Diagnostic vaginal discharge~

Candida vaginitis

• organism: Candida albicans
• pH <>
• branching hyphae

Bacterial vaginosis

• clue cells
• amine odor

Trichomonas vaginitis

• organism: Trichomonas vaginalis
• unicellular flagellated organism
• flagellar motion on a saline wet smear

Chlamydia & Syphilis

• no diagnostic vaginal discharge

Aortic insufficiency~

• diastolic murmur
• Corrigan's pulse (water-hammer pulse)
• de Musset's sign (head bobbing)
• Traube's sign (pistol shot sound over the femoral artery)
• Duroziez's sign (to-and-fro murmur over the femoral artery)
• Quincke's pulse (capillary pulsation in the nail beds)
• Hill's sign (politeal artery pressure greatly increased over brachial pressure

Malignant Melanoma~

Remember ABCDE's:

• A- Asymmetric shape
• B- Borders irregular
• C -Color variation
• D- Diameter > 6 mm
• E- Enlargement & Evolution of lesion

Lichen Planus~

Remember 5 P's

• Purple
• Polygonal
• Pruritic
• Planar
• Papules

Erytema Infectiosum~

• also known as Fifth disease
• remember slapped cheek appearance!

Potter's sequence~

• bilateral renal agenesis
• causing mother to have oligohydramnios
• lung hypoplasia

Picture

Howell-Jolly bodies~

• small,spherical, nuclear remnants
• seen in the reticulocytes and rarely, erythrocytes of persons who have no spleen (because of congenital asplenia or splenectomy) or poorly functioning spleen (eg in hyposplenism a/w sickle cell disease)

Noonan's Syndrome~

It is a male version of Turner's Syndrome!

Pyloric Stenosis~

Pocture below shows string sign

After the string sign, there was something like a mushroom. It was called as mushroom sign = kirklin sign.
Always remember hypocloremic, hypokalemic metabolic alkalosis!

Rain...

Sometimes you already know the theory part of Islam. For example, you already knows that Allah won't see the product, but look at your effort. But then, when somebody does not appreciate your work, you became so sad.

You already knows that Allah only plan something that is best for you. But when things doesn't follow your desire, you felt so sad.

That's why you will be always facing test in life so that you became more stronger and open to challenges in life.

Have you ever seen the rains?

It is He Who sendeth the winds like heralds of glad tidings, going before His mercy: when they have carried the heavy-laden clouds, We drive them to a land that is dead, make rain to descend thereon, and produce every kind of harvest therewith: thus shall We raise up the dead: perchance ye may remember. (Surah Al Aa'raf: 57)

The verse was so beautiful right? There will be sunshine after every rain.

Why?

Wallahi it was the most painful thing that ever happen to me..

I already faced so many things in life, but that was the things that i regretted most...

Why all these things happened to me?

How lucky i was if i am not alive to see all these....

Ya rabb, please give me strength to face all these...

Hypertension~

5 risk factor for hypertension

1) Hypertension
2) Cigarette smoking
3) Physical inactivity
4) Diabetes Mellitus
5) Dyslipidaemia

5 fundoscopic changes in severe hypertension

1) Hemorrhages
2) Exudates
3) Papilloedema
4) Arteriolar narrowing
5) Swollen optic nerve

5 causes of secondary hypertension

1) Sleep apnoea
2) Acromegaly
3) Coarctation of aorta
4) Chronic kidney disease
5) Thyroid or parathyroid disease

5 classes of antihypertensive medication

1) ACE inhibitors
2) Angiotensin Receptor Blockers
3) Beta-blockers
4) Calcium Channel Blockers
5) Diuretics

5 features of malignant hypertension

1) Numbness of the arms, legs, face or other areas
2) Changes in mental status – confusion, decreased alertness
3) Seizure
4) Shortness of breath
5) Blurred vision

5 investigations in primary hypertension with reason

1) ECG – left ventricular hypertrophy ( target organ damage)
2) Fasting blood sugar – diabetes (risk factor)
3) Renal function test – chronic kidney disease ( target organ damage)
4) Lipid profile – Dyslipidaemia (risk factor)
5) Chest X ray – heart failure ( target organ damage)

List 2 medication that is preferred in

1) Hypertension + diabetes – ACEi & ARB
2) Hypertension + ischemic heart disease – ACEi & Beta-blockers
3) Hypertension + congestive heart failure – diuretic & ACEi
4) Hypertension + chronic renal failure – ACEi & ARB
5) Hypertension + hypertensive crisis – CCB & Beta-blockers

5 complications of hypertension

1) Left ventricular hypertrophy
2) Angina or myocardial infarction
3) Heart failure
4) Chronic kidney disease
5) Stroke/ transient ischemic attack

5 pathophysiological changes that increase blood pressure

5 advices to patient with hypertension on discharge

1) If you are overweight, try to lose weight
2) Reduce salt intake
3) Exercise regularly
4) Moderate alcohol intake
5) Stop smoking

5 common side effect of hypertension and which class it associated with

1) Diuretics – hypokalemia
2) Beta-blockers – erectile dysfunction
3) Calcium channel blocker – ankle oedema
4) ACEi - cough
5) Alpha-1-adrenergic blockers – postural hypotension

5 drugs to prevent recurrent stroke

1) ACEi
2) Diuretic
3) ARB
4) Warfarin
5) Aspirin

5 different types of cerebrovascular accident

1) Subarachnoid hemorrhage
2) Subdural hemorrhage
3) Intraparenchymal hemorrhage
4) Epidural hemorrhage
5) Ischemic stroke

5 signs of overdose antihypertensive

1) Bradycardia
2) Hypotension
3) Altered mental status
4) Seizures
5) Angioedema (ACEi)

Nursemaid's elbow~

• sudden traction
• radial head sublaxation
  

Osgood-Schlatter disease~

• tibial tubercle apophyseal traction injury
• rupture of the growth plate at the tibial tuberosity
• tibial tubercle hurt
• caused by overuse

Baker's cyst~

• popliteal cyst
• non-pulsatile swelling
• posterior aspect of the knee
• Ddx - lipoma, aneurysm, neuroma & rarely tumor

Pes planus~

• flat feet

Scoliosis~

• physical examination - Adams test (forward bending)

SCFE~

• Slipped capital femoral epiphysis (also known as "Slipped upper femoral epiphysis")
• referring to a fracture through the physis (the growth plate), which results in slippage of the overlying epiphysis
• a/w obesity, deficient gonadal development & hypothyroidism

DDH~

• developmental dysplasia of the hip
• patients who are born with dislocation or instability of the hip, which may then result in hip dysplasia

Legg-Calve-Perthes~

• avascular necrosis of femoral head
• X-ray - wide articular surface, then necrosis - flattened femoral head - later becomes spherical

Talipes~

Moro Reflex~

Caput succedaneum~

• swelling of the scalp
• involves presenting part
• caused by the pressure exerted on the part during labor and delivery
• involving the scalp only
• crosses suture lines
• resolves quickly over several days

Cephalhematoma~

• subperiosteal bleed
• limited to bone
• does not cross suture line
• a/w overlying non-depressed skull fracture
• slow bleeders - not present at birth
• increase in size in few days
• a rim can be felt around the edge
• resolve spontaneously over several months
• can be fooled by bilateral cephalhematomas
• common cause of jaundice

Cafe-au-lait spots~

• tan or light brown lesions
• can occur anywhere
• vary in size
• sharply demarcated

Nevus sebaceus (of Jodassohn)~

• seen in infancy
• yellow-orange plaques resembling flat warts
• located on scalp
• have potential to become malignant
• usually removed

Capillary (Strawberry) hemangiomas~

• macular lesions
• quickly grow in the 1st year of life
• occur anywhere
• bright red, reminiscent of a strawberry
• tx not necessary
• regress spontaneously
• + stridor - subglottic hemangioma

Salmon Patch~

• seen over the eyelids, glabella, nuchal area
• flat vascular lesion
• disappear with time
• DDx - Port wine stains (permanent & unilateral)
• becomes darker red when cries

Neonatal Acne~

• response to circulating androgenic hormones
• rarely require therapy

Cutis marmorata~

• vasomotor response to cold stress
• lacy pattern - cobblestone
• seen in trisomy 21, trisomy 18

Milia~

• small inclusion cyst and are pearly white
• in mouth - known as Epstein's pearls

Erythema Toxicum~

• small papules / pustules
• NOT in 1st day of life
• if scraped - fulls with eosinophil
• DDx: SSSS (stapylococcal scalded skin syndrome)
• How to differentiate? SSSS - if scraped, full with neutrophil, infant looks very ill, Nikolsky sign (gentle stroking of the skin causes the skin to separate at the epidermis)

Mongolian Spot~

• Usually at presacral area
• Ddx: bruise
• How to differentiate? Bruise - fade into surrounding skin, Mongolian spot - obvious different colour

A land called paradise...

I wanna live in a land called paradise
I wanna go to the valley of the King
I wanna live in a land called paradise
Wanna see the birds fly and I wanna hear the angels


Sing the praises of my Lord so far above
As I move poetically with the struggle I fall in love
I look to the left I look to the right and all I gaze upon
Reveals the source of flowers rainbows and the dew at dawn
Some see before and some see in and some see after
I let my sight pierce the chains and see the master

(Chorus)

I wanna live in a land called paradise
I wanna go to the Valley of the King
I wanna live in a land called paradise
Wanna see the birds fly and I wanna hear the angels sing


So many times in my life I ask myself the question
What got me brought me into all this mess I’m swimming in
But pain is not and neither harm in the pool of bliss
So slap me with your hand or kiss me with your softest kiss
Tell me that you love me or that you don’t like me now
Tell me you invite me or that you don’t want me around
I won’t cry over a world that can’t change my life
I’ll put my money on what lies ahead in paradise

(Chorus)

I wanna live in a land called paradise
I wanna go to the Valley of the King
I wanna live in a land called paradise
Wanna see the birds fly and I wanna hear the angels sing


I try to do right and love my wife and trade and pray and talk
I can be anywhere doing anything and I’m mindful of God
I’m pleased in good and happy in harm and now I realize that I already live in a land called paradise

(Chorus)

I wanna live in a land called paradise
I wanna go to the valley of the king
I wanna live in a land called paradise
Wanna see the birds fly and I wanna hear the angels

I wanna live in a land called paradise
I wanna go to the valley of the king
I wanna live in a land called paradise
Wanna see the birds fly and I wanna hear the angels sing