HKL Medical Update 2012: Haematology Update

I am truly sorry for the delay in uploading these files.. here it is!

Lecture notes by:

• Dr. Ong Tee Chuan, Consultant Haematologist, Ampang Hospital

1. Approach to Anaemia
2. What Clinicians Should Know About Blood Transfusion
3. Haematological Malignancies Made Easy

• Dr. Jameela Sathar, Senior Consultant Haematologist, Ampang Hospital

1. Approach to Coagulopathy
2. Approach to Thrombocytopaenia
3. Approach to Thrombosis

If you have any questions about the lectures, let us know!

p/s: Again, a reminder.. these lectures are not to be used for any purpose without permission. Share this blog if you want other people to view it. :) 

HKL Medical Update 3/12: Haematology Update

We had a blast again on 13th October 2012. HKL Haematology Update invited two awesome speakers from Ampang Hospital, Dr. Jameela Sathar (Senior Consultant Haematologist) and Dr. Ong Tee Chuan (Consultant Haematologist). The presentations were effectively delivered by the speakers in a simple, interesting, interactive and practical way. Again, my team and I hope everybody enjoyed it and benefited from it! Most importantly, as what Dr. Jameela constantly remind me, "Hope you put it to practise and not just listen!" 

I will update the blog with the lecture slides soon.. For now, I have to excuse myself.. off to bed!

Lecture notes HKL Medical Update 2/2012: Focus on Diabetes

Below are the slides of all the lectures. Please do not use the slides other than for your own use without permission.

1. DYSGLYCAEMIA CONTINUUM by Dr. Masni Mohamed, Endocrinologist, Putrajaya Hospital
2. DIABETIC EMERGENCIES: CAN WE DO BETTER? by Dr Mohamed Badrulnizam Long Bidin, Endocrinologist, Kuala Lumpur Hospital
3. DIABETES AND EYE by Dr Choo Swee Ying, Ophthalmologist, Kuala Lumpur Hospital
4. DIABETES AND KIDNEY by Dr Sunita Bavanandan, Nephrologist, Kuala Lumpur Hospital
5. DIABETES AND NERVES by Dr. Raymond Tan, Neurologist, Kuala Lumpur Hospital
6. DIABETIC FOOT ULCER AND FOOT CARE by Dr R. Harikrishna, Wound care specialist, KKKL
7. DIETARY CONSIDERATION IN DIABETES by Pn Norafizah Nordin, Dietician, Kuala Lumpur Hospital

Hope this is useful..  Feel free to drop any comments

NEW STRATEGY IN MANAGEMENT OF T2DM: BENEFIT OR HYPE

This lecture was presented by Associate Professor Dr. Norlaila Mustafa, endocrinologist from UKM Medical Centre.

 Click here to download the presentation

HKL Medical Updates 2/2012: Focus on Diabetes

Alhamdulillah, praise to Allah, we had overwhelming response from the doctors within our department, our hospital and other hospitals as well. This was the first time my team and I handled such event. Nerve-wrecking, heart-pumping I must say as we did almost everything from the scratch. At the end of the day, we were glad that everything went on smooth. All these will not be possible without the help and support from our head of department, our advisors, speakers and participants. We hope everybody who came finds it as beneficial as we all did. As promised, I will be uploading the presentations by all the speakers.. 

p/s: we would appreciate if you do not use the teaching slides for any purpose without permission. Thank you!

Station 4

Station 4

Station 4 in MRCP PACES is an assessment of communication skills and ethics. Many, particularly Asians whom english is not their first medium find it difficult. However, I believe practice makes perfect. Like history taking station, this is a station that you will be able to practice at anytime, anywhere, all you need is a study partner and An Aid to the MRCP PACES vol. 2 by Ryder.

What I did with my study partners was each of us will take turn to become candidate and surrogate while the others will observe and give their comments after the session. Initially we practised with the senarios from the books. Later, we created our own senarios.

When reading the case senario, you should be able to relate your senario to the 4 ethical principals, this could help you in the discussion with the surrogate later.
The 4 ethical principals:

1. Patient's autonomy

2. Beneficence

3. Non-maleficence (do no harm)

4. Justice

There are few senarios that I think sometimes are difficult to discuss about, one of it is brain death.

Case Senario - Brain death

You are the SHO in medical ITU and you are about to see Mr L, the father of Miss L, a patient in ITU.

Miss L, 25 year-old Chinese lady who was admitted 3 days ago with massive intracranial bleed due to a ruptured cerebral aneurysm. She was intubated immediately in ED for poor GCS and subsequent CT brain showed massive ICB with midline shift. She was referred to neurosurgical team for intervention which was done before she was sent to ITU with 3 inotropes. Sedation was halted 36 hours ago and Miss L has shown no neurological response. Your neurology consultant and the ICU consultant has decided for a brainstem testing which was done earlier today and Miss L has been confirmed brain dead. Currently, Miss L is ventilated, her BP is 100/60 mmHg on 3 inotropes and ECG showed sinus rhythm. Your task to to explain to Mr L the diagnosis of brain death and explore the possibility of organ donation.

I shall leave this to you and your study partners to discuss about it.


Useful website:
Brain Death: A Simple Explanation for Donor Families
http://www.kidney.org/transplantation/donorFamilies/infoBooksBrain.cfm

Station 5 - Reduced Effort Tolerance (part 2)

This is a straight forward senario, this young lady has Marfan syndrome.

First picture - tall and thin build young lady with disporpotionately long arms and legs

Second picture - high-arched palate

Third picture - left eye showing superotemporal subluxation of the lens.

It is not difficult to get the diagnosis of Marfan syndrome as the features are quite prominent. What the examiner want to see is how you take history and perform physical examination to confirm your diagnosis and look for any possible complications of the disease. Of course, not to forget to answer to patient's concerns.

History:
- Family history
- Symptoms of heart failure
- Eye problem

Physical examination:
- Noted tall patient with arm span exceed the height
- Hands – thumb sign and wrist sign
- Eyes – vertical subluxation, myopia
- Head – long headedness
- Palate – high-arched
- Chest – pectus excavatum, cystic lung disease
- Heart – MVP, AR
- Spine – kyphosis and scoliosis

There are few systems that are involved in Marfan syndrome, therefore you have to be systematic when you perform physical examination. The only way to be smooth and systematic in the exam is by practising a lot. Get a member in your group to be the simulated patient and practice the flow on him/her. This is particular useful in cases with multiple systems involvement and neurology cases.

Investigations
Echocardiography, chest and spine radiography, CT/MRI

Management
- Yearly echo – monitor aortic diameter and mitral valve function
- Ophthalmology and orthopaedics referral
- Genetic counseling

A few useful websites:
1. Diagnostic criteria
http://www.marfan.org/cms/uploaded_files/8XJIUG81F3/89/docs/factsheet_mfsbodysystem.pdf
2. National Marfan Foundation
http://www.marfan.org/marfan/