diet etc
Mechanism of asthma:
inflammation involving these cells and mediators result in airway hyper-responsiveness and asthma symptoms
- inflammatory cells (mast cell, eiosinophil and T lymphocytes)
- inflammatory mediators (chemokine, cytokine, cysteinyl leukotriene, histamine,NO, PG etc)
Airway narrowing due to:
- airway smooth muscle constriction
- airway edema
- airway thickening
- mucus hypersecretion
airway hyper-responsiveness
- err.. no need to know la..
special mechanism in asthma
acute exacerbation
- due to triggers
nocturnal symptoms
- due to circadian rhythm of hormones (epinephrine,cortisol,melatonin etc)
************************************
Management depends on presentation
- (acute/chronic) and
- severity
how to assess the severity?
- by clinical examination and ix (peak flow/spirometry)
classification of severity?
- intermittent
- mild/moderate/severe persistent
so, after patient already on treatment, you have to assess level of control. how u do that?
ask for:
-day symptoms
-night symptoms
-frequency of reliever tx
-limitation of activities
-lung function (PEF/FEV1)
-exacerbations (acute asthma attack)
Levels of control are:
-controlled
-partly controlled
-uncontrolled
Treatment of asthma
- reliever (bronchodilator)
- preventer (anti-inflammatory)
hmm.. what is bronchodilator?
- B2-agonist (salbutamol, salmeterol)
- anti-cholinergics (ipratropium bromide)
- methylxanthines (oral theophylline, iv aminophylline)
- cysteinyl-leukotriene antagonist (montelukast)
What is anti-inflammatory then?
- steroid (beclomethasone, fluticasone, budesonide, oral prednisolone, iv hydrocortisone)
- cromones (sodium cromoglicate)
now you know the medication, so now, how do you manage chronic asthma?
- ok, the principle is 'lowest dose possible to achieve control'
- so if not control, step up the medication
- this is call step-wise approach (step up/ step down)
1) SABA when necessary
2) SABA + low dose steroid
3) SABA + low dose steroid + LABA
4) SABA + moderate/high dose steroid + LABA
5) SABA + oral prednisolone (lowest dose)
then, what about exacerbation? what is it and how to treat?
ok, exacerbation is progressive SOB, chest tightness, cough or wheeze, characterized by reduction of expiratory flow.
it needs repeatitive SABA tx, early steroid tx and O2 supplementation
severity of exacerbation
- mild
- moderate*
- severe*
- respi arrest immenent*
*important
important facts
1) GERD is 3 times more common in asthma
2) ~30% asthmatic adult have acute exacerbation due to aspirin/NSAID
3) in pregnancy, 1/3 become worse, 1/3 stable, 1/3 less severe
4) majority of asthma patients have hx of rhinitis. (30% rhinitis develop asthma)
5) near 70% polyps patient will develop asthma (almost 90% aspirin-intolerant have polyps)
6) viral (not bacteria) respi infection assoc with asthmatic symptom. virus include rhinovirus, para-influenza, influenza, coronavirus, adenovirus
what is asthma?
- asthma is chronic inflammatory disorder of airways characterized by bronchial hyperresponsiveness leading to widespread bronchoconstriction.
-asthma is reversible
REMEMBER: airway narrowing and airway hyper-responsiveness
Factors which cause asthma
- host factors - atopy
- environment factor - allergen, infection, air pollution, smoking, diet etc
Mechanism of asthma:
inflammation involving these cells and mediators result in airway hyper-responsiveness and asthma symptoms
- inflammatory cells (mast cell, eiosinophil and T lymphocytes)
- inflammatory mediators (chemokine, cytokine, cysteinyl leukotriene, histamine,NO, PG etc)
Airway narrowing due to:
- airway smooth muscle constriction
- airway edema
- airway thickening
- mucus hypersecretion
airway hyper-responsiveness
- err.. no need to know la..
special mechanism in asthma
acute exacerbation
- due to triggers
nocturnal symptoms
- due to circadian rhythm of hormones (epinephrine,cortisol,melatonin etc)
************************************
Management depends on presentation
- (acute/chronic) and
- severity
how to assess the severity?
- by clinical examination and ix (peak flow/spirometry)
classification of severity?
- intermittent
- mild/moderate/severe persistent
so, after patient already on treatment, you have to assess level of control. how u do that?
ask for:
-day symptoms
-night symptoms
-frequency of reliever tx
-limitation of activities
-lung function (PEF/FEV1)
-exacerbations (acute asthma attack)
Levels of control are:
-controlled
-partly controlled
-uncontrolled
Treatment of asthma
- reliever (bronchodilator)
- preventer (anti-inflammatory)
hmm.. what is bronchodilator?
- B2-agonist (salbutamol, salmeterol)
- anti-cholinergics (ipratropium bromide)
- methylxanthines (oral theophylline, iv aminophylline)
- cysteinyl-leukotriene antagonist (montelukast)
What is anti-inflammatory then?
- steroid (beclomethasone, fluticasone, budesonide, oral prednisolone, iv hydrocortisone)
- cromones (sodium cromoglicate)
now you know the medication, so now, how do you manage chronic asthma?
- ok, the principle is 'lowest dose possible to achieve control'
- so if not control, step up the medication
- this is call step-wise approach (step up/ step down)
1) SABA when necessary
2) SABA + low dose steroid
3) SABA + low dose steroid + LABA
4) SABA + moderate/high dose steroid + LABA
5) SABA + oral prednisolone (lowest dose)
then, what about exacerbation? what is it and how to treat?
ok, exacerbation is progressive SOB, chest tightness, cough or wheeze, characterized by reduction of expiratory flow.
it needs repeatitive SABA tx, early steroid tx and O2 supplementation
severity of exacerbation
- mild
- moderate*
- severe*
- respi arrest immenent*
*important
important facts
1) GERD is 3 times more common in asthma
2) ~30% asthmatic adult have acute exacerbation due to aspirin/NSAID
3) in pregnancy, 1/3 become worse, 1/3 stable, 1/3 less severe
4) majority of asthma patients have hx of rhinitis. (30% rhinitis develop asthma)
5) near 70% polyps patient will develop asthma (almost 90% aspirin-intolerant have polyps)
6) viral (not bacteria) respi infection assoc with asthmatic symptom. virus include rhinovirus, para-influenza, influenza, coronavirus, adenovirus
Saturday, May 16, 2009
my first day of 2 weeks study break
well... juz started my first day studying.. off to a slow start really. was doing al these unrelated stuff early in the morning. but no worries. i have made an organized schedule so that i will finish revising in time before exam.
today im finishing up upper & lower GI surgery. then i would read up some cardio stuff later.
im really confident i would make it in time for exam and be prepared. Insya Allah, we all will pass our xm. ;)
good luck guys!!!
Friday, May 8, 2009
class of 2009
me at front row~!from right (sitting):
izwan, uv, aimad, ME, mamat, johan, ...
i dont think, this is the complete number of people in our batch.. there should be more. the reason why many were absent:
--> it was taken at 8am, on a sunday! malas nak bangun pagi ni..
Final year PMC
well, it has really been a while since my last post. ive been busy.. with stuff.. u knoe la kan.. blaja medicine nih.. anyhow.. final year xm in 3 weeks!!!
3 weeks~!!!!!!
arrgghhh..
better start study my friend...
goodluck to all... happy revising... :)
amir torres
7th May 7.31pm
3 weeks~!!!!!!
arrgghhh..
better start study my friend...
goodluck to all... happy revising... :)
amir torres
7th May 7.31pm
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