A particularly interesting patient this week was a 25 year old lady who presented with a typical history of ureteric colic (colicky loin to groin pain since the morning and some blood in the urine). The intern I was with was able to perform ultrasound scans, so checked for any problems at the level of the ureters of kidneys and for practice/learning/teaching purposes too. There was a fluid with increased density in her bladder (likely blood). Then he had a look at the uterus and there was a clear gestational sac, on further questioning the last time she had had intercourse was ~4 weeks ago and used a condom. A blood B-HCG level came back as around ~10000, confirming pregnancy! The pregnancy was unplanned so she was referred to family planning service for further support on how she wanted to proceed. She had had renal colic as well, but had the intern not done an ultrasound scan she might not have found out so soon about the pregnancy. It definitely reinforces the need to do a pregnancy test for any lady of child bearing age with abdominal in ED, not something I’m going to forget in a hurry!
Another interesting patient was a ~50 year old lady who presented with muscle rigidity, altered mental state and hyperthermia having changed a neuroleptic drug recently. Further investigation showed signs of rhabdomyolysis and creatine kinase was hugely elevated – so it was pretty severe neuroleptic malignant syndrome. The mainstay of the treatment was supportive – IV fluids, stop the offending drug and get neuro/ITU input. Another neurological patient was a man presenting with right-sided facial paralysis and weakness of his right arm. After a thorough examination and a real grilling by the consultant neurologist he suggested that both were lower motor neuron lesions (Bell’s palsy of the face for the last couple of days, and a radial nerve palsy which after careful questioning had been there for 6 weeks which the patient hadn’t previously mentioned!).
As I finish my final week I look back at the past few months and am amazed by how quickly the time has gone! It’s been an amazing experience and I have learnt a lot, both in terms of medicine and French. I’ve had some interesting occasions where I’ve been quizzed on medicine that I knew, but it just didn’t come to me in French, which was very frustrating, so have almost had to learn things twice. Whilst my language has improved I still have a lot of room for improvement, but I really hope this is something I will keep up so that I don’t lose it!
