What medication is prescribed for Lisa Surihati's mild knee osteoarthritis?
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Paracetamol 1g, four times a day as needed.
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What medication is prescribed for Lisa Surihati's mild knee osteoarthritis?
Paracetamol 1g, four times a day as needed.
How long should Lisa use hydrocortisone 1% cream?
For 4 weeks, three times a day.
What additional symptom indicates possible limb ischemia?
Intermittent claudication.
What are the important elements to include in documentation?
Key findings, patient history, treatment plans, and any changes in conditions.
What is the dosage and frequency of Actrapid® injection for Lisa?
10 units, three times a day before meals.
What is a key phrase to use when making a verbal referral?
“Could you please come and see this patient and give me your opinion?”
What is the calculated dose of paracetamol for the 4-year-old girl in mg?
240 mg (15 mg per kg).
What are useful X-ray landmarks?
Anatomical structures that help in the interpretation of X-ray images.
What should a house officer do upon arriving at the operating theatre?
Introduce yourself to the OT staff, anaesthetic team, and regarding the operating time.
What underlying condition does the patient have?
Chronic diabetes mellitus.
What is the weight of the child diagnosed with mild acute otitis media?
16 kg.
What essential information should be included in a radiology request?
Patient details, clinical history, examination type, and urgency.
What should you have in front of you before making a referral call?
Notes, including recent observations, blood tests, and imaging.
What is an important phrase to indicate uncertainty in a referral?
“Truthfully, the diagnosis is uncertain, but I am hoping your team may be able to give us valuable input.”
What is a common mistake made when filling out the Radiology Form?
Inadequate information.
What time is recommended to arrive for morning rounds in Pediatrics?
6:15 am.
What is the purpose of GSH?
To determine the patient's blood type and screen for antibodies.
How is the timing for an urgent appointment determined?
It depends on the specific circumstances.
What institution is associated with Md Zaki?
UITM (Universiti Teknologi MARA).
What does 'HO' stand for in medical education?
House Officer.
What demographic details are required in the Radiology Form?
Name, Age, Sex, IC/MRN.
What is the maintenance fluid requirement for a 10 kg child over 24 hours?
1000 mL.
What is the dosage of Ampicillin for a patient weighing 20 kg?
100 mg/kg, totaling 2000 mg.
What is one example of a useful X-ray landmark?
The diaphragm can be used as a reference in chest X-rays.
What does GSH stand for in blood transfusion procedures?
Group - Screen - Hold.
What is the second medication in the triple therapy for a gastric ulcer?
T. Amoxicillin 1g BD for 14 days.
What are common cases seen in general pediatrics?
Dengue, respiratory issues, tonsillopharyngitis with poor oral intake, febrile fit, and AGE.
When is intubation and mechanical ventilation indicated in respiratory failure?
Severe respiratory distress, tiring from work of breathing, progressive hypoxaemia, reduced conscious level, and progressive neuromuscular weakness.
What is done during GXM?
Patient's blood is sent to the blood bank for cross-matching with a specific donor unit.
What is the energy requirement calculated for potential shock?
80 J (20 kg × 4 J/kg).
What are some renal system complications post-surgery?
Acute kidney injury, urinary retention, and urinary infection.
What is the typical timeframe for scheduling an early appointment?
3 to 4 months in advance.
What condition is the patient being referred to rule out?
Acute Coronary Syndrome (ACS).
What symptoms does the patient report in the right foot?
Pain, reduced sensation, reduced temperature, numbness, and tingling.
What should accompany a verbal referral regarding investigations?
“The investigations have been sent, but I don’t think this will affect the need for you to see and assess this patient.”
How much syrup paracetamol should be prescribed for Lily?
4.8 ml of syrup paracetamol (250mg/5ml).
What additional fluid is used for maintenance along with 0.9% NS?
Dextrose 5%.
How is the 2000 mg dosage divided for administration?
Divided into QID doses, so each dose is 500 mg.
What is the volume in mL to administer for a dose of 500 mg of Ampicillin using the drug label instruction of 50 mg/mL?
10 mL.
What are the escalation steps for respiratory support in failure?
From oxygen (via face mask or nasal cannula) to noninvasive ventilation to endotracheal intubation and mechanical ventilation.
What does GXM stand for?
Group - Cross - Match.
What was the child's weight calculation?
20 kg (8 + (6 × 2)).
What signs indicate dehydration in a patient?
Skin turgor, sunken eyes, and mucous membrane dryness.
Why is accurate documentation important in medical practice?
It ensures continuity of care and legal protection.
What does arriving earlier than your superior in the operating theatre signify?
It is a sign of respect for the hierarchy in the medical team.
What is the normal duration for a specific clinical timeframe mentioned?
7 - 8 months.
What type of fluids is given for the fluid deficit?
0.9% NS or Hartmann's solution.
What is the maintenance fluid requirement for patients?
40 cc/hour/day (Paeds use holiday segar formula).
How do you calculate fluid deficit in a patient?
10 x % of dehydration x Body weight (replace over 12 hours).
What is a key indicator for meningococcal meningitis?
Look for rash on the patient's body.
What are ongoing losses associated with fluid management?
Losses from RT aspiration, drainage, 3rd space loss, plasma loss, etc.
What is critical to include when referring to General Surgery?
Urgency, previous abdominal surgeries, and post-operative complications.
What should you monitor in a dengue patient during rounds?
Warning signs, defervescent phase, and FBC trends.
Where should hand placement be for chest compressions in pregnant patients?
At the center of the chest, not shifted upward.
Name one complication from a single blood transfusion.
Incompatibility hemolytic transfusion reaction.
What should be monitored during a transfusion?
Rate of transfusion: 1 pint of packed red cells over 4 hours with IV frusemide 30mg in between.
What is the primary diagnosis for the 69-year-old Malay man?
Chronic Limb Ischemia.
What is the significance of 'MBBS' in the context of these notes?
It signifies a Bachelor of Medicine, Bachelor of Surgery degree.
What is the total fluid deficit for a 10 kg child over 6 hours?
1000 mL.
Which department should the patient be referred to for foot assessment?
Orthopedic department.
What basic information should be included in a written referral?
To whom the referral is made, patient details (name, MRN/IC, age, gender), and a summary of the patient’s clinical history and physical examination.
What are the patient preparation steps prior to an interventional procedure?
Review blood, fasting for at least 4 - 6 hours, and ensuring functioning IV access.
What are essential items to bring when tagging in Pediatrics?
Calculator, mini-stapler, pen torch, Frank Shann book, and nurse watch.
What is another common mistake besides inadequate information?
Incomplete form.
What is assessed during the ictal phase of a seizure?
Tonic-clonic activity, whether it's generalized or focal, eye movement, drooling, urine incontinence, duration, and if it abated spontaneously.
What should be ensured about the IV line before surgery?
It should be present and well functioning.
What factors are important when making a referral to General Medicine?
Presenting complaint, relevant past medical history, treatment response, and social factors.
How often should FBC be monitored in pediatric patients?
Every 4 to 6 hours.
What position should chest compressions be performed for pregnant patients?
With the patient supine, using manual left uterine displacement for aortocaval decompression.
What is the calculated tube size for the child?
5.5 (6 ÷ 4 + 4).
What is the first-line antibiotic for pneumonia?
Amoxicillin or IV ampicillin.
What are the critical details to document in a neuro/stroke assessment?
Incident details, timing of symptoms, witness history, neuro exam findings, and imaging results.
What ICU criteria should be listed for patient evaluation?
Pressors, dialysis, intubation, timing of last 'stable' assessment, and interventions so far.
What dermatological factors should be assessed during a patient evaluation?
Duration of rash, location, medications, morphology of lesion, systemic symptoms, and current medical problems.
What is the protocol if the child develops a seizure lasting more than 2 minutes?
Administer diazepam (0.2 mg/kg, rectal or IV).
What diagnosis should be considered with this child's presentation?
Hypovolemic shock or septic shock.
How can DVT be prevented post-operatively?
Encourage ambulation and administer S/C Clexane 0.4mg OD, TED stockings.
What does #MisiLegasi refer to in the context of Md Zaki's notes?
It is a title for the notes that may relate to a mission or legacy in medical education.
What is ARP status related to in medical care?
Care limits.
What is the primary purpose of making a radiology request?
To obtain diagnostic imaging for patient evaluation or treatment.
What is the total fluid requirement formula?
Total fluid requirement = Maintenance + Deficit + Ongoing losses.
What does RF stand for in the context of the Radiology Form?
RF stands for Reproductive Factors, including LMP.
What is the drip rate for administering Flagyl 500mg in 100ml normal saline over an hour?
100 ml/hour.
What information should you provide in the 'Background' part of the I.S.B.A.R?
Patient's age, admission details, diagnosis, and medical history.
What is the primary assessment for an ENT cancer patient?
Airway status, primary site of cancer, and treatment to date.
What needs to be confirmed regarding blood products?
They should be confirmed, if needed.
What key information should be included when referring a pediatric patient?
Age, gender, hydration status, sickness indicators, birth history, and development.
What should be communicated if a patient's operation is back-to-back?
Inform the group so the ward house knows the progress.
What key information should be gathered for respiratory patients?
Current issues, known consultant, home O2 settings, previous ICU/BiPAP history, and care limits.
What specific equipment should be brought to the OT?
TED stocking, calf pump, etc.
Why is it important to have radiological images available in the OT?
They should be displayed throughout the operation.
What should be done after the patient is under anaesthesia?
Get permission from superiors to scrub in and assist as per the operation.
What should you be particularly alert to during the operation?
Every shout out by the surgeon, especially during critical periods like bleeding and anastomosis.
What hepatic assessments are crucial for a patient with potential liver issues?
Liver enzymes, INR, albumin levels, Child Pugh score, history of ethanol use, and hepatitis risk factors.
What gastrointestinal factors should be considered in GI bleeding cases?
Volume of bleeding, current BP/HR/Hb, fasting status, and risk factors.
Apa yang perlu ditanya mengenai rhinorrhea (RN)?
Tanya tentang durasi, warna discharge, dan jika ada sakit belakang mata atau dahi.
Why is it important for a house officer to inform the medical officer/surgeon about the patient's status?
To ensure proper communication once the patient reaches OT reception, is pushed to OT, and is under anaesthesia.
What must be ensured for cases involving right/left organs and stoma marking?
Make sure the site marking is present.
What is likely covered in the 'EXTRA NOTES' part of the document?
Additional information or insights beyond the standard curriculum.
What should be included in the concise clinical history?
Allergic history.
For how many days should Lily take paracetamol?
For 3 days.
What are some other possible reasons for admitting a child with Acute Gastroenteritis (AGE) to the hospital?
Failed ORS, uncertain diagnosis, social/logistic issues, no one to care at home, worsening of symptoms.
What should you check to assess hydration status?
Sunken eyes, pulse volume, skin turgor, pulse pressure, etc.
Why would you need a cardiac assessment for a patient planned for emergency surgery?
To ensure the patient's heart is stable enough for the procedure.
What is the daily fluid requirement range?
2000 – 2500 ml.
What is the GCS score of the child upon arrival in the ED?
E3, V2, M4.
What should you consider if the patient has a history of antibiotic use but was not compliant?
Partially-treated pneumonia.
What is important to write on the OT board?
Include the nurses and attendants, showing respect to the operating team.
What formula is used for calculating maintenance fluid for children over 1 year?
Holliday Segar formula (100:50:20).
How is optimal nutrition calculated for patients?
25 - 35 kcal/kg/day.
What does the fluid resuscitation calculation indicate for a normal child?
20 cc/kg.
What is the maximum bolus fluid resuscitation that can be given?
3 times (400 cc NS for 20 kg child).
What is the dose of adrenaline in this case?
2.0 ml (1:10,000, 0.1 ml/kg for 20 kg).
What is the initial glucose administration for the child if the glucose level is <3?
40 ml D 10% (2 ml/kg × 20 kg).
What is the importance of requesting a blood transfusion?
To address anemia or significant blood loss.
Is it mandatory to transfuse blood at night if blood is requested late?
Evaluate the urgency based on the patient's condition; if it's stable, it may wait until morning.
What pre-operative measures can reduce the risk of wound infections?
Pre-operative shower and skin preparation, continuing antibiotics post-op, and proper dressing of the wound.
What does the 5C technique refer to in a referral context?
It is a structured approach for effective referral communication.
What is the type of review for a patient that can be classified under 'Ward round'?
It's one of the types of reviews like New patient clerking, AM review, or HO entry.
What is the I.S.B.A.R acronym used for in the referral process?
Identify yourself, Situation, Background, Action done, Response needed.
What is the first medication in the triple therapy for a gastric ulcer?
T. Pantoprazole 40mg BD for 14 days.
What should be conveyed to colleagues at the ward after the operation?
Post-operative orders and any difficulties during the operation to help identify complications.
What can occur in neck surgery, such as thyroid operations?
Accumulation of blood in the wound can lead to rapid asphyxia and damage to the recurrent laryngeal nerve.
What vital signs should be assessed before transfusion?
Blood Pressure (BP) and Pulse Rate.
What comorbidities should be evaluated before transfusion?
CVD risk factors such as smoking, diabetes mellitus, family history, hypertension, and lipid levels.
What should be assessed in pregnant patients?
Gravida/Para status, gestation, and last menstrual period.
What is an indication for blood transfusion?
Acute blood loss to replace circulating volume and maintain oxygen delivery.
How can X-ray landmarks assist in diagnosis?
They provide reference points for identifying abnormalities.
What fluid is preferred to replace Na+ and K+?
Hartmann solution.
What is the standard assessment approach for respiratory failure?
Standard ABC approach, focusing on the work of breathing and the effects of hypoxaemia.
What is the frequency of administration for the Ampicillin dose?
Every 6 hours.
Why is honesty important when filling out the Radiology Form?
Dishonesty can lead to complications and incorrect diagnoses.
What is the urine output target?
0.5 cc/kg/hr.
For a child, what should be considered in pediatric resuscitation?
Fluid resuscitation using the W.E.T.F.A.G mnemonic.
What should be done if a patient is dehydrated?
Start IV fluids and monitor strict intake/output chart.
Apa yang perlu diperiksa ketika revisi (rv) pesakit dengan wheeze?
Cek ada respi distress, termasuk penggunaan otot aksesori, recession, tachypnea, dan nasal flaring.
What is the cause of fever on the first post-operative day?
Atelectasis (referred to as 'Wind').
How can atelectasis be prevented post-operatively?
Incentive spirometry, chest physiotherapy, and ambulation.
Bagaimana cara pengiraan neb salbutamol untuk pesakit berumur <2 tahun?
Neb Salbutamol 0.5:3.5.
What measures can help prevent UTI/Pneumonia post-operatively?
Early off CBD, propping up the patient, sitting the patient in a chair, hand washing, RT insertion, or tracheostomy toileting.
What should be checked regarding the patient before surgery?
Check consents, special orders on the OT list, GSH, antibiotics, and NPO status.
What complication is associated with neurosurgery?
Raised intracranial pressure (ICP).
What is a common complication in urology surgery, specifically TURP?
Complications such as bleeding or urinary retention.
What aspects of palliative care should be addressed?
Disease summary, current symptoms, and family dynamics.
What investigation should be ordered if the working diagnosis is pneumonia?
CXR (Chest X-Ray).
What factors should be considered regarding Urology patients with stones?
Size and location of the stone, pain level, febrile status, urine MCS, renal function, and history of previous surgeries/stones.
What renal assessments are important for patient management?
Baseline eGFR & Creatinine vs current, volume status, dialysis type, and urine output.
What details are crucial when making a referral to the Blood Bank?
Detailed patient information.
Where should IV or IO access be obtained in pregnant patients?
Above the diaphragm to ensure no interference to flow to the heart by the gravid uterus.
What is the correct order of filling the tubes for pathology requests?
Blue (Coag), Red (Plain), Yellow (SST/Gel), Green (Heparin), Purple (Hematology), Grey (Glucose).
What must be included in a pathology request form for identification?
At least 2 patient details, such as IC and full name.
When should a perimortem cesarean section be performed during cardiac arrest?
Within the first 5 minutes of cardiac arrest or arrival to the ED.
Apa yang perlu ditanya jika pesakit mengadu batuk?
Tanya berkahak atau kering, tempoh batuk, dan jika ada facial congestion atau cyanosis.
What is the final step before leaving the OT?
Thank everyone, including nurses, attendants, and anaesthetists.
What lab values are important before transfusion?
Hemoglobin (Hb), platelet count, and blood type (GSH negative or positive).
What is a risk in vascular surgery?
Reduced patency of grafts and anastomoses.
What complications are seen in the first 24 hours post-surgery?
Systemic response to trauma and pre-existing infection.
What complications can occur 3 to 7 days post-operation?
Urinary tract infection, chest infection, wound infection, intra-abdominal sepsis, anastomotic leak, thrombo-phlebitis.
What is cryoprecipitate used for?
Low fibrinogen or factor VIII deficiency.
Apakah langkah pertama jika ada masalah wheeze?
Dapatkan profil asma (PIFET) dan sejarah neb pesakit.
What key elements should be communicated when referring to Cardiology or Orthopedics?
Specific injuries or cardiac details relevant to the referral.
What should oxygen saturation levels be maintained at in pregnant patients during cardiac arrest?
At 95% or greater, or PaO2 > 70mmHg.
Who should perform intubation during a cardiac arrest in pregnant patients?
The most experienced provider due to higher risks of complications.
How many carbon copies does the pathology request form have?
Three carbon copies.
What are the four different sub-departments for tracing results in pathology?
Chemical/Clinical Pathology, Hematology, Histopathology, Immunology.
Apa tindakan jika mendengar bunyi barking cough?
TRO viral croup, berikan budesonide 2mg STAT dan 1mg setiap 12 jam untuk 3 hari.
What is a common complication in orthopaedic surgery?
Loss or reduced neurovascular supply to the extremity, leading to compartment syndrome.
Apa yang perlu dicatat mengenai demam pesakit?
Tanya bila demam bermula, durasi, suhu jika ada thermometer, dan jika ada pengambilan PCM.
What are some immediate complications of the respiratory system post-surgery?
Upper airway obstruction, reduced ventilation, and hypoxemia.
What CNS complication can occur post-operatively?
Post-operative delirium.
What component of blood is indicated for perioperative anemia?
Packed red cells.
What should be done with antibiotics before the operation?
They should be brought to the OT, diluted, and given to the anaesthetist team for administration.
What are some general post-operative complications?
Bleeding, DVT, PE, Fever, Wound dehiscence, Pressure sores.
Apa yang perlu ditekankan jika pesakit dalam keadaan respi distress?
Stabilize pesakit terlebih dahulu dan pastikan SpO2 >95%.
Seberapa kerap neb salbutamol diberikan untuk pesakit dengan wheeze?
Neb salbutamol biasanya diberikan setiap 4 jam.
What is the cause of fever on the third post-operative day?
UTI/Pneumonia (referred to as 'Water').
What should be done after the operation regarding documentation?
Fill up all histopathology forms, cultures forms, and operative notes; ask if unsure about findings.
What complication is associated with the fifth post-operative day?
DVT (referred to as 'Walk').
What post-operative day is associated with wound infection or abscess?
The seventh post-operative day (referred to as 'Wound').
What should be considered if there is bleeding?
Estimate blood loss and assess the need for transfusion accordingly.
What symptoms should be assessed as part of pre-transfusion evaluation?
Current symptoms and response to management, such as medications like GTN or anticoagulants.
What is fresh-frozen plasma rich in?
Coagulation factors; used as first-line therapy for coagulopathic hemorrhage.
What geriatric assessments are essential in patient evaluation?
Age, living conditions, current acute issues, and functional & cognitive baseline vs current.
What to do if antibiotics show no effect after 48 hours?
Consider escalating coverage, possibly adding a macrolide for atypical coverage.
How often should IV lines be checked and changed?
Every 3 days.
What is the format for an AM review?
4D+SOAP (Date & Time).
What oncology patient details are critical during evaluation?
Type of disease, stage/grade, treatment history, intent of treatment, ECOG status, and previous complications.
What should be done regarding anaesthetics in the OT?
Make sure the anaesthesia GA form and special orders are all carried out.
What complications may occur in plastic surgery?
Failed flaps or implants.
What can happen 24 to 72 hours after surgery?
Atelectasis.
What complication can arise from thoracic surgery?
Fluid overload or collection in the pleura and bronchopleural fistula.
What cardiovascular complications can occur post-operatively?
Hypotension, hypertension, stroke, myocardial ischemia, and arrhythmia.
What is a specific complication that can occur after abdominal surgery?
Paralytic ileus, localized infection, bleeding, or anastomotic issues.
What is important in assessing pain management?
Underlying disease and previous pain control measures.
What are prothrombin complex concentrates (PCC) used for?
Emergency reversal of anticoagulant therapy in uncontrolled hemorrhage.
Apa yang perlu ditanya mengenai cirit-birit?
Tanya tentang onset, frekuensi, jenis Bristol, toleransi oral, dan jika ada darah.
What history is important regarding previous transfusions?
Inquire if the patient has previously received a transfusion.
What should be evaluated regarding the patient's social history?
Premorbid condition and family dynamics.
What complications can arise 7 to 10 days after surgery?
Deep vein thrombosis (DVT) or pulmonary embolism (PE), prosthetic infection.
What should be considered in infectious diseases evaluation?
Antibiotic regimen, source control, and blood culture results.
When are platelets indicated?
If platelet count is <20, and it should be >50 before surgery.
