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long case with Dr S

(patient was very drowsy during history taking, one thing u ask, a word came out, so it took longer taking history, and patient not much cooperative as well)

50 M/M restaurant manager D8 admission
k/c/o HPT, DM and heart failure
c/o loss of consciousness on the day of admission
occur in the car in the evening
preceeded by palpitation, sweating and lethargy
denied chest pain, shortness of breath, vomiting
denied aura, seizure, fever, headache, neck stiffness
claimed taking lunch prior to LOC
claimed compliant to medication

PMH DM, HPT x 3 years heart failure x 3months

FMH of IHD and stroke

SH Smoker 30packs years

O/E alert, conscious, tachypneic on NPO2, good hydration, obese type 2
pallor, pulse irregularly irregular, JVP not raised, bilateral pedal edema
precordium: apex beat displaced, no parasternal heave or thrills, s1 s2 heard with no murmur, bibasal crept detected with no hepatomegaly or ascites

dx: ccf

ix:
ECG
CXR
CE
FBC
BUSE
RBS

Mx:
ABC
IV diuretics
ACE-i
ARB
b-blocker

NB: there's much to tell but hard to convey, this is my time, maybe tomorrow, someday who knows there'll be yours, just get better and better k!

Short case with Dr C R:

Dr C R: patient has progressive shortness of breath, examine respi system

general:
elderly chinese male tachypneic with NPo2 dehydrated, cachexic, branulla and cbd attached
pallor and clubbing, but no jaundice or cyanosis
no nicotine staining no HPOA no flapping tremor
pulse was 72b/min regular and good volume
no injection marks, no BCG scar, no raised JVP
left horner's syndrome, good oral hygiene, trache deviated to the left,
2FB tracheal tug, multiple cervical lymphadenopathy, pitting pedal edema up to mid shin level
chest:
pectus carinatum, no dilated vein, no scar,
chest expansion reduced on left side, dullness at left middle zone, stony dullness bibasally, otherwise hyperresonance, tactile fremitus and vocal resonance almost equal bilaterally, reduced air entry on the left side middle zone, vesicular breath sound heard with generalized crepts

dx: lung collapse secondary to lung carcinoma with underlying aecoad and pleural effusion

what u need to know?
1. causes of tracheal deviation ipsilaterally - fibrosis, lung collapse
2. features of fibrosis - dullness and increase vocal resonance and tactile fremitus
3. features of lung collapse - dullness and normal vocal resonance and lung collapse
4. causes of lung collapse - malignancy: obstruction of bigger airway leads to collapse of distal airway, TB: big hilar lymphadenopathy leads to blockage of proximal airway, bronchiectasis: obstruction by copious mucos in the airway
5. pleural effusion and pneumothorax cannot cause lung collapse because it only compress the lung externally and yet lung still can expand a little

Re-exam short case with Dr A S:

examine cvs (another patient with heart failure)

almost same questions were asked but with some additional questions:
1. right sided heart failure features
2. left sided heart failure features
3. copd causing heart failure - right congestive heart failure, not both side congestive heart failure
4. causes of heart failure - thyrotoxicosis, anemia, ihd,hypertension, valvular heart disease, infection, pregnancy, cardiomyopathy
5. causes of hypertrophic cardiomyopathy
6. causes of dilated cardiomyopathy
7. causes of atrial fibrillation
8. causes of irregularly irregular pulse
9. causes of syncope
10. causes of LOC
11. relation between heart failure and arrhythmia (pathophysio)
12. explain vasovagal syncope
13. explain cardiogenic syncope
14. classification of obesity
15. treatment of heart failure both in stable and acute onset
16. mech of action of betablocker
17. mech of action of digoxin
18. side effect of betablocker
19. side effect of digoxin
20. mech of action ACEi
21. side effect of ACEi
(reminder: i did give 4-5 answers for each Q yet still not enough, maybe at least 10 answers would satistify them, wondering how much medical student's brain can remember multiple systems with thousands of pathology with millions of etiology and drugs to remember, in my point of view if u can remember at least one is fine, about 5 is good enough and 10 of those is superb)
Study hard guys, dont be like me ^^

this is link for some dialogue during my long case(for those who wants to know only)
Category: 5 comments

5 comments:

Qarnikuri said...

gile ar.. punye byk soklan ko jwb, still dia bg 47??????

mgkin dr ingat 47/50 so 94%

Anonymous said...

fuh fuh.. penatnye nak baca soalan...nak jawab tentu lagi2

pezol said...

fighting...

N_MAM said...

byk2 kan solat hajat... doa byk pada tuhan semoga Allah berikan yg terbaik.... sedikit sebyk, Aku paham ape yg ko lalui...

bolapi87 said...

wish me luck, insyaallah we all pass^^

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