8.30.2006

like a ton of bricks

here's my summary of events regarding the appeal for those interested. i love the way things work around here ~ told to enroll in Obs/Gyn because i've already been timetabled for the next rotation and withdraw from the rest of the Yr 5 courses. you heard right. i've been timetabled for a course i haven't enrolled in. considering that i've officially only emailed the appeal outcome to the Prof yesterday, asking for a meeting sometime this week or the next... and considering that i haven't gotten a reply about meeting times until the University Complaints Manager called up a member of the faculty who called up the Prof this afternoon.

suddenly, i'm meeting him at 9.30am tomorrow. suddenly, i come home 10 mins later to find his reply in my inbox - he was happy to discuss arrangements for next term but can't help me with appeal itself cuz he wasn't involved in the process, contact faculty if any questions. Somewhere in the list of duties befitting the role of Course Coordinator is the line stating that he should oversee or co-operate in the remarking or moderation of students' marks. hmmmmmm...

plenty more inconsistencies where that came from that i shan't bore you with.

as for my long case.. first time i got a borderline and was happy. i seriously thought i was going to fail it. in my current state, i would've came outta that room laughing whether i passed or fail. it was comforting to get encouraging "congrats" from both sympathetic profs. one even smsed me from sydney asking "any news amy?" awwwww! he told me "chin up, that was a case for the fellowhip exams, not for a medical student. you did well considering the stress you've been under" awwwwwwwww... that made my day =)

for those of you who're interested, here's my traditional write-up of my long case:

19 year old girl presented with a diagnostic problem of 1/12 Hx SOB + generalized chest pain on background of similar episode 6/12 ago. She has the current working diagnosis of myocarditis after initial investigations. Other possible diagnoses could be PE, chest infections/pneumonia, other cardiac causes/pericarditis.

SOB - increasing severity over past 1/12 with assoc. dry cough. not relieved by antibiotic therapy/ventolin commenced by GP. orthopnea, sleeps on 2 pillows. PND. no assoc fever, nausea/vomitting, chills, rigors, cyanosis, LOC.

Chest Pain - pt driving car at onset of generalized constant pain similar in quality to heartburn. radiated to L shoulder, neck and both ears. 8/10 in severity, lasting few hours. no relieving/aggravating factors. previous similar episode 6/12 ago - abnormal ECG suggestive of "infection" and d/c on panadol with no further f/u

HxPC -
· Symptoms first thought to be chest infxn, commenced on antibiotics w/o CXR with no resolution.
· GP thought she may have had exacerbation of asthma, commenced on steroids, ventolin w/o lung function tests with no resolution.
· Presented to hospital 2/52 ago to CCU.
· Since being here, she has had a DVT @ R upper arm on Day 2 that progressed to a pulmonary embolus.
· Also had a UTI that has since resolved with antibiotics (?trimethoprim)
· Is now at Day 15 of hospitalization - doing much better. no c/o pain, SOB, appetite well, bladder/bowels normal.

Background -
· unable to recall childhood Hx of illnesses (like rheumatic fever, chromic infections, etc).
· no recent illnesses, travel, surgery, trauma. vaccinations all up to date, no fluvax/pneumovax ever.
· non-smoker. binge drinker averaging once/month. (forgot to ask about IVDU)
childhood asthma - last attack 10 years ago, has not used ventolin/puffers for that long.
· no Hx of diabetes, HT, hyperlipidemia, previous cardiac problems. not obese.
· no other significant Hx on systems review.


Family Hx - significant cardiac Hx on both sides of family.
· Mother's side: mother - "blocked artery" (? coronary artery stenosis)
uncle 1 - PDA, died as baby
uncle 2 - MI @ 50yo a few months ago
aunt - MI @ ? age
· Father's side: father - MI @ 32, died. diabetic.

Meds -
@ home: OCP (levolin)
@ hospital:
warfarin 3mg daily
lasix (frusemide) 20mg mane
aldactone 25mg daily
digoxin 125mcg daily
astrix (aspirin) 100mg daily
prednisone 40mg daily
ramipril 2.5mg nocte
clexane 50mg bd
dilantrand 12.5mg bd

NKDA

SHx - lives at home with mother and brother. works as hospitality trainee, will graduate in Feb '07

O/E - well looking girl of stated age sitting comfortably in bed.
Obs - HR: 56 BP: 95/61 RR: 16 T: 35C Sats: 100% RA
No cyanosis noted. Did not appear to be in distress.
CVS - JVP not seen, apex unable to be felt (tho she states she's got cardiomegaly - would expect a laterally displaced apex beat), extra heart sound heard tho unable to tell if it was S3 or S4. i thought it was a S3 gallop. no ankle/sacral edema.
Resp - no acc mm use. chest clear.
Abdo - soft, non-tender with bruises from heparin injection sites
Peripheries - hands: no clubbing, no splinter hemorrhages @ nails, several small transverse white bands on each nail w/o hx of recent trauma. no signs of anemia. good capillary refill. feet: TEDS worn.

Impression - heart failure due to unknown cause, most likely due to myocarditis/pericarditis. endocarditis less likely given no supporting history. PE/DVT of unknown cause (should've said ? coagulopathies)

Plan - Admit. Pain relief + O2. Routine bloods, coags, ECG, CXR, echo (TTE/TOE), cardio consult. appropriate meds as commenced for heart failure (diuretics, b-blockers, ACE-I). later on, heparin/aspirin/clexane --> warfarin for DVT. trimethoprim for UTI.

there ya go.. *sigh* poor girl. yes, both of us =P

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