A further elaboration of the art of history-taking

There are two forms of history-taking: that which the disease is known ("please take a history of this patient's diabetes mellitus") and that which the disease is unknown ("this gentleman is short of breath").
If the disease is known we use the D2FMC3 framework outline previously.
If unknown we use the method we most commonly use. My variation of this method will be outlined below:
First we clarify the symptoms and find out what the patient means. Most time the use the words wrongly or imprecisely.
Then we find out the duration.
Then we determine the history of presenting illness. For me there are two components: the character of the symptoms and the differentials.
For the character I use OPPA:

1. Onset
2. Progression
• frequency
• severity
• timing
3. Previous similar symptoms
4. Aggravating and alleviating factors

Then depending on what the symptoms are I will ask further questions. For example for pain, I will ask the character, site, and radiation.

The illustration is seen here.

Systems Review in Kayan

I would to thank my student Cristal Asong for getting her parents to help me with this. May it be of use to people. The Review of Systems in Kayan.
Below are also the Review of Systems for:

1. Iban
2. Bidayuh Bukar-Sadong
3. Melanau

So I would have the review of systems for most of Sarawakian languages but so far I haven't had much luck with the Sabahan ones.

Name change

If you noticed, it is no longer Klang Hospital House Officers' Resource Centre but University Hospital Students' and House Officers' Resource Centre because I left Klang almost 3 years ago.

Sodium Correction Calculation Formula

This is the calculation for sodium correction:

Formula One:

[Na]_serumold(Total Body Water)+[Na]_infusion(Volume Given)=[Na]_serumnew(Total Body Water+Voume Given)

Formula Two:

ΔNa=[Na]_serumnew-[Na]_serumold

Rearrange Formula Two:

[Na]_serumnew= ΔNa+[Na]_serumold

Replace Rearranged Formula Two into Formula One:

[Na]_serumold(Total Body Water)+[Na]_infusion(Volume Given)= (ΔNa+[Na]_serumold)(Total Body Water+Voume Given)

Expand:

[Na]_serumold(Total Body Water)+[Na]_infusion(Volume Given)= ΔNa(Total Body Water)+ ΔNa(Volume Given)+[Na]_serumold(Total Body Water)+[Na]_serumold(Volume Given)

Rearrange all with variable (Volume Given) to one side:

[Na]_infusion(Volume Given)-[Na]_serumold(Volume Given)-ΔNa(Volume Given)= ΔNa(Total Body Water)-[Na]_serumold(Total Body Water)+[Na]_serumold(Total Body Water)

Cancelling and grouping variables:

([Na]_infusion-[Na]_serumold-ΔNa)(Volume Given)= ΔNa(Total Body Water)

(Volume given)= ΔNa(Total Body Water)/([Na]_infusion-[Na]_serumold-ΔNa)

In Sarawak Handbook variable ΔNa was rearranged to one side:

ΔNa(Total Body Water)+ΔNa(Volume Given)=[Na]_infusion(Volume Given)-[Na]_serumold(Volume Given)

ΔNa(Total Body Water+Volume Given)=[Na]_infusion(Volume Given)-[Na]_serumold(Volume Given)

ΔNa=[Na]_infusion(Volume Given)-[Na]_serumold(Volume Given)/(Total Body Water+Volume Given)

Volume Given was assumed to be one litre so replacing “Volume Given” with 1 giving:

ΔNa=[Na]_infusion(1)-[Na]_serumold(1)/(Total Body Water+1)

ΔNa=[Na]_infusion-[Na]_serumold/Total Body Water+1

A YouTube Channel

On and off there will patients with good signs that I will show my students. Unfortunately this a generate an avalanche of students visiting a patient who is already ill. By recording the signs I hope to be able to show the signs without harassing the poor patient. The channel is at UM Clinical Skills or https://preview.tinyurl.com/yau8d9nq.

Short algorithm for communication skills

The communication skills station for PACES can be daunting but at the end of the day it is surmounted by a series of basic techniques techniques. This is my personal algorithm.

A little guide to ECG

Dear Friends,
This is a little guide for identifying ECGs. Just follow from the beginning to the end. What I did was just group the criteria together.
ECG guide