November 9, 2016 – Dr. Paul Vincent Opinaldo guided the presentation of clerk JM de Blois and Intern Mia dela Vega, whose case was that of a 79 year old male with decreased sensorium, headache, and dizziness. Clerk de Blois discussed the clinical history and physical examination of the patient and presented the working impression, while intern dela Vega discussed the diagnostic modalities to confirm the diagnosis of B cell lymphoma. Dr. Carlo Barredo also shared some insights on the case.

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As with any clerks and interns presentation, the case raised questions and comments from the audience. Dr. Greg Dayrit commented that though progressive headache warrants imaging, a strong clinical impression is necessary especially when there is no MRI available.

Dr. Vincent Valencia delved more with the prognosis of the patient, asking if the patient still needs chemotherapy even with his advanced age, and if there may be risks when it comes to burr holes. Dr. Opinaldo stressed the importance of informing the family with regards to management decisions, while Dr. Barredo answered the query by assuring the audience that burr holes implore a minimally invasive approach with little or no morbidity.

Dr. Agnes Rico-Mendoza raised the importance of a good clinical eye and asked about the physical examination, whether the patient was spontaneously breathing. Clerk de Blois answered that the patient was already intubated and therefore breathing was mechanically assisted.

The college dean, Dr. Brigido Carandang Jr., took to the microphone and pointed out that imaging of the brain in vivo is a privilege only in St. Luke’s. He mused, since tuberculosis can also mimic a primary lymphoma, would an initial CT scan done in St. Luke’s make a difference?

The dean’s query was answered by Dr. Ron Pilotin. He noted that the technical aspect is important in imaging, and that the first step in examining images is to see whether they are interpretable or not. Other hospitals may not have the equipment in St. Luke’s, which will allow axial, sagittal, and coronal cuts. Dr. Barredo agreed with Dr. Pilotin, saying that other hospitals may not be at par with St. Luke’s.

Dr. Geraldine Mariano joined the discussion and told of the importance of clinical, radiological, and pathological history when coming up with an impression.

Dean Carandang concluded the presentation by reminding the audience that in clerk and interns presentations, there is already a complete history; it will be different in reality.