Day 5 (10/7) – The Chest Clinic 

10th JULY 2009 – FRIDAY

8.00 AM

  • I arrived at the hospital around 8 morning.
  • I went straight to the ward, reporting myself to Dr. W.
  • There was a patient with case of diabetes mellitus. Dr. W asked about the history taking of a patient with diabetes mellitus.
  • History taking of patient with diabetes mellitus is characterized by 3 main complaints – 3P
    • Polydipsia (thirst)
    • Polyuria
    • Polyphagia
  • Other complaints are also significant, for example weight loss and blurred vision may suggest nephropathy or retinopathy.
  • The diagnosis of diabetes is established when
    • Random glucose sample is >11.1 mmol/l
    • Fasting blood glucose is >7 mmol/l
    • Oral Glucose Tolerance Test (OGTT) 2 hours >11.1 mmol/l

10.30 AM

  • After I finished the ward round I went straight to the chest clinic (respiratory clinic), accompanying Dr. W.
  • Chest clinic is a special clinic targeting those with complaints of respiratory system diseases. Common cases in which are treated there – Pneumonia and TB.
    • Community Acquired Pneumonia (CAP)
      • I was given the chance to look at the xray of a patient with CAP. The xray shows right-sided shadow at the level of 4th/5th intercostal spaces.
      • The same patient also complained of coughing with white sputum, and pain at the right side of the chest.
      • The patient was then scheduled for sputum analysis.
    • Tuberculosis (TB)
      • Then, there was a patient with tuberculosis.
      • He was a male asian teenagers, with history of smoking since age of 14.
      • He developed cough since 2-3 months ago, with white-yellowish sputum. He also suffered from weight loss.
      • From the xray, I could see the distinguished border of a circle at the upper lobe of left lung, indicating the presence of a cavity caused by the disease.
      • According to Dr. W, upper lobe involvement is more common in asian patient of tuberculosis.
      • I also learned about the drugs used for treating tuberculosis. The drugs are:
  • Name of Drugs                         mg/kg (daily)           max dose (daily)
  • Streptomycin                                     15                      1000
  • Isoniazid                                             5                        300
  • Rifampicin                                         10                        600
  • Pyrazinamide                                     25                      1500
  • Ethambutol                                        25                      1200
  • I ended my day in the hospital at 1 PM. I was then allowed to be free.