Another tutorial session with the registrar, Dr. Chee. We were asked to see a patient who presented with epistaxis and haemoptysis associated with myalgia, fever, and night sweat. First thing that came to our mind was infection, probably TB. During the discussion, we were asked to work out the other possible differential diagnosis. From what I had learnt today, they could be due to infection, malignancy, medication (blood thinner/anti-platelet), autoimmune diseases (SLE, Goodpasture syndrome etc), vasculitis, pulmonary embolism (as the patient also complained of calf pain) and the list goes on. According to the registrar, the abnormal features seen on the radiological investigation was unlikely to be infection or malignancy. However, it was not enough for them to draw a conclusion. Thus, future investigations such as sputum examination, autoantibody tests, and urine examination have to be done to narrow down the diagnosis. I would never have thought of autoimmune diseases when it came to haemoptysis. Again, I learnt something.
In the afternoon, I attended the weekly grand round presentation. The presenter was Professor Julie, Chief of endocrine surgery from Duke University, USA. The content was about thyroid cancer and its evolving management. I got to know that thyroid cancer is quite an issue in United State. Apparently, they are working hard to figure out the preventive measures and the choice of effective management for this disease.
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