My first day of Urban Community Rotation was basically a PCAP-y kind of day. We saw around 70 patients, 80% of which were children under 5 who either came in for complaints of cough, colds and fever or came in for follow-up after five days of antibiotic treatment for diagnosed PCAP.
There were just three of us doing the consultations. Basically everyone had to go through the Interns (that's me and my partner) before being seen by the Attending Physician. So except for a very few who went directly to the real doctor (because the interns had their hands full calculating recommended dosages), everybody went through us first.
My diagnostic reasoning went like this. Chief complaint of cough, cold and fever. Rales on auscultation? No = URTI. Yes = Pneumonia.
The whole day went like this with one or two hypertensives and one Acute Gastritis (Epigastric tenderness? Yes. Fever? No. Nausea & Vomiting? No. Psoas and Obturator Sign? No. Acute Gastritis) thrown in for variety.
My last two patients were two little girls, siblings. Both of them came for monthly check-up for the Feeding Program (or something like it). Both were underweight. The elder sister in particular, was below the -2SD line. Her lung auscultation revealed clear breath sounds. But then there was something not quite right with her heart auscultation. I detected a murmur on the left upper sternal border. A brief history from the mom revealed easy fatigability and episodes of circumoral cyanosis when she cries. Very suspicious.
When the AP confirmed it was indeed a murmur although she could not quite tell what kind (which makes me feel a bit better for not being able to better describe the murmur myself), part of me felt just a wee bit proud that I had detected the murmur and now she could be properly assessed for cardiac abnormalities. Part of me felt ashamed for feeling proud when every medical intern at this level should by now detect a murmur, for goodness sake!
And that's how thoughts of Pediatric Cardiology once again tickled my fickle brain.
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