A young girl consulted me yesterday. She had come for a general check up. Routine history revealed menstrual irregularity. Her build, dietary habits suggested a possibility of Polycystic Ovarian Disease. On close questioning she said she was on treatment for acne and' migraine.' I asked for an abdominal ultrasound (which indeed revealed Polycystic Ovarian disesase) serum Prolactin level which promptly came as high. The diagnosis was obvious - Pituitary tumor most likely prolactinoama. One must make use of the opportunity and see whether one diagnosis is possible. Patient gives a story. Doctor must listen to it patiently.
I remember the good old days where the skill of observation was taught as one of the first things. One of our professors ordered a student to exactly mimic him. The professor dipped a finger in a jar of urine and then into his mouth. The obedient student did just though he felt repulsive. The Professor had a hearty laugh. " I dipped my middle finger in urine and put my index finger in my mouth! You should have observed!" he said. Students had their first demonstration of 'skill of observation'.
A keen sense of smell was a prerequisite for a good physician. Ability to smell ketone bodies is an asset. It has helped me many times to start treatment before the urine report arrives. One of my professors in surgery could smell malaena from quite a distance. "You learn the trick once and you will never forget it" he would say. So true!
I remember seeing a patient at home for abdominal pain and vomiting many years ago. A just married girl just back from honeymoon was lying quite ill in a room near the window. She was writhing in pain. I observed urine kept nearby indicating her inability to use the toilet. The sunlight was directly falling on it and the urine had a port wine color. The diagnosis was made on the spot "Acute Intermttent Porphyria". I was a beginner at that time and I discussed with my chief. He gave me the 2nd clue for the diagnosis. "When a good surgeon thinks that the abdominal pain is due to a medical cause after ruling out surgical conditions, and when the physician thinks it is a surgical cause after ruling out medical conditions, think of Porphyria".
I once visited a young relative of mine, an orthodox girl who had just got married. She was having high fever and loose motions. I was thinking of the possibility if Typhoid. Just then she developed a rigor so typical of Malaria. On looking beneath the bed, I observed stools typical of Amoebic dysentery. I was indeed surprised at the obvious diagnosis of Intestinal Amoebiasis because she had not eaten any external food. How did she get it then? I promptly referred Manson's Textbook of Tropical Medicine. There it was- Acute Falciparum malaria can sometimes unmask Amoebic cysts (the quiet forms) and result in mass excystment resulting in a fresh attack of intestinal Amoebiasis without fresh infection.
We had a Professor who was an excellent teacher. He was good in bedside teaching. He would attract a lot of students by his dramatic classes. He would demonstrate clinical findings accurately and at the end of the class ask for the chest x ray. The students would run to the radiology department and get it. It would exactly match with his clinical findings! One day a PG student volunteered to guess the findings on the x ray. Much to the surprise of the students he was right. The professor was flabbergasted. "How on earth did you guess?" he asked the student. in desperation. The student gave a wide grin and said "Sir, I saw you go to the radiology department just before the class. I went in and saw the x ray too after you came out!"
I remember the good old days where the skill of observation was taught as one of the first things. One of our professors ordered a student to exactly mimic him. The professor dipped a finger in a jar of urine and then into his mouth. The obedient student did just though he felt repulsive. The Professor had a hearty laugh. " I dipped my middle finger in urine and put my index finger in my mouth! You should have observed!" he said. Students had their first demonstration of 'skill of observation'.
A keen sense of smell was a prerequisite for a good physician. Ability to smell ketone bodies is an asset. It has helped me many times to start treatment before the urine report arrives. One of my professors in surgery could smell malaena from quite a distance. "You learn the trick once and you will never forget it" he would say. So true!
I remember seeing a patient at home for abdominal pain and vomiting many years ago. A just married girl just back from honeymoon was lying quite ill in a room near the window. She was writhing in pain. I observed urine kept nearby indicating her inability to use the toilet. The sunlight was directly falling on it and the urine had a port wine color. The diagnosis was made on the spot "Acute Intermttent Porphyria". I was a beginner at that time and I discussed with my chief. He gave me the 2nd clue for the diagnosis. "When a good surgeon thinks that the abdominal pain is due to a medical cause after ruling out surgical conditions, and when the physician thinks it is a surgical cause after ruling out medical conditions, think of Porphyria".
I once visited a young relative of mine, an orthodox girl who had just got married. She was having high fever and loose motions. I was thinking of the possibility if Typhoid. Just then she developed a rigor so typical of Malaria. On looking beneath the bed, I observed stools typical of Amoebic dysentery. I was indeed surprised at the obvious diagnosis of Intestinal Amoebiasis because she had not eaten any external food. How did she get it then? I promptly referred Manson's Textbook of Tropical Medicine. There it was- Acute Falciparum malaria can sometimes unmask Amoebic cysts (the quiet forms) and result in mass excystment resulting in a fresh attack of intestinal Amoebiasis without fresh infection.
We had a Professor who was an excellent teacher. He was good in bedside teaching. He would attract a lot of students by his dramatic classes. He would demonstrate clinical findings accurately and at the end of the class ask for the chest x ray. The students would run to the radiology department and get it. It would exactly match with his clinical findings! One day a PG student volunteered to guess the findings on the x ray. Much to the surprise of the students he was right. The professor was flabbergasted. "How on earth did you guess?" he asked the student. in desperation. The student gave a wide grin and said "Sir, I saw you go to the radiology department just before the class. I went in and saw the x ray too after you came out!"
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