1) Today my friends and I practised CNS Examination on a patient who was admitted to the Ward with complaint of slurred speech and right-sided body weakness. He had distal weakness and facial asymmetry. We tested him for Babinski Sign but he kept on laughing, I wasn't sure if the result was positive or not.
2) A Year 5 Brother who happened to be in the Ward with us taught me and Aina briefly on how to do Hands Examination (Rheumatology). He mentioned that we should read more on Rheumatoid Athritis, Osteoarthritis, Gouty Arthritis, Spondyloarthritis and Dermatomyositis.
3) Our friend told us about the topics often asked in exam: Murmur, Asthma, Pneumonia, Bronchiectasis, Hepatosplenomegaly, Kidney problems, CNS and Rheumatology Examination.
4) Short Case session with Dr.Anis Shah was very informative. He asked us to examine a patient with AECOAD, the one who wears a pacemaker. We could hear vesicular breath sound with prolonged expiration and rhonchi on both lungs.
These are the things I've learned from him:
x Acute causes of SOB - Asthma, MI, Pneumonia, Pneumothorax.
x Chronic causes of SOB - Pulmonary TB, Bronchiectasis, Heart Failure, COAD
x Symptoms that we must ask if patient has SOB - Cough, Palpitations, Chest Pain
x Ecchymosis > Purpura > Petechiae
x Causes of tachycardia - Anxiety, Fever, Pregnancy, Respiratory distress, Arrhythmia, Shock, MI, Heart Failure, Pulmonary Embolism, Hyperthyroidism.
x Grades of Clubbing:
Grade 1 - Increase fluctuations in nail bed (difficult to detect)
Grade 2 - Straight line of nail bed, loss of angle
Grade 3 - Increase curvature of nails from side to side (parrot's beak)
Grade 4 - Tissue hypertrophy, swollen terminal phalanges (drumstick appearance)
5) My patient was discharged from the Ward yesterday. This evening, I asked for his Case File from the Staff Nurse only to discover that the file had been dispatched to the Record Office. Obviously I was too late.
My Clerking Note is already half completed, I just want to check the Management Plan!
Now I need to find a new patient. This time, I'll keep in mind to read the patient's Case File thoroughly and complete my Clerking Note right after I interviewed the patient.