Wednesday, 29 December 2010

PreTest GIS


jom cabar minda kita!!

1. Which of the following is the proper sequence for examination of the abdomen?

a. Auscultation, percussion, inspection, palpation
b. Auscultation, inspection, palpation, percussion
c. Inspection, percussion, auscultation, palpation
d. Inspection, auscultation, percussion, palpation
e. Inspection, percussion, palpation, auscultation

ANSWER:(d)- It is necessary to auscultate the abdomen prior to percussion and palpation because percussion may alter the frequency and the intensity of bowel sounds.

2. A 40-year-old man presents to the emergency room complaining of severe abdominal pain that radiates to his back accompanied by several episodes of vomiting.He drinks alcohol daily. On physical examination, the patient is found on the stretcher lying in the fetal position.He is febrile and appears ill. The skin of his abdomen has an area of bluish periumbilical discoloration.There is no flank discoloration. Abdominal examination reveals decreased bowel sounds. The patient has severe mid epigastric tenderness on palpation and complains of exquisite pain when your hands are abruptly withdrawn from his abdomen. Rectal examination is normal. Which of the following is the most likely diagnosis?

a. Acute cholecystitis
b. Pyelonephritis
c. Necrotizing pancreatitis
d. Chronic pancreatitis
e. Diverticulitis
f. Appendicitis

ANSWER:(c)- The patient most likely has necrotizing pancreatitis, which is a complication of acute pancreatitis. Other complications of pancreatitis include pseudocyst, abscess, and phlegmon. The periumbilical discoloration (Cullen sign) suggests a hemoperitoneum. Discoloration of the flanks would be a positive Turner sign. When the patient experiences pain as the hands of the examiner are abruptly withdrawn from the abdomen, he or she is said to have rebound tenderness (a sign of peritonitis). Decreased bowel sounds are another sign of peritonitis. Risk factors for acute pancreatitis include alcohol use, trauma, hyperlipidemia, gallstones, and medications. An abdominal radiograph in acute pancreatitis might show a sentinel loop (air-filled small intestine in the LUQ) and colon cu toff sign (air in the transverse colon). Patients with chronic pancreatitis present with bouts of abdominal pain and signs of pancreatic insufficiency (weight loss, steatorrhea, and diabetes). The abdominal radiograph in patients with chronic pancreatitis demonstrates calcifications in the pancreas (pathognomonic).


3. Which of the following best describes the location of McBurney’s point?

a. In the midclavicular line just under the right costal margin
b. At the midpoint of a line connecting the symphysis pubis and the anterior superior iliac spine
c. Midway along the right inguinal ligament
d. One-third of the way along a line drawn from the right anterior superior iliac spine to the umbilicus
e. One centimeter to the right of the umbilicus

ANSWER:(d)-McBurney’s point is the point on the abdomen that overlies the anatomic position of the appendix and is the site of maximum tenderness in a patient with appendicitis. McBurney
described the point as being “between an inch and a half to two inches from the anterior spinous process of the ileum on a straight line drawn from the process to the umbilicus.”

4. A patient with a long history of cirrhosis presents with asterixis. He is alert and oriented to person, place, and time. His breath is positive for fetor hepaticus. His abdomen is significant for caput medusae and a positive fluid wave. He has no focal neurologic deficit. His wife states that the patient is very functional at home but is moderately confused and drowsy. Which is the most likely stage of hepatic encephalopathy in this patient?

a. Stage 1 hepatic encephalopathy
b. Stage 2 hepatic encephalopathy
c. Stage 3 hepatic encephalopathy
d. Stage 4 hepatic encephalopathy

ANSWER:(b)-Asterixis is also referred to as “liver flap” or “flapping tremor.” It is a nonrhythmic, asymmetric lapse in a sustained position of an extremity. It is nonspecific for cirrhosis and may be seen in other metabolic derangements (i.e., renal disease and metabolic
acidosis). Fetor hepaticus (due to mercaptans) is a musty odor of the breath and urine and is part of the encephalopathy. Caput medusae is the dilated abdominal veins seen in patients with portal hypertension. It is often helpful to stage the hepatic encephalopathy to follow the course of
the illness:

Stage 1: Euphoria/depression, mild confusion, slurred speech, disordered sleep, +/-asterixis
Stage 2: Lethargy, moderate confusion, +asterixis
Stage 3: Marked confusion, incoherent speech, sleeping but arousable, +asterixis
Stage 4: Comatose, −asterixis

5. Which of the following factors may cause a false-negative fecal occult blood test (FOBT) result?

a. Vitamin C
b. Turnips
c. NSAIDs
d. Red meat
e. Aspirin
f. Horseradish
g. Poultry
h. Fish

ANSWER:(a)-Vitamin C may cause a false-negative test. The false-positive rate for FOBT is
1–5%, and patients must be told to abstain from ASA, NSAIDs, poultry, fish, red meat, and vegetables with peroxide activity (horseradish and turnips) for 72 h before testing.

6. A 16-year-old boy has had lifelong constipation. He requires suppositories and often enemas to initiate bowel movements. His abdomen is distended. Palpation reveals a tubular mass in the left lower quadrant. Rectal exam reveals no stool in the vault. Barium enema reveals a dilated colon above a normal-appearing rectum. Which of the following is the most likely diagnosis?

a. Colon carcinoma
b. Gardner syndrome
c. Peutz-Jeghers syndrome
d. Hirschsprung’s disease
e. Volvulus

ANSWER:(d)- Hirschsprung’s disease (aganglionic megacolon) is a disorder characterized by the absence of enteric neurons in the submucosal and myenteric plexuses. The contracted segment of bowel is unable to relax and a mass may become palpable. Hirschsprung’s disease may lead to megacolon, but resection of the affected bowel is curative. Peutz-Jeghers syndrome is autosomal dominant (AD) and is characterized by hamartomatous polyps in the small intestine and perioral melanin deposits. Gardner syndrome (also AD) is familial adenomatous polyposis syndrome. Gardner syndrome and Peutz-Jeghers syndrome are risk factors for colon cancer. Volvulus (malrotation that leads to gangrene) is usually seen in the first year of life; infants present with bilious vomiting, bloody stools, rigid and discolored abdomen, and shock.

ok.tamat sudah ujian kita hari ini.

PERHATIAN!
  • soalan2 diatas bukan lah soalan yg direka oleh saya sendiri atau diambil dari kertas peperiksaan universiti perubatan tapi diambil dari buku Pretest PHYSICAL DIAGNOSIS 4th Edition by JO-ANN RETEGUIZ, M.D. & BEVERLY CORNEL-AVENDAƑO, M.D.
  • saja2 kongsi untuk pelajar2 perubatan dan orang awam especially for my twp08 friends.(exam nk dekat da weii.....)
  • good luck for TWPO8 untuk exam yg mendatang nih.-awal sgt ker wish???xkn...??hihihiihi..





Friday, 24 December 2010

:: aku JELeS...

AMARAN!!!!~post inih panjang.hihihi.

hai.hello.gud afternoon... assalamualaikum.hehheh. sy gembira hari ini kerana hari ini hari cuti.yeayy!!saya suka cuti.ade sape2 xsuka cuti ker???waw...klu ada meh cnih bg cuti tu kat aku ..em..topik post kali nih pasal jeles.hiishh....jeles2..setiap orang mesti pernah rase perasaan nih kn??.xkisah lah korang nak jeles pasal apa pom.yang penting, jgn la korang buat benda xelok sebab perasaan jeles nih."jeles" jer pom. ehehehhee .korang ade baca paper x??i mean newspaper. pergh, ada 1 berita tuh laki tuh sanggup tikam mkwe dia sbyk 17 kali beb semuanya kerana jeles.ishk3....sayang sgt sampi dia bunuh mkwe dia.sayang ker camtuh???tuh bukan sayang tuh. tuh gila bab! namanya.ooopsss...sori! terkasar bahasa. orang kalau dah psycho...hishh seram.. toksah citer lah.ishk4....jeles2 ko memang betoi2 power lah. ke pompuan yg power sebenarnya??heheheh..ok..~abaikan.sekian berita terkini.

actually jeles nih terkeluar dari sanubari aku sebab nih,jom ikuti perbualan antara anak dan ibu ini (phone calling):

aku:ma..tikah duk wat gapo?

mama:ado duk make...tu lah kijaan dio loni..tido make.tido make jelah..bakponyosss??

aku:xdop gapo..ho la..cuti panje nih.baik cari kijo.bole dapat duit lebih..heehehhe(dlm ati bole la belanja aku nanti..heheheheeh)

mama:oowwhhh...xpo lah.lagipom sat g dio nok g wat lesen doh tuh.

aku:bilo???(curiga...curious)....lesen moto ko???

mama:ari selasa nih kot...dop ehh..lesen moto ngan keta skali la.......

aku:gulrrppp...gluppp..(tercengang sebentar...)waw...betoi ko???adekah aku bermimpi????uwaaa...

haaaa......tulah citernya..woooo..woo....wooot...woot....adik aku nak amek lesen kereta skali.. ingat motor jer. kalu motor aku kisah. ha4....jahat gila kakak.mana aku xjeles.. aku ada lesen basikal ja.uuwaaa..... moto pom kurang gheti...apatah lg kereta..uwaaaa..jeles2....nak jgak~nk jgak...sok sek sok sek. "udoh lo tuh cik bella oii buruk benor den nengoknyer". huhhu..ok2...kawal emosi. so sekarang den nok citor lah sikit pasal den. ehh silap...pasal adik den nih..actually ramai jugak yang ingat aku ni anak bongsu...hehehehehe..suka2***...tapi nak wat cmner..budok nih nak kuar jugok dr perut mak aku.terima jo lah~~

ok. nama pena dia tikah or gema. hahahaha. aku yg panggil dia gema tuh. ala bese la guraw adik beradik. koh3. nama penuh NUR ATIKAH WAHIBAH BT NOORDIN. die nih lah 1 1 adik aku yang selalu menemani hidupku.waww..ayat xle blah. yela dah namenya 1 bilik msti lah selalu kn??kn??kn?he3,,dulu masa kecik2 kitorang selalu gaduh. yela nak gaduh ngan sape lg,kang gaduh ngan abang2 kang kompen kalah. kalu gaduh ngan kakak2 nanti xleh makan nasi plak. hhehehe..so ngan dia la aku gaduh.keh3 tp skg dia lak yang buli aku.hu4.xberani den nak melawannya..skali die buat sumo die..huiishhh..sakit dohh..dulu dia nih bole la kate kecik skit dari aku.eh..x.x..pendek sebenarnya..hahaaha...tgk la gambo nih.


yang mana 1 aku???cer teka?sowie gambo kaburrrr

tapi sekarang aku tetap juara. mksudnya still tinggi la dari die.heheheeh...dulu owang selalu tertukar antara aku dan dia. msti owang ingat aku lah yang bongsu tuh..hehehehe. mungkin sebab mase tuh aku agak kering berbanding ngan dia.tapi setelah melihat parut kat tangan dia tuh,owang taw la dia bongsu.actually adik aku nih lahir xcukup bulan,pastuh masa operation nak belah perut mak aku tuh doctor terpotong skali tangan adik aku tp xdelah potong semuanya..cam terkena pisau lah..tp luka dalam kot sebab parut tuh timbul and sampai sekarang xilang.masa dia lahir tuh mak aku cakap berat dia 1kg jer pastuh kalu pegang cam sebesar tapak tgn jer...keciknya..pastuh penuh wayar2 kat badan dia.mak aku cakap menyesal xamek gambo mase tuh.huhuhuhu...kalu x bole tunjuk kat korang gmbo sbnar.hehehehe.umo budak nih 19thun skg.baru abeh exam stpm.jarak umo kami dekat thats y dia xpanggil aku kakak..ceet,kurang asam toi!!...hehehehehe..its ok.chill babeh,



camnih lah kot dia mase tuh.tp nih gambo twin.heehehe(sian kembar nih,masa lam kandungan nutrition bayi kecik tuh transfer kat bayi yg besar tuh, thats y die kecik dr kembar dia)..apa entah nmer medic die lupa lak.hi4



masa kecik2 kami camni lah.asyik pakai baju sama corak even kadang2 warna lain.sampai kasut pom mesti sama.kalu x, gaduh lah nnti.hishh..masa kecik2 pom dah ada perasaan jeles.

kalau mak ayah beli barang ke makanan ke mesti kena beli 2.kalau x,ha..apa lagi mula la berebut.even p kenduri kawin mak ayah kena balik dengan 2 biji telor.ahhaahah..sampi mcm tuh skali.tp kalau mak ayah p skali msti dapat 1 je kn???so yg menjadi mangsa adalah atuk guwe.hhehehehe..yg atuk punya aku dapat...yabedubedu...wooo....windu lak kat atuk.semoga arwah atuk bersemadi dgn tenang.amin3....



nih gambo kami.yang come2 tuh aku la.sejak bila mata aku ijau???hehehhhehe



belagak gila yg duk blkg tuh.xpki topi keledar pom.ishk3...

disebabkan i kurang gheti nak bawak motor so bila i balik umah dia jd driver i.keh3....bukan xgheti k.actually bukannya aku xpenah blajar bawak motor ni.1st time aku blajar masa tingkatan 3 kot ke 4 ek.,,heheeh..lebih kurang camtuh lah.mula2 bawak ok la abang ade kt belakang,pastuh skali dia lepas aku bawak sowang..aku cuak arr..skali terlaju...boommm..kebabooo....masuk longkang depan umah atuk aku..masa tuh aku pk,bek aku lari skang meletup kang moto nih,mati aku.pengaruh citer la nih.biasanya kn kalu bnde2 trbalik nih minyak tumpah pastuh apa lg meletup la.kan2??heheheh,,,aku lari sepantas mungkin...aku tinggal jer moto tuh..hahahahaha..kelaka habis,,pastuh kena marah ngan abang aku sebab wat rosak n calar kan moto dia..hehehe...sori bang,adik xsengaja.kih3..sejak hari tu den xbawak lg moto..den dok belakang jer..jd VIP terhormat.keh4....tp sebenarnya susah jgk kalu xgheti motor nih.nak p mana2 naik basikal.malu beb.budak darjah 1 pom gheti nek moto,berlagak seyh dak nih nek depan aku..ceet...hhuuhuh.kalau nak p jauh2 abang yg kena hantar..hishh,,,susah toi.sbb tuh la jd putri lilin duk ghumah, xleh nk p mana2.hu4....itu lah hakikatnya.bagus lah kn??kalu xmsti aku dah jd perempuan rempit.xelok sebut minah rempit.minah tuh kn dr perkataan aminah.nama ibu nabi kita tuh...sama jgk dgn mat.mat kan dr perkataan muhd.ishk3....bahasa2.


p/s: moral of de story jangan la jeles sampi melakukan bnda2 xelok.n sayangi lah keluarga anda selagi mereka masih ada di depan mata kita.nnti bila dah xde baru nk menyesal xwat tu..xwat ini...n for my sis..gud luck!!he3..kalau ko pndai bawak keta bole la bawak ma p mana2..hehehheeh..

k.la.jari jemari dah penat menulis.nk p makan la.lapo.hi3...k.daa....wsalam.

Saturday, 18 December 2010

-nk Citer ckit-

emmm...apa aku nk citer nih???

emmm...nk cter apa ekk...sempena nk memenuhi hasrat sesorang tuh.den update lah blog nih.k..la..no more surprise2.nk citer la ckit kisah den p kuar ngan gepren nih..actually den ada 2 gefpren..tp disebabkn yg sowang lg skit..so den date ngan 1 gefpren jelah hari tuh,sob3...wat2 sedih plak....im not playgirl k.neither gay~eeeuuwwww......

location date hari itu adelah bandar bandung.actually den just nk teman my gefpren nih ha..katernyer nk p bli barang2 nk wat blik malaysia nnti cuti krismas....hu3...uwwaaa...sodih lg..sbb den xblik skli...dsebabkan mase terhad and malam tuh den ada praktis dikir barat so just 1 tmpat jela yg kitorg p..iaitu pasar baru..or nama singkat nya PABA. org cnih memang suka wat singkat2 nih..smpi skirt pom ske singkat2...oppssss....abai kan~

masam~menunggu memang 1 penyeksaan.actually my gf yg siap dulu.he4...


ni lah gf sayer.mira namernyer.gf sy nih bijak.slalu dpt dean list.woootwooot...salut la bebeh"

kitorg p nek bas jer.murah.tambang dia =3500rp=rm1.50 la....tp tula bas xdek air-cond..huhhuhu..dah ade mcm2 bau..aiiyakk..memang pening gile nek bas nih..tp ada kebaikkannyer jgk dsebalik kburukkan...aceceecce...pndai ekau nk cover ek.he3,,,,

naik2 bas jer ada dak nih~he3..comey.suka die owang tangkap gambar die.nsib baik mak dia xnmpk.xpasai kena saman kang...

haaaa.....nih la kebaikkan nya nek bas nih.anda dapat melihat konsert live.xperlu pasang radio dalam bas.natural music.hahahaha....best...bkn suara katak k...ala2 unggu la jgk suaranyer.band taw.

bukan gitar n gendang jer.biola skali taw.tu yg jd best tuh.heheheh..bkn 1 lagu diorang nyanyi..tp boleh la 4-5 kot....haaa...nih la klebihannya...tp diorang nyanyi bukan free la.nnti kna bayar la ckit...tp up to u la nk byar ke x..diorang xkisah pom..ye ke???hahahahaha...sometime i buat2 tido jer sbb xmaw kasi.tp at least diorang usaha nk dapat duit berbanding dgn peminta2 sedekah jalanan yg tiada cacat cela yang masih mampu buat kerja tu.yela sometime kesian jgk, diorang kn ramai...peluang pekerjaan pom limit.nk dpat keja kt cnih bkn senang.thats y la yang berlambak owang die kt malaysia...kn?kn??angkat kaki cepat tanda stuju.he4..guraw2 je,

nih(kuih) jugak dijual atas bas.penjual tuh naik bas,then dia letak 1 1 atas peha penumpang bas.sapa yang nak dia bayar la.sape xnk kasi balik...jangan korang sorok plak...kesian.owang cari rezeki halal tuh.

nih(pin + pengorek telinga besi) pom dijual jgak di atas bas.tp penjual yang berlainan lah dari yang jual kuih tadi.rezeki ada dimana2 je.nih la orang indonesia.rajin~aceceecec..puji nmpak.mner ada..cuma memberitahu kenyataan ja.tp xsemua lah cmtuh..cam owang kita jgk la..

dah sampai stesen bas nak p pasar baru kita nek ANGkutan KOTa or nama singkatnya ANGKOT or van yg xttup pintu.keh3..angkot nih mcm2 warna ada, ikot tempat dia kena bawa penumpang lah.angkot memang salah 1 pengankutan yg pnting kt indonesia lah.nk p kelas pom den naik angkot.angkot xdak loceng nak tekan.so kalau nak suruh angkot nih berenti...kna cakap.."kiiii...riii...."kiri taw.bukan kanan.n 1 lg kna ada nada lenggok dia skali...wuahahgagaga..

dalam angkot nih pom ada yg cari rezeki lg.tp biasa nya kalu yg solo memg xbest lah...alamak memilih la plak...koh4

then sampai2..p la shopping....tgk bukan main lg cik mira nih memilih~

nih la rupa pasar baru tuh.ade 8 ke 7 tingkat camtuh lah.nk jalan semua kedai sehari memang xcukup lah.mase p nih memang byk kali lah terserempak dgn owang malaysia.owang malaysia memang suka shopping kt cnih.barang kt cnih boleh la kate murah.tp bg owang xdak duit cam den nih..lg murah lg bgus.hhaahhaah...

selepas selesai apa yg patut, kitorang p makan kt foodcourt.yeayy!!!den memang suka air cendol nih...perrghh..memang sedap lah.kt malaysia pom ada.teh tuh mira punya k...

pastuh balik dengan girang nyer kerana jumpa baju yang cantik.he4...trus beli bila dah berkenan.den memang camtuh..nak cari benda yg den suka memang susah..kalau bole semua kedai nk tgk..tp skli jumpa...harga memang tolak tepi...asalkn barang tuh den dapat.heheehhhe...

apa lagi...pakai n posing la puas2...ha3.....

pakai masa jamuan batch 08.


malu***...nk amek gambo pom owang tgk..hahahahahaha(perasan)

nie dia baju den suka.ade sape2 nk tampah???aku jual rm200..nk??nk???haahahaha


kucing pom nk posing skali...aiiyakk....warna baju dah bertukar.~~

k...harap anda berpuas hati.selamat malam.n jemput2 la datang melawat saya disini...woot..wooot....woot...

wsalam!