ward

I agree with my classmate. We are lucky.

Our IM Clinical Ward group has been very fortunate with regards to patient assignments for clinical history and physical examination. Last semester my group was stuck interviewing patients who suffered from myocardial infarctions (heart attack) or cerebrovascular accidents (stroke). This semester we have been introduced to less common diseases.

It all started with a discussion in Immunology about autoimmune diseases. One of the topics we covered was Myasthenia Gravis. The week after, we were assigned a patient whose clinical manifestations were almost textbook.

GO is 32-year old female presenting with a chief complaint of dyspnea. For Myasthenia Gravis women are more commonly affected with a 3:2 female to male ratio, the peak incidence occurring in women in their 20s and 30s. The disease is often unmasked by coincidental infections leading to disease exacerbation. Exacerbations can also occur before menstrual periods. Our patient had the first day of her period when she was admitted and was having a lower respiratory tract infection. The history of the present illness revealed a slow progression of symptoms commonly seen in the disease – ptosis, dysarthria, dysphagia and generalized weakness worsening in the late afternoon. To stretch our luck a little more we later found out that the patient in the next bed also had Myasthenia Gravis.

I will not go into the details of the other patients. Let me just say that our next patient, MC, was diagnosed as having Antiphospholipid Syndrome secondary to Systemic Lupus Erythematosus, a topic we discussed the week before. Patient MCG who we saw last Tuesday is being treated for arthritis possibly of autoimmune etiology. Today in Immunology we talked about Rheumatoid Arthritis.

I dare you to tell me I’m not lucky.