VIVA 1 FAMILY MEDICINE GROUP E

Lecturer Case and questions

Dr Nilesh Immunisation
 History to be asked?
 Age, last vaccine, a/e from last vaccine, …..fikir sendiri etc
 If patient have fever can we give vaccine? – Yes (Not a CI)
 Immunisation schedule
 When and how to give hep B
 If patient is 10 months old and never get vaccine, what to give?
 All vaccine before 10month
 If 1 vaccine only to be given? – MMR (based on schedule
 Vaccine for diarrhea
 Cholera, typhoid, rotavirus
 Waterborne disease that can be vaccinated
 Advice to mother after vaccine
 Explain the vaccine what it protects from
 Ask to wait outside for 30 mins (adverse effect)
 Tell date for next vaccine
 Give immunisation card
 If oral vaccine: avoid breastfeeding for 30 mins
 Absolute contraindication for vaccine. Why?
 Immunocompromised pt, the vaccine itself will cause disease

Asthma
 Relevant history and examination
 Investigation
 Management
 Prevention
 Status asthmaticus
 Drugs for asthma
 Drugs contraindicated in asthma

Neonatal jaundice
 Specific history for neonatal jaundice
 Examination
 Treatment and management

Anemia
 Relevant history
 Relevant PE
 Investigation
 Food fortification
 Pancytopenia
 Iron metabolism
 Prevention
 Management
 DM
 Types of diabetes
 What sign & symptoms you should ask in a newly diagnosed DM in
hospital
 Important history, important findings in PE
 Complications of DM
 Investigation
 Management of DM: pharmaco and non-pharmaco
 Health promotion & prevention of DM (primary, secondary, tertiary)

Dr Smruti Hypertension
 Present case
 Investigation
 Management
 How to choose anti-hypertensive drug
 Health promotion

Anemia in pregnancy
 Relevant history, PE findings
 Investigation
 Management
 Health promotion

Alcohol therapy & Quit smoking

 Present history
 What are the withdrawal effects
 PE to do
 Investigations
 Management
 Interventions at PHC level

Asthma
 Signs & symptoms of asthma
 Cause of asthma
 Management of stable asthma
 Management of acute exacerbations of asthma
 Preventions of asthma

DM
 Present case
 Investigations
 Management
 Complications – with specific investigations
 PVD investigation – ankle brachial index
 Health promotion and education
Dr Geeta UTI
 Relevant history
 Signs & symptoms of UTI and renal stones
 Management
 Anatomy of kidney, common site for stones

Quit smoking
 How do you treat smoking addiction?
 What is NRT?
 Forms of NRT
 Long term effect of smoking
 Consequences of smoking to the patient & family members
 Withdrawal symptoms of smoking deaddiction

Normal pregnancy
 Laboratory investigations
 CBC, Hb, PBS, Blood group, Rh, Urine analysis, HbsAg, HIV, VDRL,
Malaria (if having S&S), thyroid function
 What to check in urine?
 Albumin, pus cell
 Specific lab
 USG, CTG
 Treatment
 Tab folic acid 0.5mg 0-1-0
 Tab ferrous sulphate 60mg elemental iron 0-1-0
 Tab calcium 1000mg 1-0-1
 Advice?
 Eat dietary biscuits, avoid fatty/spicy food to reduce morning
sickness
 Have regular ANC check up to detect any abnormal rapid weight gain
 Eat more protein diet to reduce risk of preeclampsia
 Eat more fruits, veg to get enough nutrient
 Take complex carb to avoid spike of glucose release (in GDM pt)
 If patient is to be GDM, how to diagnose?
 India, DIPSI. 75g of glucose load regardless of last meal, if >140mg/dl
is considered as GDM
 WHO use OGTT. 75g of glucose load.
 Fasting: 100mg/dl, after 1h: 180mg/dl, after 2h: 155mg/dl. Any 2
readings met considered GDM
 In Malaysia, CPG. How to diagnose?
 OGTT
 Any need to repeat OGTT in GDM? If needed, how often?
 Yes. Need to repeat 6w postnatally, then every year need to repeat
to detect risk of developing DM
 Any more to give to patient other than supplement?
 Drink more water to avoid constipation
 Avoid lifting heavy objects to reduce back pain
 Wear loose garment
 Avoid high heels
 Stop smoking, alcohol
 Have enough rest in left lateral to reduce ankle edema
  How much rest? – 8-10 hours
 Any other advice?
 Pt need to come immediately to PHC/hospital if having PV leak or
painful uterine contractions of increasing intensity at regular interval
(indicating true labor onset)

COPD
 Present case
 Why do you think this is a COPD case?
 Risk factor for this case. Tanya social hx: masak guna natural fuel tak?
(cow dung) – asap dalam rumah
 COPD is restrictive or obstructive?
 Complication of COPD – corpulmonale, later leads to pulmonary
hypertension
 Investigations? (CXR and Lung fx test) – which one better? Ofcos Lung
fx test
 Blue bloater and pink puffer (Chronic bronchitis & emphysema)
 Management for COPD

Ear pain
 Diagnosis
 Investigation
 Management (pharmaco & non-pharmaco)

Dr Sudhir Kamat Osteoarthritis

 Present case
 Other types of arthritis
 How to differentiate between gout, OA, rheumatoid arthritis and septic
arthritis
 Investigations
 Managements

Hypertension
 Sign and symptoms of hypertension
 Sign and symptoms of hypertensive encephalopathy
 Precautions when patient with hypertension come to PHC
 Precaution when giving anti-hypertensives
 Types of hypertension
 What is essential hypertension?
 Complications
 Investigations
 Management

Typhoid fever
 All about typhoid fever
 Temperature taking

Pulmonary TB
  Present case
 Investigations you need to do
 Management
 How long is the TB regime?
 Complications of TB
 Features of TB meningitis

DM
 Present case
 Common symptom present to diagnose DM
 Clinical finding in GPE for DM
 Investigation
 Management
 Complication
 Have you ever heard about DKA?
 Define DKA
 Clinical features of DKA
 Treatment for DKA