I've been pondering this one for a while. Can anyone show me exactly what I'm missing?
Attending: Medical Student, this patient has bilateral pitting ankle edema, shortness of breath and borderline hepatomegaly. What do you think could be going on here?
Medical Student: Well, it sounds like it could be right heart failure.
Attending: I don't think so. It's most likely Cor Pulmonale.
Medical Student: (confused) oh.
This is the second time I've had this conversation. Lesson: Always use latin when available.
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What's missing? The MD after your name.
ReplyDeletethe only difference btwn right heart failure & cor pulmonale is you call it cor pulmonale if there isn't (at least an obvious) cause for the HF.
ReplyDeletebut yeah - that was just a put you in your place back-hand. :-/ Keep up the good work though!
If they had some stigmata of lung dz, cor pulmonale would be the more correct answer.
ReplyDeleteI had this happen all the time during my Medicine clerkship....would answer (correctly), and then they would disagree and then tell me the "correct" answer, which was exactly what I had just stated only in a few different words. I like to laugh it off :)
ReplyDelete90% of the time, I don't think they're even LISTENING. I'm guessing one of 2 things occurred: 1- he assumed that because you're a student that you're an idiot or 2- he asked you so he could buy time to think of his own answer (therefore not listening to you, and thus refer to #1, just assumed you're an idiot with the wrong answer). Either way. HILARIOUS!!! Well done, Doctor.
ReplyDeletedude no matter what I say Im wrong. I could have the most correct harrisons definition, they then say nope and proceed to tell me the same thing I just told them. My favorite thing, when they preemptively correct your presentations. You are about to say that and they jump in and said you are missing something. Best is the non-listener who corrects. You give your presentation head to toe for physical portion then have them say, don't jump around go head to toe.....you are left with huh??? It helps when you have a kind intern around who tells lets you know you were correct after the chief or attending leaves.
ReplyDeleteYou are both right, but your attending is more right. Pt is SOB, suggesting lung pathology. Cor pulmonale is R heart failure secondary to lung pathology, often with pulmonary hypertension. It's true the the patient has right heart failure, but that is not the specific diagnosis and does not encapsulate the nature of the problem. Primary R heart failure would be a whole different pathology.
ReplyDeleteRemember, you're smart, but you're not experienced, and the medicine attendings at an academic health center know an incredible amount of medicine.
Since the patient in this case had shortness of breath, lung involvement is obvious. Cor pulmonale indicates that there is some kind of lung pathology that lead to right heart failure. Right heart failure alone would not cause pulmonary symptoms.
ReplyDeleteahh, most common cause of RHF is LHF. In no way do the symptoms or signs necessarily indicate primary lung pathology.
ReplyDelete