Tuesday, January 3, 2012

~aku bukan parasit~ #003 Session with Prof 01

Assalamualaikum w.b.t.

Some recap on session with Prof, sorry for the limited info, hardly able to recall everything:

The case is about a HbE beta thalassemia complained of vomiting, etc.. (sori xingat, but in short, this pt is most like having food-poisoning with underlying anemia d/t thalassemia).

**HbE is a variant of abnormal Hb, a subset of beta-thalassemia since it is affecting the beta globin chain. please click here or here for more detailed information. Also, please note that HbE is the most common variant in Southeast Asia (epid medicine :D)

In anemia(pale/reduced Hb) case, it is important to ask about

  • bleeding tendency
  • relevant social hx [ i)diet hx- IDA, ii)hx of barefooting-percutaneous parasitic infx: hookworm(Necator americanus or Ancylostoma duodenale), iii) hygiene-feco-oral infx: most likely present with dysentery, caused by Trichuris trichiura), iv)auto-immune ds (SLE, RA)- auto-immune hemolysis]
Prof did touch a little bit on food-poisoning:
i) can the pt point out any food that s/he took that may be the culprit? is anyone else affected-if yes, does this person consume the same food?
ii) has the pt went out to eat? if yes, how is the hygiene of that place/restaurant/stall? its environment?


This pt has thalassemia, so the peripheral blood film would show hypochromic, microcytic, pencil-shaped erythrocytes[is this correct?-a little bit confused]. As for which investigation would you like to request: ask for electrophoresis first as beta-thalassemia is diagnosed by electrophoresis(since it is most common). If negative or not available, perhaps you may want to request for chromosomal analysis(alpha-thal)...

Other things:
  • Prof asked about how many percent of myelocytes/myeloblast in peripheral blood film will be diagnosed as leukemia? @ >x% myelocytes/myeloblast=leukemia? - i couldn't find the answer, anyone knows?
  • leukemoid reaction- there is leukocytosis with normal amount of myelocytes(may happen in severe infection/stress)
  • Causes of macroglossia: B12 & folate def., Down Syndrome, acromegaly, amyloidosis, hypothyroidism.
  • Collapsing vs bounding pulse... the term collapsing is used only when the etiology is of CVS problem, otherwise it is called bounding pulse... 5 causes of collapsing pulse: i) aortic regurgitation ii) Patent ductus arteriosus iii) arteriovenous malformation iv) arteriovenous fistula v)i forgot~ sorry!
  • hypokalemia in ECG- i)prolonged QT interval ii)presence of U-wave(a camel hump effect next to T wave)- fusion of T and U wave cause QT interval to appear prolonged. Other features: ST-segment depression, reduced T-wave amplitude
  • Comments on short case examination: i) Clinical is all about practise ii)During examination, you will be assessed on: speed, steps, smoothness, correlating signs and diagnosis... This shows that clinical skill is the major bulk of it, not your diagnosis... Most students are lacking in smoothness... You need to be systematic, confident and correct. Confidence but wrong is useless and so does vice versa.
  • Recommendation from Prof: multiple short cases per day and all systems in each week. (to be honest, I am far from achieving this, please don't blame me if I don't achieve it, I am sharing this for your benefit:) *p/s: I don't want to be CaTakSeruKin...
Disclaimer: I am sorry if I posted the wrong info but at this point of time, I wrote only things that I know are correct(unless I mentioned otherwise). If any of you is able to point out the mistake/wrong info, please, please and please comment on it... you help is very much appreciated!

Mood: this posting is not easy but lots of nice things can happen too:)

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