Ward Round Notes

Lung cancer is one of the most common malignancies worldwide, but has one of the poorest outcomes as 2/3rds of patients present late with the disease. Given this it is important to be vigilant of the possibility of lung cancer in patients. Patients with lung cancer may present with r espiratory symptoms , with worsening chronic disease such as COPD, with symptoms suggestive of malignancy without symptoms specific to the respiratory system, and occasionally with other symptoms which are neither respiratory or point to a malignancy. NICE guidelines suggests that an urgent chest x ray (within 1 week) should be considered for the following symptoms: Haemoptysis Persistent (+3 weeks) cough Persistent shortness of breath Persistent chest signs Persistent hoarseness Persistent weight loss Persistent clubbing Persistent cervical lymphadenopathy Persistent chest or shoulder pain (think of pancoast tumours) Persistent signs or symptoms suggesting metastases such as bone pain...

patients with diabetes are at increased risks of developing peripheral arterial disease and peripheral neuropathy, which commonly affects the feet causing secondary problems such as ulceration or joint deformities. Diabetic neuropathy is thought to affect 16-26% of patients with diabetes, 2.2% of diabetics will present with foot ulcers annually, increasing to 7.2% in patients with neuropathy. the incidence of amputations is around 0.5-5 per 1000 of people with diabetes. Risk factors Risk factors for developing peripheral neuropathy includes increased age, increased periods of poor glycaemic control, increasing time since hyperglycaemia first occured, smoking, hypertension and ischaemic heart disease. Risk factors for peripheral ischaemia includes smoking, hypertension and hypercholestrolaemia.

Diabetes is characterised by chronic hyperglycaemia caused by increased insulin resistance or reduced insulin release.  Aeitiology:  Diabetes may be primary or secondary. The main types of diabetes include type 1 diabetes, type 2 diabetes, secondary diabetes, and gestational diabetes. This post mainly discusses type 1 and type 2 diabetes. The main differences between type 1 and type 2 diabetes are summarised below:  Type 1 diabetes Type 2 diabetes Caused by the autoimmune destruction of B cells in the islet of Langerhans. Caused by increased peripheral insulin resistance and reduced insulin secretion. Tends to present before puberty, but may present at any age. Tends to occur in patients above 40 but increasingly affects younger individuals. Polygenetic, associated with inheritance of HLA types: HLA-DR3 and HLA-DR4. Associated with other autoimmune conditions. Polygenetic ...

Non pigmented skin cancers (click to enlarge)

Some respiratory diseases seen in children (click to enlarge)

Type Names Main diseases HHV – 1 Herpes simplex virus 1 Genital herpes Oral herpes Herpes simplex eye infection and enchephalitis Cold sores HHV - 2 Herpes simplex virus 2 Genital herpes Oral herpes Herpes simplex eye infection and enchephalitis Cold sores HHV- 3 Varicella zoster virus Chicken pox Shingles Ramsay hunt syndrome HHV – 4 Epstein Barr virus Infectious mononucleosis (glandular fever) Linked with burkitt’s lymphoma, hodgkin’s disease B lymphoproliferative disease, X- linked lymphoproliferative syndrome, nasopharyngeal carcinoma and oral hairy leukoplakia. HHV – 5 Cytomegalovirus Assymptomatic in immunocompetent people but can affect multiple organs if it manifests. Mononucleosis syndrome (febrile illness, impaired liver function and s...

Definition:  Pneumonia is the inflammation of the terminal bronchioles and alveoli, characterised by consolidation of the affected part by inflammatory cells, exudate and fibrin. Pneumonia is most commonly caused by infection. Community acquired pneumonia is defined as pneumonia presenting in the community or in the first 2 days of hospital admission. Pneumonia occurring after this time is more likely to be hospital acquired and caused by a different set of mircoorganisms.