Transcript Clinical dialogue five

Clinical dialogue five
Xiao Xiong Li
Department of neurological
Surgery
Ren Ji Hospital
Part one
D: I see from your notes you were in hospital 10 years ago with
thyroid trouble.
P: Yes, that’s right.
D: What has actually been happening since that?
P: All sorts of things. I’ve been feeling very depressed for a year.
D: Did you go to your doctor?
P: Yes, he gave me some Valium tablets to slow me down but they
slowed me to a halt. I did nothing but sleep.
D: Did they affect you in any other way?
P: Yes, I got stomach trouble, maybe indigestion,
I think.
D: What symptoms?
P: All the food stays up here. (indicating chest)
D: When do you get it?
P: Two to three hours after food.
D: Burning or stabbing pain?
P: It feels like some wind there and I want to get
rid of it.
D: Do you belch?
P: Not much.
D: Does it bother you at night?
P: No, it comes on when I was hungry and I feel
I’ll collapse if I don’t eat straight away
D: How about your appetite?
P: Very poor, it started to deteriorate 10 years
ago.
D: What about your weight?
P: I’m loosing weight.
D: What about your bowels?
P: I’m constipated.
D: How often do you have them opened?
P: Only when I take medicine.
D: Every day?
P: No, every other day.
D: Do you always sweat?
P: Yes, but more recently.
D: All over you body?
P: Yes, all over.
D: Any depressed , nervous, edgy, irritable?
P: Yes, it started one month ago before I
got my job.
D: Periods regular?
P: Every month since I had my baby five
years ago.
D: Is there anything else you’ve noticed ?
P: No.
D: Has anyone in your family had thyroid
trouble?
P: No, I have one sister and two brothers,
they are well.
Part two
D: I see you’ve been anaemic and you had a blood test
last May. Has anything else trouble you?
P: I’ve kept getting a roaring in my ears and giddiness.
D: All the time?
P: Most of the time.
D: How long has all this gone on?
P: Say, about six months.
D: Since your treatment with iron?
P: Yes, I keep getting dizzy spells.
D: Does anything bring them on?
P: Rushing about. Sometimes I know I’m falling but I
can’t stop myself.
D: Do your legs give way?
P: Yes.
D: If you stand still, do you hold on?
P: Yes.
D: Are you all right between spasms?
P: Yes.
D: Does it affect your ears?
P: I get roaring in my ears.
D: How long?
P: Minutes.
D: Do you feel sick?
P: Yes, first thing in the morning. Terribly.
D: Do you suffer from headaches?
P: My periods are only half a day and I get terribly
headaches.
D: How often do you have your periods?
P: It varies, every two or three weeks.
D: Is it always like that?
P: Yes.
D: You say you are breathless?
P: Yes, I get puffed if I go upstairs.
D: Do you have any bowel trouble?
P: No.
D: Water?
P: No.
D: Do you get up at night?
P: No.
Part three
D: I see from your notes you came to us a year ago with
an overactive thyroid gland.
P: Yes, and I had a miscarriage in May and I’m now
pregnant again.
D: When is your baby due?
P: Roughly 10th July.
D: Have you been taking pills for your gland?
P: I stopped about six months ago.
D: How are you at the moment?
P: I keep feeling queer and my doctor
suggested I had a check-up.
D: Do you ever faint?
P: No, but I feel faint.
D: Do you actually flush or sweat?
P: No, not as before.
D: Have you been gaining weight?
P: Yes, I didn’t realise I was pregnant.
D: Are your bowels regular?
P: Yes.
D: Do you go more than once a day?
P: No.
D: They are quite well-formed, are they?
P: Yes.
D: How are your nerves? Are you jittery,
fidgety?
P: No.
D: Do the family get on your nerves?
P: Not now.
D: Were your eyes always prominent?
P: Yes.
D: Are you particularly bothered by weather?
P: No, I used to be before.
D: You suffer from palpitations?
P: Yes, but I’ve had them since I was a child.
D: In yourself, you feel different?
P: Oh, yes.