Never rush to examine the patient. Always remember the first few steps. Firstly, always introduce yourself to the patient then shake hand (except in Rheumatology) then ask the patient permission for examination.
The next step is to position the patient. Then it will be to start with inspection.
For the abdomen station, inspect at the end of the bed. This is a very crucial step. If you notice in the above patient which was taken during a medical student exam last year, you could actually get the diagnosis. There is an obvious swelling at the L hypochondriac region and if you are sitting for a medical exam, it must be the spleen or the L kidney.
The favourite questions for medical students :
What are the causes of massive splenomegaly ?
- Malaria
- Chronic myeloid leukaemia
- Myelofibrosis
- Kala azar (mention this last if you are in Malaysia or places where it is not endemic)
- Gaucher's disease
- Thalassaemia (though some would classify as mild to moderate)
Kidney - ballotable, moves inferiorly, resonant on percussion, able to get above it, traube space resonant
Spleen - not ballotable, moves inferomedially, dull on percussion, unable to get above it, splenic notch, traube space dull
The above patient has CML with massive splenomegaly !!
4 comments:
mm, this case i was asked to examine before..but, my one was in urological ward in my teaching hospital..she presented with LHC mass too, which was kidney in origin..
one thing to ask you, can you teach us how to start insulin in a Type II and Type I DM patient?
wow ! That is a long topic. There are various methods. For type 2 DM, we normally start with BIDS which is bed time insulin and daytime suphonylurea. The night is a long acting suce as Humulin N or Insulutard. If this does not work the we convert to full dose insulin which is BD dosing or basal bolus. You can calculate initially base on body wt of 0.6 U/kg and get the total requirement per day. After that, you will divide into 2/3 in the morning and 1/3 at night. If you are using a long and short acting, then you may want to use 2/3 long acting and 1/3 shjort acting. It may sound confusing but it is easier to explain if there are cases. I'll try to simulate cases in the future. For Type one you may consider using BD or basal bolus or you can use soething like a glargine which is suppose to be peakless and then ultrashortacting at meals.
I am sure I confused you by now :)Topic is too wide to explain it fully here.
i understand bit..but just i confuse, because as what i read in AAFP, it mentioned of use 0.15 unit/kg if the insulin in the patient body still have, just not enough...but once their control very difficult then use 0.5unit/kg...so, i confuse whether 0.15 or o.5 unit/kg...
then 2nd confuse is 2/3 in morning and 1/3 in night...then how come can have 2/3 long acting and 1/3 short acting?
ok...ok..
i'm waiting for your case simulation...
thanks you very much..as i think this topic is very important for me as a houseman next year...
Thank you in advance first..
Hey I would like to ask more about the MRCP part 1 exam! is there any way to contact u for further information and also advice please?
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