electives day 4

thursday.

things of notice

• always weigh patients on follow-ups
  this is to monitor patient's diet and metabolism, some diseases have a wasting pattern e.g. thyrotoxicosis
• Always ask risk factors e.g. smoking, alcoholism etc - to be able to give advice and grade risk upon lifestyle
• not advised to take blood from the wrist - painful.

things observed

• patient with severe pulmonary hypertension, LV function
• patient with iatrogenic hypotension - patient presented with treatment history of medically treated urolithiasis (a-antagonist) hypertension, (diuretics) and he experienced postural hypotension - dizziness when standing up. when he was allowed to take BP at home, his BP was found to be below 110/70, although his BP at clinic was 160/100. he has white-coat HTN, and the previous doctor did not recognize that. diuretics was cut off, and his symptoms disappeared.
• patient with benign ectopic ventricular beats. - ectopic ventricular systoles are differentiated benign/malignant by stress-ECG. if the sinus rhythm overrides the ectopic beat at hightened Pulse rate, then it is benign.
• gross cardiomegaly - heart enlarged more then 70% of chest transverse diameter. apex displaced to mid-axillary line. patient had dilated cardiomyopathy, probably from alcoholism. he had gross pedal edema which caused cellulitis.