Case 6, Session 1
Mrs Beatrice Collins, aged 68, living in rural South Australia
PC: Fainting while shopping, was carrying groceries at that time. Unconscious for 1-2 minutes but recovered without further symptoms.
HPC: She felt weak and dizzy, didn't reach the shop bench. Her husband was with her and told her that she looked pale, ashen in colour and sweaty. Not injured herself nor have any symptoms at that time.
PMC: Similar "fainting attack" while attending meeting before Christmas, but say it may due to the heat on the day. Not feeling well for past 2-3 months (malaise and lethargy). No chest pain nor SOB, never had BP or blood sugar problems. General health good. No major illnesses. Not taking any medications. No abdominal pain, reflux symptoms, or vomiting before, and bowels are regular (daily), not changed recently. Not notice any bleeding from back passage nor blood in her motions, and no melaena. No urinary symptoms, doesn't get up to pass urine at night. No vaginal bleeding, menopause 15 years ago. No troubled with headaches or double vision. Does not cough or bring up sputum. Weight have dropped 2-3 kg in the last 6/12.
SH: Appetite good, balanced diet (3-4 times/week red meat). Never smoked cigarettes, drinks wine infrequently, only on social occasions.
FH: 5 out of 9 siblings died. Out of 5, 3 died because of cancers (stomach, lung and oesophagus) and 2 died because of cardiovascular origin (Acute MI? and berry aneurysm). Other 3 siblings still living, but 2 of them have cancers (breast and prostate) and one of them has stroke.
On PE:
Tall thin woman. Alert & oriented. Obvious pallor. Not distressed
CVS: HR 74/min, regular, good volume.
JVP not raised.
BP 150/80 mm Hg sitting (no postural drop)
Dual heart sounds, no murmurs.
No carotid bruits.
Resp: Rate 20/min.
PN resonant
AE equal both sides
Breath sounds normal, no added sounds.
Abdomen: Soft, non-tender, no masses palpable.
Liver span normal, edge feels smooth.
Spleen and kidney impalpable.
No ascites/bloating.
Bowel sounds normal
Digital rectal examination - empty rectum, no blood on glove, no masses to feel.
CNS: NAD
Clinically euthyroid.
Erm, any ideas what this patient is suffering? Hehe..
4 comments:
Aku belasah gak ko nie karang aie... hello aku baru first year... kelas physio tak start lagi... apa kata aku prescribe kat makcik tue racun ajer...
Rp : Arsenici 500g
Misce, in aquae fiat solutio
Da tales doses numero 1
Signa
Kalo makcik tue mati bukan salah aku... aku prescribe kat dia arsenic... poison for all carbon bases organism... sorry yek...
ermmm... org jauh nak bg idea... hihiks!!! ni agak2... x mgkn cvs cases... since everything is normal except a slight increase in systolic BP.. well, respi cases??? ermm... susah nk ckp.. tp mcm x jgk jer??? haemato system... x de kot..since most cases in haemato melibatkan hepasplenomegaly.... ermm..tp cam ade associated with anemia.. since she got pallor.. n GI cases??? ermmm... maybe.... tp br start GI system.. so xde facts yg dpt tlg diagnose... hehe.. tp SI cancer has got to do with anemia.. ermm... maybe related??? then ttg repro cases xleh nk bg D.D coz i still have looongg way to go b4 blajar psl repro... =)
ermmm... cant help much... tp kan.. sumthing bout cancer la yg pasti.. hihi.. the FH told us everything rite??? juz which one is the possible one jer nk perlu kene diagnose... cam kesian la plak family this old lady kan??? sume siblings die ade diseases??? huhu... ok... FUTURE DOCTOR, DR KHAIRI... good luck in making the diagnosis... enjoy ur PBL sessions... (",)
heh...banyaknye cues, kat NC jangan harap la ye nk bg cues byk camni...btw case problem yg mencabar otak jugak nk pk....hehehe....nnt kalo tatau ble la tanye org yg dah expert ni kan....ok...slamat berstudian
mak cik ni sakit kekejangan pundi kencing agaknya--> berkumpul air kencing--> hypercontraction-->pecah--> pastu bertaburan kencing merata-rata--> orang pukul dia--> berdarah teruk-->kehilangan darah yang agak membimbangkan-->anaemia of bad behaviour.
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