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Clinical Case: Is this just ‘old age’?

admin — Mon, 09 Aug 2010 21:49:33 +0000

Student Surgery: You’re a medical student conducting a surgery list under supervision from your GP trainer. Your next patient is a retired GP who has been booked in by his wife for concerns about his memory.

A 74 year old retired GP, Dr Wallis comes to see you.His wife reports that his memory is not ‘as it was’ however the retired GP dismisses this as ‘nonsense’ and proceeds to tell you about his early research on the use of anti tuberculous medications. His wife is concerned that he may have a brain tumour. The concern about this is that she has read brain tumours can cause memory problems.

Dr Wallis is frustrated by his wife’s concerns about his memory and mentions she is always meddling in his affairs. In his history his wife tells you he has put on a stone in weight, and fractured an ankle when being run over by a car 12 months ago.

PMHx

Previous history of skin psoriasis, treated with topical preparations only.

Drug history

Vitamin D tablets ordered over the internet (patient unsure of strength, wife believes it to be 1000 international units a day)

Examination

You proceed to examine Dr Wallis to evaluate him for any neurological problems. The examination is as follows.

Observations normal. Normal Cardiovascular, Respiratory and Gastrointestinal Examination

Neurology:

	Upper Limbs			Lower Limbs
	Right	Left		Right	Left
Tone	N	N		N	N
Power	5/5	5/5		5/5	5/5
Coordination	N	N		N	N
Sensation Fine touch Proprioception	N N	N N		N N	N N
Reflexes Biceps triceps supinator	+ + -	+ + +	Knee Ankle Plantar	+ - ?	+ + ?

Cranial Nerve Exam

Normal. Fundoscopy normal.

Mental Test Score:

Question	Mark (x/10)
Age	Correct
DOB	Correct
Time (nearest Hr)	Correct
Person	Correct
Place (house number/ name of hospital)	Incorrect
Recall Address	Correct
WWII	Incorrect
Year	Correct
Queen	Correct
20-1	Correct

Adapted from Hodkinson HM. “Evaluation of a mental test score for assessment of mental impairment in the elderly.” Age and Ageing 1972;1:233-8

Recent blood tests

Test	Result	Normal Range
Hb	12.9	(12-15g/dl)
WCC	5.4	(4-10 x10⁹/l)
Plt	152	(150-300 x10⁹/l)
MCV	88	(80-99 fL)
INR	0.9	(0.9-1.3)
Na	137	(135-145 mmol/l)
K	4.8	(3.5-5.1mmol/l)
U	4.1	(4-9mmol/l)
Creatinine	88	(60-100 micromols/l)
Albumin	39	(35-45g/l)
Alk Phos	53	(<110iu/l)
ALT	45	(<40 iu/l)
Bilirubin	19	(<20 micromols/l)
CRP	9	<5
TSH	5.6	(0.5-5)
Fasting Blood sugar	6.2	(<7mmol/l)

What is the most likely diagnosis is this just ‘old age’, and does the patient require any other investigations? You can pick a maximum of 5 answers.

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Medical Students approaching finals exams with new technology at their fingertips

admin — Mon, 11 May 2009 16:14:25 +0000

The overall average score of medical students on MedicalEducator.

The following weeks will represent the culmination of years of hard work by medical students over the past 1-5 years. Revision patterns have been changing and increasingly medical students are approaching final examinations preparing for them using web based MCQ, OSCE and video guides. For the first time, resources like podcasts and the like have taken a firm footing in the medical students preparation for final examinations.

One technique of sitting mock written papers has long been popular. Short answer questions, EMQ and MCQ format questions help people to prepare.

To quote one of our contributors:

I always felt more comfortable preparing for any exam, and I mean any, by running through exactly what I should know, first from a theoretical perspective, then from a practical perspective. If that meant filling in multiple choice questions, I got a book on multiple choice questions. It was what it was.

Maybe you’d like the opportunity to measure yourself against other medical students across the UK or

The average mark in one of our mock final examinations, which was added to the site in April 09.

across the world. A good example of this is our *(tough) mock medical finals paper. This is designed for students sitting year 1, year 2, year 3 year 4 or final examinations, which have a clinical component.

The average for this exam is 49.6%. Tough. But will it help you learn? A comment from a subscriber:

You keep doing questions where a principle that you didn’t understand is explained in the answer. Thats the value of them.

Overall this is a stressful time for medical students, on behalf of the Medical Educator team, good luck in those examinations.

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An unusual cause of jaundice… (or is it?)

admin — Sat, 15 Nov 2008 20:47:37 +0000

A 38 year old female is diagnosed with breast cancer and having had a lumpectomy proceeds to have 6 cycles of chemotherapy.

PMHx: Asthma, Previous Intravenous drug user

SHx: Current smoker

She does not attend for her pre op chemotherapy clinic appointment, but nevertheless goes on to have the chemotherapy.

6 weeks into her chemotherapy treatment she becomes jaundiced and has the blood tests taken

The problem has not arisen as a result of an adverse drug reaction.

What is the most likely underlying problem that has caused her to be jaundiced?