Ward Round Notes

Grade 1 - heard by specialist in optimum conditions Grade 2 - heard by non specialist in optimum conditions Grade 3 - Easily heard no thrill Grade 4 - loud murmur with thrill Grade 5 - very loud heard over wide area with thrill Grade 6 - Murmur heard without stephoscope Douglas G, Nicol F, Robertson C, Macleod's clinical examination 12th ed . Edinburgh, churchill livingstone, 2009. 

Persistent hyperkalaemia (above 7mmol/L) Acidosis - pH less than 7.2 or base excess over 10 refractory pulmonary oedema Uraemic encephalopathy Uraemic pericarditis High catabolic state with progressive renal failure Reference Longmore M, Wilkinson IB, Davidson EH, Foulkes A, Mafi AR, Oxford handbook of clinical medicine, 8th ed. Oxford, Oxford university press, 2010. 

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.

Ulcerative colitis Definition: Ulcerative colitis (UC) is a relapsing and remitting inflammatory condition of the large bowel, with unknown aeitiology. Ulcerative colitis is moderately common with a prevalence of 100-200 per 100 000. It is 3 times more common than crohns, and is more common amongst Caucasians, and tends to affect women more than men. It has a bimodal distribution, most commonly affecting people between the ages of 15-30 with a smaller peak between 55-65. Risk factors: ·       Ulcerative colitis is thought to be autoimmune ·       Family history of parent, children or sibling with ulcerative colitis increases the risk of an individual developing it. ·       Smoking is protective in ulcerative colitis, and UC is 3 times more common in non smokers.