ONE of the regular features I've put in the paper over the last year has been Education Corner. They're pretty geeky and not funny to
anyone non-medics but I thought I'd put up a few from time to time for any budding doctors to groan at.
Presenting Complaint - Ankle Swelling
PQ is a 45 year old man who presents to you in clinic with a history of ankle swelling. He gives a gradual progression over several years. He has no specific complaints but you fear the oedema could be quite severe as he has also noticed abdominal and facial swelling.
He has no cardiac history, nor any symptoms of kidney or liver disease, but he has noticed that his appetite has been affected. He is currently not taking any medication. Family history is unremarkable, but in the social history you learn he has increased his trouser size recently and as such you begin to consider endocrine pathology.
Examination is unhelpful. Shifting dullness is negative. No organs are palpable, JVP is normal and no abnormalities are detected.
You run a battery of tests. Nothing is conclusive and you are stumped. You recall that malnutrition can cause abdominal swelling - but an inexplicable hunch tells you that his nutritional status seems intact. As usual, you have no clue as to the diagnosis and are about to run away crying. Luckily a band of wandering minstrels give you a clue. They sing a song suggesting you take a step back and observe the patient from the end of the bed. Suddenly it all becomes clear.
What's the diagnosis?
Your patient is fat.
Chubby fat fat fatboy porker's disease (or as it was previously known, obesity) is a remarkably under-diagnosed condition. This is normally explained by the subtlety of the clinical signs suggestive of fatness, but it is important to rule it out in every patient you see, so be sure to look for it. The pathognomonic finding is a big fat person on examination. If you are unsure as to the diagnosis, do not be afraid to ask "are you fat?"
Fatness afflicts many, spread across all age groups. Symptoms include inability to fit through doors, causing earthquakes, losing small objects between rolls of flab and chronic celibacy. Treatment for fatties (it is impolite to use any other terminology) is a controversial field. Those that insist it's their glands should be punched on sight. This is the cruel-to-be-kind approach which has produced superb results in America, where 1 in 1 people are fat. Others should be shunned and treated as social pariahs. A novel therapy from GlaxoSmithKlineBeechamWellcome is very encouraging. A wet towel is used to 'whip' the tubby wideload's rear-end, as he or she runs around and tries to escape, often shouting "I'm full of chocolate". This fascinating treatment's full name is Liquid-Activated Rear-Driven Ass-Snapping Sequence, abbreviated to LARDASS.
If all else fails, pump them full of steroids, they never do any harm.
Originally published in Medical Student Newspaper