hari dua

DAY TWO,21st July 2009.
Ward round

Patient one
Female.Around 50-60 years old.Patient has back pain and pain in joint.Drug prescribed is Arcoxia(Etoricoxib)-NSAID’s drug,COX-2 selective inhibitors.Dose is 60.90 mg/day for chronic pain and 120mg/day for acute pain.

Current therapeutic indications are: treatment of rheumatoid arthritis, psoriatic arthritis, osteoarthritis, ankylosing spondylitis, chronic low back pain, acute pain and gout

Patient two
Female.Around 20-30 years old.Patient will do endoscopy.She is yesterday’s admitted patient with acute epigastric pain that irradiate to the left upper quadrant and positve kidney striking test.Patient is given IV infusion of Sodium Chloride(0.9%).

Patient three
Male.28 years old.Pain in right upper quadrant area during palpation and percussion of stomach.He is yesterday’s admitted patient.Serum amylase is high about 200.(normal 25-119).This signs can be observed in acute pancreatitis.

Patient four
Male.52 years old.Churg-Strauss syndrome patient.The conditon is being monitor.The doctor changed the amount of drugs given by reducing it due to improved motor activities.

Patient five
Female.Around 60 years old.I was asked to described the patient appearence,condition by visual examination.
I just described roughly and not in order.The doctor asked to describe in order-from head to toe.
The patient is obese and maybe in the 3rd stage.Moon-face apperance.Pursed,cyanosed lips.Buffalo humps.The skin of the patient is very thin.Rash on the face.Some purple(purpura) and white spots is seen on the face and hands.In the abdomen,can see red striae.This the common clinical signs of Cushing Syndrome.
According to the doctor,the patient has been taking Chinese medicine.This medicine contain high amount of steroid that can cause Cushing Syndrome.The patient had been asked to stop the chinese medicine taking.

Patient six
Female.Around 20-30 years old.Complained of fever,headache in previous 2 weeks.Patient has facial puffiness and periorbital edema.Also.legs edema.Test has been conducted and the patient has Systemic Lupus Erythromatous(SLE).Platelet and albumin count is low.Urine protein is high.Leucocytosis.Present of Klebsiella shows sign of infection in urine.Patient is prescribed with prednisolone.

10.30 am-1.00pm
Clinic session

Patient one
Female.Around 50-60 years old.Patient has Grave’s DIsease.Patient has bulging eyes.Diagnosis of these disease by antibody detection(TSH antibody,anti-thyroglobulin Ab,microsomal Ab,anti TSH receptor Ab.

Patient two
Male.Around 50-60 years old.Patient has AHPT and gout.Patient taking etinolol and allopurinol.

Patient three
Male.Around 50-60 years old.Patient complained stiffness of left middle fingers.Stiffness is stronger in the morning and last for hours.The area of stiffness is swelling.According to the doctor,this is not a joint pain due to the localization of stiffness and swelling is at the proximal area,not in the joint,but pain in the peripheral area.Patient also complained that the stiffness have spread to the middle finger of right hand.The doctor assured the patient this is not Rheumatoid Arthritis when the patient thought he has this disease.Patient seems afraid as his mother’s has RA.The doctor explained this is some sort of point inflammation along tendon in synovial membrane.

Patient four
Male.Around 60-70 years old.Patient has granulomatous inflammation of the right hand,lefr chest and lower lumbar area.T his is called scorrisis due to severe arthritis.

Patient five
Female.Around 70-80 years old.Has scorritic patch due to severe arthritis.

I asked about RA and OS is it true that RA usually develop in big joints and OS usually develop in small joints?
The doctor answered that OS always affected knee joint,sometimes hip joint and distal phalanges joint.But in RA,distal phalanges joint is not affected.

Patient six
Female.Around 30’s.Patient has ankylosis spondylitis.Patient felt pain on the back for 3 weeks ago.Physical examination of retina can be done to identify arthritis problem.Patient complained of diarrhea.She always has diarrhea since she was small.Diarrhea is accompanied by some mucus.The doctor suspected that she has ulcerative colitis,a chronic degenerative bowel disease that maybe the cause of her ankylosis spondylitis.So,he suggested the patient to do chronoscopy for investigation.


first day

DAY ONE,20th July 2009
8.30 am
Report myself to the Human Resources Department.Got my name tag.Being informed the name of the doctor incharged and being showed around the area of hospital by authorized person.I was sent to the clinic of the incharged doctor.

9.30 am-12.00pm
Clinic session
Patient one.
Male,around 60 years old.Symptoms of redness,swelling,tenderness but without pain in both legs.According to doctor,this is unilateral legs swelling in case of Deep Vein Thrombosis (DVT).Patient also has cellulitis.

Doctor asked about DVT, and explained the diagnosis method,which includes: renogram method,where radioactive dye is injected into vein to determine location of deep thrombosis.Next,Doppler’s Ultrasound, the flow test compatability method.This test can determine the velocity of blood flow in veins.

Patient two
Female,around 60 years old.Complained pain in back joints that cause difficulty in moving.Being prescribed to do physiotherapy to maintain posture.Patient has spondylitis and taking Nirontin to ease neuritic pain.

Doctor prescribed Calcium diet for healthy bones by asking patient to drink milk.Patient is also given supplement Caltric D.

Patient three
Male,52 years old.Complained continous numbness and tingling sensation on left feet.Later that sensation is felt on right feet too.Next to both hands.Due to this,patient can’t walk and using wheelchair to move.Patient has a rare disease,called Churg-Strauss Syndrome.

Doctor examined the patient’s motor strenght.Hand grip power, 3 over 5.Both waist extension and flexion,4 over 5.Foot extension and flexion againts gravity, 3 over 5.Medication such as Prednisolone,Nirontine,Cyclophosphamide,Bactrim,Naxonate and Vitamin D is prescribed.

Patient four
Female,around 60 years old with history of previous stroke attack.Patient can’t come for check-up.Represented by family members to conclude the present conditon to doctor.According to them,patient complained on the back at the vertebra area.This cause difficulty to walk.Showing the latest X-ray on vertebrae,the doctor concluded that there was some small fracture in the vertebrae.Looking in the kidney test result,the function is a little bit impaired.All other system function is normal.

Doctor prescribed MRI to identify any other area of thrombus or artheroslerosis in brain to prevent next attack.Ultrasound for kidney to identify any underlying stone.For the small fracture doctor said that that it can heal itself.Medication include pain killer.

Patient five.
Female,65 years old.Pain in joints(hands and upper limbs).Maybe in case of osteoarthritis.
Doctor checked the patient retina.He also tapped the patient wrist.Patient complained pain on right wrist.

Patient six
Female.Around 50-60 years old.Pain on foot.Vitamin D prescribed.

Patient seven
Female.Around 50-60 years old.Pain and swelling in lower legs for the past 2 month.This patient has osteoarthritis.

Doctor conducted intrarticular steroid injection.Aseptic method,local anaesthetic(xylocaine) is used.Aspiration of knee joint fluid to asses colour and any pus.If pus content is minumum,injection of steroid is being proceed.Classical sign of OS include,crepitation of bone during joint examination.

Patient eight.
Male.28 years old.Pain in upper quadrant of stomach.Pain in the Th-10 in front and irradiated to L9.Patient is admitted to ward for further investigtion.Maybe there is some prroblem with the gallstone.

Casualty department

Patient one
Female.Around 20.Complained acute pain in the epigastric area.Kidne striking test is performed and the result is positive.Patient is admitted to the ward for further investigation.
Assignment of investigation and history taking is given to me about the patient with Churg-Strauss Syndrome.