Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Download
Standard view
Full view
of .
Look up keyword
Like this
19Activity
0 of .
Results for:
No results containing your search query
P. 1
TMLE.ppt ประกอบการบรรยาย อ. ณรงค์กร

TMLE.ppt ประกอบการบรรยาย อ. ณรงค์กร

Ratings:

4.5

(4)
|Views: 1,021|Likes:
Published by imorkzone

More info:

Published by: imorkzone on Nov 03, 2008
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

05/09/2014

pdf

text

original

 
1
Thailand Medical LicensingExamination 2008
NarongkornSaiphoklang, M.D.Department of internal medicineFaculty of medicine, ThammasatuniversityThailand
Why we exam the medical license ??
The medical council of Thailand
()
want tomake the
international standard 
.
Thai National test
(beginning in 2006)
 –Basic medical sciences Preclinic –Clinical sciences (& clinical skill) Clinic
Copy 
from
USMedical Licensing Examination
 –USMLE step1 –USMLE step2 (& step2 CS)
Topicsof preclinicTopic highlight of Preclinic
General principles + 10 systems
 –Normal processes basic sciences –Abnormal processes clinical knowledge
Suggestion for
National test of Preclinic 
:
 –Read
USMLE
step1:knowledge&
sample questions
 –Prepare for national test of clinic:
USMLE
step2
Remember !!
Reference range
REMEMBER ! 
normal range
Blood: AST,ALT, ALP,protein, albumin, globulin,Amylase, Lipase, Ca,PO, T3, FT4, TSH, cholesterol, TG,LDL, HDL, BUN, Cr, Na, K, Cl, HCO3, ABG, glucose,serum osmole, uricHemato: BT,PT,aPTT, ESRCBC(Hb,Hct, wbc& diff., plt, MCV)CSF: pressure, cell, glucose, proteinUrine: Spec.gravity, osmole, blood, ketone, cell, cast,Urine electrolytes: Na, K, Cl
 
2
Problem-based learning(PBL) !!!
9.
A patient being treated with clindamycin for aspirationpneumonia develops diarrhea.The stool contains a toxinthat kills cultured epithelial cells.Stool culture grows ananaerobic grampositive rod.The same organism iscultured from his bedpan.Which of the following is mostlikely to sterilize the bedpan?(A)Boiling for 45minutes(B)Exposure to benzalkonium chloride for 1hour(C)Exposure to ethyl alcohol for 1hour(D)Exposure to saturated steam (121°C)for 15minutes(E)Heating in an oven at 150°C for 30minutes
 
ClindamycinVs Diarrhea
side effect of long duration use =Antibiotic-associateddiarrhea& colitis,
pseudomembranouscolitis
(C.difficile)
Clostridium difficile
 –Anaerobic GPB –toxins A & B
diarrhea –spores are resistant to heat, acid & ATB –Saturated stream kills spores –Rx: Metronidazoleor Vancomycin
pseudomembranouscolitis
10.
An 18-year-old woman has gastroenteritis withnausea and vomiting and is able to ingest only smallamounts of water.After 3days,she develops light-headedness,especially when sitting or standing.Arterialblood gas analysis is most likely to show which of thefollowing sets of values?
PCO2HCO3pH (mm Hg)(mEq/L)
(A)7.302815(B)7.305527(C)7.404024(D)7.503022(E)7.504735
Acid-base mechanism
pH(H+), pCO
2
, HCO
-3
Buffer system:HCO
-3
, protein, boneRespiratory abnormality :CO
2
Lung(1
st
)Metabolic abnormality: HCO
-3
kidney
 
3
REMEMBER ! 
Metabolic Acidosis/Alkalosis =disturbances of HCO
3
Respiratory Acidosis/Alkalosis=disturbances of PaCO
2
PCO
2
H
+
,HCO
3-
Acid-base disturbance
If
CO
2
(Repiratoryacidosis)
Lung RR
&HCO
-3
(kidney)
CO
2
(Repiratoryalkalosis)
Lung RR
& HCO
-3
(kidney)If
HCO
-3
(Metabolic acidosis)
CO
2
by Lung RR
&HCO
-3
(kidney)
HCO
-3
(Metabolic alkalosis)
CO
2
by Lung RR
& HCO
-3
(kidney)
Vomiting, dehydration
= Metabolic alkalosis
Diarrhea
= Metabolic acidosis, normal anion gap
Sepsis, infection, RF
= Metabolic acidosis, wide anion gap
DKA
= Metabolic acidosis, wide anion gap
COPD
= Respiratory acidosis
Hyperventilation
= Respiratory alkalosis
Anion gap= Na -Cl-HCO
-3
(normal
8 -14
)
ABG: pH 7.4
±0.05,
pCO
2
= 40,HCO
-3
=24,pO
2
= 80-100
Interpretation of ABG
1
st
: pH
acidosis/alkalosis
2
nd
:PCO
2 /
HCO
3
,
3
rd
: Pure(compensate) /Mixed disorder
pHAcidosisAlkalosis
CO
2
HCO
3
CO
2
HCO
3
Res.acidMet.acidRes.AlkaloMet.AlkaloPure(compensate) /Mixed disorder
Compensation Formulas forCompensation Formulas forSimple AcidSimple Acid--Base DisordersBase Disorders
--Metabolic acidosisMetabolic acidosisPaCOPaCO
22
= 1.5 (HCO= 1.5 (HCO
33
) + 8) + 8++22--Metabolic alkalosisMetabolic alkalosisPaCOPaCO
22
= 0.9 (HCO= 0.9 (HCO
33
) + 9) + 9++2020oror
∆↑∆↑∆↑∆↑∆↑∆↑∆↑∆↑
PaCOPaCO
22
= 0.6= 0.6
∆↑∆↑∆↑∆↑∆↑∆↑∆↑∆↑
(HCO(HCO
33
))--Ac. respiratory acidosisAc. respiratory acidosis
HCOHCO
33
= 0.1 (= 0.1 (
PaCOPaCO
22
))--ChrChr. respiratory acidosis. respiratory acidosis
HCOHCO
33
= 0.35 (= 0.35 (
PaCOPaCO
22
))--Ac. respiratory alkalosisAc. respiratory alkalosis
HCOHCO
33
= 0.2 (= 0.2 (
PaCOPaCO
22
))--ChrChr. respiratory alkalosis. respiratory alkalosis
HCOHCO
33
= 0.5 (= 0.5 (
PaCOPaCO
22
))from the normal value of 40 mmHg for PaCOfrom the normal value of 40 mmHg for PaCO
22
or 24 mEq/L for HCOor 24 mEq/L for HCO
33--
10.
An 18-year-old woman has gastroenteritis withnausea and vomiting and is able to ingest only smallamounts of water.After 3days,she develops light-headedness,especially when sitting or standing.Arterialblood gas analysis is most likely to show which of thefollowing sets of values?
PCO2HCO3pH (mm Hg)(mEq/L)
(A)7.302815(B)7.305527(C)7.404024(D)7.503022(E)7.504735
 
1.pH: alkalosis2.HCO
3
=
Metabolic3.Pure(compensate)
PCO
2
=(0.9 x 35) + 9 ±20= 20.5 to 60.5Or
∆↑∆↑∆↑∆↑∆↑∆↑∆↑∆↑
PaCO2PaCO2
= 0.6= 0.6
∆↑∆↑
(10)=6 (+40)=46(10)=6 (+40)=46
45.
A 31-year-old man with a history of epilepsy has a major motor (grandmal)seizure.Laboratory values obtained immediately after cessation of theseizure include:Arterial bloodpH7.14PCO235mm HgPlasmaNa+140mEq/LCl98mEq/LK+4.0mEq/LHCO317mEq/LWhich of the following is the most likely acidbase disturbance?(A)High anion gap metabolic acidosis(B)High anion gap respiratory acidosis(C)Low anion gap metabolic acidosis(D)Normal anion gap metabolic acidosis(E)Normal anion gap respiratory acidosis

Activity (19)

You've already reviewed this. Edit your review.
1 thousand reads
1 hundred reads
Lumpoo Junklang liked this
Lumpoo Junklang liked this
Supawadee GT liked this
thokinwat liked this
rashmiaj liked this
Narumon Saelee liked this
Adisak Kanoksin liked this

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->