OK, it's been a good day - for a change! Being positive eh?

Got to school late for the x-ray lecture, so decided to skip it and see a patient instead. Tutor just said to us yesterday, "Examine his cranial nerves." It was MOST exciting. The poor man couldn't hear (and he was really a lovely person), so I had to write out instructions on paper for him. After the examination it just didn't make sense at all. All I gathered was, he had palsy of the 6th (yes, abducens, I know now'!), 9th, 10th and 12th nerves. It all just didn't make sense, since a brainstem lesion above nerve IX should affect XI too. If in doubt, read! And tah dah! It was really exciting, I was suspecting a bulbar palsy, but just needed to check. It had to be a bilateral lesion of the 9th, 10th and 12th nerves plus lower motor signs, yet I thought the 10th nerve was only affected unilaterally. Went back to the patient, and ooh lah lah! Normal jaw reflex, typical bulbar dysathria, and bilateral 10th nerve palsy! OK, this case really made my day, since I managed to solve the mystery. Thing was, it wasn't stated in the casefiles, so I was a bit wary. But checked his really old case notes, and tucked into a single line on a sheet of paper was "diagnosis: bulbar palsy". Beautiful!

Just a note, something really funny happened. Groupmates and I went to see him together later in the afternoon (the patient's family was reeeaaally nice too - does niceness run in families?), and when EW and I touched his hands, we were shocked to find it scaldingly hot. And given his presenting complaint of an appendicitis, we were alarmed .. what if it has perforated, and he is in septic shock right now? Just then, the man took her hands and placed it on his tummy. DUH! A heat pack!! I could have died laughing.

Subsequently saw another 4 patients (hmm .. is this my high count so far? 5 in a day), 3 with murmurs. Alas. I'm always lousy at it, so we had a fine time trying to argue it out. Same person, 3 different interpretations of the murmur(s)! Today's summary aint too bad:

1.Bulbar palsy
2.Pansystolic murmur radiating to the carotids (Tricuspid regurg?) with ejection systolic murmur
3.Cardiac failure with a murmur .. forgot what it was
4. ?Acute hepatitis/?cholecystitis/?hepatic cyst/?? melioidosis ?? .. the mystery will be solved tomorrow.
5.and the most controversial, a PSM radiating to the axilla with/without mid-diastolic murmur. Thing was, the patient had a really prominent apex beat, loud S1 and what we thought was a palpable P2 impulse. She was not in atrial fibrillation though. Will see her again tomorrow morning. Another lovely patient who's so sweet it almost breaks your heart to see her ill.

Why do nice people always fall ill? It's been lovely. All 5 patients today were not grouchy, the nurses were not grouchy (ok, except one semi-grouchy one who rushed over, almost screaming "don't mess up my things!", when she saw me writing on a stack of casenotes. Nearer, nearer, approach, and Oh. The poor medical student was writing on his OWN clipboard. Yes? My dear nurse, can I help you? Wouldn't like to be her at that time, what an embarrassing situation!). 2 doctors were nice too. One helped us with melioidosis, and halfway through that another poked her head into the room and asked if we'd like to hear a murmur. Happy Be-Nice Day, everyone!

Hope my days will be as good as this, it makes life as an overworked medical student so much more fulfilling. Good reading, good learning, plenty of signs and the right diagnosis makes the perfect learning day.

Now. Freaking out. It's the end of the 4th week!!! ARGHH!!!!! Need to rush out my stupid writeup. Cr@p ...