Thursday, July 7, 2011
GP posting #2
Stomach flu is actually what we meant by viral/bacteria gastroenteritis, while some food poisoning may not only be due to infectious agent but also chemicals and toxins or allergens contaminating the food. There's one patient I thought to had food poisoning but was diagnosed as stomach flu by the doctor. He had fever, vomiting, diarrhoea and exacerbated abdominal pain during deep palpation. Gentamycin was injected at the upper outer quadrant of the buttock. Doc said food poisoning doesn't come with fever but i doubt so. why not?
There's one lady came with head trauma. X-ray revealed intact skull. BP rose due to head injury (Cushing reflex). The pathology is as such: if the intracranial vessel ruptures, intracranial pressure will build up and compress the visual center, causing double image and dizziness. Dizziness can be broken down into a few types: vertigo (spinning ceiling), disequilibrium(floating sensation), Presyncope(lightheadedness, fainting). If the fluid build-up compresses the respiratory center, the patient will die from respiratory arrest. 48 hours after a head trauma is the crucial period and requires close monitoring. There are a few things to look out for during this period:
1. is there any bleeding(eyes, nose, ear)
2. vomiting
3. dizziness, visual worsen
4. blurr, lack concentration or stupor
If there's any of this signs get hospitalised IMMEDIATELY and get a brain CT scan.
There are 2 types of stroke: Ischaemic or Hemorrhagic.
If the stroke is ischaemic, non-progressive and not life-threatening, normally the patient will recover after 3 months, depending whether the acute phase was managed well and also the size of the lesion. Normally if the lesion is small, the brain tissues surrounding the lesion will be temporarily compressed by odema, contributing to various stroke symptoms. But rest assured that this will subside after 3 months. That's the reason why some stroke patients can walk and move normally like nothing had happened.
Since a patient can be recovered from stroke after 3 months, the health-care providers will be deemed as demigods if the stroke patient so happened to see them during the recovery phase. That's why some people believe that some sinseh can cure stroke. Just a few testament can make them instantaneously famous.
There's one lady came with an abscess right beside the anus. Doc suspected anal fistula since it is very close to the anus. She had fever, probably due to this big abscess. Anal fistula originate from anal glands, which are located between 2 layers of anal sphincters and which drain into the anal canal. When the outlet becomes blocked, an abscess can form. When the abscess is opened or ruptures, a fistula is formed.
Fortunate to see CIRCUMCISION done in a GP clinic =D A 20 year old teenager has a long foreskin. Because of the long foreskin covering over the glans, it is not able to be stretched as wide as possible and will therefore cause pain during erection. Furthermone, it hinders the flow of the urine and may cause some to be retained under the overlapping skin, rendering it unhygienic and prone to infection. The purpose of circumcision is to uncover the glans. Patient may feel sensitive initially and will get used to it later. The doc cut off the foreskin and left a little bit near the edge of the glans connecting to the shaft, then stitched them back, leaving the glans fully exposed. There were numerous of hematoma and had to be stopped by ligation.
There were one couple came opting for abortion. Since there's no way for us to stop the patient, we referred them away to a professional(gynae). For the safety and health of the patient we rather it was illegally done by a professional than a unqualified personnel. It's like choosing the best between 2 evils in this kind of dilemma.
Now the new trend of controlling diabetes is early administration of insulin as it prolonged the survival of the diabetic patient for another 10-20 years more! It's the "Legacy Believe" if im not mistaken. Insulin should not be the last resort or to be dragged for too long a time. The reason patients dislike insulin is mainly because it is done by needles. Without needles aka 'insulin pump' device is available but it is very expensive.
Subconjunctiva hemorrhage can be due to the following causes:
1. sleep deprivation
2. straining of the eyes like staring at the computer for long hours
3. rubbing of the eyes, physical trauma
4. coughing, sneezing (high pressure)
The first 2 will cause the vessels to be fragile. The last 2 will trigger the rupture of the already fragile vessels, causing hemorrhage.
It is self-limiting and takes 1 week to completely goes off. The WBC will clean it up for you (=
One man came with fever and flu + TONSILITIS. His tonsils are swollen and filled with white pus. Some people are more prone to tonsilitis. Their flu or cold will always be accompanied with tonsilitis. In the long run, infection is harder to cure and may require stronger antibiotic, which may contribute to the emergence of MRSA. The best option is to remove the tonsils since you no longer need it unless you're a growing child. Tonsils is like your appendix, you need it when you are little, you can remove them when you hit adult.
From the doc's conversation i learnt that QuantiFERON®-TB Gold is the gold standard for TB testing now. it claimed to be 99% accurate. Mantoux is not accurate because of the BCG vacination, which is still compulsory in malaysia and singapore but abolished in Europe. It is recommended to give a final boost during primary 6. If the antibody hits to zero, need another 3 japs all over again =/
For people who has allergic rhinitis, i have learnt that Omnaris is a local acting steroid that can give relieve effectively. It has to be inhale daily like a nasal spray but it will only take effect 1-2 weeks after. Even the doc and his family are using because they find it effective. It was prescribed to a patient who complained of allergic rhinitis that is easily irritable by dust and smoke.
Hairline fracture will heal by itself as long as its position is not moved. A cast is thus required and painkiller and anti-inflammatory drugs may be prescribed if the patient needs them.
On the side note, people who has medical problem can take loan to buy a house, but will find it difficult to buy insurance. If anything happen, touch wood, the bank has the right to confiscate the house if im not mistaken.
Don't try to claim insurance over a small matter like cough and cold. The insurance company will rate their customers according to their pattern of claiming. If you are 'blacklisted', you may face some trouble when you really need it. The company may want to do a thorough investigation over your case. So why do you abuse them in the first place? Save it for raining days! (=
Those suspected dengue because of fever, a blood test is recommended.
1. Platelet low in dengue
2. WBC low in dengue, high in bacteria infection
if the platelet count ever drops below 100, please go to the hospital (=
