Day 2

 Today was day 2 in the ward and this time we knew what we had to do. Today's experience was more like a jagged line that a child makes while attempting to make that straight line. We were allotted a new patient, a 21 year old male who looked totally healthy. He stood up to greet us, and was in a pretty normal state. 

So, we were 15 people today, and 2 of us were asked to take the patient history and the rest of us were asked to observe them. We followed the very beautiful list that we had prepared yesterday religiously. Taking care to ask every single point and getting panicked with even a slight change in the format. We are taking our first steps and we want them to be as perfect as we could make it. 

The patient had come with his father and his chief complain was generealized headache for the last week which is accompanied by pain in the eyes. He had been taking homeopathy medications and that helped with the headache, but it was getting worse for the last 3-4 days for which he was admitted here. He said that he had started vomiting since the last 2 days. He did not have fever. On further questioning, he admitted to having slight tinnitus.

On further inquiry, the patient admitted that he had been having episodes of headache for the last 3 years. Though their frequency has increased in the last few months. He was also diagnosed with Renal stone which led to pain in abdomen and difficulty in urination which was treated very recently. The patient was also detected with cerebral hemorrhage in a latest MRI scan. He was a pure vegetarian. His family has a history of Diabetes Mellitus. 

With all of these information jotted down in our notebooks, we all decided to go to the student's room and start discussing these and try and come to a conclusion. One of my friends, let's call her J, was allotted the topic of Headache and she very soundly enlisted all the differential diagnoses associated with different types of Headache. On listening to her list, the two students (Let's say A and D) taking history realized that we do not have enough information. But we proceeded with the information we had in our hand. 

So, the patient had headache so the first things that come in mind are- migraine, vision problem, stress, hysteria, cavernous sinus thrombosis, neoplastic growth, head injury, meningitis, increased ICP, otitis media among other things.

First of all we ruled out migraine since it wasn't recurring and it wasn't sensitive to light and sound. We had already asked the patient about vision problems and he had denied of having any changes in vision. The headache was definitely aggravated by stress .  The patient said that he also has headache if he doesn't get complete sleep and thus sleeplessness is also an aggravating factor. Migraine usually has unilateral headache which is pulsating and preceded by an aura (The doctor asked the patient about sense of aura by simply asking if he already knows when his headache will start), but the patient did not complain of any of these. Meningitis was ruled out due to absence of photophobia, neck stiffness or fever (this rules out any kind of bacterial or viral infection). I suspected increase in ICP since the person had history of hemorrhage, was complaining of pain in the eye and the pain was progressive. He also had vomiting which is sometimes seen in increase in ICP. All the factors seemed in favor of ICP increase but it was diagnosed as Cavernous Sinus thrombosis and not ICP increase since there are no cerebral compression manifestation supporting parenchyma damage. 

I am still not 100% satisfied, but let's see what comes up next.

Also! apart from the clinical postings, we also have theory classes of subjects of 3rd semester which are Pathology, Pharmacology and Microbiology. 

We are having all the classes in online mode and it has just begun. With cell death and injury in first class of Pathology we are looking forward to the wonders that the subject is reputed to have! :)