Subaqua Sternal Rubs

Every afternoon this week I have been scheduled for Clinical Skills 2 Small Groups. This sucks because, well, it's every day. It's good however, because by doing the "completion" sessions now, I won't have to worry about Clinical Skills the rest of the term. The sessions aren't really that bad - 1.5 hours each day learning about patient interviews, and ultimately interviewing an actor feigning some illness. It was pretty interesting, except it is done in groups of 6-8 students where all of the group hears each previous interview. Today I was the last to go, and as usual, all of the questions had been asked by my predecessors, and the patient was getting exhausted of answering the same questions over and over. So I ended up just reviewing/summarizing the case with the patient, and then went into my plan of treatment. I think I got a little too detailed, listing medications by name, and explaining various diagnostic procedures in detail. Hopefully the rest of the group didn't think I was showing off too much, but I had to say something. Anyway for those of you who like to play along at home, here was today's case:

Pt: 66 yo female
CC: Difficulty swallowing/Chest Pain
HPI: Pt unable to swallow, progressively worse for the past 3 and a half months. Now so bad she could only get a "couple of teaspoons of water" down each day. Unable to keep solid food down. Progressive weakness/tiredness. Loss of 15-20 lbs weight. Excruciating 10/10 pain sternal chest pain. All started after eating "oil-down" - felt like she got a bone stuck in throat. Disappeared same day, but then a week later gradually became worse.
PMH: None per pt.
PSH: Hysterectomy 30 years ago.
Meds: Maybe an OTC Tylenol, no Rx.
Allergies: States Codiene makes her vomit (This is not an allergy, folks, but that's another story.)
Social History: 1+ PPD Smoker x30 yrs. Drinks 4-5 alcoholic beverages daily, more on weekends.

So what's your diagnosis? Click on "Read the rest of this entry" to find out!

My differential diagnosis: Foreign Body in Throat/Related Trauma/Swelling vs. Esophageal Cancer

The Clinical Tutor's (MD's) Diagnosis: Esophageal Cancer (Woohoo! I got one right! )

And in another feel-good moment, the patient complimented all of us on our interviewing skills/demeanor, because she felt that we really cared about her predicament. She complimented me in particular for "giving [her] hope." Well, I guess the promise of IV pain medication helped me on that one

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