goo goo

over omar series

acute appendicitis

http://www.authorstream.com/Presentation/jigardoc-264548-acute-pancreatitis-entertainment-ppt-powerpoint/

mind-boggling afterall

been searching for this kind long-long time ago. yippie!!

http://abc.go.com/shows/greys-anatomy/medical-case-file/ThemeGallery/621498

Můj šestý smysl (my 6th sense)

MISS, PAP SMEAR IS ON THE GO

It's O&G time !!

FRIDAY, FEBRUARY 25, 2011

Counsel for pap smear

Posted by medik-ukm on Friday, February 25, 2011

1. Introduction

2. Ask patient if she know what we will do

3. Explain indication

-screening tool for cervical Ca

-yearly for two years,if normal then three yearly

- age 20-65 / once sexually active

4. Explain procedure

- duration is about 5-10 minutes

-no analgesia/ LA/ sedation given

- patient will feel uncomfortable during the procedure

-this is sterile procedure, wash hand,do aseptic technique, wear sterile gloves

- in dorsal position with open leg

- clean the perineum first with sterile water

- do bimanual palpation to know the position of cervix

- insert the Cusco speculum

-visualize if there is any lesion or abnormality if vulva/vagina/cervix

-use Ayre’s spatula to take sample

- rotate the spatula 360⁰

-put the smear on the slide

-make sure the slide have name and RN

- fix the slide with cytofix/ alcohol

-send the slide to lab

-then remove the speculum

-the procedure is finish

5. Explain complication of procedure

-spotting

-if having heavy bleeding come to hospital ASAP

-infection

6. Result

- ready in 1-2 weeks

- if normal, we don’t call. But if abnormal,we will call

- futher management will be done if any abnormalities detected

7. Ask patient if any question

source: workshop and dr. nasir

hanisah A115275

Reference :http://persiapbba0611.blogspot.com/2011/02/counsel-for-pap-smear.html

My letter to my medical students

posted in - Education, - Guest, - Inspiring |

To all of you my medical students,

You are very important. The future of many lives and families depend on what doctors do and SAY. I hope this realisation will uplift us with a sense of our remarkable place in the world as doctors.
And that is also why I keep on harping that Doctors MUST not be Wallpapers!
Please remember that Doctors had always stood at the forefront of change in society… those of you training under me MUST not only be skilful in diagnosis and management but also in social skills and leadership. It is your heritage that you cannot deny!

But the practise of Medicine is in trouble. Blatant commercialisation, rampant blood tests done without any doctors ordering or supervising, scans and probes of all kinds, are being conducted by laboratories and some doctors misguilded by wants rather than needs.

Hope lies in every one of us doctors, present and future, for the sensible management of patients; YOU remain the hope for untold numbers of patients in the future. Sadly some doctors see patients not as patients but as a disease that needs treatment which provides our source of income. This is nothing new, physicians like Osler had repeatedly cautioned againstnot forgetting the man behind the disease, and medicine as a calling rather than a business.

“The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with potions and powders, but with the exercise of an influence of the strong upon the weak, of the righteous upon the wicked, of the wise upon the foolish”.

~ Sir William Osler

Many doctors are unhappy with their work or simply too busy to talk, console or listen. Many just treat the disease and completely ignore the person who has it. We hear endless tales carried by patients of doctors who grunt instead of talk, who are capable only of monosylable conversation and who zip patients in and out of the consultation room with a speed that will make Superman jealous.

The reasons are complex. But one reason may simply be that some of us doctors have forgotten why we became doctors in the first place, and the wonder of caring for fellow humans. Some may be a bit burnt out. We had in our careers, seen and taken care of more pain and misery than most people. We saw prostitudes, drug addicts, criminals and the worst of humanity.
We also treated decent human beings, doting grandmothers and innocent children. No doubt, the demands on our skills and the medical-legal complexities that accompany our practise would have made even the greatest of our medical ancestors shudder. Yes, we deserve some rest from our weariness. But let’s not let go of the calling. Rather than try to correct the system which is basically dictated by our political masters, a system undeniably sick, we need to repair ourselves. Yes the system only makes it more painful. Regulations as thick as a medical text. Pharmacies selling controlled medicines like sweets. To change that will require one of us to be the next Prof Virchow, plunging head on into politics to make a difference. For the vast majority of us struggling on as individuals practising medicine, we hopefully don’t need much repairing; but to recall why we first fell in love with medicine, and why we wanted to become doctors.

In school we rose above the hoard, we were thecream de la cream. We obtained results the envy of most and we strove with pride to enter medical school. We sacrificed parties and dates to study for those results, we read volumes. In medical school we worked like ants on a long march. We reeked of formalin, we stared at slides till we saw mitochondria in our dreams and memorised volumes of facts
and figures. We did tough postings, survived the strictest professors, rounded in the pre-dawn drudgery of crowded wards, worked till hypoglycaemic on medicine rounds, performed every procedure required in the book, and passed our exams reasonably well. We stayed late, studied hard and looked at X-rays until our eyes turned red.

We finally graduated and became houseofficers. Yes, that year made the second world war look like a walk in the park but we survived. A few years later, we picked a specialty, from paediatrics to surgery, family medicine to cardiology, internal medicine to radiology, and shuffled off to more clinics, rounds grand or otherwise, work and studies. And MORE EXAMs.
During post grad training, we had exposed ourselves to the dangers of infectious disease, exhaustion, depression and violence. Operative instruments became flying daggers that we dodged in OT when the surgeon grew frustrated. I still recall with trepidation managing the very first patient admitted to our hospital with AIDS. We knew very little but feared a lot. As registrar, it was my duty to examine him. But again we survived. And learned. Now at almost every bedside teaching, I see patients with HIV. Fear can be turned to compassion. We drained fluid filled tuberculous chests, placed central venous lines, resuscitated the dying. We obtained consent for a thousand procedures, pronounced people dead, wrote enough case summaries to make ‘War and Peace’ look like short fiction and was almost ‘form-ed’ to death by the endless forms the admin would have us fill.
Our youthful enthusiasm and dedication well deserved the applause of our patients, when there was any. Weren’t we incredible then, if only because we came back to the wards night after night, day after day for emergencies, calls, rounds or simply a ’tissued’ drip. “Bengkak” the nurse will phone and we leave our dinner to struggle with chemo wrecked veins for IV access.

We as doctors must hold onto that commitment, that wonderful calling. Then we see another world – the realm of the business of medicine, where every disease is a “case” to be investigated.

A very senior Professor tells me she had seen doctors ordering investigations before even taking a history! Here is also the world of the grunting and monosylable doctor, the superman of 2 minute consultations and management. True, the superb rare genius of a diagnostitian may well have obtained all the data that he needed sub- 2 minutes, but the poor human called ‘the patient’ needed at least 6 minutes of compassionate conversation. (By the way, that is why your OSCE exam is 6 minutes long, or SHORT from your examinee viewpoint.. now you know how the patient will feel when the consultation is even shorter than this!). Recall that the only reason the woman in labour remembered us the attending medical student is because we held her hand while she screamed.
In the midst of all that we call Medicine, let us always remember the human behind the disease.

Let us recall that our work is a wonderful calling, a great gift. We are the descendents of Aescalapius, the inheriters of all that is noble in the Hippocratic oath. We may fail to change the ideas of many doctors however we may preach from some illusive high moral ground. But as individuals let us try not to lose our ideals.

Don’t let the system, colleagues or patients burn us out. Go for a holiday, trek lonely mountains, meditate, pray, sing, chant or simply relax. The sick is the reason for the practice of medicine, their care is why we became doctors! If we keep our mission clear, and our calling intact, we’ll care less about money and in all probability still make all that we need. By all means earn what is deservedly ours, but never forget the human who is paying. He is called the patient!

And in the process we can teach and inspire the next generation of doctors, ie you and all your friends. If we tell our students that the learning of medicine is through their apprenticeship to us their seniors, then we better be sure that we are good role models.

As medical students and future doctors, you all are the hope of the febrile, the breathless and the pregnant. And let us old froggies never forget the calling that we answered after decades of preparation from school to university to hospitals.

Do not let what you see in the misadventures of some doctors discourage you. Instead let them be teachers to you for you now know what you do NOT want to be like.

When a doctor have taken medicine to be a business or trade, he will ask what are his achievements — material success, cars, wealth, etc..
When a doctor has taken medicine to be a calling, he will ask what has he become — his character.

I hope we doctors can discern and reflect on what we have become in the practice of medicine, and teach all our young charges, delivering them safely through the long 5 years of protracted labour into a reasonably sane medical world.

Thank you

Your lo si,

Associate Professor Wong YO.

medicine.com.my

Acuostic neuroma

Acoustic Neuroma (Vestibular Schwanoma) Acoustic neuromas are benign tumors that arise from the cochleovestibular (hearing and balance) nerve. At least four thousand of these tumors are diagnosed in the United States per year. These tumors are slow growing and arise within the temporal bone which contains the nerves to the inner ear. As these tumors expand, they grow into the intracranial cavity and lead to compression of cranial nerves that regulate facial movement, facial sensation, hearing, balance, and speech and swallowing. In addition, the portion of the brain that regulates coordination and motion (the cerebellum) and the brainstem itself may be compressed by these tumors. Early in tumor growth the acoustic neuroma is limited to the internal auditory canal a structure that transmits the hearing and balance nerves from the inner ear to the brain, and that also transmits the facial nerve on its journey to the muscles of facial expression. Patients with a stage one or intracanalicular stage acoustic neuroma (confined entirely inside the internal auditory canal) often complain of difficulty with hearing in one ear, which may begin suddenly or insidiously. Hearing loss may be accompanied by noise inside the ear (tinnitus), dizziness and vertigo.  

Figure 1 is a view of the head from above. The posterior fossa with the intracranial contents of the cerebellum, brain stem and cranial nerves, as well as the temporal bone can be seen. The temporal bone is a part of the skull base. In the temporal bone is the internal auditory canal that allows the cochleovestibular (hearing and balance) nerve and the facial nerve to pass from their intracranial site of origin to either the cochlea (snail like hearing organ), vestibular apparatus (balance organ with the 3 semicircular canals), or the muscles that move the face. Acoustic neuromas most commonly arise in this canal. In Figure 1, a small intracanlicular tumor (colored brown in this illustration) can be seen. 

In Figure 2, a larger acoustic neuroma is present. This tumor has grown out of the internal auditory canal into the region known as the cerebellopontine angle, or CPA. The tumor has a characteristic shape, with a root like extension in the internal auditory canal and a globular portion in the intracranial cavity, just touching the brainstem, cerebellum and some of the cranial nerves. Patients may have the same symptoms as when the tumor is in the internal auditory canal or patients may have additional symptoms such as headache. 

The brainstem compressive stage can be seen in Figure 3. In this figure the brainstem, cerebellum and cranial nerves are being compressed by the tumor. Acoustic neuromas are almost universally benign (not cancer), so they do not erode into, or replace brain tissue. Rather acoustic neuromas cause damage by taking up space in the intracranial cavity where no extra space exists. Compression and attentuation of vital structures in this stage can lead to increased headaches and numbness of the face. 

The final stage of acoustic neuroma growth, seen in Figure 4, causes hydrocephalus or a blockage of drainage of the cerebrospinal fluid in the head that bathes the brain. This increased pressure and further compression of the brainstem, cerebellum and cranial nerves results in more severe symptoms such as double vision , difficulty with speech and swallowing, and even difficulty with breathing, and, if left untreated for an extended period, eventually death. 
The treatment of acoustic neuromas is complex and requires a sophisticated and well coordinated team. Our Consortium on Skull Base Tumors cares for patients with these and other complicated tumors in this region. The skull base surgery team is composed of a neurotologist-skull base surgeon and neurosurgeons who perform microsurgical resections of these lesions. During the microsurgery a third physician, a neurophysiologist, performs electrophysiologic monitoring of many of the nerves compressed by the tumor, so that these nerves can be both electrically and visually identified, in an effort to preserve function.



Radiosurgery:
Gamma Knife and X Knife - LINAC Our team is also known for our expertise in treating with focused forms of radiation therapy including gamma knife radiosurgery and X knife Linac based radiation. Increasingly, these forms of radiotherapy are being used both in combination with surgical debulking for larger tumors, and as a form of primary therapy for selected smaller tumors, often in older patients.
If you would like to schedule an appointment, please contact:

http://www.nycornell.org/ent/acoustic.neuroma.html