Ask the Medical Student :)

[ChirpChirp]

Ask away!

 

[Hidden101]

If a patient was seeing you as their doctor, and the next day they became bankrupt and could not afford your fees; would you still allow them to continue seeing you for the problem that they first presented you with? I guess I should throw an example: burns.

 

[Daughter of Ararat]

Can a person who normally is about 98.7 degrees but who is run down from being sick have a subnormal temperature that is brought closer to the norm by a fever or is that necessarily not a fever because it is not above the normal temperature?

 

[ChirpChirp]

If a patient was seeing you as their doctor, and the next day they became bankrupt and could not afford your fees; would you still allow them to continue seeing you for the problem that they first presented you with? I guess I should throw an example: burns.

Yup, if the hospital lets me (welcome to bureaucracy)

 

[TillICollapse]

Without Googling:

1) A patient with a PICC begins to present with short runs of multifocal premature ventricular contractions. The short runs become more frequent, and the patient starts to complain of light headedness and palpitations. What do you suspect is the cause, and how do you verify it ?

2) What are two ways you can test a patient suspected of presenting with a pseudo seizure, to find out if they are really having a seizure verses fabricating one ?

 

[ChirpChirp]

Can a person who normally is about 98.7 degrees but who is run down from being sick have a subnormal temperature that is brought closer to the norm by a fever or is that necessarily not a fever because it is not above the normal temperature?

Well the definition of a fever is body temperature above the normal range which is around 97.7–99.5 degrees or 36.5–37.5 °C for Europeans like me . Your body temp varies throughout the day with you being coldest around 5-6 am and warmest in the evening and that is normal. Most people may differ slightly in their normal body temp too.

Fever means that your normal body temperature regulation has been reset to a higher point so I guess if you tend to have a slightly lower body temp a lower reading might for you indicate that your body temp is being reset to a higher point, however just because your temp is a little higher doesn't necessarily mean you have a fever. I'd say particularly if the temp is quite low, I wouldn't call it a fever unless it's accompanied by signs and symptoms that show you're feeling unwell, the typical headache, tiredness etc...

Good question!

 

[ChirpChirp]

Without Googling:

1) A patient with a PICC begins to present with short runs of multifocal premature ventricular contractions. The short runs become more frequent, and the patient starts to complain of light headedness and palpitations. What do you suspect is the cause, and how do you verify it ?

2) What are two ways you can test a patient suspected of presenting with a pseudo seizure, to find out if they are really having a seizure verses fabricating one ?

Oh wow! Didn't think this would turn into a quiz! Ok...I googled PICC to see what it stood for

1. That the central cathether is in too great proximity to the heart's atrium and this is interfering with the electrical conduction / irritating the heart

2. EEG and if you are able to observe the clinical characteristics of the stroke they may not fit in with those of an epileptic fit

May I ask the inspiration for the questions?

 

[TillICollapse]

Oh wow! Didn't think this would turn into a quiz! Ok...I googled PICC to see what it stood for

1. That the central cathether is in too great proximity to the heart and this is interfering with the electrical conduction

2. EEG and if you are able to observe the clinical characteristics of the stroke they may not fit in with those of an epileptic fit

May I ask the inspiration for the questions?

Dude (I know you're a female, sorry) ... dude I said without Googling ! Not fair lol

The answer to #1 is basically correct ... suspect the PICC is in too far. Surprisingly this common cause is sometimes often overlooked and the issue is presumed to be from other causes and time is wasted before a simple chest x-ray is ordered to verify PICC placement and pull it out by degrees if necessary.

The answer to #2 is not necessary ... a few quick tests of the patients reflexes can usually tell if there is an actual seizure taking place. Clap your hands in front of their eyes to see if they respond; raise their arms a bit and drop them, to see if they fall like dead weights or if the patient lowers them more naturally; and I have also heard of beginning the process of intubation and this will sometimes make a patient stop pretending to have a seizure variation

My inspiration for asking ? Your OP was my inspiration lol It said "Ask away !" Also, when you do your residency, there are little bits of helpful, practical knowledge that can help give you a bit of an edge over the other noobs. For example, if a patient with a PICC starts to have runs of V-Tach, and the noobs are freaking out and grabbing crash carts and trying to call cardiologists and go looking for other physician's help ... you can pipe up and say, "Um ... how about we just verify PICC placement first ?" and then everyone will applaud you hahaha I was trying to ask useful questions ;-)

 

[TillICollapse]

Okay three more then, for useful-info-fun ... and then I'll stop lol

*Without* Googling (haha !)

1) A patient is now on their 3th day in the hospital for a fracture in one of their legs, and hasn't been ambulated very much during that time (obviously). During a routine taking of their vital signs (on their 3rd day), the patient suddenly starts to complain of shortness of breath, and their breathing rate increases (tachypnia). They also start to complain of chest pain. What is the first thing you may suspect, and what test do you order as a result ?

2) A patient was starting to CTD (what does CTD stand for ?), and so before an actual code is necessarily called, while the patient is still more or less stable, you help transfer the patient to the ICU for more critical care. During the transfer, the patient starts to go into V-Tach. Even though you have the defibrillator attached to the patient for good measure, what else can you do that may bring the patient out of V-Tach other than defib right there in the elevator ? I've seen this done btw, and it worked ;-)

3) What is the difference between a pink puffer and a blue bloater ?

If this isn't fun to you, I'll stop

 

[ChirpChirp]

1. PE, CT

2. CTD?
Carotid massage

3. pink puffer = type 1 resp failure, blue bloater = type 2 resp failure

Don't stop it's fun

Are you a doctor?

 

[TillICollapse]

1. PE, CT

2. CTD?
Carotid massage

3. pink puffer = type 1 resp failure, blue bloater = type 2 resp failure

Don't stop it's fun

Are you a doctor?

Okay cool, glad it's fun I thought I may have crashed your thread and I was feeling bad

Okay on ...

1. PE is right, CT sure, but first I would order a D-dimer ;-) My questions are more geared towards thinking on your feet, fast, kinda stuff D-dimer stat

2. The carotid massage is more for SVT, PSVT, differentiating SVT from a high rate a-fib, etc ... not V-Tach. If the rate is so fast it's hard to differentiate V-Tach from SVT, then sure ... but I should have clarified that the rhythm was quite obviously V-Tach when you're stuck there with the patient in an elevator and you want to think fast on your feet. I'll let you answer the original question still if you like haha And CTD stands for "circling the drain" ... unofficial medical abbreviation right there lol

3. Yeah basically, I was wanting to know if you knew the difference merely by looking at someone

Glad it's fun ... and my medical credentials aren't the topic here hahaha (I'm copping out of answering that question lol). I'll leave that #2 then as "yet to be answered" and won't ask more till then