Brandon brooks 26 year old man 1463782 you have a look there are no investigations I'm assuming there is a doctor there rhinovirus positive on nasopharyngeal swab chest x-ray heart looks enlarged in age consider cardiac echo no gross lung lesion ap film blood culture's normal userni's normal lfts alt a 159 crp 23 urea normal ast 57 coagulation screen normal neutrophilia set with neutrophil 7.36 white cells 9.6 was normal 2 previous emergency department attendances in december and july 2025 first in december with self harm and deliberate self harm with a razor blade and in july 2025 with depression and suicidal ideation oh okay you come in to give us I'm 1 the medical registrars yeah so the aed team have seen him and asked me to see him yeah to see about what we can do about this nasty headache and trouble with his vision and things like that he's been yeah he's I mean he seems to be a lot more comfortable now his temperature is a bit better he's able to walk to the loo whereas he couldn't even get out of bed this morning alright I think the pain is gone but he's had quite a lot of pain from the loo so yeah I don't know what else you know we're just waiting for labs yeah seen the results oh yeah okay yeah I can go back and tell you what's yeah mean I guess morning you need to tell him more exactly because he's he's a grown here he is now he's a grown adult now so yeah hi is it brendan yes hi I'm rob I'm 1 of the medical registrars next to you see you've got a little present for us thank you very much nice treat are you good how are you you okay I'm feeling a lot better good I'm glad in this morning still a bit rubbish mhmm but yeah I can actually get up and walk that's good to know and what's been happening the last few days tell me about that it's just been like sort of little bits of back pain mhmm what about in your back what's back there lower back lower than the right yeah it started on tuesday weren't it I think so yeah but it kind of wasn't anything really bad it was just like a little ache I just got the doctor to come back right I just don't know I don't know I don't you alright no no it's just oh that's nice helps a little bit yeah so is that like doing some like angle running down the corridor it's almost like 30 work going on everywhere stroke yeah I don't even know what that's about here it's pretty mad isn't it anyway yeah you were saying you've you've got you on tuesday yeah 2 days ago you had back pain mhmm it wasn't like anything major with and then I kept getting sort of like lightheadedness and dizziness mhmm and it felt the same way when I've forgotten to take my antidepressants sometimes mitalopramine I'm on venlafaxine venlafaxine yeah like when I was on sertraline if I'd forgotten for a couple days to take it my effects started to feel a certain way it felt similar so I thought maybe it's just where I'm not maybe I forgot to take my medication mhmm and then yesterday I woke up and it was like sort of a little bit of back pain but not too much it started getting worse through the day mhmm starting in the same place but then sort of felt like it moved like it like it kind of just in my hope and then around so I wanna say I ate a lot last night I just started to feel really really cold mhmm it felt like all my all my joints felt like they like just locked it's not I couldn't really move anything I couldn't get warm really really dizzy really lightheaded and like I've decided to go to bed mhmm hoping that I'd wake up within an hour right yeah and then whatever time after 4 05:00 this morning wasn't it somewhere around half past 4 I woke up and I was just in excruciating pain and your back again yeah it was kind of mostly my back but my whole body ached even now everything's quite stiff mhmm and I just I felt I was freezing cold and I could feel like putting my hand on my chest that it was really really hot mhmm and I just kept feeling like I was gonna be sick and my head was absolutely pounding mhmm were you sick no okay and the lights were bothering you as well wouldn't you yeah they still kind of are a little bit yeah that's why I've got the glasses on yeah but they're very starving sorry thank you yeah and then and any fevers feeling shivering and shaking at the bottom of the shaking weren't you you just sweats a lot I think so yeah at night yeah mhmm and and anyone else at sorry anyone else at home no no no that's fine but you're guessing that you live at home together I'm guessing yeah there's a whole family at the house pretty much everyone lived is still living at home but you've been a part now mhmm a week ago yeah and and stuff like that so we didn't know because you came back from holiday and you had a bit of a cold and all that didn't you yeah and then you've you've got better from that kind of and then a couple of days after that isn't started mhmm so yeah we didn't know if it was all kinda linked or whatever sniffly and sneezy yeah yeah and sore throat as well yeah yeah probably fair enough okay and I thought it was just like I caught a cold from from the plane because yeah 1 of the guys I with also had a cold so things are perfectly fine now patient's 0 maybe can I examine you quickly you're right no it's just not nothing you're not gonna take anything off or anything like oh okay your hands and listen to your chest oh it's okay nothing horrible that's bit of hard answer it's a tissue it's a a pain it's quite slightly more expensive you look at your hands is that right thank you turn the mic on that's lovely you look a bit blushed and red is that normal for you or is that I think normally I'm a bit red mhmm anyways but I think it's it's been a bit more mhmm yeah and more tattoos other than this 1 no no it's just done looks like it was done professionally yeah I struggled to do something that good with it anyway that's fine no living with tattoos no breathe all the way out vision yeah and look okay I'm ready I'm ready okay good good good good good and that looks like I'm do that okay any pain at all earlier it felt like a sort of pain I've got in my back the pain isn't sort of like blank yeah it felt like I was getting a similar pain there but not similar and what were you up to in prague labs are they kinda yeah it was it was we did a lot of like museums and stuff like that so it doesn't sound like do no that's a modern kind of no that's fine more like a country yeah okay can I have a look at your legs any rashes on your legs at the time that you're there just stay keen for me just take look at your glasses so that you can see yeah okay do you mind if I just speak to these people because they clearly wanna talk to me yeah I'm already around the course I'll leave you 2 seconds I'll just have a second okay alright you're calling me very hi there sorry about that sorry sorry I'm about here a few moments but I'm bit longer that's alright I hope it's okay 2 times okay I've examined you haven't I but I haven't found your tummy because you said you had a bit of tummy discomfort can I touch it can you touch sure sure okay you're at a lie on your left side james oh I can just touch your tummy I should say okay thank you and so you went around some museums in prague yeah and anything else that you're paying slightly in prague went to the grand zoo they have their office okay nice to meet you 1 of your like biggest best zoos it was massive we feel like we didn't get to see everything because k that was just really nice perfect and anything else any other exciting things any sex drugs rock and roll no nothing that can okay you can sit up if you like that's fine tell me to answer the stuff so you've had a few tests since you've been here yeah you've had some tests and markers in preventing that infection yours are raised modestly okay and you've had and you've had some observations with the nursing team which have shown you've got some low grade fevers okay and then you've had some more blood tests on the back of those inflammatory tests your liver function is ever 1 of the tests is ever so slightly elevated we often see in the context of viral infection okay and you've had your kidneys tested their enzymes normal and you've had a swab for viruses which shows you have rhinodvirus which is 1 of the many viruses that cause cold like symptoms okay but it's hit you quite hard because you need a bit of oxygen and you've got a bit of a liver injury with it okay and that can happen in the context of a viral infection some people will shrug it off other people the same person 6 months later it will have been a bit harder and it's entirely variable how people respond to those kind of infections I would suggest having on a panel of blood borne viruses just to make sure you haven't got something like infectious mononucleosis or epstein barr virus or cytomegalovirus those 2 viruses can also make a bit of slabby so I'll add those off okay the a and e team were concerned about meningitis as important for your symptoms is why they refer you to you okay because of your problems with tolerating light yeah you're tolerating being in this room quite well yeah it's gotten a lot better can you get your chin down to your chest yeah very good does that make does that hurt your neck and make your symptoms worse it's a little stiff a little stiff yeah nice are you showing it in your chair yeah excellent and if you lie down a bit flat you shift your leg straight forward yeah and how if I push in a bit harder what does that feel like it quite it aches quite a in your legs yeah yeah got a stool hold down a few tests on muscle and that's good okay people with meningitis usually have a very stiff neck they can't get their chin down to their chest at all they're incredibly rigid and that sign usually causes stretching and pain on their lower back okay so that sounds good I doubt very much that you have meningitis yeah if you had bacterial meningitis you'd be far more near than you are if you had viral meningitis we don't usually manage it in any way under the supportive care okay so I think that's another reason to think less about meningitis okay the third reason is the only way to test for it is in a very basic test where you take a sample of fluid from your back called the lungs okay so I think for the moment let's move with thinking you've got rhinoplasty yeah you're bit hard with this oxygen requirement of things let's when do you last have some blood tests this morning yeah great I'll add on a few more tests to your blood test okay we could try and get you walking around and see if we can get you off the oxygen and if you're feeling better and you're off the oxygen then we can get you out of here okay if not the oxygen is good yeah alright I felt I was only a little bit sort of off balance mhmm when I went to the restroom but I was just suffering a lot better than I was this morning good okay yeah that's good know we'll we'll we should get better relatively quickly okay and we don't have a treatment for rhinovirus yeah I think it's important again and things like that okay any questions or anything I've forgotten no no what other things I to help you with the plan I'll add on some blood tests to see what they show try and move around and ask the nurse to keep checking your oxygen levels we're in a tiny little snitch of oxygen if you can get off it then we can get you out of here and take you home but if you stay on it then you'll need to stay in hospital until they're over there that will be up to you and you can get your own blood just sit and take care of that okay yeah sounds good sounds good almost going on now yeah are you allergic to anything no good that's fine I wanna go take thank you thank you very much yeah with the door open yeah you got the light on on off pad yeah with the on air pressure on the vent like I'll get it I'll so so an examination mechanical sounding murmur allowed us in the tricuspid area systolic full stop query tricuspid regurgitation full stop loudest on inspiration full stop chest x-ray shows cardiomegaly chest clear to auscultation lungs lungs are clear on chest x-ray abdomen soft and nontender no peripheral edema no rash 1 l oxygen requirement plan add blood borne viruses including cmv ebv hiv discussed findings on examination and cardiomegaly on chest x-ray patient states has ebstein's anomaly and is under follow-up with the royal brompton with regular echocardiography plan for leave for their follow-up impression rhinovirus on a background of cyanotic congenital heart disease leading to oxygen requirements liver mild liver injury plan supportive care discharge once no oxygen requirement

[PATIENT_NAME] 26 year old man [PATIENT_MRN] you have a look there are no investigations I'm assuming there is a doctor there rhinovirus positive on nasopharyngeal swab chest x-ray heart looks enlarged in age consider cardiac echo no gross lung lesion ap film blood culture's normal userni's normal lfts alt a 159 crp 23 urea normal ast 57 coagulation screen normal neutrophilia set with neutrophil 7.36 white cells 9.6 was normal 2 previous emergency department attendances in december and july 2025 first in december with self harm and deliberate self harm with a razor blade and in july 2025 with depression and suicidal ideation oh okay you come in to give us I'm 1 the medical registrars yeah so the aed team have seen him and asked me to see him yeah to see about what we can do about this nasty headache and trouble with his vision and things like that he's been yeah he's I mean he seems to be a lot more comfortable now his temperature is a bit better he's able to walk to the loo whereas he couldn't even get out of bed this morning alright I think the pain is gone but he's had quite a lot of pain from the loo so yeah I don't know what else you know we're just waiting for labs yeah seen the results oh yeah okay yeah I can go back and tell you what's yeah mean I guess morning you need to tell him more exactly because he's he's a grown here he is now he's a grown adult now so yeah hi is it brendan yes hi I'm rob I'm 1 of the medical registrars next to you see you've got a little present for us thank you very much nice treat are you good how are you you okay I'm feeling a lot better good I'm glad in this morning still a bit rubbish mhmm but yeah I can actually get up and walk that's good to know and what's been happening the last few days tell me about that it's just been like sort of little bits of back pain mhmm what about in your back what's back there lower back lower than the right yeah it started on tuesday weren't it I think so yeah but it kind of wasn't anything really bad it was just like a little ache I just got the doctor to come back right I just don't know I don't know I don't you alright no no it's just oh that's nice helps a little bit yeah so is that like doing some like angle running down the corridor it's almost like 30 work going on everywhere stroke yeah I don't even know what that's about here it's pretty mad isn't it anyway yeah you were saying you've you've got you on tuesday yeah 2 days ago you had back pain mhmm it wasn't like anything major with and then I kept getting sort of like lightheadedness and dizziness mhmm and it felt the same way when I've forgotten to take my antidepressants sometimes mitalopramine I'm on venlafaxine venlafaxine yeah like when I was on sertraline if I'd forgotten for a couple days to take it my effects started to feel a certain way it felt similar so I thought maybe it's just where I'm not maybe I forgot to take my medication mhmm and then yesterday I woke up and it was like sort of a little bit of back pain but not too much it started getting worse through the day mhmm starting in the same place but then sort of felt like it moved like it like it kind of just in my hope and then around so I wanna say I ate a lot last night I just started to feel really really cold mhmm it felt like all my all my joints felt like they like just locked it's not I couldn't really move anything I couldn't get warm really really dizzy really lightheaded and like I've decided to go to bed mhmm hoping that I'd wake up within an hour right yeah and then whatever time after 4 05:00 this morning wasn't it somewhere around half past 4 I woke up and I was just in excruciating pain and your back again yeah it was kind of mostly my back but my whole body ached even now everything's quite stiff mhmm and I just I felt I was freezing cold and I could feel like putting my hand on my chest that it was really really hot mhmm and I just kept feeling like I was gonna be sick and my head was absolutely pounding mhmm were you sick no okay and the lights were bothering you as well wouldn't you yeah they still kind of are a little bit yeah that's why I've got the glasses on yeah but they're very starving sorry thank you yeah and then and any fevers feeling shivering and shaking at the bottom of the shaking weren't you you just sweats a lot I think so yeah at night yeah mhmm and and anyone else at sorry anyone else at home no no no that's fine but you're guessing that you live at home together I'm guessing yeah there's a whole family at the house pretty much everyone lived is still living at home but you've been a part now mhmm a week ago yeah and and stuff like that so we didn't know because you came back from holiday and you had a bit of a cold and all that didn't you yeah and then you've you've got better from that kind of and then a couple of days after that isn't started mhmm so yeah we didn't know if it was all kinda linked or whatever sniffly and sneezy yeah yeah and sore throat as well yeah yeah probably fair enough okay and I thought it was just like I caught a cold from from the plane because yeah 1 of the guys I with also had a cold so things are perfectly fine now patient's 0 maybe can I examine you quickly you're right no it's just not nothing you're not gonna take anything off or anything like oh okay your hands and listen to your chest oh it's okay nothing horrible that's bit of hard answer it's a tissue it's a a pain it's quite slightly more expensive you look at your hands is that right thank you turn the mic on that's lovely you look a bit blushed and red is that normal for you or is that I think normally I'm a bit red mhmm anyways but I think it's it's been a bit more mhmm yeah and more tattoos other than this 1 no no it's just done looks like it was done professionally yeah I struggled to do something that good with it anyway that's fine no living with tattoos no breathe all the way out vision yeah and look okay I'm ready I'm ready okay good good good good good and that looks like I'm do that okay any pain at all earlier it felt like a sort of pain I've got in my back the pain isn't sort of like blank yeah it felt like I was getting a similar pain there but not similar and what were you up to in prague labs are they kinda yeah it was it was we did a lot of like museums and stuff like that so it doesn't sound like do no that's a modern kind of no that's fine more like a country yeah okay can I have a look at your legs any rashes on your legs at the time that you're there just stay keen for me just take look at your glasses so that you can see yeah okay do you mind if I just speak to these people because they clearly wanna talk to me yeah I'm already around the course I'll leave you 2 seconds I'll just have a second okay alright you're calling me very hi there sorry about that sorry sorry I'm about here a few moments but I'm bit longer that's alright I hope it's okay 2 times okay I've examined you haven't I but I haven't found your tummy because you said you had a bit of tummy discomfort can I touch it can you touch sure sure okay you're at a lie on your left side james oh I can just touch your tummy I should say okay thank you and so you went around some museums in prague yeah and anything else that you're paying slightly in prague went to the grand zoo they have their office okay nice to meet you 1 of your like biggest best zoos it was massive we feel like we didn't get to see everything because k that was just really nice perfect and anything else any other exciting things any sex drugs rock and roll no nothing that can okay you can sit up if you like that's fine tell me to answer the stuff so you've had a few tests since you've been here yeah you've had some tests and markers in preventing that infection yours are raised modestly okay and you've had and you've had some observations with the nursing team which have shown you've got some low grade fevers okay and then you've had some more blood tests on the back of those inflammatory tests your liver function is ever 1 of the tests is ever so slightly elevated we often see in the context of viral infection okay and you've had your kidneys tested their enzymes normal and you've had a swab for viruses which shows you have rhinodvirus which is 1 of the many viruses that cause cold like symptoms okay but it's hit you quite hard because you need a bit of oxygen and you've got a bit of a liver injury with it okay and that can happen in the context of a viral infection some people will shrug it off other people the same person 6 months later it will have been a bit harder and it's entirely variable how people respond to those kind of infections I would suggest having on a panel of blood borne viruses just to make sure you haven't got something like infectious mononucleosis or epstein barr virus or cytomegalovirus those 2 viruses can also make a bit of slabby so I'll add those off okay the a and e team were concerned about meningitis as important for your symptoms is why they refer you to you okay because of your problems with tolerating light yeah you're tolerating being in this room quite well yeah it's gotten a lot better can you get your chin down to your chest yeah very good does that make does that hurt your neck and make your symptoms worse it's a little stiff a little stiff yeah nice are you showing it in your chair yeah excellent and if you lie down a bit flat you shift your leg straight forward yeah and how if I push in a bit harder what does that feel like it quite it aches quite a in your legs yeah yeah got a stool hold down a few tests on muscle and that's good okay people with meningitis usually have a very stiff neck they can't get their chin down to their chest at all they're incredibly rigid and that sign usually causes stretching and pain on their lower back okay so that sounds good I doubt very much that you have meningitis yeah if you had bacterial meningitis you'd be far more near than you are if you had viral meningitis we don't usually manage it in any way under the supportive care okay so I think that's another reason to think less about meningitis okay the third reason is the only way to test for it is in a very basic test where you take a sample of fluid from your back called the lungs okay so I think for the moment let's move with thinking you've got rhinoplasty yeah you're bit hard with this oxygen requirement of things let's when do you last have some blood tests this morning yeah great I'll add on a few more tests to your blood test okay we could try and get you walking around and see if we can get you off the oxygen and if you're feeling better and you're off the oxygen then we can get you out of here okay if not the oxygen is good yeah alright I felt I was only a little bit sort of off balance mhmm when I went to the restroom but I was just suffering a lot better than I was this morning good okay yeah that's good know we'll we'll we should get better relatively quickly okay and we don't have a treatment for rhinovirus yeah I think it's important again and things like that okay any questions or anything I've forgotten no no what other things I to help you with the plan I'll add on some blood tests to see what they show try and move around and ask the nurse to keep checking your oxygen levels we're in a tiny little snitch of oxygen if you can get off it then we can get you out of here and take you home but if you stay on it then you'll need to stay in hospital until they're over there that will be up to you and you can get your own blood just sit and take care of that okay yeah sounds good sounds good almost going on now yeah are you allergic to anything no good that's fine I wanna go take thank you thank you very much yeah with the door open yeah you got the light on on off pad yeah with the on air pressure on the vent like I'll get it I'll so so an examination mechanical sounding murmur allowed us in the tricuspid area systolic full stop query tricuspid regurgitation full stop loudest on inspiration full stop chest x-ray shows cardiomegaly chest clear to auscultation lungs lungs are clear on chest x-ray abdomen soft and nontender no peripheral edema no rash 1 l oxygen requirement plan add blood borne viruses including cmv ebv hiv discussed findings on examination and cardiomegaly on chest x-ray patient states has ebstein's anomaly and is under follow-up with the royal brompton with regular echocardiography plan for leave for their follow-up impression rhinovirus on a background of cyanotic congenital heart disease leading to oxygen requirements liver mild liver injury plan supportive care discharge once no oxygen requirement