Archive for January, 2012


A 10-year-old girl has had a “cold” for 14 days. In the 2 days prior to the visit to your office, she has developed a fever of 39°C (102.2°F), purulent nasal discharge, facial pain, and a daytime cough. Examination of the nose after topical decongestants shows pus in the middle meatus. Which of the following is the most likely diagnosis?

a. Brain abscess

b. Maxillary sinusitis

c. Streptococcal throat infection

d. Sphenoid sinusitis

e. Middle-ear infection

the answer is below…
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A fully immunized 2-year-old presents to the emergency room with several days of low-grade fever, barking cough, and noisy breathing. Over the past few hours he has developed a fever of 40°C (104°F) and looks toxic. He has inspiratory and expiratory stridor. The family has not noticed drooling, and he seems to be drinking without pain. Direct laryngoscopy reveals a normal epiglottis. The management of this disease process includes which of the following?

a. Intubation and intravenous antibiotics

b. Inhaled epinephrine and oral steroids

c. Inhaled steroids

d. Observation in a cool mist tent

e. Oral antibiotics and outpatient follow-up

the answer is below…
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Friends are considering adopting from another country a “special needs” child. The family has few details, but the information they have received so far suggests the 4-year-old child has had surgery for an endocardial cushion defect, is short for his age, and had a history of what sounds like surgically repaired duodenal atresia at birth. You are suspicious this child may have which of the following syndromes?

a. Kleinfelter

b. Waardenberg

c. Marfan

d. Down

e. Turner

the answer is below…
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During a routine well-child examination a 10-year-old girl reports that she has occasional headache, “racing heart,” abdominal pain, and dizziness. Her mother states that she has witnessed one of the episodes, which occurred during an outing at the mall, and reported the child to be pale and to have sweating as well. Other than some hypertension, she has a normal physical examination. Evaluation of this child is most likely to result in which of the following diagnoses?

a. Hysterical fainting spells

b. Pregnancy

c. Diabetes mellitus

d. Pheochromocytoma

e. Migraine headache

the answer is below…
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The state laboratory calls your office telling you that a newborn infant, now 8 days old, has an elevated TSH and low T4 on his newborn screen. If this condition is left untreated, the infant is likely to demonstrate which of the following in the first few months of life?

a. Hyperreflexia

b. Hyperirritability

c. Diarrhea

d. Prolonged jaundice

e. Hyperphagia

the answer is below…
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A 46-year-old woman presents to your office complaining of something bulging from her vagina for the past year. It has been getting progressively more prominent. She has started to notice that she leaks urine with laughing and sneezing. She still has periods regularly every 26 days. She is married. Her husband had a vasectomy for contraception. After appropriate evaluation, you diagnose a second-degree cystocele. She has no uterine prolapse or rectocele. Which of the following is the best treatment plan to offer this patient?

a. Anticholinergic medications

b. Surgical correction with a bladder neck suspension procedure

c. Placement of a pessary

d. Antibiotic therapy with Bactrim

e. Le Fort colpocleisis

the answer is below…
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A 78-year-old woman with chronic obstructive pulmonary disease, chronic hypertension, and history of myocardial infarction requiring angioplasty presents to your office for evaluation of something hanging out of her vagina. She had a hysterectomy for benign indications at age 48. For the past few months she has been experiencing the sensation of pelvic pressure. Last month she felt a bulge at the vaginal opening. Two weeks ago something fell out of the vagina. On pelvic examination the patient has total eversion of the vagina. There is a superficial ulceration at the vaginal apex. Which of the following is the best next step in the management of this patient?

a. Biopsy the vaginal ulceration

b. Schedule abdominal sacral colpopexy

c. Placement of a pessary

d. Prescribe oral estrogen

e. Prescribe topical vaginal estrogen cream

the answer is below…
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A 28-year-old woman presents to your office with symptoms of a urinary tract infection. This is her second infection in 2 months. You treated the last infection with Bactrim DS for three days. Her symptoms never really improved. Now she has worsening lower abdominal discomfort, dysuria, and frequency. She has had no fever or flank pain. Physical examination shows only mild suprapubic tenderness. Which of the following is the best next step in the evaluation of this patient?

a. Urine culture

b. Intravenous pyelogram

c. Cystoscopy

d. Wet smear

e. CT scan of the abdomen with contrast

the answer is below…

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Saya teride untuk membuat postingan ini, karena saya ingin tahu juga apakah teman-teman memiliki pengalaman yang menarik untuk di- share.

Momen paling konyol.
Saat kuliah di awal semester 1, mata kuliah yang diajarkan mata kuliah dasar. Saat itu adalah mata kuliah anatomi. Dan materinya adalah ekstremitas inferior.

Dr. Onggung yang memberi kuliah. Dan pada satu slide beliau menampilkan daftar vaskuler dan nervus yang ada pada ekstremitas inferior. Lantas beliau bertanya, “apa yang kamu pikirkan ketika membaca daftar ini?”

Saya duduk paling depan. Dan menjadi sasaran empuk. Melihat daftar yang panjang dan banyak itu, saya pusing juga mau jawab apa.

Dan akhirnya… saya menjawab, “sulit dihafalkan, Dok.”

Hadeh. Bisa aja deh saya ngeles nya. Dan apa komentar beliau?

“Ya. Itu namanya jawaban tukang becak!”

Whew. Awal kuliah sudah seperti ini. Nyesek!!
Hehe..

Momen paling sedih.
Masih tentang anatomi. Di semester satu ada praktikum anatomi. Suatu sesi ujian masih tentang nervus dan vaskuler. Saya hanya mendapat nilai 18 dari maksimal 100.

Ini benar-benar momen yang memacu semangat saya belajar anatomi lebih keras di semester-semester berikutnya.

-note: anatomi lho ya. Bukan histologi. Hehe..-

Momen paling berkesan.
Nah ini momen saat saya dan deny mengerjakan tugas akhir kami. Kami mengamati pengaruh paparan morfin dosis lethal pada mayat terhadap pertumbuhan larva lalat.

Yang paling mengesankan adalah: saat kami nongkrong berjam-jam di tempat penampungan sampah kampus dan dengan sabar menangkapi lalat satu demi satu.

Hehe.. sesuatu yah!!

Momen paling menyebalkan.
Ini terjadi saat saya sudah pendidikan profesi a.k.a koass. Hehe.. saat itu stase Ilmu Penyakit Dalam. Seperti biasa, tim jaga wajib melaksanakan morning report keesokan paginya.

Yang tidak biasa adalah: yang memimpin morning report kali ini adalah dr. Harriadi SpPD. Sosok yang terkenal tegas dan menuntut kami untuk menguasai keluhan dan gejala pasien kami.

Saya pribadi sudah menyiapkan diri. Sejak dini hari sudah meminjam beberapa textbook dari PPDS untuk menguatkan jawaban.

Dan… ternyata textbook itu tidak mempan. Alias, kami tetap ‘habis’ di depan supervisor yang satu ini. Hadeh. Kami bahkan dapat julukan koass GMB!! Gak Main Blass!!

Senyum Kecut. Mesem Asem.

Momen paling campur-aduk
Ini terjadi masih ketika saya stase IPD. Saat itu saya stase di ruang 25. Dan saya merawat seorang bapak yang dirawat dengan hepatocarcinoma. Selama dua minggu saya rutin melaksanakan evakuasi asites. Setiap pagi saya selalu followup dan melaksanakan evakuasi.

Yang membuat campur-aduk, sang Bapak ini selalu menunggu saya tiap pagi, menyapa dengan suara keras dan bersemangat. Beliau selalu menanti-nanti saya. Pernah suatu kali saya tidak melakukan followup dan evakuasi asites, beliau protes.

“Kalau dokter yang nyuntik (evakuasi asites), rasanya ndak sakit.”

Bahagia rasanya disenangi pasien. Dan sedih karena penyakit beliau dengan keterbatasannya sebenarnya prognosisnya buruk.

Tapi tugas kita bukan untuk tetap membangun optimisme tanpa meninggalkan fakta untuk disampaikan?

Senang sekaligus sedih.

Momen paling canggung.
Saat stase kulit kelamin. Seperti biasa kami standby di poli kulit kelamin. Saya mendapat tugas di bagian Sexual-Transmitted-Disease. Nah hari itu saya membaca status pasien yang akan saya periksa dengan PPDS.

Pasien kedua adalah pasien dengan kondiloma. Hemm… menarik, pikir saya. Saya ingin tahu seperti apa kondiloma ini dan (tentu saja) seperti apa pasien nya.

Lantas saya baca nama pasien. Jederrr!!

Ini teman saya semasa SMP!!

Setelah konsultasi dengan dr. Evvy, akhirnya saya memutuskan untuk keluar ruang periksa karena tidak nyaman rasanya.

Nah, pas keluar ruang periksa, pas dengan sang Pasien yang akan masuk ruang periksa.

Hemm… kikuk.

-end-

Hehe… itulah sebagian momen-momen saya saat sekolah kedokteran. Mungkin ada yang mau berbagi?

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King Tutankhamun

King Tutankhamun’s Life and Health Status
Around 1324 BC, when 10 years of age, Tutankhamun, popularly called King Tut, became Egypt’s ruler, reigning as Pharaoh for 9 years (see Figure 2). He died when he was only 19 years of age and was buried in a secret, well-hidden crypt along with a unique collection of priceless objects. Now, thanks to modern molecular technology, we have detailed information about the illnesses he suffered during his life, and the probable contributory factors leading to his death.

Figure 2. Gold mask, representing King Tutankhamun, at The Egyptian Museum.

Genetic analysis conducted in 2007-2009[4,5] strongly suggests that King Tut’s parents were brother and sister. Could this incestuous relationship have been another factor leading to his early demise? This seems plausible, but since incestuous marriages are so rare, there is limited information about life expectancy of the offspring.
Detailed analysis of the bones of his left foot revealed several deformities, including aseptic bone necrosis of the metatarsals known as Köhler disease II, or Freiberg-Köhler syndrome.[6] He also had a cleft palate, mild kyphoscoliosis, and a leg fracture. The disabilities of his foot would have impaired his gait, explaining why so many canes were found in his tomb.
Genetic testing also revealed an unexpected finding: malaria tropica, a severe form of this infectious disease. Malaria has been suspected to exist in other ancient populations, but evidence for this malady had not been previously identified in Egyptian mummies. In addition to being found in King Tut, malarial DNA was also confirmed in several other mummies of the same kindred, implying that malaria was endemic in the region during this period of Egyptian history.
In addition, the examination of the exhumed body of King Tut revealed evidence of a skull fracture, which is consistent with the popular belief that he had been murdered. However, the skull injuries probably did not occur at the time of death, but during the hasty excavation in 1922, when the mummy was first discovered. The cause of King Tut’s death was probably multifactorial, resulting from a combination of a weakened immune system, underlying malaria, and a fall, resulting in a fractured leg. All of these factors may have contributed to fatal sepsis.
How Would King Tut Be Treated Today?
Today, with universal restrictions on sibling marriage, King Tut would not have been the offspring of such a close incestuous relationship and, therefore, his health might have been more robust. His leg fracture could have been easily managed, probably with internal fixation. During King Tut’s time, treatment for malaria was unknown, but now, in addition to protective bed netting, which would certainly have been used by the royal family, prophylactic drugs would have reduced the likelihood of contracting this disease and, if he did, agents, such as atovaquone-proguanil and artemether-lumefantrine, would have been effective therapeutic options. However, even today, malaria persists as a major cause of mortality, accounting for about 1 million deaths worldwide every year.
The Pharaoh’s Curse: Fact or Fiction?

Perhaps as a deterrent to grave robbers, some Egyptian tombs contain warnings threatening dire consequences to persons disturbing the buried remains. Such a warning had not been found in King Tut’s tomb, but the idea of the mummy reaching out to kill the discoverer, the “curse of the pharaoh,” was popularized by reporters after Lord Carnarvon’s unexpected death, which occurred so soon after the discovery of the spectacular grave site. Even Sir Conan Doyle, the author of the Sherlock Holmes mysteries, encouraged the belief that Carnarvon’s death was caused by “elementals” that had been created by Tutankhamun’s priests. He also believed that an Egyptian curse was responsible for the death of a friend. There is no evidence to support this myth, and, of the many persons involved in the original exploration of the tomb, Lord Carnarvon is the only one whose death occurred shortly after the tomb was opened. Howard Carter, who performed most of the actual archeological work, died in 1939, many years after working on the tomb.[7]

Nevertheless, “the curse of the pharaoh” has been used in the scientific literature to support the hypothesis that an organism of high parasitic virulence is correlated with prolonged parasitic survival.[8,9] If this hypothesis is correct, it lends credence to the idea that a persistent, highly virulent organism lying dormant in King Tut’s tomb for centuries was responsible for Lord Carnarvon’s death. If so, then we can blame an infectious agent, rather than King Tut’s priests, for the putative “curse”.

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