From Seniors Accounts, Class of 2011
Me: Mdm, what medical problems do you have?
Pt: first, i had loss of appetite
Me: ok..................... can you tell me your other medical problems? (i was trying to get her to tell me her other co-morbids so i would have a rough guide on how much time to spend on each, but auntie didn’t get my drift)
Pt: then i had loss of weight
*oh crap... had sinking feeling already*
Me: oh as in, do you have diabetes, hypertension, hyperlipidemia, heart disease, asthma? any past surgeries?
Pt: none
*felt relieved. but not for long*
Pt: then both my hands numb, then leg swollen
*zomg* ?!??!?
Me: ok the leg swelling, one leg or both legs?
Pt: right leg more swollen than the left
*….........................*
Pt: then i had constipation, then shortness of breath, then felt tired, then after i went to see my gp, he told me to come hospital, and the doctors at the hospital said i was YELLOW
*zomgggg*
* * *
Then ask about management: scope done? What does it show and which part of the intestine involved? At this point the mother said small plus large intestine and I shouted out Crohns right?!? She finally admitted and I pat my own back mentally. I asked about steroids use and side effects of steroids. She also told me about sulfusalazine and 6mp! I really did not know what is 6mp.
On hindsight, maybe I should have joked with her 6mp? the doctor gave u a 6mp camera issit. lame. It is mercaptopurine, an immunosuppressive drug used for IBD, non hodgkin lymphoma, psoriatic arthritis etc.
What are the differentials for acute kidney failure in this man? (he had been previously admitted for episodes possibly linked to either his CLD or DM nephropathy)
I said Hepatorenal syndromes 1/2 and they seemed to be appeased. Know some impressive shit like Hepatorenal syndrome to tickle your examiner’s balls. They probably won’t know more about it than you do so can chillax and bask in the glory of your 7-syllable diagnosis.
* * *
15 year old chinese boy who looks like he is 10 years old. I was pretty surprised when told his age. Then I started to ask about presenting complaint. I was totally hoping for a asthma and was quite sure he is one with steroids toxicity plus plus. But my balls shrunk when mummy said he had diarrhea a few years ago. I really never thought I would get things like GE, functional abdominal pain or my worst nightmare IBD! I got one such case before in an EOPT and totally flunked it. And the day before I was furiously mugging paeds when i came across this topic and I said to myself, screw it, how likely is lightning going to strike twice? I guess the MBBS is really an astounding combination of all our previous karma and the idiosyncrasies of lady luck.
I wished I had helped a few more old ladies cross the road. i muttered an audible obscenity which the boy caught and looked very pleased.
Then I proceeded to give him a tutorial on IBD when I realized the indian guy (examiner) was reading from a set of pre-prepared questions and points. That showed he probably did not know IBD very well. So I started my first menthols light of my life. On endoscopic visualisation UC involves certainly rectum, plus colon. It is a mucosal and submucosal thing and show crypt abcess, pseudo polyps , cobblestones and longitudinal fissures. the lesions are continuous. Crohn’s is transmural and has skip lesions and strictures and fistulas and bah bah bah. UC more likely to bleed and Crohn will show non-caseating granulomas. I spoke real fast so that he will hear the terms and even if I make a mistake he will not be so likely to catch it.
Koh Pei Ling was looking amused and nodding furiously by this time which the Indian prof was frowning as he tried his best to coordinate his eyes and ears.
