Sunday, July 25, 2010

PACES Case Sharing

The UK trip is very rewarding in terms of learning experience. Here I'd just like to share a few "tricky" cases that I've seen during my attachment/ courses:

#1
In station 5, you're asked to see a lady complained of lethargy and joint pain. This lady has intermittent fever, arthralgia and history suggestive of Raynaud's phenomeon. She also has background history of Hypertension for years. So you suspect this is a case of SLE.
Straightforward? Not really.
Examiner hintingly asked what is the link btw hypertension and SLE.
Further history (only if you specifically asked) revealed that she was treated with Hydralazine for months before symptoms onset. So ya, this is a drug-induced lupus. Did that come into your mind?
Questions discussed were about percentage of anti-histone ab positivity (only about 30% in Hydralazine-induced, as compared to other drugs) and what are slow/ fast acetylators.

#2
Cardiac murmurs!
This is gonna be the best case I've auscultated.
Basically there are full of murmurs: You hear ESM over aortic area to carotid, EDM over LLSE, then also systolic murmur over apex to axilla, with MDM in mitral area as well.
So you thought this is a case of mixed mitral (MS/MR) and mixed aortic valve disease (AS/AR)?
Examiner then said there's no primary mitral valve disease.
The diagnosis is actually mixed aortic valve disease. At mitral area, the systolic murmur you heard is just part of the Gallavardin phenomenon, and diastolic murmur is the Austin Flint murmur due to AR.
Tricky enough?

#3
Station 5 again. You're asked to see a lady presented with seizure, and you should examine her hands.
She has family history of epilepsy. On visual survey you noted she has an AVF at left arm.
ESRF with seizure? Was it due to electrolyte imbalance?
In her hands you noted lesions suggestive of peri-ungual fibroma. So you thought this is a case of Tuberous sclerosis, but there's no facial angiofibroma.
Time's up.

Wanna know the answer? Yes she's a case of tuberous sclerosis with epilepsy. ESRF was because she underwent bilateral nephrectomy due to severe renal angiomyolipoma hemorrhage.
Then why is that she doesn't have the typical facial angiofibroma?

Well, she underwent laser therapy for cosmetic reason!

So these are a few..will share more later!

Tuesday, July 13, 2010

The Perfect Drug?


I'm not sure whether you're aware of this drug, it's really powerful. (I guess you might have heard of it somewhere)

It's basically a "magic drug" for practically everyone.

For children, it enhances the immune system. Be worry-free of infection. You know, some even said that child who takes this drug will never need to visit a doctor!

For teenagers, it's good for brain development. Want a smart boy who can score excellent in exams? This is the right drug!

For working adults, it keeps you energetic all the time. And of course, if anyone thinks that his certain "function" is insufficient, this will keep you really energetic! And for young women, this can regulate menstrual cycles, make your skin super smooth, guaranteed!

Can you take this drug during pregnancy? Of course you can! Your baby will be extra-healthy and extra-cute, and with very strong immune system!

For middle-aged people? Ya it can be used also. It's very good in preventing prostate enlargement, memory loss ( Ya, I know you've been looking for such magical drug for long time) and joint pain. Some actually said that their uncles/ aunts who's got Diabetes Mellitus are actually CURED by this drug! Seriously, their doctors are very surprised too!

Oh I forgot to mention, it has another function. If you grind it into powders and mix it in water, guess what, it can be used as eyedrops! You can use it to treat conjunctivitis, glaucoma as well as cataract!

You ask how come this drug is not available in hospitals and it can only be bought from my company? Come on, this is a state-of-the-art product of the latest technological breakthrough which is patented, of course it's not available anywhere else!

So, you wanna get this drug?

If you think the above statements sound familiar, you might have heard it from a traditional medication/ direct-sales product seller. I think I have heard too many. And I noticed that regardless of the product that they are selling, there are some commons in the products:

1. This product can benefit ALL age-groups. From the unborn to the elderly. For both genders, healthy or diseased, and for all kinds of medical conditions! The "Eye-drop" story is real. Gosh, I really can't imagine what will happen if you simply mix it and put in your eyes. Can treat glaucoma and cataract simple as that? The ophthalmologist will be jumping!

2. This product can CURE chronic medical condition (diabetes, hypertension) and prolong survival in cancer patients. Well, please analyze how true can this be. But those vulnerable groups are usually targeted and they would actually choose to believe.

3. This is a product of a new tech, hence not available in hospitals, and hence your doctor never told you this. Oh come on, you mean there's actually a cure for diabetes (by oral medication) and the docs are not aware of it? Think again.

I'm doing nephro rotation now, and seeing patients who suffer the outcome of believing this could work. Irreversible kidney failure. The worst thing is, will the seller ever be responsible for it? The asnwer is, sorry, NO.

Sad, isn't it?

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