Neurology is rolling right along. Yesterday I was basically one-on-one with my attending because my partner took two (yes TWO hours) to see and write a report on a patient who is for all intents and purposes braindead. I have many questions...but moving along. The first patient had an array of symptoms that were fascinating to observe as a student. He had a present Babinski sign on the L, a L ankle clonus, and diminished L knee reflex. I became unnecessarily excited when I observed the Babinski: "Um, doctor, I think this is an upgoing Babinski. Do you want to verify?" I was indeed! Same with the clonus. I didn't see it, but felt the ankle jerk an extra time after the initial reflex, which I initially didn't think anything of, but after a second I asked the doctor to verify that as well, and indeed, I was paying close attention! Go me??
Later, we had a patient who has a history of thrombotic thrombocytopenic pupura. She had significant neurological damage. She had a rubral tremor, and noticeable cognitive impairment. Getting her to do Serial 3's (1, 4, 7, 10, 13...etc), you'd think I was asking her to do quantum mechanics. So all in all the doctor said I did very well with those cases.
Fast forward to today. We had a patient come in who on top of being hard of hearing didn't speak English as her first language (not unusual). We knew ahead of time that she had a pontine lesion, so the attending asked us to pay special attention to her cranial nerves. I noticed what I found out to be square wave jerks in her eyes. The doctor did not notice that immediately while my partner was doing the exam, and appreciated me calling it to his attention. Also this morning we had a patient who was known to the doctor. He had me examine her cold and to find her abnormality. I correctly diagnosed her problem as an ulnar nerve neuropathy. She had a noticeable left palpebrae that wasn't equal to the right, and I noticed she also had a slight left-sided mouth droop while the doctor was addressing a sensory complaint in her arm. I was able to bring that to his attention. I felt unnecessarily accomplished, and totally geeked out.
I'll leave with some awesomely bad jokes from my attending:
Did you hear about the Invisible man ? He married an invisible woman. Their kids aren't much to look at.
Disgruntled patient who just happens to be an NRA member: "If another doctor tells me there's nothing wrong with me I'll kill him."
Doc: "There's definitely something wrong with you."