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    (Original post by Ataloss)


    I used to get excited by it too. However, it means I have to work for 13 hours on call on Easter Monday :mad: so it is somewhat losing its appeal.
    Don't get me wrong, I still want to do it, but it's very depressing being on here and having all you clinical types/people who get early clinical exposure chatting on about all this. I'm sure there is stuff I know more about, thanks to the delightful structure of my course (which most of the time I love!) but mostly nobody cares.
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    (Original post by Helenia)
    ...but mostly nobody cares.
    Consultants do, you will be universally hated and simultaneously revered by your idiot pbl-instructed bretheren for the knowledge that you are gathering now, it will make you a better diagnostician in the long run. I would imagine if you asked most clincial students if they wish they had got more formal teaching in the basics they would answer yes (I know I certainly would)
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    (Original post by Ataloss)
    Why wasn't someone brave enough to call it "Care of the dying : a pathway to heaven" ?

    Or even more inappropriately - "Care of the dying - your poor PRHO will soon be getting £62"
    I know someone who used to cry: "oh sh*t, she's being buried, there goes my ash cash"
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    (Original post by Fenella)
    I know someone who used to cry: "oh sh*t, she's being buried, there goes my ash cash"
    One of my friends was vey gutted to say the least when they found out that their only chance of a PrHO job was gerry's. Soon changed his mind when they ash cash started rolling!
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    Yer, although to be fair most of the doctors I know don't keep much of their ash cash - a lot of it goes behind the bar.
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    (Original post by Renal)
    Yer, although to be fair most of the doctors I know don't keep much of their ash cash - a lot of it goes behind the bar.
    I'll drink to that!!!
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    (Original post by Fluffy)
    I'll drink to that!!!
    Should come Mx Hockey more often then, shouldn't you!
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    More more! Whose turn is it?
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    (Original post by Helenia)
    Don't get me wrong, I still want to do it, but it's very depressing being on here and having all you clinical types/people who get early clinical exposure chatting on about all this. I'm sure there is stuff I know more about, thanks to the delightful structure of my course (which most of the time I love!) but mostly nobody cares.
    Don't worry, my clinical knowledge is next to nothing too. I probably wouldn't be able to diagnose a drunk outside Yates at closing time. We did have a little bit of clinical integration in the second year but I switched off during the "hospital" weeks as it wasn't being examined
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    (Original post by Miles)
    I probably wouldn't be able to diagnose a drunk outside Yates at closing time.
    Probably because you are the drunk outside Yates at closing time.
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    (Original post by Ataloss)
    Probably because you are the drunk outside Yates at closing time.
    hehe, Yates is far too up-market for me! :eek:
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    (Original post by Miles)
    hehe, Yates is far too up-market for me! :eek:
    *is saddened*
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    (Original post by Fluffy)
    *is saddened*
    That's all I can afford at the moment :p: Ooo maybe you can have your McFlurry as well!
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    Ok, I have a case:

    A 55 year old man came to A&E complaining of diffuse abdominal pain and profuse nosebleed. He was moderately confused, but said that the nosebleed started suddenly about 30 minutes ago, following worsening abdo pain all day. He also mentioned a 'flu-like' illness that he had been suffering with over the last week, but which had subsided a couple of days ago. He has a past history of Hepatitis B, which he contracted several years ago whilst on a business trip to the far east. He also suffers from asthma - which he states has been well controlled for over 40 years. He is a smoker, 20/day (30 pack year history) and a moderate drinker. He has been married since the age of 23 and has 3 children, but on further questioning about his family he became more cagey and refused permission to contact them. He has just returned from another business trip to Bangkok, searching for prospective clients for his computer firm.

    On examination he was febrile (40C), pulse 70bpm, BP 110/80. Capillary refil time 6s
    He had tenderness to deep palpation across his whole abdomen, and an enlarged liver. He also has generalised lymphadenopathy.

    Bloods were taken for FBC, U/E, LFTs, blood culture and serology. A portable CXR was indicitive of right-sided effusion.

    Whilst awaiting the results of the blood tests his gums started bleeding and his pulse rose to 110bpm. He became more confused and agitated, and was abusive to staff.

    He was sedated with lorazepam, and the SpR phoned haematology to get preliminary blood results:

    FBC shows lymphocytosis with no other abnormality.
    U/Es - Sodium 130, no other abnormalities
    LFTs - ALT 300, AST 254, no other

    Blood culture was also negative on preliminary assessment, though the microbiologist stated that she would need more time to confirm the sample.

    Suddenly the patient's BP dropped to 80/60, peripheral pulses were lost and he started vomiting blood. He was promptly admitted to ICU where, despite agressive fluid resuscitation and transfusion, he died 8hrs later.

    What is the diagnosis of underlying cause (I hope this is accurate and actually leads to a diagnosis as it's a second-hand story :p: )

    PS i left out a simple clinical diagnostic test, done by the on-the-ball SpR, as a simple google would spoil the fun - though if someone asks about it i can give the result
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    It sounds very much like some kind of viral haemorrhagic fever.

    Ebola is the only one my brain can muster at this kind of the morning - although if he's been a naughty boy on his trip to Bangkok that is quite likely.

    I'm a bit lost as to the simple diagnostic test. ELISA not a simple test - but all my weak brain can muster. :p:
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    You are on the right track. However ebola is not endemic in built-up areas of thailand.

    The test is a bedside test that can be done easily using equipment that will be readily available in any hospital A&E
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    Dengue?
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    Yeah it was.

    If you are wondering where the bloods got to, well so was the reg. Apparently the labs were short-staffed and the results didn't get back til much later that day.

    The test done was the tourniquet test (inflating the BP cuff to midway between systolic and diastolic pressures for 5 minutes - After deflating the cuff, wait for the skin to return to its normal color, and then count the number of petechiae visible in a one-inch-square area on the ventral surface of the forearm. Twenty or more petechiae in the one-inch square patch constitutes a positive test.)

    Dengue is quite rare amongst business travellers who tend to stay in the more upmarket hotels and so are generally less susceptible to disease vectors. However on deeper questioning Ataloss' suspicions were confirmed and he had spent more than one night outside of the hotel
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    (Original post by j00ni)
    Yeah it was.

    If you are wondering where the bloods got to, well so was the reg. Apparently the labs were short-staffed and the results didn't get back til much later that day.

    The test done was the tourniquet test (inflating the BP cuff to midway between systolic and diastolic pressures for 5 minutes - After deflating the cuff, wait for the skin to return to its normal color, and then count the number of petechiae visible in a one-inch-square area on the ventral surface of the forearm. Twenty or more petechiae in the one-inch square patch constitutes a positive test.)

    Dengue is quite rare amongst business travellers who tend to stay in the more upmarket hotels and so are generally less susceptible to disease vectors. However on deeper questioning Ataloss' suspicions were confirmed and he had spent more than one night outside of the hotel
    I actually know bugger all (no surprise there), the above was very similar to a Holby story line a few years back That and I love viruses! I nealy did a virology BSc - you've got to have respect for a little bit of RNA or DNA that can do that to a person...
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    (Original post by Renal)
    (Shamelessly ripped from a PBL scenario)

    A 5 year old boy was admitted to hospital. His mother had taken him to their general practitioner with a recent history of listlessness and excessive bruising.

    On examination he was pale and had ecchymoses and petechial haemorrhages, particularly on his legs. He also had generalised lymphadenopathy and a palpable spleen on deep inspiration.

    Blood test results were as follows:

    Hb 6.0 g/dl (Normal 12.0 – 14.0)
    MCV 86 fl (Normal 76 – 92)
    WBC 100.0 x109/l (Normal 5.0 – 15.0)
    PLT 10 x 109/l (Normal 150 – 400)

    Leucocyte differential:
    Neutrophils 1.0 x109/l (1%)
    Lymphocytes 4.0 x 109/l (4%)
    Blasts 95.0 x 109/l (95%)


    Did anyone come up with a diagnosis for this one??, or have I missed something?. I think I have a diagnosis, but not being a student doctor , I am not going to say what I think it is for fear of looking stupid in front of all you really clever peeps.
 
 
 
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