CANTIK SIUT!



hari nie dah 3 hari posting kat hospital selayang, posting pasal penyakit rheumatology. cantik betul hospital selayang nie, macam hospital private. sejuk ber aircon, tak macam hospital kuno kerajaan lain. wad pun luas. katil pun baru. setiap pesakit dpt cubicle sendiri beserta ngan tirai. tak macam ngan HKL. tirai pun tak de. sometime kalau nak buat per rectal examination pun tak bertirai, open!

Nilah kelebihan hospital baru. kerajaan sebaik mungkin nak perbaiki perkhidmatam kesihatan rakyat.

Workload kat sini pun tak banyak. so boleh concentrate pada patient in detail dan hopefully tak mismanaged.



KEs-kes rheumatology kat sini memang menarik. adela tengok kes SLE dan rheumatoid arthritis. pagi tadi clerk case patient suspecting ada connective tissue disease. History pt nie:



19 year old Malay, boy:

c/o bilateral calf pain for 3 months

-worse on walking

-relieved at rest, taking analgesic

-intermittent, moderate in severity



went to nearby clinic, blood Ix showed raised ESR,

referred to Kajang hospital,

xrays done: normal, discharged but developed,

bilateral ankle swelling for 1 month

sudden in onset.



also had LOW, LOA, sms of anaemia

no history of alopecia, malar rash, oral ulcers, joint pain, fit

no family history of connective tissue disease



o/e

cachexic, pale, no jaundice

left supraclavicular bruit

CVS, Resp and abdomen normal

livido reticularis both lower limbs

erythema nodusom both feet

generalized hyperreflexia



What is yr dx?





p/s they are thinking of polyarteritis nodosa, investigations are waiting.