Wardround 27ii9

The two minute talks on Gram positive cocci and gram negative bacilli were well researched and presented.You should now have a structure to help choose an appropriate antibiotic regime. We will test this on the ward rounds over the coming weeks. Dr Jones has also asked for a brief on the use of Tigecycline and Daptomycin for next week

The paper for discussion next Tuesday is Unburdening the Difficult Clinical Encounter, Kurt Kroenke, Arch Intern Med 2009;169 333-334.

Friday will be you opportunity to shine while solving the Plague of Athens.

Interesting Topics:
Nutritional support in chronic liver disease
Aortic stenosis

MJM

Wardround 20ii9

Good efforts in your talks about thrombolysis. I would like you to make the talks more specific and precise. Tell us the actual evidence, precise numbers and sources. Don't waste time with introductions or telling us stuff we all know already. Make the two minutes count. Let's have the re-hashed talks on thrombolysis on Tuesday.

The assignment for Friday is to produce a diagnosis of the illness in Athens described by Thucydides in 431 B.C. in The History of the Peloponnesian War . If you click on the link it will take you to a copy of the piece. The web page begins with chapter VI, but you can skip down to chapter VII (unless you would like to read about the war). If you cannot find the right section, press ctrl-F and type in plague.

You need to have an opinion on the diagnosis and be prepared to argue your corner. Make sure you revise the signs and symptoms of the disease you choose. Your two minute tutorials could be on some aspect of your chosen disease.

MJM

Wardround 6ii9

The reading for discussion on Tuesday is Aunt Sophie’s Choice: the perils of paternalism. Schafer A.

The two minute talks this week were about abscesses. Good talks which I hope you found helpful. Remember the basics: consider the types of organisms that are possible, which will be altered by travel and immunocompetence. Always, ALWAYS, have your own plan in mind when seeking advice, then make sure you understand why any new plan differs from your own.

For nest week the two minute talks will be Neurology: recognising and understanding the following as causes of impaired walking:
Amyotrophic lateral sclerosis
Myelopathy (Dr Teo)
Peripheral neuropathy (Dr Jani)

Two minutes only. Be concise and precise. Quote your sources.

Interesting Topics

Benzodiazepine withdrawal exacerbated by quinolones (papers in patient's notes)

MJM

Wardround 30i9

The reading for Tuesday will be "Human guinea pigs"--a history. M H Pappworth. BMJ 1990 December 22; 301(6766): 1456–1460. Read and think.

This week's talks were about clinical assessment of parietal lesions, cerebellar dysfunction and differentiating bulbar and pseudobulbar palsy.

To simplify things, I like to think of parietal dysfunction as Motor: Dysphasia (dominant) and Dyspraxia (non-dominant); Sensory: Inattention and astereognosis. (The inability to recognise a deficit is called anosagnosia). I had not come across cerebellar DASHING before, and being stuck in my ways I will be keeping to DANISH. Pseudo and true bulbar palsy have many subtle differences, I would concentrate on tongue wasting with fasciculation and absent gag in bulbar palsy and increased jaw jerk and choking episodes in pseudobulbar disease.

For Friday, the assignments as two minute talks are Abscesses: contributing factors, organism and treatment. Choose among yourselves which sites to talk about from:
Brain
Liver
Psoas
Empyema (not an abscess, I know)

Interesting topics

Dyspraxia

Arteria Lusoria, see here for diagrams of the anatomy, and NEJM Volume 346(21), 23 May 2002, p 1637 for a case report.

MJM