Previous Challenge Entry (Level 3 - Advanced)
Topic: Doctor/Nurse (11/02/06)
TITLE: An odd menagerie of patients
By Gregory Kane
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Community Association of best-loved fable and fairy-tale characters
Candidate’s name: Dr Knot A. Llew, MRCP (Wales)
The candidate will describe seven brief case studies, so as to provide the committee with an indication of his/her/its suitability for this position.
1. Patient presented with panic attacks and probable paranoia; further declared himself temporarily homeless following refusal to grant admission to visiting wolf. Have prescribed antidepressants and recommended patient purchase house built of bricks rather than wood or straw.
Examiner’s note: adequate treatment plan. However candidate failed to diagnose patient’s obsession with lack of facial hair on chin.
2. Patient presented with delusional account of abnormal growth in proboscis. Upon examination I failed to identify any evidence of either carcinoma or sarcoma, although appendage did seem surprisingly stiffer than would ordinarily have been expected for cartilage. Have referred for psychiatric assessment.
Examiner’s note: candidate failed to evaluate correctly patient’s self-diagnosis. More sympathetic investigation would have confirmed significant extension following exclamation of a deliberate fabrication.
3. Patient presented involuntarily inside overstuffed forest wolf. Performed emergency geriatrectomy using conveniently situated wood-cutter’s axe. Patient now sitting up comfortably in bed, albeit making disparaging comments about attending physician’s physical features.
Examiner’s note: candidate failed to identify additional presence of semi-conscious female child attired in crimson head covering.
4. Patient presented with simple fracture in the femur. Further examination revealed a surprising degree of brittleness, strongly suggesting widespread osteoporosis. Have encased fracture in plaster and prescribed biphosphonates to increase bone mass.
Examiner’s note: a more thorough history would have revealed that the injury came about as a result of the taunting of friends and neighbours, due to the patient’s perceived ability to run faster than anyone else. The underlying issue was psychological and hence left undiagnosed. Unfortunately patient has since disappeared, having last been seen crossing a river on the snout of an accommodating fox.
5. Patient presented with compulsion to osculate small amphibians. When invited to explain this propensity, patient related incoherent tale of losing a favoured ball as child and the subsequent transference of affection to a nearby frog. Narrative strongly suggested the possibility of sexual abuse although this was adamantly denied. Have strongly encouraged patient to experiment in kissing members of her own species for a while.
Examiner’s note: patient has since resolved her compulsive behaviour and is now happily married to Prince Ferdinand of Hollingstein.
6. I’m sorry. I know I’m meant to write in a formal, detached way but this last patient defied every standard of expected behaviour. He was clearly a dwarf; one leg was hideously misshapen so that he appeared to hop everywhere; his visage was badly scarred, apparently as a result of self-mutilation. He claimed to be a successful weaver and spinner of cloth but refused outright to tell me his name. He ranted incessantly about a grudge he held against some miller’s daughter who, he alleged, had not paid him for services rendered. I regret to say that I never ascertained the reason for his visit. He’s most probably quite harmless, albeit demented.
Examiner’s note: No comment made
7. Patient presented with a chronic chest infection. Have prescribed course of antibiotics. As patient was entirely naked and lives in a draughty palace, advised that some warm clothing would help avoid future illness. However, patient responded that this merely confirmed that I was evidently a charlatan and unworthy to call myself a physician. He immediately threw the prescription on the floor and stormed out of the consulting room. Presumably some form of mental illness - I understand this is not uncommon among royalty.
Examiner’s note: I would tend to concur with His Majesty’s assessment that this candidate is not really suitable for this post. A more astute and deferential physician would have complimented the King on his regal attire, thus assuring himself of the opportunity for some lucrative private consulting work.
Committee’s Assessment: Modern medical practice is an exacting vocation and Dr Llew is evidently an astute and capable member of his profession. It is apparent however that our archaic structures and atypical membership require a more old-fashioned approach to medical care. Accordingly, the committee moves to offer the position to Dr P Inboots, provided the latter is able to supply an accredited copy of his medical degree, as has been promised.
Message from the author: hearty congratulations to any readers who correctly identify all seven patients
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