3 interesting cases in general medicine posting

1. In-patient, 60+y/o male complaint of oedema in both legs, on admission both legs were swollen, the diameter was as big as a long ruler ~30cm. this has caused a limitation of mobility in this gentlemen. He has a past medical history of prosthetic femur on the hip. Both femur were replaced 10years ago. LFT, RP, CXR were done to rule out liver failure, renal failure & cardiac failure. the results were normal. Inflammatory markers were tested and the result was negative. what would be the diagnosis if everything looked normal? according to the registrar, this gentlemen rarely walks and he normally sits on the chair and doesnt move much. due to prolonged immobility, the veins were pooled in the legs and caused the leds to be oedematous. Walau A~ there is no underlying organic cause, the swelling legs were just simply because the patient was lazy to move around. therefore, the management is just giving diuretics to loose the extra fluid in the legs. Score of interesting: 8/10, nvr come accross in my life that the admission was due to laziness in moving.

2. Out-patient, 50+y/o, chinese female. ( i remember her the most because she is the only chinese patient i have seen in uk so far) she came to the clinic for follow up of her hepatitis. but she ended up telling stories not related to her hepatitis. it was because on the blood result, she has cleared her hepatitis virus. no viral load was found in the blood. however, she and her spouse had spent nearly 45 min to talk to the registrar and consultant. She was diagnosed with carcinoid sydrome few weeks ago, but it was not in the GIT. It was an incidental finding from a polyp in the bladder. The mass was found in the bladder when she went for ultrasound screening for cervical ca. On operation, the surgeon intended to take biopsy sample of the polyp, but the polyp wall off on its own. As a result, the tissue was sent to the lab and carcinoid cells were found. Initially the specialist thought it would be a benign tumour but nvr thought that it would be carcinoid. Acc to the specialist who was looking after this lady, there were only 8 cases of carcinoid in the bladder in the whole world. it was super rare. This lady had complaint of flushing, lethargic, mood swing and all the while she thought that was pre-menopausal syndrome or her hepatitis flares over the past few months. do u think that's the end of the story after the polyp removal? No!!! The specialist thinks that it would be secondary deposit in th bladder. there might be some primary in elsewhere. Her urine 5HIAA-5 hydroxyindoleacetic acid was monitored for few days after polyp removal to make sure there are no extra neuroendocrine function. She has to go for Ct scan the following to check for any primary carcinoid. I didnt get to know what's the out come after that coz i only seen her once in the clinic.
Score of interesting: 10/10, carcinoid in the bladder lei!!! it was even more rare than male breast cancer!!! It was unbelievable when the patient came to a gastro clinic to tell stories of carcinoid, not in the GIT, but in the bladder.

3. 80+y/o female, admission for pneumonia. blood and sputum was sent to lab for culture and sensitivity. this old lady was a known MRSA(methicillin resistant Staph aureus) patient, all staffs who visited her must wear gloves and gown. this is to prevent the staffs transmit the bacteria to the next patient they are in contact with. her lab results were sent back. she was suffering from sepsis & pneumonia of the same causative agent, it was staph aureus. but not the MRSA one, is the normal commensal staph aureus. the consultant was thinking of any other source of staph aureus infection that predispose to this attack. no dermatology history of staph aureus infection, would it be the bone then? lumbar X ray was taken and no injury seen on the X ray. So... so.. so ... at the moment that the consultant was scratching his head, this lady's medical notes was sent to my hospital from the previous hospital she was admited to. she had subacute infective endocarditis few months back!!! murmurs were heard on examination actually, but this lady was known to have a past medical history of valvular heart disease. her old medical notes have cleared all the doubtd of the source of staph aereus of her sepsis and pneumonia. Immediate treatment was given regardless the cause of infection. she started on antibiotics and her blood test were improving as inflammatory markers went down. but she still looked ill and renal function was deteriorating. very very very sad to say that she was the 1st patient whom i followed throughout in the ward and was not discharged back to home. she passed away the day after the consultant diagnosed her of SIE. Her renal function and cardiac function were compromised even tough she was dong well in recovering from infection.
Score of interesting: 9/10, 1st time not seeing patient in ward round the next day because they have gone to heaven or hell, but not bec to their home.

initially i wanted to write 10 cases. after finish writing the 1st one, i saw the length of my 1 case, i decided to share 5 cases. but after finish writing the 2nd one, i decided to share 3 cases of my posting. not because i am self-fish but i think i m writing too long. i hope u would enjoy reading this la.