Saturday, June 27, 2009

There is laughter in Medicine too; what about the Stethoscope sign?

I started a couple of months to post quotes that I wanted to remember some years from now and this's just a continuation of that:

-so we're in morning report and the next patient is an HIV +ve male who was admitted for Epididymitis (he had swollen testis). Then immediately after the resident calls the patient's name and gets ready to present him, here goes the attending "so how does his balls looks today?" The pharmacists who sits in on rounds burst out laughing but in a discrete way and I couldn't help either.

-"The stethoscope sign?"
so I had seen a patient earlier and was presenting the abdominal findings to the resident, who had also seen the patient after me. My abdominal exam was impressive in that it was tender to palpation but the resident want impressed with the abdominal exam. So she said "have you ever heard of the stethoscope sign?" I was like "no". So she said "when you palpate on the patients abdomen and they act like they're in pain and you want to validate your exam in suspicious cases, just place your stethoscope on their abdomen as if you're listening to their bowel sounds but apply pressure equal to that which you used during bare hand palpation and if the patient doesn't act like they're in pain, then the stethoscope sign is +ve" which means patient is just feigning.

- The cry for "vigina"
So this woman in her 40s comes in with chief complain of vertigo (felt as if she was spinning while in reality she was still) and had unstable gait. So we decided to r/o any Cerebro Spinal Fluid (CSF )infection etiology. She had earned a Lumbar puncture (which is where you basically insert a needle into some one's spinal canal -while avoiding the spinal cord and nerves) in order to collect some CSF for testing. Usually the area of needle penetration is numbed by injecting Lidocaine. So as the resident penetrates the spinal canal, the patient starts to really becomes anxious and I calmly talk her into being as calm as she can but she was still a little anxious. Then all of a sudden she says "awww, I can feel it going down me." "Do you feel pain or pressure? the resident asks" patient replies " I feel presssuuurreee" then a couple of seconds goes by and patient shouts " awwwww my viiiiigiiiiinnaaa; a sharp pain just went down my viigiinaa" and at this point we're looking at each other is dismay and thinking what's possibly happening here. Not to mention that the LP ended up being unsuccessful i.e no CSF could be obtained.

Thanks for reading,
Later.

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