Always Smile

Besi 7 Pa - Parang - Pasak - Pagar - Paku - Pahar - Palung (kerambit) Kesemua besi tersebut mestilah bersifat Pa iaitu mestilah patah dan diambil dari 7 daerah yang berbeza

An-Nisa' 4:171 O People of the Scripture, do not commit excess in your religion or say about Allah except the truth. The Messiah, Jesus, the son of Mary, was but a messenger of Allah and His word which He directed to Mary and a soul [created at a command] from Him. So believe in Allah and His messengers. And do not say, "Three"; desist - it is better for you. Indeed, Allah is but one God. Exalted is He above having a son. To Him belongs whatever is in the heavens and whatever is on the earth. And sufficient is Allah as Disposer of affairs. Wahai Ahli Kitab! Janganlah kamu melampaui batas dalam agamamu, dan janganlah kamu mengatakan terhadap Allah kecuali yang benar. Sungguh, Al-Masih Isa putra Maryam itu, adalah utusan Allah dan (yang diciptakan dengan) kalimat-Nya yang disampaikan-Nya kepada Maryam, dan (dengan tiupan) roh dari-Nya. Maka berimanlah kepada Allah dan rasul-rasul-Nya dan janganlah kamu mengatakan, "(Tuhan itu) tiga,"Berhentilah (dari ucap...

Pack Year = Number of pack of cigarettes smoked per day x Number of years of the person has smoked 1 pack = 20 cigarettes 1 pack year  = 1 pack per day for 1 year    (20 cigarettes per day for 1 year) = 2 packs per day for 0.5 year    (40 cigarette per day for 6 months) 1 pack year = 365.24 packs of cigarettes = 7305 cigarettes Example A male patient smoked 15 cigarettes per day for 40 years = 15/20 x 40 = 30 pack years Risk for development of bronchogenic carcinoma increases when pack years exceed 40 Example 20 cigarette per day for 40 years 40 cigarette per day for 20 years 80 cigarette per day for 10 years

Lumbar Puncture Procedure Indication Diagnostic Meningitis Therapeutic Administration of drugs Decrease intracranial pressure Guillain – Barré syndrome Contraindication Increased ICP Patients under anticoagulant therapy Procedure If patient is under anticoagulant therapy Heparin Stop the drug 4 days prior to the procedure Aspirin Stop the drug 7 days prior to the procedure Instruments Lumbar puncture needle 22 Gauge Anaesthesia Injection Lignocaine Sample collection 3 samples 10ml each sample Microbiology Histopathology If repeated procedure indicated After 5 days of the previous procedure Complication Brain stem herniation Post dural headache Due to decreased ICP Prevented by 1 hour lying down before getting up Prevented by administration of paracetamol, caffeine, blood (epidural patch) Bowel & bladder incontinence Nerve damage due to negative pressure Infection

Cardiovascular System Examination Inspection 1. Precordium 2. Apex impulse 3. Pulsation 4. Dilated veins over the chest wall 5. Scars and sinuses Palpation 1. Apex beat 2. Parasternal heave 3. Diastolic shock 4. Thrills Percussion 1. Left border 2. Upper border 3. Right border Auscultation 1. Heart Sound 2. Murmurs Systolic murmurs - mid systolic - late systolic - pan systolic - early systolic Diastolic - early diastolic - mid diastolic - late diastolic

Per Abdomen Examination Inspection Umbilicus Position - can be upward or downward due to ascites, pregnancy, mass Inverted/Everted Shape Swelling Discolouration Distance between xiphisternal and umbilicus Distance between umbilicus and pubic symphysis Palpation Percussion False negative shifting dullness seen in Tense fluid - fluid is unable to move freely Loculation of fluid Auscultation Bowel sound Hepatic bruit Splenic bruit Renal bruit Venous hump