Cardiac monitoring - various methods

Inotrope- various types and most complete

Screening of bowel cancer

The Screening of bowel cancer
Western country has done a good work
When would be our country has a complete system to do so
Not only the health care providers to offer the service
Public awareness is another important issue to address

Spinal cord disorder and pattern oaf sensory loss

Different type of spinal disorder will give rise to different pattern of sensory loss
Even though nowadays everybody confirm the diagnosis by MRI, but go back to basis, in pre-MRI era, how our brilliant doctors diagnose them

Visual pathway and its defect

Somebody finds this is simple
But other may face problem on this.

This is actually quite straight forward
It elaborate optic nerve and the associated defect with the effect against vision/ visual field

Brain function

Human brain is complicated, expert may be can only defines less than 10% of brain. The other 90% is still unknown.

Now let us go through the known 10% of brain function.

Type of dressing

Optimum environment for wound healing

• Moist


• Free from infection, with minimal slough


• Free of chemicals and foreign bodies


• Optimum temperature


• Minimal number of dressing changes


• Correct pH

1. Different dressings are appropriate for different stages of the wound healing


2. Good wound management necessitates flexible approach to election and use of dressings

Requirements from a dressing
Wound

• Protection from infection and trauma


• Debrides, both mechanically and chemically


• Absorbent and removes excess exudate, whilst keeping wound moist


• Maintains temperature and gaseous exchange

Patient

1. Comfortable and cosmetically acceptable


2. Stimulates healing

Healthcare provider

1. Inexpensive


2. Easy to change

Type of mesh repair for incisional hernia

There are 3 types of mesh repair, inlay, onlay and sublay.
All have different advantages and disadvantages.
There is a bit too long to elaborate.
See later whether I can get the mind map online

Macrophage mechanism

Cellular illustration how macrophage in action

Acute inflammation

Acute inflammation has 2 stages
First is vascular stage, with initial vasoconstriction, then subsequent vasodilatation.
Capillary becomes leaky, where fluid accumulated at interstitial space causing edema

Second stage is cellular stage, which involved all the inflammatory mediators and phagocytosis of antigen. With formation of APC and manifestation of cardinal signs of inflammation

management of benign breast condition

the basic is still triple assessment

crucial point is when to do operation

it is just a guide, detail still need to refer to local center protocol

carcinoma of unknown origin

recently there are few cases of these

pt presented with metastatic CA, but unknown of primary

CT scan and biopsy are needed

then will be a challenge for pathologist to interprete this

breast anatomy

in breast posting under prof yip

her first question is always be: tell me the anatomy of breast

then 2nd question is: what is triple assessment

morbid obesity

obesity is a major problem in the world now

there was a 200kg patient came to ED

and we found that even the normal bed cannot be fitted

anorectal benign disease

anorectal benign disease is far more common than carcinoma/ cancer of the region

1 of the painful experience of colorectal surgeon is: have to do per rectal examination of all his patient

(perhaps some of them enjoy it..)

anyway, that the summary of all the common benign disease

CSF circulation

how CSF circulation work..

some name need to be remember: eg monro, sylvius, megendia, luschka..

sign neurosurgery...

calcium absorption in gut

calcium abosrption in duodenum

and how hormonal influent in cellular level

been asked before during part 1 master

just memorise the picture and u can answer well

calcium metabolism

important part 1 question

basically calcium metabolism controlled by

- 3 main hormones: 1-25-dehydrocholecalciferol (DHCC), PTH and calcitonin

- other associated hormones: growth hormone, glucocorticoid, estrogen, thyroxine, insulin and IGF (insulin growth factor)

calcium sources are from:

- GIT absorption, renal absorption

- bone resoption and deposition

calcium in blood/ serum has 2 forms

- free calcium

- bound to protein/ albumin

do remember the formula of how to count corrected calcium

- [Ca] + 0.02(40-alb)

brachial plexus

wondering u still remember brachial plexus?

is 1st year anatomy, then can forget about it?

no, no way, it will still come out in final year..

neuromuscular junction

how neuromuscular junction function?

all in this diagram..

first year physio..

both of MBBS and master program

muscle contraction

bit of physiology.. how skeletal muscle contract

it involve calcium..

so later there are lots of stuff about calcium

acute limb ischaemia

first pic is the full management of ALI

2nd pic is the categories that taken from HKL vascular unit

protocol of breast clinic ummc

stomach- blood supply

this is the common question asked during exam, either written or viva

sometimes it may be twisted and turned, but basically the answer will be the same

example, what vessels that u need to cut/ ligate during total gastrectomy

stomach- gross anatomy

this is the basic that everybody should know

adding on to this, the cardio-esophageal junction/ lower esophageal sphincter pressure is about 15-25mmHg, measured by manometer

wound healing

this is a common essay question

if can memory the pic above and vomited out in exam

then surely can score

management of upper GI bleed

a complete summary of management of UGI bleed

for surgical candidate, this should be in finger tip, is perhaps is for HO/ medical student as a reference

Management of variceal bleed

management of variceal bleed..

seem too complicated. but just follow the flow chart

if u wanna classify the management, a good way is to divide it

- initial resuscitation

- OGDS and banding

- sangtaken blackmore tube, TIPSS

- surgery: porto-caval bypass/ esophageal transection/ liver transplantation

Management of non variceal UGI bleed

Upper GI　bleed basically divided into variceal and non-variceal bleed

the management is somehow different

(even though both of them started fr resuscitation and then OGDS)

just follow the flow chart and you won't get wrong

for the complete management and management of variceal UGIB will be posted later

Forrest classification

it is important as it predicted the rate of mortality and rebleed

somohow i find out that lots of junior dr cannot remember this classification

thus just to post up as a reference.

fluconazole as first line of fungal infection

fungal infection always been ignored, it happened more common than it has been detected

this is because medical personal does not suspect it, and it is difficult to be cultured.

thus some studies suggest that to start fluconazole empirically in high risk patients (as noted in upper Left conner). it is daily dose, and so far is 1 of the safest drugs

the evidences of the studies shown in another 3 charts. it will reduce mortality for at least 50%

but beware not all candida will respond to fluconazole, eg candida kruzei that need better antifungus..

bowel prep rules

this is basically to induce diarrhoea to patient

so that procedure of large bowel can be done

example: colonoscope, or surgery.

different hospital use different protocol of bowel prep

even different surgeon uses different type and time

basically it starts the night before procedure

and usually repeated for twice, sometimes 3 times

(for certain pt, it even started 2 days prior to procedure)

some formulary given orally and some per rectally

below is the caution of giving bowel prep

this is because sometimes large amount of fluid shift will do harm to pt,

particularly for those with heart, lung and kidney diseases

BIRAD classification in breast examinatin

triple assessment of breast is very important during under grate exam

in fact it will be 1 of the question during phase 3A

triple assessment included:

1) clinical examination

2) imaging: ultrasound for those < 35 years old, mammogram for > 35 years old

3) pathological sampling: usually FNAC is sufficient, but sometimes we do request for excisional biopsy or incisional biopsy (very rare)

this topic i will bring it a bit deep, regarding BIRADs classification

this is during imaging, the common language btw radiologist and surgeon, regarding management and follow up of patient.

definitely it won't be asked during under grate exam

but post grate... it could be asked

lots of ppl think that it would be mentioned at the end of radiological report

but if suddenly been asked during exam, surely u will know how insufficient u are..

Los Angle classification

this is for reflux esophagitis.

these 2 posters actually pasted on the wall of scope room UMMC

is picture and description

easy to memorize and reproduce

if medical student mention this, can impress the examiner

but post grate candidate should know this by heart

treatment of Helicobacter pylori

most of the doctor know that triple therapy for Helicobacter pylori

but actually there are 4-5 lines of treatments

we use quadruple therapy if triple therapy fail, which can be as high as 20%

algorithm as showed in above picture

(modified from nycomed)

introduction

everything under the sun can be classified

this is one of my prof used to say

so to start, i classify this into various categories

simply as follow:

- head and neck

- cardiothoracic

- breast and endocrine

- abdomen

- gastrointestinal

- urolory/ renal

- vascular

- principle

- physiology/ pathology

- metabolism

- infective: including antibiotic etc

- miscellaneous: including some anatomy and anaesthesiology that cannot classify elsewhere

hope this will progress well..