So, I am planning to make this blog a bit interesting by writing some stories about my experience in the wards. It could probably help me in my learning process too.
This week my group was allocated to the Respiratory wards for ward rounds, observing clinical cases and bedside teachings. One thing for sure, we learned a lot from interesting cases that we saw in the clinics and wards.
Most of the cases are due to the presenting complaint of shortness of breath aka dyspnoea aka chuan (Hokkien) aka sesak nafas (Malay) aka uhh..I forgot to ask what does it call in Tamil.
Among the cases that are worth to remember:
1) A 13 year old boy presented to the clinic with shortness of breath and abdominal distension. When X-ray was done, there was a massive tumor (germ cell tumor most probably) compressing the lung and was just next to his heart. Treatment : Surgery was partly impossible due to the critical location, however germ cell tumor responds quite well to radio/chemo therapy.
2) A 49 years old gentleman presented to the casualty with a 1 month history of progressive shortness of breath associated with fatigue, weight loss and a history of chronic recurrent cough. He was initially suspected to having TB, but the sputum smear turned out to be AFB negative. On physical examination, there was prominent scratch marks over his limbs, yellow sclera (jaundice), oral thrush, hepatomegaly and bibasal creps on lung auscaltation. Oral thrush?? Think of HIV! After bronchoscopy being done, the result was PCP (pneumonia). So, when we asked about multiple sexual partner, he said " Sekarang takda, tapi dulu-dulu ada laaa..." *Oo....okeyyy....*. No wonder he was divorced. Err...
3) A 37 year old gentleman presented to the casualty with a history of productive cough with yellowish sputum associated with SOB, night sweats, fever, weight loss and loss of appetite. A typical TB presentation isn't it? He was diagnosed with TB for the past 4 months and he is still on his TB medication. He claims to be compliant on his medication under DOTS because he needs to go to the clinic everyday to get the tablet and the TB treatment card signed. I was just wondering how he got TB so I asked about his occupation and social history. He said he was a lorry driver loading factory's stuffs. When asking about recreational drugs, he said " Dulu pernah la, tapi dah lama berenti..." We then asked, "Ambik apa ek?" he replied "Ganja" aka marijuana. Remember, greater risk of TB exposure includes homeless and IVDU!
Then I peeked on his medical file stating "KES POLIS". He was hospitalised months ago due to violence attack by a stranger and he was stabbed on his head. He never mentioned this to us. Obviously his memory was slightly impaired due to the attack kott or maybe he was in denial state. Yeah then I knew why there were 4 police officers "berkampung" at the corner of the bed observing us carefully when we were examining the patient! Haihss...(=.=)
4) There were quite a few of cases with drug induced hepatitis in TB patient. The liver function is impaired due to TB medication ( especially pyrazinamide ). The side effect usually shows up within the 1st month of medication. However, there was one male patient presented himself to the clinic with the same problem (hepatitis) but not within his 1st month of medication. It was possible that the medication itself causing hepatitis but there should be something else to find out. When asking him about recent travel history, he replied " Amsterdam! " Ouh, need not asking for further questions! (Amsterdam-sexual city-whatever you think he was doing over there-red light district-hepatitis) Bingo!!
There's actually alot to share but I think this should be enough at least for this post. I'll try to share some other stories (if there's any interesting stuffs to share laa...=p~) on next time around.
Ima & me in Klinik Sakit Dada~
Next week : Endocrine Wards!!
p/s I'm actually scared to death of all these infectious diseases ( TB, pneumonia, HIV etcs ). Praying hard that I wont get infected! Precaution..precaution..precaution!