January 26, 2012

interesting patients i saw today

Posted in Med school tagged clinicals, cool things, dr. at 10:23 pm by shangela

• 1st woman looked like she was on drugs, and when taking her history, she openly admitted to smoking marijuana. “To help her sleep” she said, and apparently she gets her supply from her kids. Plus, the reason she was in was for dyspareunia (pain with intercourse). That’s a pretty common complaint, but her husband had just passed away 2 months ago. As my doc said (not in front of her of course), she’s “back in the saddle” already.
• Another came in with intense abdominal pain, poor thing. She was practically writhing on the exam table and I felt so bad for her. It was the first case of real rebound tenderness I’ve seen though, which was super cool (that’s when you press down on the belly then let go, and the patient screams in agony). A positive sign equals peritonitis, so she had pelvic inflammatory disease and we shipped her to the hospital for IV antibiotics. I’m gonna round on her tomorrow to see how she’s doing.
• A morbidly obese woman (according to her BMI, and it actually says that on the chart) came in complaining of itching and tenderness in her vagina. Actually, she outright said she was thinking it might be STDs. So we probed more into that history and found out she had been seeing multiple partners at once.  (My doc later turned to me and asked “wonder if she had them at the same time”…LOL. He’s so inappropriate sometimes but its hilarious.) I got to do a pelvic exam on her…getting better at feeling for cervices! Turns out probably not STDs, maybe just yeast infection, but incidentally we also found a disgusting looking abscess on her mons pubis. I asked her if she had noticed it before, and she was like “when you’re this fat you can’t see much down there”. Heh…true I guess. Possibly staph infection.
• Then saw a 23 year old whose IUD had popped out a while ago and wanted to talk more about oral contraceptives. Actually, nothing too interesting with this patient, but as I rarely get to see women younger than 30 (my doc does only GYN now so its mainly menopausal women with things falling out of their vaginas. For serious, that’s what can happen when you get older…), a youngster was refreshing. Although the fact that she was younger than me and talking about sex was kinda weird, but I got over that quickly. You become desensitized to a lot of things in the medical world.

But yeah…southern Indiana farm country (that’s where most of the above patients came from), that’s where its at. Drugs, Medicaid, and obesity — you can practically write that on everyone’s chart. Bloomington is actually the largest hospital in practically a 2+ hour radius so we get all of those cases. Made for an interesting afternoon.

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