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My Short Case IM with Dr. H

Dr: I want you to examine the pulse of this patient and tell me your findings

Me: 76 beats per minute, irregular rhythm, normal character

Dr: What type of irregular rhythm? Irregularly irregular or regularly irregular?

Me: Irregularly irregular

Dr: What do you mean normal character?

Me: There is no bounding pulse,...

Dr: (muka berkerut) You said irregular irregular rhythm, how can it be normal in character?

Me: Oh, abnormal character.

Dr: What about the volume?

Me: Sometimes low, sometimes high volume.

Dr: Ha, so, inconsistent volume means NOT normal character right. What do you think the patient has?

Me: AF

Dr: What else do you want to look for in this patient?

Me: Pulse deficit

Dr: OK what else?

Me: Errr...

Dr: What else??? What happens to the a wave of JVP? Absent or present?

Me: (hentam) Absent a wave

Dr: OK. You can proceed by examining the heart sounds. Auscultate only.

Me: On auscultation, 1st and 2nd heart sounds were heard, with a mid-diastolic murmur loudest heard at the mitral area, getting louder on expiration. There is no radiation and the grade is 3.

Dr: 3 over what? 10?

Me: 3/6

Dr: Are sure? How many gradings are there for a diastolic murmur?

Me: 6

Dr: Are you sure?

Me: Errr..(dalam hati: salah ke?) not sure

Dr: Then why you answer 6? There is actually 4 gradings of diastolic murmur. 6 is for systolic murmurs

Me: Ohh, (Dlm hati: Ye ke? Tak pernah terbaca pun)

Dr: So what murmur does the patient have?

Me: Mitral stenosis

Dr: What do you think may be the cause?

Me: Congenital (sebab patient mcm muda lagi je)

Dr: (berkerut – tanda tidak setuju dgn jawapanku). You say it’s congenital. I say it’s not. What else may be the cause?

Me: Rheumatic heart disease, infective endocardotis

Dr: Ok, what else?

Me: (Em, apa lagi ek cause MS?) Err...

Dr: What else can cause this condition?

Me: Oh, the cause of AF ke? Thyrotoxicosis.

Dr: Do you think this patient has thyrotoxicosis?

Me: Not really.

Dr: What else?

Me: (sebut jelah semua – ada yg Dr setuju, ada yg Dr tak berapa setuju sbb unlikely in the patient, but sebut jelah semua yg tau...) MI, HPT, pneumonia, etc...

Sekian... Harap bermanfaat..

Category: 2 comments

2 comments:

Qarnikuri said...

Cerpenot (nota berbentuk cerpen)

Anonymous said...

thank you so much, ur 'cerpenot' helped me in my LC examination... thanks!!

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