Special Sub-Topic: You're the Doctor Today!
|Your first patient today is an elderly lady. She's somewhat overweight and complains that she's thirsty all the time and has to go to the bathroom much more often than usual. You tell her you want to check her blood sugar level after a night of fasting, so you give her an appointment for tomorrow. Which disease are you thinking of?|
Diabetes. Since your patient is elderly, she probably has type 2 diabetes, which means that her body either doesn't produce enough insulin, or ignores the insulin that is produced. Without insulin the sugar from her food can't be absorbed by the cells in her body. Type 1 diabetes is more common among young people.
Cystic fibrosis is a hereditary disease that causes bodily fluids like saliva and mucus to thicken, and people suffering from CF don't have a high life expectancy. Your patient is definitely too old to be diagnosed with CF. Patients with hemophilia don't have enough blood clotting factor, so without treatment they could bleed to death. The disease is very rare among females and your patient would have discovered it ages ago, had she had it. Trichomoniasis is an STD that is caused by a parasite. The symptoms don't match your patient's.
|A little boy comes in with his mother. While the boy tries to tear down those expensive oil paintings you got for your birthday last year, his mum worriedly tells you her son has these strange red concentric circles on his left leg. The first thing that pops into your mind is Lyme disease, but to be more certain you need some extra information. What do you ask the mother?|
Has your son been bitten by a tick lately?. Lyme disease is spread by ticks, so it would be helpful to know if the mum recalls a recent tick bite. People don't always notice them however, so the absence of a bite doesn't rule out Lyme disease. You'd definitely want to treat the boy with antibiotics, if it really is Lyme, because the disease can cause meningitis, paralysis, arthritis and heart problems, among other things.
|The next person sitting in the waiting room is an absent-minded young woman. When you try to get an overview of her medical history, she mentions she's been seeing some kind of doctor. The woman doesn't remember exactly, but he was Chinese and did something with needles. What was his specialism?|
Acupuncture. An acupuncturist inserts very thin needles into specific locations on your body, the so-called acupoints, to either treat or prevent health problems. Acupuncture is a component of traditional Chinese medicine, just like acupressure and sonopuncture, but of course the acupuncturists don't have to be Chinese. Acupressure involves the application of pressure on the acupoints, sonopuncture is the application of sound on acupoints. Tuina is a traditional Chinese massage technique.
|After you've finished some paperwork it's time for the next patient. It's a teenage boy and although he isn't exactly happy to see you, the visit is a welcome escape from school, and from his algebra test! His face is full of pimples and he's really desperate, because the Clearasil that his mum bought him just won't work. What's the common name for the skin condition he (and a lot of adolescents with him) is suffering from?|
acne. A lot of people get to deal with acne, mostly during puberty, but adults can also be affected. Knowing that he's not alone probably won't help your patient much though. He'll be better off with a prescription for a stronger medicine or maybe you could refer him to a dermatologist.
|When the teenager leaves your office, he almost bumps into the patient coming in. It's a well-dressed man in his forties, who's very busily talking on his mobile phone. He's carrying a briefcase, probably a business man. He's here to get his cholesterol level checked. What influences the cholesterol level?|
All of these (Genes, Food, Physical exercise). There are two sorts of cholesterol, HDL and LDL or "good" and "bad" cholesterol. They're named after their carrier lipoprotein. LDL clogs up your arteries, whereas HDL is thought to undo the effects of the LDL to a certain extent.
If you have the hereditary condition familial hypercholesterolemia, the LDL level in your blood is already elevated when you're born and you'll likely suffer from heart problems when you're still young. If it turns out that you're patient's LDL level is too high, you could advise him to exercise more, because that is said to increase the level of HDL in your blood. Soy has the same effect on your HDL level and while he's changing his diet he might as well stop eating so many saturated fats, since they increase the level of "bad" cholesterol. Of course, cholesterol lowering medication could also be a solution.
|Just when you're about to go out for lunch a waiter is brought in. While serving lemonade he was stung by a wasp and his leg has started to swell already. He's obviously allergic to wasps, so you prepare an injection to stop the allergic reaction. What does your syringe contain?|
An antihistamine. During an allergic reaction the body releases histamines, which cause swelling and itching. An antihistamine stops the histamines from doing their job and blocks the release of more histamines. It's only effective for mild allergic reactions however. Had your patient the waiter been more allergic, his body could have gone into a possibly fatal anaphylactic shock. Then you should have given him epinephrine to reverse the anaphylactic reaction.
|Your lunch was delicious and you're ready for whatever the afternoon may bring, so you call in your next patient. It's an anthropology student planning a trip to Africa to do some research. He wants a prescription for chloroquine. For which tropical disease is chloroquine used as both a prevention and a treatment?|
Malaria. Chloroquine is sold under different brand names around the world. It's not only prescribed to people traveling to a malaria area, but also to sufferers from e.g. rheumatoid arthritis or the autoimmune disease lupus erythematosus. Let's hope your patient will very dutifully take his pills during his stay in Africa.
|An adolescent girl on rollerblades comes skating through the door while you're busy reading her chart. She only needs you to remove some stitches in her arm that were put in last week, after she'd skated into a dumpster. You have the stitches out in a flash, but you're still thinking about your patient's chart. It said she was diagnosed with glandular fever (mononucleosis) two years ago. Back then, which of these symptoms would she have been complaining about?|
All of these (Fever, Sore throat, Swollen and painful lymph nodes). Among teenagers glandular fever is known as the "kissing disease", because of the way it spreads, namely through saliva. In adolescents and young adults the Epstein-Barr virus, which is harmless if caught by young children, causes glandular fever, or infectious mononucleosis. There's really no treatment for the disease, except for treating the symptoms with bed rest and drinking lots of water. The Epstein-Barr virus will stay in your body for the rest of your life, but after the first time it usually won't cause any symptoms anymore. So if your patient ever returns with the same symptoms, you shouldn't have to worry about glandular fever.
|The next patient is a little girl, brought in by her nanny. She has a rash and bloodshot eyes, and after asking a couple of questions you're relieved that the only other patient left in the waiting room is male. Why? Because you just diagnosed the little girl with a disease that can be very harmful to unborn babies and since he's male, well, he can't be pregnant, can he? Which disease, that can cause foetal defects or miscarriage when contracted by a pregnant woman, do you think the little girl is suffering from?|
Rubella. Rubella, also called German measles, is a mild disease in children. However, the defects it can cause in unborn babies are pretty severe and vary from deafness or blindness to heart problems and mental retardation. Nowadays most children in the western world are vaccinated against rubella, so pregnant women are safer from catching the disease. If a woman is planning on getting pregnant and she's not certain if she's immune to rubella, she can get tested and vaccinated.
|Phew, only one more patient for today, and then you can enjoy your well-earned night off. The guy entering your office looks a bit timid and when you ask for the reason of his visit he blushes a bit. After beating around the bush for a while he confesses that he's had unprotected sex last weekend and is afraid that he's caught an STD. So, which disease is he not worried about?|
Cercarial dermatitis. Cercarial dermatitis is more commonly known as swimmer's itch. It's a skin rash caused by parasites. The STDs chlamydia, syphilis and chancroid are all treatable and are caused by bacteria. It's a good thing your patient came for a check-up pretty soon, because syphilis for example can cause blindness, bone problems or even paralysis if it's not treated in time. I hope you had fun being a doctor today!
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