Breaking Bad News

SPOILER ALERT - THIS BLOG HAS NOTHING TO DO WITH BREAKING BAD NEWS AND EVERYTHING TO DO WITH THE AMC DRAMA SERIES 'BREAKING BAD'

Tom recently cajoled me into littering the internets with some poorly formed ideas on medically related matters. The vehicle for such a violation? That's right, almostadoctor.co.uk. Anyway, adopting the Karl Pilkington approach I constructed the pun title first, then came up with the tenuously related content for the blog. I'm going to run with simple spot diagnoses as an idea. We'll see how long that lasts, hopefully longer than Rockbusters...

This is a potential OSCE patient to appear as early as Year 3 for University of Manchester students, and one I saw on the ward only recently. It is also a lesson in inspecting from the foot of the bed:

67 year old male - well at rest

• On inspection: decreased expansion right side of chest; right lateral thoracotomy scar.
• Hands: tar staining.
• Percussion: dull over right lower lobe 
• Auscultation: diminished breath sounds right lower lobe

Have a think...

Diagnosis:

The caveat was the mention of Breaking Bad, in which the protagonist has a diagnosis of small cell carcinoma of the lung. The patient above had the same previous diagnosis, for which he then had a right-sided lobectomy of his lower lobe, thus the thoracotomy scar. In other words - when reeling off the things you look for on inspection remember to actually look for those things. The other learning points? Knowing operation scars and indications for those operations is incredibly helpful. So yeah, I guess the title did end up relevant to the content...

MJ out.