Clinical Years scribbles

Hello and welcome to a little segment where I just write about things I have learnt during my clinical years. Some of these little notes are very important to me and some have helped inspire me. These are the scribbles i've written down taking home the messages of heroes, lecturers, and doctors over the years. Take care and enjoy :).


#1
Dealing with a Difficult Patient. (NURSE)

N = Name the emotion. [anger? sadness?] [worry? anxiety?]
U = Understanding the emotion of the patinent
R = always Respect the patient
S = Support [by listening, setting up appointments]
E = Explore/Empathize

#2
Pregnancy

HTN --> do not give ARB, ACEi, statins [teratogenic]. Safest bet is labetolol & methyldopa
DM --> Safe OHA are metformin & gibleclamide. Should also start folic acid.
IUCD --> Safe for DM patients if glucose controlled. Unlikely to get infection.
Theraputic Lifestyle changes --> exercise 20mins/day, total 150/week. But can cause hypo if on insulin therapy.

#3
Ward Round With hero 2

LBBB is always pathological
Unilateral tender leg swelling --> Top 3 diffrential = 1. DVT 2.DVT 3.DVT.
Lymphatic edema is a diffrential (non-pitting edema)
Should do Well's Score when suspect DVT.
Doppler and D-dimer should be done. [high sensitivity]
In patient with gout/RA develop calf swell and pain ---> Ruptured Branchial Cyst

Pruritus
Local = fungal, scabies, lichen planus
Systemic = Liver, obstructive jaundice, CKD, DM, hyperthyroid, drugs, CHF. Pregnancy in young ladies.

CKD
Normally ARB should reduce proteinuria but can be bad for kidney. Thats why must do baseline RP and compare 3 weeks later. If increase 30% then must stop.
Renal Artery stenosis can be fibromuscular dysplasia (young ladies) or atherosclerosis