As part of continuous assessment for this module, we have to prepare and present a case to the Module Head.
Due to my apparent silence in hospital rounds since everybody knows that I can actually speak in public, my wonderful clinical group (I do love them :P) informed me that I would be presenting if we were selected.
We got selected, but then I kind of had an idea we would.
This is the gist of our patient. Bear in mind that it is not a particularly rare or strange case. This exercise served to teach us how to present a case, as we shall be doing so for the rest of our careers.
Mr J. P, 43 year-old male:
- Any time of day but worse at night
- Productive, yellow
- No haemoptysis
- Severe drenching night sweats
- Grade III
- SOB after minimal exertion, rest alleviates
Paroxysmal Nocturnal Dyspnoea
Weight loss: 10kg since August 2010
Previous medical history:
- Known hypertension
- TB treatment – no reaction
- “Pills” for suspected asthma
- No allergies
- Polio as a child
- No known family history of disease
- Lives on a farm in a house
- Three children and wife healthy
- Worked on open coal mine for three months many years ago.
- No exposure to gold or asbestos
- Currently employed on fruit farm and works with pesticides
- Previous smoker: 5 pack years
- Weekend use of alcohol – no abuse
- Ideas: something on the farm caused his “asthma”
- Expectations: to alleviate his symptoms so that he can go home
- Fears: none
- Respiratory distress – use of accessory muscles
- Severely clubbed
- Peripheral oedema
- Median sternal scar from stab wound six years ago
- Rib retraction
- JVP not visible due to accessory muscle use
- Hyper-inflated, stiff chest
- normal apex beat: 5th intercostal space MCL
- central trachea
- normal lung percussion
- normal heart percussion
- liver displace but not enlarged: 6th intercostal space
- slight bilateral wheeze, lower lobes
- fine bilateral crackles
- normal S1 and S2, S2 slightly loud, no murmers
No significant findings on GIT examination.
Differential diagnosis (made by the real doctor:
- occupational asthma
- Type II Respiratory failure
Treatment as prescribed by Mr J.P’s doctor:
- HCTZ [diuretic for associated cardiac effects due to Respiratory Failure]
- ACE inhibitors [for high blood pressure]
- Theopylline [for asthma, COPD not suspected]
- Cimetidine [for heart burn]
- Heparin [anticoagulant, possibly for polycythaemia due to decreased oxygen]
So that is our patient. I didn’t feel that we did so well, but the lecturer gave us some of the best feedback she had given all day. Her reasons were that we presented in a very systematic manner and didn’t use any redundant facts or expressions.
That felt good. I got a lot of compliments since I did all the talking, but to be honest, I spoke well because the slide-show and write-up were so well done by the whole group. I enjoy this whole co-operation thing!
On a side note, we visited Mr J.P. yesterday and because I tend to daze off a bit I didn’t know that we were going back to a previous patient. I kept thinking, “This sounds so familiar.” Only when we checked for his pedal pulses and for pitting oedema and I saw his brown socks did the switch in my head click and I realises that I had seen him before. I felt terrible. I never want to be one of those doctors who can’t remember patients’ names.
There you have it. Not necessarily exciting but definitely a good learning experience (and an ego-booster). Unfortunately the life of a medical student can be rather mundane at times. :)