July 22, 2006
diagnostic paranoia
if there's anything to be said about having too much knowledge, it's that doctors (or in this case, medical students) can have it much harder than most.
case in question: an intelligent, witty, lovable, and hot 18-year-old up medical student contracts a rhinovirus, which presents regular symptoms since over three weeks ago. a week ago, he notices an increased number of pruritic, erythematous papules regionally distributed on his chest, where some soon coalesce into a well-defined plaque on the right side of his jugular notch. he also notes a purpura on the flexor side of his right foreleg. four days ago, he starts complaining of intermittent headaches localized on the right occipital area of his head. the next day, he notices a lymph node swelling on the right nape area, and slight ringing in his right ear. around this time, he decides to consult the up-pgh health services clinic after the much-dreaded derma-upper extremities exam duo, foregoing the first two hours of cadaver dissection, which started a week ago.
now, how do you even start making sense of all those differentials? if i was still the typical simple-minded high school student i was a couple of years ago, all this would have been attributed to a typical flu, which would have then been taken care of with fluids, bed rest, and the occasional paracetamol tablet. but now, thanks to the advent of anat/physio subjects, icpc's, and medical enlightenment in general, simple symptoms can take on entirely different (and mostly outrageous, i hope) diagnoses.
in the span of a few days, we've already looked up lymphadenitis and lymphedemas, parotitis, cranial neoplasms, hodgkin and non-hodgkin lymphomas, and probably a couple illnesses more, each more unlikely than the last. it's like we can't just relegate common symptoms to common diseases; our mere awareness necessitates a drive to uncover any and all possible causes behind the physical signs. once we start associating these signs to the respective diseases, it gets even worse when all the related symptoms, prognoses, and complications of each disease are uncovered. considering that the chances i contract mumps or that i develop malignancies are slimmer than my chances to ace the last two exams, it's still frightening to think of the possibility of sterility or a 10-year lease on life developing from a simple lymph inflammation.
and if the disease-guessing scare wasn't already enough for me to handle, now my caring father has to get on my case about cheering my lungs out at uaap games and my daily living habits, implicating them to my inflammed nodes. as if i'm not aware of the need for proper sleep and daily vitamin doses. when your child gets sick, or might be sick, i think it's more standard operating procedure to lay off the repetitive, stressful sermons and show your concern through more constructive means, am i right? luckily, i'm more than a bit used to the apparent lack of discretion on his side, so i'll just be stashing away counter-arguments for next time, and taking the silent way out this time.
anyway, the respectable diagnosis i got yesterday from the doctor at the health services was rhinitis with possible reactive adenitis. a week on co-amoxiclav to start with, and a referral to the department of otorhinolaryngology just in case. we'll just see how good our doctor-ing skills are at this point by then.
case in question: an intelligent, witty, lovable, and hot 18-year-old up medical student contracts a rhinovirus, which presents regular symptoms since over three weeks ago. a week ago, he notices an increased number of pruritic, erythematous papules regionally distributed on his chest, where some soon coalesce into a well-defined plaque on the right side of his jugular notch. he also notes a purpura on the flexor side of his right foreleg. four days ago, he starts complaining of intermittent headaches localized on the right occipital area of his head. the next day, he notices a lymph node swelling on the right nape area, and slight ringing in his right ear. around this time, he decides to consult the up-pgh health services clinic after the much-dreaded derma-upper extremities exam duo, foregoing the first two hours of cadaver dissection, which started a week ago.
now, how do you even start making sense of all those differentials? if i was still the typical simple-minded high school student i was a couple of years ago, all this would have been attributed to a typical flu, which would have then been taken care of with fluids, bed rest, and the occasional paracetamol tablet. but now, thanks to the advent of anat/physio subjects, icpc's, and medical enlightenment in general, simple symptoms can take on entirely different (and mostly outrageous, i hope) diagnoses.
in the span of a few days, we've already looked up lymphadenitis and lymphedemas, parotitis, cranial neoplasms, hodgkin and non-hodgkin lymphomas, and probably a couple illnesses more, each more unlikely than the last. it's like we can't just relegate common symptoms to common diseases; our mere awareness necessitates a drive to uncover any and all possible causes behind the physical signs. once we start associating these signs to the respective diseases, it gets even worse when all the related symptoms, prognoses, and complications of each disease are uncovered. considering that the chances i contract mumps or that i develop malignancies are slimmer than my chances to ace the last two exams, it's still frightening to think of the possibility of sterility or a 10-year lease on life developing from a simple lymph inflammation.
and if the disease-guessing scare wasn't already enough for me to handle, now my caring father has to get on my case about cheering my lungs out at uaap games and my daily living habits, implicating them to my inflammed nodes. as if i'm not aware of the need for proper sleep and daily vitamin doses. when your child gets sick, or might be sick, i think it's more standard operating procedure to lay off the repetitive, stressful sermons and show your concern through more constructive means, am i right? luckily, i'm more than a bit used to the apparent lack of discretion on his side, so i'll just be stashing away counter-arguments for next time, and taking the silent way out this time.
anyway, the respectable diagnosis i got yesterday from the doctor at the health services was rhinitis with possible reactive adenitis. a week on co-amoxiclav to start with, and a referral to the department of otorhinolaryngology just in case. we'll just see how good our doctor-ing skills are at this point by then.
Posted by no_brainer on July 22, 2006 at 09:22 PM | 16 comments
PiXiESTiX

hahahahaha!
takes me back to the days when i used to bust out my stash of medical jargon...
shweeeeeeeeeeeeet!
no_brainer
someday, i'm going to look back on all of this and laugh. lol. :-P
mixlits (guest)
no_brainer
kuazee (guest)
sigamik

no_brainer
i have to constantly keep on reaffirming myself that i am learning something in med school. or maybe i'm just a bit too over-eager for my own good. hehe.
sana naman hindi pa kayo nagsasawa sa akin. hehe. :-P
sigamik

may iba pa bang student-doctor sa tabulas? ikaw lang ang kilala kong nag-aaply ng medterms sa entry niya. coolness.
pero please, kapag nagkaharap tayo, wag mo akong bigyan ng prescription tungkol sa physical health ko. kung ayaw mong bigyan rin kita ng reseta ng mga psychological remedies.
no_brainer
and don't worry, di naman ako humihirit ng medical jargon out of campus and blogosphere, unless i'm with my just-as-nerdy friends. but i wouldn't mind a free psychoanalysis. i'm pretty sure i'll be an *interesting* patient. lol. :-P
aahhhron (guest)
Anyhoo,your second paragraph i didn't understand much, may mga terms lang akong naalala from 2nd year bio. Hehe Hot eh? hahahahahahahahaha
["now my caring father has to get on my case about cheering my lungs out at uaap games"]
he should meet my lola. pinapagalitan ako dahil cheerleading ang kinuha kong PE.
Gosh ang haba na ng comment ko. Haha
no_brainer
anyway, baka gusto mo syang balikan ulit pag nakapaglagay na ako ng links. it's not that complicated really, pinagpilitan ko pang gamitin ung ibang terms talaga para magtunog *professional* ung entry. haha. ;-)
to heck with what anyone says. up fight!!! :-D
koficola

no_brainer
magnificent_migz
impotence isn't equivalent to sterility and the latter is the complication to epidemic parotitis.
history taking done well...(ang feeling ko, i know)
anyway, i told you, sometimes, sleep and water won't be enough specially if things are compounded by the stress of med life. hahaha. anyway, your "principle" does work pero...
anyway, the issue is no longer relevant. you have to take your antibiotics, after all, cervical adenitis is bacterial. and sympre, you still have to take lots of water. hahaha
anyway, di ba differential pa lang naman yung ca? though most of it naman talaga are from infection in the nose, tonsils and adenoids.
hahaha. naisip ko lang, can pranic healing "heal" adenitis?
hahahaha
no_brainer
differential pa lang ba ung lymphadenitis, if sya na nga talaga ung identified condition? but then, physical manifestation nga lang sya of a possibly deeper disease. rhinitis ata ung proper diagnosis talaga eh.
pranic healing. lol. though we shouldn't scoff at it, highly regarded na nga sya by some consultants eh. hehe. :-D