Friday, April 28, 2006
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.
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.
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.
Bowel sounds normal
Digital rectal examination - empty rectum, no blood on glove, no masses to feel.
Erm, any ideas what this patient is suffering? Hehe..