Interesting Chest Xray (5)

This is an interesting one to share.
What do you see in the CXR? Dextrocardia? Or deviated trachea?

(Answer's in comment)


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Skin Case

I'm doing my dermatology attachment now and it'll be 4-month duration. I think it's good that you can be rotated to different subspecialties and to strengthen your clinical experience on that particular field. For most physicians, dermatological diseases are diagnostically challenging and consultation to skin specialist are usually needed.

I got this referral the other day and I think it's interesting to share.
She's a lady presented with generalized pruritic rashes for 2 days, associated with fever. The rashes were initially erythematous, then became pustular 1 day prior to admission. Further history revealed that she had some URTI symptoms about a week ago and she visited GP for treatment.


Skin rashes was extensive and also involving oral mucosa. Blood investigation showed neutrophilia.

From the much simplified history and the pictures, what do you think is the diagnosis?

(Answer's in comment)

You Have a Dream?

Thanks to Susan Boyle, I guess we have once again witnessed how powerful a dream can be. "Never judge the book by its cover" is the description of her in her website now. I guess everyone will just feel the same when first listen to her singing.



Her performance is amazing. I'm sure her voice has captured the hearts of many worldwide.
Please also see the full clip on what comments she got from the judges. "It's a complete priviledge listening to it..." I agree!
And she's already got plenty of fansites! Just to name a few:

http://www.susan-boyle.com/
http://www.susanboylefansite.com/

And certainly, the most inspiring part is, the power of dreams! ;)

Severe Murmur?

Having busy mad call.

Got a call from X ward.

HO: "Hi Dr, I would like to refer you a case."
Me: "Sure, what case is that?"

HO: "This is a man who's admitted to our ward for blahblahblah, then incidentally found to have a heart murmur."
Me: "Ok...symptom wise? I mean is he symptomatic?"

HO: "No he's not symptomatic at all."

Me: "Ok...if that's the case, would you mind getting him an ECHO appointment, then see us in MOPD (Medical outpatient)?"

HO: "Hmm...you think you can come and see the patient in the ward?"

Me: "Why?"

HO: "Because my specialist insists you to have a look. We are not sure whether it's a mild or severe murmur."

Mild or severe murmur...what a reason! (No such thing exists okay)

So, in the end, have to go and see the patient also...despite the busy mad call.

Is this some form of bullying again? But this just keep happening during my call. Sigh!


Related posts:
Mad Referrals (1)
Mad Referrals (2)

Not-so-interesting Case

Got a case here.

Symptoms:
Fever since 2 days ago. Associated with bad coryza and nose block, cough with yellowish sputum, nausea and few episodes of diarrhea. No rashes. No recent history of travelling/ contact with H1N1 patient.

Examination:
PR: 122 BP Normal Temp: 38.5
Examination no remarkable findings except mildly injected throat.

Investigation:
FBC showed normal white cell count, platelet in good normal range.

Treatment:
Regular paracetamol, increased fluid intake. Already empirically started on broad-spectrum oral antibiotics.

Progress:
Despite the treatment, fever is persistent. Temp still 38 degree Celsius at Day 3. Occasional chills and rigors. Very giddy with bad headache. Otherwise no new signs/ symptoms.

Psychosocial aspect:
Feeling depressed because unable to get MC due to not enough manpower, according to the in-charge. So the patient still had to come to run the clinic from 8am to 1.30pm (65 patients), then finally went back home and collapsed. Then only he was given MC for 1 and half day.

Discussion:
Some said doctors usually can't treat themselves. What's your point of view? Would you suggest the abovementioned patient to go see a doctor or something?

Finally,
Ya the patient is me. I have not much clues why the temp still spiking at Day 3. Hope it doesn't turn into a PUO (pyrexia of unknown origin) or something.
Meanwhile,

Plan
Continue self-treatment as planned for now.
Encourage orally.
Beware of PCM overdose - strictly 1g QID but not more. Ignore the headache.

=)

Randomz (4)

Ya just some short updates..

My parents came down the other day. So we went to Ipoh to seek around for some famous local food. Had the breakfast in the Fu San Dim Sum restaurant (2 thumbs up!) and then lunch in the so-called the "origin" of the Old Town Cafe. The white coffee, of course, can't be missed!

Then 4th May we had our MRCP Mock exam, held by my medical department. The most exciting thing, beside the event, is to be able to meet up with Yew! Having known him through blogging for long and finally can meet him in person. I like the pic but I think our head sizes look kinda imbalanced due to angle problem haha. Anyway, Yew, the next time I'll see you is when I go Seremban k! ;)

YEAH I Passed!

Dear all,

Ya, after a month of nervousness and paroxysmal palpitation, finally the MRCP Part 2 result's out..I Passed! ;)

Thanks for everyone's support and wishes...I'll definitely study hard for the next and the last part. Now really overjoyed with this moment! Hehe;)