I-Deologue

1 - Presenting Complaint of Mrs DV, a 29 year old lady:

Racing of heart, for the past 3 days

2 - History of Presenting Complaint:   
-   
-    The palpitations started from Friday, which was intermittent in duration. She was sleeping when it starts. The palpitations progressed until Monday when it became worse and continuous throughout the day. She had difficulty of breathing too. e She then referred herself to A&E
-    She denied of any ankle swelling, orthopnoea, dyspnoea on exertion, paroxysmal nocturnal dyspnoea or crushing chest pain.
-    She loss 22kg for the past 2 years, she attributed it to being a vegetarian.
-    However she described that she was being hungry all the time, although she didn’t eat much since she becomes increasingly picky with her food.
-    Her bowel habit is regular for the past 2 years except that she had loose stools for the past 3 days, not watery, and there was no blood or mucus.
-    For the past 2 years, she got anxiety attacks over flying and driving. She could not drive now. She would scream hysterically or being agitated although there is no danger. She never experience that before.
-    For the past 2 years, her menstrual cycle was regular but a bit light. She is on contraceptive pill.
-    She preferred to be in warm room but she can wear a light coat over the winter. She can tolerate the cold weather well.
-    She was feeling weak when getting out from the bed and getting into shower.
-    Last week she noticed that her neck was so big.

This is perhaps the most interesting case in my first 6 weeks rotation in Beaumont hospital. A classic presentation of hyperthyroidism, all the facts that I learned from my pathology course becomes so handy especially in history taking from this ever so pleasant lady. It is like a long read story unfolds itself upon my own eyes. I felt an indescribable feeling of fulfillment by making the right diagnoses, just from history and physical exam. I presented the case to Dr. Smith during the ward round, my first case presenting with a consultant. I was so nervous at first, all the feedbacks from my previous presentation flashed back in, but suddenly a sudden urge to just being confident taking over me. It was really a phenomenal experience, just me to inform him on everything and he relied on it. I feel like a real doctor working with him. I did a thorough thyroid physical exam and he was satisfied with all the findings I presented. All in all he was very satisfied with my presentation and I got a good feedback from him. For the first time, I feel so motivated. I learned a really big point today, that I can do it; I can present a case successfully, if I just want to do it. ☺

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