Cutaneous Manifestation of Hepatitis C

Resource: http://emedicine.medscape.com/article/1134161-overview
http://www.medscape.com/viewarticle/548006_4

I have seen a patient today with a history of Hepatitis C. The lesion is located inferior to the right medial malleolus. Itchiness and clear discharge due to scretching of lesion was mentioned by patient. No obvious erythema noted except for some purpura over the skin.

Differential Diagnosis:
1) Prurigo nodularis
2) Acral necrolytic erythema
3) Cryoglobulinemia (Leukocytoclastic vasculitis)
4) Erythema nodosum
5) Erythema multiforme
6) Porphyria Cutanea Tarda (Least likely due to the fact that it required sunlight to cause symptom)

Family Medicine

https://www.med-ed.virginia.edu/CourseSites/quiz/quizsheet.cfm?keywordID=1999&CourseID=19&num=1&start=1&noindex=1
http://www.gpnotebook.co.uk/homepage.cfm
http://fmclerkship.mc.duke.edu/student/commprob.html
http://www.hmc.psu.edu/ume/fcmonline/
http://www.sh.lsuhsc.edu/fammed/OutpatientManual.htm
http://www.nlhep.org/books/pul_Pre/intro-plpr.html

I come across 2 women the other day and domestic violence was brought up between conversation before they broke out into tears. Helpless as I can say and I think I can do more for them. SAFE questionnaire and Abuse Assessment Screen (AAS) can be used to access the situation.

Common stuffs in FM:
1) Post-nasal drip
Post-nasal drip is mucus accumulation in the back of the nose and throat leading to, or giving the sensation of, mucus dripping downward from the back of the nose. One of the most common characteristics of chronic rhinitis is post-nasal drip. Post-nasal drip may lead to chronic sore throat or chronic cough. Post-nasal drip can be caused by excessive or thick secretions, or impairment in the normal clearance of mucus from the nose and throat.
2) Skin Problems
Scabies and tinea. http://www.medicinenet.com/ringworm_pictures_slideshow/article.htm A good website with slideshow showing you a list of tinea problems. One thing good to know is that it is NOT a problem with WORM, but it's a fungus problem. The word that comes after tinea dictates which part of the body it is occuring. I think you know it already. Scabies, big thing. 5% permethrin preparation should do it.
http://dermatlas.med.jhmi.edu/derm/
3) Osteoporosis
http://www.medpagetoday.com/Endocrinology/Osteoporosis/4247http://www.webmd.com/osteoporosis/features/soda-osteoporosis Interestingly, scientists are trying to link osteoporosis with consumption of soft drink. Theory-wise, it's linked but there are still a long way down the road to proof the connection.
4) http://www.mhhe.com/socscience/hhp/fit_well/web15/

Cancer Screening

http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer

I guess this link will provide you a knowledge on cancer screening:
American Cancer Society Guidelines for the Early Detection of Cancer
The American Cancer Society recommends these screening guidelines for most adults. Good to know so that you can get up-to-date information.

Enjoy reading'em.

My Ob Gyn

www.permanente.net/homepage/kaiser/pdf/6289.pdf
https://secure1.csmc.edu/nicu/cbg/ (Cord gas)

This is a good article talking the difference of level 1 ultrasound and level 2 ultrasound. Still have a lot of readings to do and assignments to complete. Got to hasten my pace.

http://www.gentlebirth.org/archives/dic.html

This is an article about DIC in pregnancy. I witnessed a patient with this condition. Was transferred to ICU and was well taken care of. Let's not forget that there is a possibility that a mother will get into this condition during pregnancy.

Golden phrase from Jefferson

Below listed are the phrases I got from today's orientation:

1. Don't ever ask questions that you can look up the answers.
2. Never pimp another student in front of team.
3. Never answer question directly specific to another student. Wait for your turn.
4. If you are asked a question, even if you do not the answer, make sure you reason them "out loud"
5. Always be within or easy contact with residents. Observe also what the residents are doing.
6. Check patient often!
7. Appear interested all times!
8. Think "How can I make my resident's job easier?" e.g. discharge summaries, scripts, pre/post-ops checks
9. Do not get caught in race for information with fellow students

Journals:
1. Periodically bring respected journals e.g. NEJM, JAMA
2. Read whole article and make an intelligent sentence or 2 summing them up
3. Do not overdo a.k.a. overkill (one to two times per week will be good)
4. Do not print and distribute to whole team

Presentation:
1. Handouts for all
2. Appropriate presentation
3. Practice before you give presentation
4. If information is split among teammates, NEVER present information someone was assigned to

Handheld/Smartphones:
Do not use them in rounds unless looking for drugs. Resident will think you are playing games. You are warned!

If you are absent in rotation, call the clerkship coordinator or resident on team.
Nurses are your biggest ally. DO NOT SLEEP IN ROTATION!