MBBS YEAR 1 (PBL 3) by Aqilah Qhistina https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77 en-us 2023-02-08 06:14:57 UTC 2025-11-07 17:00:52 UTC hello@padlet.com TRIGGER1 noorazuinsuliman87 https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474403603 2023-02-09 03:07:25 UTC https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474403603 Trigger 1 https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474407583 1.easy fatiguability - increase susceptibility to fatigue - lethargy
2. gingival - tissue of upper or lower jaw - gum - found in oral cavity]]> 2023-02-09 03:12:37 UTC https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474407583 Trigger 1 https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474423270
Key information
1.20-year-old male : immunocompetent ; male - lower innate and adaptive  immune response - female have x chromosome ; high testosterone- immune suppressant

2.gingival  bleeding  of  one  day  duration-build up of plaque at gum line, thrombocytopenia, haemophilia, scruvy, coagulation factor deficiency

3.easy fatiguability,headaches - leukemia, anemia,CNS problem (meningitis), infection

-few episodes of nose bleed - blood vessel injury of lining of nose, acute sinusitis, infection, exposed to chemical, cancer, leukemia

4.no  significant  past  medical  or  surgical  history - immunocompetent

5. neither smokes nor drinks alcohol - unlikely cancer cause by smoking/alcohol 

6. not taking any regular medication - no taking anticoagulant - symptom not cause by taking drug

7.No  history  of  allergy  to  drugs - no reaction to drug 

8.Family  and  social  history were unremarkable -unlikely to be inherited disease 




]]> 2023-02-09 03:31:58 UTC https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474423270 TRIGGER2 noorazuinsuliman87 https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474432886 2023-02-09 03:43:52 UTC https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474432886 Trigger 1 https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474432900 Differential diagnosis
1. Scruvy - gum bleeding, headache
2.Infection (bacterial/viral)
3.Leukemia
4. Anemia
5. acquired coagulation disorder (DIC, vit. K dependent factor deficiency)
6. Haemophila 
7. TTP (thrombotic thrompocytopenia purpura) 

Further questioning
1. physical examination - vital sign
2. FBC
3. BM examination
4. Coagulation test
5. FBP]]> 2023-02-09 03:43:53 UTC https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474432900 trigger 2 https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474447487
1. multiple ecchymotic skin lesion- bruises on the skin due to continuous - appear blue black
2. lower extremeties- body part that includes leg and ankle, feet 
3. D- dimer - fragment that make when the blood clot dissolve in the body 
4. auer rods- pink or red stain that we obseve in the myeloid cell - due to aggregation of myeloperoxidase that contain in myeloid cell
5. marrow aspiration - sample of fluid from BM - check for specific cell - asess cellularity , fragment stores and iron stores 
5. faggot cell - blast with multiple auer rods in the cytoplasm - hallmark for AML 
6. sinus rhythm- rhythm of healthy human heart 
7. ]]> 2023-02-09 04:01:41 UTC https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474447487 trigger 2 https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474472091 1. pale  with  multiple ecchymotic skin lesion measuring from 2 to 3 cm in diameter on lower extremeties- physical trauma- pale due to anemia- AML can cause this due to bleeding in the skin-insufficient thrombocytes - thin blood vessels easily ruptures- high pressure during walking or running 

2. lungs  were  clear  and  no  organomegaly found  on  abdominal  examination- no abscess- no edema- no cavitation - no infection -

3. no  evidence  of regional lymphadenopathy.- no abnormality in the lymph node- if lymph node swollen indicates infection 

4. presence  of  abnormal  mononuclear  showing  Auer rods in the cytoplasm with few typical Faggot cells-shows promyelocyte- hallmark for APL 

5. consistent  with  the  diagnosis  of  acute  myeloid  leukaemia 
(AML).- presence of faggot cell and showing auer rods indicated this disease 

6. bleeding manifestations associated with 
abnormal  blood  coagulation  tests  accompanied  by  
progressive thrombocytopenia-due to low platelet - progressive and severe - tendency to bleed higher- bleeding cause reduction in platelet 
decreasing  fibrinogen,- causes defect in the secondary hemostasis - coagulation factor decrease and not activate - VWF decrease 
  elevated  D-Dimer levels- indicates the patient has DIC  

7. laboratory evidence of disseminated intravascular coagulation (DIC)- significant problem that occurs in AML- could be due to APL as well  

8. vital signs- temp and bp normal -pulse rate high (tachycardia) - need more o2 

9. Hb low due to bleeding , Hematocrit low due to low RBC , MCV, MCH , MCHC normal- normochromic normocytic , rdw normal, total white cell count normal, 

10. WBC- neutrophill low, lymphocytes low, monocytes normal, eosinophill normal- basophill normal -  impaired hemotopoiesis due to AML- 

11. CRP high due to inflammation - higher risk of MI - respond to injury and infection - 
  
12.   prothrombin time long - due to DIC 

13. INR high - measures the time for clot
14. plasma fibrinogen low due to
]]> 2023-02-09 04:34:09 UTC https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474472091 trigger 2 https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474472528
Differential diagnosis
1. Scruvy - gum bleeding, headache
2.Infection (bacterial/viral)
3.Leukemia-AML /APL  DIC
4. Anemia
5. acquired coagulation disorder (DIC, vit. K dependent factor deficiency)
6. Haemophila
7. TTP (thrombotic thrompocytopenia purpura)

FURTHER QUESTIONING
1. IMMUNOPHENOTYPING
2. chromosomal study
3. DNA STUDY using PCR

 

]]> 2023-02-09 04:34:36 UTC https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474472528 TRIGGER3 noorazuinsuliman87 https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474477941 2023-02-09 04:41:50 UTC https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474477941 TRIGGER 3 https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474485496 1.FISH- method to study translocation in DNA
2. complete remission- disappearance of cancer sign due treatment
3. chromosomal  translocation- chromosome break and either whole or portion of it reattach to another chromosome
4. immunophenotyping- technique that use Ab to identify cell based on Ag type or marker on surface cell
5. flow cytometry - recognize pattern and intensity of different Ag on surface normal and leukaemic cell



]]> 2023-02-09 04:51:01 UTC https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474485496 TRIGGER 3 https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474488373
1. prompt treatment of the DIC related bleeding with blood component 
therapy initiated - o specific treatment and use only blood transfusion

2. normalisation of the blood coagulation tests - indicate DIC 

Treatment with specific combination 
chemotherapy retinoic acid (ATRA), 
idarubicin, 
and 
arsenic 
trioxide) 
along 
with 
supportive 
care 
were 
started. 
He 
achieved complete remission and
 
had a favorable response.
]]> 2023-02-09 04:54:58 UTC https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474488373 noorazuinsuliman87 https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474488690 2023-02-09 04:55:22 UTC https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474488690 TRIGGER 3 https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474489141 acute myleoid leukamia with DIC]]> 2023-02-09 04:55:48 UTC https://padlet.com/aqilahqhistina03/e6ymsyx9q7p3ag77/wish/2474489141