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dr, how to look for / elicit central hypotonia ? 

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dr, how to look for / elicit central hypotonia ? 

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Nelson(7th ed) pg629

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Dr, what is the difference between central hypotonia and peripheral hypotonia?  In guide book it's written that However is hypereflexia in central hypotonia whereas there was be hypereflexia in peripheral hypotonia. However, it is not mentioned such in Nelson and illustrated sunflower text book.. so is it true?
Hi
Hmmm...it's wrong, but not entirely wrong.
Central hypotonia babies/ children have normal reflexes, however, they may present with hyperreflexia if they have concomitant UMNL.
Peripheral- hyporeflexia or even absent.
Thank you for pointing that out.

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Dear all,
Exam is near, make sure log books updated.
Write ups completed.
Mid posting assessment done.

Please read up on common diseases.
Practice short cases.
Always be honest and humble.
Work hard. Study smart.

Do that, I’m sure you guys will excel!

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Good morning doctor. We are not able to observe the procedure of passing ryle's tube in both post natal ward and labour room during neonatology week as this procedure is not done in both places. Is it okay if we leave the signature blank?

If possible look for the procedure in ward.

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https://youtu.be/1Evwgu369Jw

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Good evening doctor, is that possible a patient to present without hematemesis in oesophageal varices ? And how else do they manifests the bleeding apart from low Hb ?

Yes....esp if minimal bleed n small varies so history is very important. High index of suspicion.
what sort of history you’ll ask?
Significant bleed will be in hemodynamic instability.

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Rales=low pitch crackles?

Nice.

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Good afternoon doctor, in HOPI can we just mention no cyanosis or need to mention there is no bluish discoloration ? Is bluish face and cyanosis 2 different things ?
Bluish discolouration of lips and tongue history
Cyanosis examination
Unless your historian is a clinician.... 🤓

When you say face mcm pt dah collapse 😨

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I have been informed that some (or most) students did not go for ward duties as scheduled.
Remember that this is counted as attendance, not only teaching sessions.
You are expected to be at your designated place(s) from 8am-5pm. Any absence must be accompanied with explanation letter/MC.

I will barr you from end posting exam if you do not comply.

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Dr, what does it indicate when we ask about chills and/or rigors in fever? Does it indicate severity of the fever, as in chills and rigors in high grade fever

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Dr, what does it indicate when we ask about chills and/or rigors in fever? Does it indicate severity of the fever, as in chills and rigors in high grade fever

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Back to basics
Abrupt onset fever with chills and rigors is a feature of certain infections/ illness
Read on pathophysiology of fever, hypothalamic control, activation of lymphocyte and pyrogenes.
for example, malaria.

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If the child is above 8 years old and the parents do not remember the milestones, how do we assess the development milestones for long case?
pls refer to guidebook page 36 under developmental history

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Dr,if the history is taken from the parents, how do we clarify if it is apid  breathing or difficulty breathing?
Fast breathing. Not same as difficulty in breathing. Clarify with historian- nafas laju or susah nafas

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Dr, when we ask about post-tussive vomiting in cough it's refer to severity of cough or to rule out aspiration?
Severity of cough and fluid loss from the vomiting/ inability to feed. risk of aspiration in small infants.

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When we describe the fever, we need to mention it's high grad, moderate or lower grad fever right. So is there any specific range of temperature to classify it to that range?
Tq
depends on which reference you take
lippincott (2006 ed) says....
low grade <39
moderate 39-40
high 40-41
hyperpyrexia >41, but in malaria hyperpyrexia is >40

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Good evening doctor, there is one group who don't have pass over at all throughout the posting.. hopefully the group can get the chance of doing pass over..thank you

Morning.
Pass over not necessarily for the group on call the night before. It is meant for all students  on call for the week. Do you mean one group did not get any call duty?
I will check again on Tuesday. Tq.

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If parent said the child have rapid breathing it's same with breathlessness?
tak samaaaaaaaaaaaaaaa :p

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In order to check for evidence of dehydration, we can palpate at the area of anterior fontanelle right. So any specific technique to do the palpation? And how can we said that our findings suggestive sign of dehydration.
Tq☺
Palpation in supine and upright position. I'd rather you use the flat surface of your finger than your thumb.
it should be felt soft/ and sometimes it bulges but not tensed.
In dehydrated infants, you may see and feel that it is sunken. A sunken fontanelle must be accompanied by other mucous membrane abnormalities, which signifies significant level of dehydration. Like sunken eyes, dry oral mucosa, no tears etc.

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What is the the best reference should we use for normal range lab investigation for paedatric? Thankyou Dr😁
Most textbook will have. Or you can look at Frank Shann

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Good afternoon doctor, acellular pertussis vaccine was given due to it's least side effects but there is a recurrence for pertussis in adults.. why is it so doctor ? Is that the vaccine doesn't cover all the subtype or the pathogens that causes pertussis increased ?

Read up on waning of immunity post vaccination. the question is how long does the immunity from vaccination lasts.... then only you can answer why adult, mainly in 20-30 then the elderly gets the illness

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goodluck everyone, siapa on call malam ni siap siap ah hahahahahhaha

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Briefing