NR Medical Academy

NR Medical Academy Coming soon Radiation Protection Officer (RPO) course.

Academic activities Medical: CME for x-ray license renewal (4 CPD points), 40 hour course for new license holders (20 CPD points), PoCUS Ultrasound Workshops & Radiographic Technique Workshop.

AVULSION FRACTURE OF THE 5TH METATARSAL TUBEROSITY31F, alleged fall at workplace, climbing stairs, mosaic broke, rt ankl...
14/01/2026

AVULSION FRACTURE OF THE 5TH METATARSAL TUBEROSITY
31F, alleged fall at workplace, climbing stairs, mosaic broke, rt ankle inverted
X-ray foot showing fracture base of 5th metatarsal.
There are 3 types of fractures that can occur here:
-Avulsion fracture
-Jones fracture
-Stress fracture
Avulsion fracture occurs at the tuberosity. Tuberosity is the site of attachment for plantar aponeurosis and peroneus brevis tendon.
Jones fracture occurs at the level of 4th – 5th inter-metatarsal articulation.
Stress fracture occurs in the proximal diaphysis, distal to the level of 4th – 5th inter-metatarsal articulation.
Why is it important to differentiate between them? Treatment and prognosis between the 3 are different.
-Avulsion fracture heals well without surgery.
-Jones fracture may require surgery and can have delayed healing.
-Stress fracture has increased risk of impaired healing due to poor blood supply and have the poorest prognosis.
KLINIK SAFIYA & SURGERI, KULIM, KEDAH, MALAYSIA

FRACTURE PATELLA 42M, fell down while working on boat - right knee pain and swelling +++right knee x-rays showing displa...
14/01/2026

FRACTURE PATELLA
42M, fell down while working on boat - right knee pain and swelling +++
right knee x-rays showing displaced fracture of patella with significant haematoma and joint effusion.

How do you get patella fracture?
- Direct trauma to the patella
- Sudden forceful contraction of the quadricep muscles (usually related to sport injury)
How do you treat patella fracture?
- Minimally displaced fracture with intact extensor mechanism – knee splint
- Displaced fractures or disrupted extensor mechanism – K wire
MEDUS CLINIC, HUTAN MELINTANG, PERAK , MALAYSIA

13/01/2026

POLYOSTOTIC FIBROUS DYSPLASIA
42M, c/o right sided lateral chest pain on and off since 1-2 years, pain recently increasing intensity since past 3 days, no h/o fall / trauma, never been investigated before.
CXR AP & PA views were done showing multiple and bilateral expansile rib lesions. They involve the following ribs:
-4th anterior right rib
-6th anterior right rib
-8th posterior right rib
-7th posterior left rib
-9th anterior left rib
Differential diagnosis are fibrous dysplasia, enchondroma and metastases. Given the history, this is most likely fibrous dysplasia.

Fibrous dysplasia is a rare, benign bone disorder where normal bone is replaced by fibrous, scar-like tissue, making bones weak and prone to fractures. If it affects single bone, we call it monostotic. If it involves multiple bones, we call it polyostotic.
Most often detected during routine examination or present with bone pain due to fractures.
KLINIK SOFEA PLUS SEREMBAN, NEGERI SEMBILAN, MALAYSIA
Klinik Sofea Seremban

PERICARDIAL CALCIFICATION 60M, MVA, h/o bypass surgery. CXR done TRO rib fracture.There is a curvi-linear opacity along ...
12/01/2026

PERICARDIAL CALCIFICATION
60M, MVA, h/o bypass surgery. CXR done TRO rib fracture.
There is a curvi-linear opacity along the right heart border. This is pericardial calcification. Also seen sternal wires and surgical clips, indicating previous heart surgery.
Pericardial calcification is usually seen in patients with a history of pericarditis, but it can also be seen after trauma and cardiac surgery. In this patient, most likely this happened after his cardiac surgery.
It is most common on the right side and left sided calcification is rare.
The most important task is to assess for signs of constrictive pericarditis.
Clinically, patients will p/w SOB and on examination, JVP is elevated.
On CXR, looks for signs of pulmonary venous congestion - prominent upper lobe vessels, thickened interstitial septa or kerley B lines, peribronchial cuffing and pleural effusion. Most often heart is not enlarged.
KLINIK OASIS SKY AWANI, SENTUL, KUALA LUMPUR, MALAYSIA

SPONDYLOLYSIS WITH GRADE 1 SPONDYLOLISTHESIS36M, c/o backpain on off x 3/12 radiating to both lower limb , especially le...
12/01/2026

SPONDYLOLYSIS WITH GRADE 1 SPONDYLOLISTHESIS
36M, c/o backpain on off x 3/12 radiating to both lower limb , especially left lower limb more pain. no trauma.
X-ray showing L5 spondylolysis (red) and grade 1 spondylolisthesis (yellow).
Patient claimed no trauma – this is possible if patient is referring to major trauma. Spondylolysis is a form of stress fracture. There must be history of repetitive but low stress trauma to the back. The above is a foreign worker, possibly his job involves carrying heavy loads most of the times.
Radiating pain to both lower limbs – L5 nerve roots pass thru between L5 and S1.
L5 dermatome begins in the lower back and radiates into the buttock area, travels down the posterolateral aspect of the thigh, moves to the anterolateral aspect of the calf, covers the dorsum of the foot and the first, second, and third toes, as well as the web space between the first and second toes.
KLINIK UTAMA RANTAU PANJANG (24 JAM), KLANG, SELANGOR.

FAECAL IMPACTION5F, c/o stomachache for few days.AXR showing clumps of faecal matters in ascending and descending colon ...
12/01/2026

FAECAL IMPACTION
5F, c/o stomachache for few days.
AXR showing clumps of faecal matters in ascending and descending colon as well as re**um.
Faecal impaction in children is common.
Faecal impaction occurs when the re**um is full with hard stool and child is unable to evacuate their bowel unaided.
It usually starts with inadequate bowel motion for days, or weeks, and a large compacted mass of faeces builds up in the large bowel which cannot be passed.
Next, spurious diarrhoea occurs. This is when liquid stool leak around the mass. The leakage occurs with no awareness as the urge to defaecate has been lost as a result of the distended re**um.
Most faecal impaction occurs on the re**um but it can also occur in the colon and ileum.
POLIKLINIK TIRAM, ULU TIRAM, JOHOR, MALAYSIA.
https://whatsapp.com/channel/0029VbBo6OYKgsNxHXzyt71H

We had a successful Majlis Khatan with 138 kids circumsized.NR Medical is not just academic but charity as well.
11/01/2026

We had a successful Majlis Khatan with 138 kids circumsized.
NR Medical is not just academic but charity as well.

CALCIFIED UTERINE FIBROID 68F, alleged fall. X-ray pelvis done TRO fracture.There is a 2.5cm calcified mass in the right...
11/01/2026

CALCIFIED UTERINE FIBROID
68F, alleged fall. X-ray pelvis done TRO fracture.
There is a 2.5cm calcified mass in the right hemi-pelvis. This is calcified uterine fibroid.
Why do fibroids calcify?
There are 3 reasons for fibroid to calcify
Fibroids, as they grow, can ‘outgrow’ their blood supply, leading to tissue death and degeneration. Calcium deposits form in the dying tissue, causing it to harden. The larger the fibroid, the more likely to calcify.
After menopause, declining estrogen levels cause fibroids to shrink. As they shrink, they degenerate and calcify
Uterine Fibroid Embolization (UFE): This procedure cuts off blood flow to fibroids, causing them to shrink and calcify as a response to the induced degeneration.
KLINIK HARMONI, DENGKIL, SELANGOR, MALAYSIA.

Dear doctors,Today, God willing, we are making history.Persatuan Doktor Islam Malaysia (Perdim) in collaboration with Ho...
09/01/2026

Dear doctors,
Today, God willing, we are making history.
Persatuan Doktor Islam Malaysia (Perdim) in collaboration with Hospital Beyond Borders (HBB) with NR Medical as major sponsor, are organising majlis khatan in Cambodia. 138 kids have registered. We are supposed to send a team of Malaysian doctors but due to the escalating war, the event will be conducted fully by our Cambodian counterpart led by Dr Roly Yaacob. Lets pray for the success of this event.
I wish to repeat this again in the future and would like to invite volunteers to join us.
Regards
Dr Rahman

SECONDARY SPONTANEOUS PNEUMOTHORAX (SSP)8 year old boy, persistent fever, productive cough with SOB, LOA, LOW x1/12.Ches...
08/01/2026

SECONDARY SPONTANEOUS PNEUMOTHORAX (SSP)
8 year old boy, persistent fever, productive cough with SOB, LOA, LOW x1/12.
Chest radiograph showing cavitating lesions (yellow arrows), pulmonary infiltrates (blue arrows) and left pneumothorax (blue arrows). Changes are consistent with active pulmonary tuberculosis with pneumothorax. Pneumothorax in the presence of lung disease is called secondary spontaneous pneumothorax or SSP.

How does active TB leads to pneumothorax:
- Cavity rupture
- Pleural invasion
- Bronchopleural fistula
In old TB, bullae formed and these can rupture to cause pneumothorax.
Presentations: SSP may presents as active TB or SSP itself as primary presentation. In the latter case, TB work up ought to be done in unexplained pneumothorax.
KLINIK UTAMA MALURI 24 JAM, TAMAN MALURI, CHERAS, KUALA LUMPUR, MALAYSIA.

CERVICAL SPONDYLOSIS58F, c/o neck pain 1/12 associated with numbness bilateral handsCervical spine x-rays showing focal,...
08/01/2026

CERVICAL SPONDYLOSIS
58F, c/o neck pain 1/12 associated with numbness bilateral hands
Cervical spine x-rays showing focal, moderate spondylotic changes at C5/6. Both anterior and posterior osteophytes are present, and C5/6 disc space is reduced. Both uncinate joint spaces are reduced and the margins are sclerotic.
Yellow circle showing a very much reduced C5/6 disc space.
Orange lines showing sclerotic irregular C5/6 end-plates.
Red circle and red lines showing sclerotic uncinate joints.

- What is the possible cause of this spondylosis? The spondylosis is focal, most likely patient had history of trauma before. In aging, changes are more generalised.
- Which nerve roots do you expect to be affected? It’s the C6 nerve roots.
- What dermatome is C6? Side of forearm, down to the thumb. This is where you would expect numbness to be.
- What should you do next? MRI to assess C5/6 disc.
APOLLO MEDICAL CENTRE, TAIPING, PERAK, MALAYSIA

RETAINED SHRAPNEL68M, involved in arm robbery 2 years ago. Robber wanted to enter his shop. He was holding the door when...
07/01/2026

RETAINED SHRAPNEL
68M, involved in arm robbery 2 years ago. Robber wanted to enter his shop. He was holding the door when the robber randomly fired his gun. A shrapnel entered his hand. Now, c/o 3rd MCP joint stiffness.
X-ray left hand showing a 5mm squarish metallic foreign body in the soft tissue of the palm, in the vicinity of 3rd metacarpal head. No fracture or joint involvement.

What is shrapnel? Shrapnel is fragment of a bomb, shell or other object thrown out by explosion.
What is retained shrapnel? Retained shrapnel refers to fragments from explosion that become stuck inside the body after an injury and are not surgically removed immediately.

What should you do? Remove or leave it?
Remove if:
- it is intraarticular
- close to nerves or major blood vessels
- causes significant pain or infection
- associated with chronic toxicity such as lead
Leave it if:
- asymptomatic
- non-critical areas
Many people live for decades with retained shrapnel without issues
KLINIK MENARA, SHAH ALAM, SELANGOR, MALAYSIA.

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