the works
a typical long case precis....
"Good Morning Dr.
Mr X is a 62 yr old malay gentleman who presents with a hard, non-painful mass in the right side of the face just above the angle of the mandible that grew from a small lump to a much larger one in 2 mths. He also complains of pain in his right lower limb following a fall 2 mths ago, as well as loss of weight of 10kg in 7 mths. Mr X denies having any fever, breathlessness, LOA or sleeping problems.
Significantly, Mr X has a past history of masses diagnosed as lymphomas dating back as follows: in 2000, he complained of swollen testes and was given chemo and radiotherapy at TTSH. In 2003, another lymphoma which was hard and swollen but non tender appeared in his jaw, for which he was given only radiotherapy, as he refused treatment with chemotherapy. in Jan 2007, another lymphoma was found in his left inner thigh, for which radiotherapy treatment was given. all 3 lymphomas were resolved following treatment.
In addition, Mr X sustained a right lower limb injury following a fall 2 mths ago, for which he received painkillers. An X-ray was taken but found no fractures. He also has a 20 yr history of DM and a 20 yr history of HTN, but denies having any heart or cerebrovascular problems.
Mr X is married with 2 daughters and 1 son aged between 24 and 37 yrs old. He has 5 sisters, 3 grandaughters and 1 grandson, and lives with his wife and youngest daughter. Significantly, 2 of his sisters suffered from stroke previously, and his mother and grandmother both had a history of DM and HTN. the family visits every night. Mr X smoked an average of 3 packs a day for 7 years, but denies any drinking habit.
Mr X has been working as a prison supervisor at Changi Prison for the past 15 yrs, and his employer is paying for the bulk of his medical bills, the rest of which is covered by his personal medisave account.
Mr X is on the following medications: Acarbose, Glibenclamide and metformin for his DM, Captopril for his HTN and Simvastatin for his high chol.
My preliminary diagnosis for Mr X is a recurrence of a lymphoma, possibly secondary to a primary malignancy site. my differentials include a lipoma, infection, parotitis, squamous cell malignancies, and a submandibular gland swelling. With your permission, I would now like to perform a physical examination of the mass, as well as the rest of Mr X's cervical lymph nodes, together with their drainage areas in the head and neck region to further confirm my diagnosis, as well as exclude the rest of my differentials. thank you."
~finis~
josh
"Good Morning Dr.
Mr X is a 62 yr old malay gentleman who presents with a hard, non-painful mass in the right side of the face just above the angle of the mandible that grew from a small lump to a much larger one in 2 mths. He also complains of pain in his right lower limb following a fall 2 mths ago, as well as loss of weight of 10kg in 7 mths. Mr X denies having any fever, breathlessness, LOA or sleeping problems.
Significantly, Mr X has a past history of masses diagnosed as lymphomas dating back as follows: in 2000, he complained of swollen testes and was given chemo and radiotherapy at TTSH. In 2003, another lymphoma which was hard and swollen but non tender appeared in his jaw, for which he was given only radiotherapy, as he refused treatment with chemotherapy. in Jan 2007, another lymphoma was found in his left inner thigh, for which radiotherapy treatment was given. all 3 lymphomas were resolved following treatment.
In addition, Mr X sustained a right lower limb injury following a fall 2 mths ago, for which he received painkillers. An X-ray was taken but found no fractures. He also has a 20 yr history of DM and a 20 yr history of HTN, but denies having any heart or cerebrovascular problems.
Mr X is married with 2 daughters and 1 son aged between 24 and 37 yrs old. He has 5 sisters, 3 grandaughters and 1 grandson, and lives with his wife and youngest daughter. Significantly, 2 of his sisters suffered from stroke previously, and his mother and grandmother both had a history of DM and HTN. the family visits every night. Mr X smoked an average of 3 packs a day for 7 years, but denies any drinking habit.
Mr X has been working as a prison supervisor at Changi Prison for the past 15 yrs, and his employer is paying for the bulk of his medical bills, the rest of which is covered by his personal medisave account.
Mr X is on the following medications: Acarbose, Glibenclamide and metformin for his DM, Captopril for his HTN and Simvastatin for his high chol.
My preliminary diagnosis for Mr X is a recurrence of a lymphoma, possibly secondary to a primary malignancy site. my differentials include a lipoma, infection, parotitis, squamous cell malignancies, and a submandibular gland swelling. With your permission, I would now like to perform a physical examination of the mass, as well as the rest of Mr X's cervical lymph nodes, together with their drainage areas in the head and neck region to further confirm my diagnosis, as well as exclude the rest of my differentials. thank you."
~finis~
josh
posted by signed on the doctored line at 12:43 AM
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