Physical Exam Finding of the Day

This is an 18 year old male who came in complaining of shortness of breath and peripheral edema. His echo showed textbook Tetralogy of Fallot (yes it's crazy that he's 18 with this and still living!). This case was one of my favorites from the male ward. The patient had been admitted several times to different hospitals and not once did a doctor explain to mom what was wrong. She thought that her son had a lung problem! She had no idea that his heart was involved. She seemed well educated because her English was fantastic, and when I sat down with her to draw out a diagram of her son's defect she was using terms like deoxygenated blood as if they were part of her every day vocabulary. Why hadn't anyone taken the time to educate this woman about her son's condition and prognosis?

More often than not, patients and family members here have little insight into what is happening inside their own or their loved one's bodies. It seems that they completely leave their fate in the hands of their doctors or God - never even questioning when a crucial test is postponed over the weekend or when the intern only has time to do a quick, mediocre exam. This is vastly different from the U.S where patients at times seem to drift towards the other detrimental extreme - demanding unnecessary tests or taking unapproved supplements.

Anyway, the best part of this case was that this patient was used during the medical student practical exams. According to one of the test takers, the mom was so excited that she knew her son's diagnosis that she ended up explaining to each examinee the 4 components of tetralogy and completely giving away the answers to the practical. Let's just say that the attending physicians were not at all pleased. :)

Below you can see the significant clubbing that typically indicates chronic lung or heart disease.