ECGs – some examples from the Real Ward

The following are examples of ECGs that i encountered during my medical posting…


(this is Q wave)


(this is PVC wave – remember this pattern, its classical) *will write more about this later


(T inversion at lead V1-V5)


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Quotes from Dr Umeed’s class (PSY Philosophy)

Dr Umeed shared these two short poetry which was taken from Psychiatry books in our group. He even took the trouble to photostate these poetries in a piece of A4 paper. How nice of him. ūüôā

Book 1 – “Child & Adolescent¬†Psychiatry: Modern Approaches” edited by Michael Rutter (from Institute of London). Continue reading

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HIV & Paediatrics (from Dr Zain’s class)

From Sheth fb

Paediatric HIV

  • Adults

Heterosexual sex intercourse is the most common mode of transmission.

IV drug users: mislead by statistics? ..due to compulsory screening.

  • How it involves children?

90% is due to Mother-child-transmission

–¬†¬†¬†¬†¬†¬†¬†¬†¬† Rate of transmission from mother who is HIV positive

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How to assess the suicidal risk? & its Management

From Puteri ND fb

Guide by Dr Kartini

In a patient that have suicidal attempt, you have to assess the suicidal risk first.

1. Is it a real suicide or not?

– It is very important to know whether the act is really intentional or just an impulsive


– In real suicide, the patient will usually have a very detailed plan.

– When did the patient try to do it? if its in front of other people;usually because they want

attention or its a way for them to “cry for help” or to manipulate the key partner

2. Precaution against discovery?

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Ward Round IM (Block 3)

Warning sign of dengue :

Abdominal pain or tenderness
Persistent vomiting
Clinical fluid accumulation (pleural effusion/ascites)
Mucosal bleed
Restlessness or lethargy
Liver enlargement > 2 cm
Laboratory: Increase in HCT concurrent with rapid decrease in platelet.

Hepatitis serology test:
Hep B
HBsAg (surface antigen) is present from 1-6 months after exposure
HBsAg persist for more 6 months indicates carrier status
HBcAg indicates past infection
HBeAg (e antigen) is present 1 1/2 – 3 months indicates highly infective state.
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PMP – PSY (Block 3)

Trigger 1
14 yo girl/ mother complained of withdrawal since father passed away 2 years ago. Locked herself in room, dislikes presence of other siblings, angry if did not get what she wants. Still watch TV if her favourite show is on. She has trouble initiating sleep but able to wake up early in morning to go to school.
– 4 DDx and reasons
– Diagnostic criteria to support your DDx
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Long Case – Psychiatry

Long Case

Case 1

33/malay/male/single/unemployed since 7 yrs ago/from Kg Pandan/education up to Form 3

k/c/o mental illness since 7 years ago, multiple admission to psy ward, last admission was 2009

c/o poor sleep for 1 week

Рhave auditory hallucination, 2nd person, clear, from outside, cannot control, respond to voice by scolding it, claimed      voice   of syaitan, comes almost everyday with no specific time. he felt disturbed

– have persecutory delusion & delusion of reference

– impaired his social function – advised by the employer to stop working because of poor performance at work

– have a brother who have schizo

– poor relationship with family, the dont understand his illness, always angry at him, not supportive

– previously on T. risperidone, T. sulpiride & T. artane. claim to be compliant

– recently changed to depot risperdal consta every 2 weeks

– patient was premorbidly happy go lucky person, have many friends, love sport, not religious always skip prayer

significant MSE finding

– still having AH

– poor insight

provisional dx : relapse schizophrenia

ddx : delusional d/o

drug induced psychosis


urine drug toxicology

hx from family and friends

work record

previous psy record


continue depot risperidone

refer to rehab


family therapy

supportive therapy

Q from examiner (Dr Z)

– cam bese doc tny provisional n diff dx, jwb accordingly (doc nk tau DSM criteria)

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