A lot of cases being presented.... the juicy ones are..
Wahab presented:
1. an MVA case which sustained 4th rib # with pneumothorax. Clinically trachea was deviated, reduce air entry and resonant on percussion.
Unfortunately CXR was ordered and surgical team was referred before inserting a chest drain!
"Decision for CXR for a clinical suspicious pneumothorax is dangerous" - Prof Jasmi
"Take home msg, to put a chest tube first in a suspected pneumothorax.. it is not a mistake to put a chest tube" - Prof Jasmi
2. 36 year old Indian man complaining of abdominal pain, notice a mass in his abdomen for the past 5/12. There was also bilateral axillary LN which was matted and firm. The mass was supraumblical and mobile, hepatosplenomegaly present. Hb was 5.4........ A differential of lymphoma and TRO CA stomach was made
"if lymphoma the LN would be discrete and rubbery" - Prof Jasmi
"very unlikely CA stomach with present of axillary LN" - Prof Jasmi
Q - "how often gastric lymphoma present with axillary LN" - Prof Jasmi
A - everybody look away from Prof Jasmi....... looking for answers
"mysenteric LN in lymphoma is rare, there are usually paraaortic LN which are lobulated and fixed" - Prof Rohaizak
"LDH can carry prognosis of lymphoma" - Prof. Rohaizak
Wahab would like to transfuse PC in this pt but..
Q - "Hb of 5 in a asymptomatic chronic anemia why transfuse 2 pint PC, how much to bring up? how long to transfuse? when to transfuse?" - Prof. Jasmi
3. 17 year old Chinese Man presented with perianal abscess
Q - "what are the predisposing factors in a young man developing perianal abscess?" - Prof. Rohaizak
A - somebody answered homosexuality
Prof. Jasmi rebutted, "is it evidence base homosexuals are prone to develop perianal abscess,..... I am not trying to defend them" ha.....ha.....ha....ha..
Hasnul presented:
1. A 57 year old obese Chinese lady with late presentation of abdominal pain, amylase 51 TW 8.0, no free gas under diaphragm and clinically peritonitis. A differential dx of PGU was made and decision to operate. However a CT Abdomen was ordered
Q - "Why CT-Scan?" - Mr Lukman
A - "if CT shows severe pancreatitis, hold tight and not to go in" - Mr Hanafiah
"In obese pt, diagnostic laparoscopic would be ideal...less wound infection" - Prof Jasmi
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