Examined II

Cardiovascular System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M48_F1.jpg"}},{"insert":"\n\nAs you walk along the time-worn corridors of the medical faculty, your thoughts wander over to when you were a student there yourself.\n\nAll the doubts and uncertainties about the future ... and how graduating didn\u0027t really change this!\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M48_F2.jpg"}},{"insert":"\n\nPassing through the crowd of medical students awaiting the exam, you enter the interview room.\n\nA couple of minutes later, you are joined by Professor Grant, one of your old teachers.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M48_F3.jpg"}},{"insert":"\n\n\u0022Hello Doctor!\u0022, he greets you, beaming widely. \n\n\u0022Good morning, Professor!\u0022 you answer. \u0022How are you today?\u0022.\n\n\u0022I\u0027m fine, thank you! Shall we start?\u0022 he responds.\n\nYou nod in agreement, and call in the first student, Sophia.\n\nAlthough you are now on the same side of the table as your old teacher, you still feel a tinge of nervousness.\n\nIt would be horrible if you somehow made a mistake in front of him ....\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M48_F4.jpg"}},{"insert":"\n\n\u0022Good morning! How are you, Sophia?\u0022 you ask.\n\n\u0022Good morning, Doctor. Good morning, Professor Grant. I\u0027m fine, thank you!\u0022 she responds.\n\n\u0022So, tell us about the patient you just saw,\u0022 you ask.\n\n\u0022My patient was Mrs. Jackson, an 87-year-old woman, who was found unresponsive at home,\u0022 she responds.\n"}]}


{"ops":[{"insert":"Sophia continues with her presentation.\n\n\u0022Mrs. Jackson was brought in at 10:14 PM yesterday, after being found unresponsive at 9:50 PM. She had been in good health beforehand, and was last seen well at 9:30 PM. This is her first such episode.\u0022\n\n\u0022Her comorbidities are uncomplicated hypertension, diagnosed 15 years ago, regularly followed up, and well-controlled with ramipril 5 mg daily; and uncomplicated type 2 diabetes mellitus, diagnosed 10 years ago, also regularly followed up, and well-controlled on metformin 850 mg bd.\u0022\n\n\u0022She was not on any other drugs, including over-the-counter medications, and herbal supplements. She had only been admitted once before, due to community-acquired pneumonia 10 years ago.\u0022\n\n\u0022Mrs. Jackson has not had any surgeries, has no known allergies, and has never smoked. She does not drink anymore. She has two adult daughters, and currently lives with the younger of them. So far, she has been able to conduct her activities of daily living by herself.\u0022\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M48_F6.jpg"}},{"insert":"\n\n\u0022Upon arrival, her pulse was 96 bpm, blood pressure was 202\/105 mmHg, and oxygen saturation was 98% on room air. Her temperature was 96.8 F. The general examination was unremarkable, with no evidence of cranial or other trauma. There were no features of meningism.\u0022\n\n\u0022Neurological examination showed global aphasia; a conjugate gaze palsy, with deviation to the left; right homonymous hemianopia; right central facial paresis; and right-sided hemiparesis, with 3\/5 motor strength throughout.\u0022\n"}]}


{"ops":[{"insert":"\u0022The cardiovascular, respiratory, and abdominal examinations were all normal,\u0022 Sophia states, and then stops. \n\nYou recall that students are supposed to only obtain the history and physical examination findings at the time of presentation. This forms the starting point of their interview.\n\n\u0022Thank you, Sophia\u0022, you say, feeling mildly impressed. If only your junior staff members were that focused and to-the-point.\n"}]}


{"ops":[{"insert":"\u0022What is your clinical diagnosis?\u0022 Professor Grant asks.\n\nYou look on and hope that the bright young student answers properly.\n"}]}