Monday, February 27, 2012

Febrile seizure

Saw a 5 y/o child with seizure that lasted for 15 minutes. Temperature was 38.8 degrees.

Dx: Febrile seizure secondary to some URTI (apparently the child has prominent adenoids... he has been snoring throughout the entire consultation)

I asked if he had any rash but the parent said no.

Areas I need to improve on:
  •  I guess I could have asked more symptoms to rule out meningitis (e.g. photophobia, neck stiffness) if the patient was able to give a response or test it on the patient (e.g. kernig's / brudzinski's sign). 
  • I should also have asked more about the seizure itself: During - irregular breathing? pallor? After - is he back to his usual self?

Learning point:
  • Parent getting reassurance from the doctor in that simple ones do not cause permanent brain injury and most children usually grow out of it by their 6th birthday.

On a side note, family history is also important. I remember clarking a patient before whose entire family had some form of febrile seizure.....

Anyways I think I have improved on my history taking skills... practice practice practice (unlike Allen Iverson :P)

Saturday, February 25, 2012

History taking

The presenting complaint and HPC should be able to give you a differential diagnosis. It has taken me several months to realise that... only up till now have I had some sort of meaningful criticism of my case presentation.

I hope to engage more with case presentations so I can improve on the not so goods!

With the lessons learnt I hope I could go back in time and be able to interview the same patients I had interviewed... whereas before it just felt like a history taking exercise... now I think medicine makes a lot more sense to me!




I shall finish this post with a chest radiograph taken from oocities.org



Thursday, February 23, 2012

Back from a year+ of Hiatus... (hernia)


Don't think anyone really looks at my blog... anyway I hope to use this blog more to share my frustrations of life on the net!

Recently: Had been on habbo... still was addicted to the typing game (Revenge) and also to miniclips but quitted them weeks ago because I felt it was dragging me behind in my studies. and Thankfully I also passed my mock exams(!).

Today: Nothing special really... but few days ago, I got grilled by a consultant about history taking - not detailed enough and not making sense. My take-home message: Make sense of what patient say to you and question if need be (the patient said the child vomited 3x/day for a week... not possible!). The exercise of history taking is not to repeat what they say to you but for you to make a differential diagnosis! 

I still have a long way to go on becoming a (good) doctor!!!