Welcome

This blog is for all things med school. It's my notebook of important things to remember to get you through those 5 crazy years and beyond.

Enjoy

Potentially pathogenic gut flora

We're happy with them in the bowel - not so happy when they get elsewhere.

Escherichia coli - Gram -ve rods
Enterococcus faecalis - Gram +ve cocci (formally streptococcus faecalis)
Pseudomonas - Gram -ve rods
Klebsiella - Gram -ve rods
Proteus - Gram -ve
Clostridium - Gram +ve rods
Bacteroides - Gram -ve rods

Initial treatment:

penicillin + gentamycin or
cephalosporin
+ metronidazole

Just 15 seconds

Quick conversion of pulse/breathing rate timed over 15 secs

BR

2 8
3 12
4 16
5 20
6 24
7 28
8 32
9 36
10 40

HR

10 40
15 60
20 80
25 100
30 120
35 140
40 160
45 180
50 200

Chest x-ray

Name DOB
Date
Previous x-rays
Projection (PA)
Position (erect)

Rotation (check clavicles)
Inspiration (7 ribs)
Brightness (exposure)

Bones
- clavicles
- vertebra
- ribs

Trachea

Borders
- costal
- phrenic (r higher than left)
- mediastinal (size, moguls)

Corners
- costo-phrenic
- cardio-phrenic

Hilum
- left higher than right
- equal size
- lymphatics
- vessels
- bat wings

Lungs

Shadowing
- nodules
- reticular
- alveolar

Septal lines
Kerley B lines
Triangle infarct (PE)
Ring shadows (cavitation)
Plaques
White out
Air outside the lungs

Review of Systems / Functional Enquiry

General/Constitutional

Average weight, weight loss or gain, general state of health, sense of well-being, strength, ability to conduct usual activities, exercise tolerance

Skin/Breast

Rash, itching, pigmentation, moisture or dryness, texture, changes in hair growth or loss, nail changes

Breast lumps, tenderness, swelling, nipple discharge

Eyes/Ears/Nose/Mouth/Throat

Headaches (location, time of onset, duration, precipitating factors), vertigo, lightheadedness, injury

Vision, double vision, tearing, blind spots, pain

Nose bleeding, colds, obstruction, discharge

Dental difficulties, gingival bleeding, dentures

Neck stiffness, pain, tenderness, masses in thyroid or other areas

Cardiovascular

Precordial pain, substernal distress, palpitations, syncope, dyspnea on exertion, orthopnea, nocturnal paroxysmal dyspnea, edema, cyanosis, hypertension, heart murmurs, varicosities, phlebitis, claudication

Respiratory

Pain (location, quality, relation to respiration), shortness of breath, wheezing, stridor, cough (time of day, of productive, amount in tablespoons or cups per day and color of sputum), hemoptysis, respiratory infections, tuberculosis (or exposure to tuberculosis), fever or night sweats

Gastrointestinal

Appetite, dysphagia, indigestion, food idiosyncrasy, abdominal pain, heartburn, eructation, nausea, vomiting, hematemesis, jaundice, constipation, or diarrhea, abnormal stools (clay-colored, tarry, bloody, greasy, foul smelling), flatulence, hemorrhoids, recent changes in bowel habits

Genitourinary

Urgency, frequency, dysuria, nocturia, hematuria, polyuria, oliguria, unusual (or change in) color of urine, stones, infections, nephritis, hesitancy, change in size of stream, dribbling, acute retention or incontinence, libido, potency, genital stores, discharge, venereal disease

(Female) Age of onset of menses, regularity, last period, dysmenorrhea, menorrhagia, or metrorrhagia, vaginal discharge, post-menopausal bleeding, dyspareunia, number and results of pregnancies (gravida, para)

Musculoskeletal

Pain, swelling, redness or heat of muscles or joints, l;imitation, of motion, muscular weakness, atrophy, cramps

Neurologic/Psychiatric

Convulsions, paralyses, tremor, incoordination, parathesias, difficulties with memory of speech, sensory or motor disturbances, or muscular coordination (ataxia, tremor)

Predominant mood "nervousness" (define), emotional problems, anxiety, depression, previous psychiatric care, unusual perceptions, hallucinations

Allergic/Immunologic/Lymphatic/Endocrine

Reactions to drugs, food, insects, skin rashs, trouble breathing

Anemia, bleeding tendency, previous transfusions and reactions, Rh incompatibility

Local or general lymph node enlargement or tenderness. -Polydipsia, polyuria, asthenia, hormone therapy, growth, secondary sexual development, intolerance to heat or cold

Ward Round Notes

1. WR - people present
2. Reason for admission
3. Subjective - how is patient feeling
4. Objective - impression
5. OE
6. Plan

Reference Ranges

Trop T 0.01-0.09 suspicious >0.1 high