Содержание
- 2. Case 1 Your next patient in general practice is a 45 year old Mr. Snider who
- 3. history I’m sorry that your brother passed away recently. I know that it is hard. Assess
- 4. History Diet: what kind of food you eat What is your level of exercise? SAD and
- 5. Physical examination General Appearance - Acromegaly- bossing of forehead, Cyanosis Vitals – Normal BMI – normal
- 6. Investigations FBE, U&E, BSL lipid profile, serum uric acid, TFTs, ECG Stress test
- 7. CVS chart
- 8. Without DM
- 9. Management All the investigations are normal. I could not find any abnormality in physical examination.. But
- 10. Management Alcohol – up to 2 standard drinks for 5 days a week Physical activity –
- 11. Case 2 A 63 year old car sales man, John, presents to the emergency department with
- 12. History John was woken up from an afternoon nap by sudden onset of severe, tearing pain
- 13. History Of Presenting Complaint- SOCRATES Site: where exactly do you have the pain? Onset: how did
- 14. Previous Episodes Is this the first episode or have you had similar episodes before? If previous
- 15. physical examination BP 155/100, no BP difference between right and left arm, P 78, RR 18,
- 16. Causes risk factors Bicuspid aortic disease Marfan syndrome and Ehlers-Danlos syndrome Other connective tissue disorders (Marfanoid)
- 17. Thoracic aortic dissection Aortic dissection is the tearing of the inner layer of the aortic wall,
- 19. Management Supportive: A B C Oxygen Analgesia Monitoring Arterial/CVP lines Medical Management: BP reduction to 100
- 20. CT scan of Type A
- 21. Case 3 You have a middle-aged clerical male coming to your GP practice with a 1-day
- 22. Differentials PSGN IgA Nephropathy Bladder cancer Renal cell cancer PCKD
- 23. History How bad is it? When did it start? What is the kind of pain? Is
- 24. History Have you noticed bleeding from anywhere else such as bruising or nosebleed? Any problem with
- 25. Explanation From the history most likely you have a condition called IgA nephropathy. Do you know
- 26. Mechanism
- 27. Difference Between Nephrotic and Nephritic Syndrome
- 30. Prognosis Is it risky? The prognosis is usually good especially in those who have normal BP
- 31. Case 4 76 year old Mr. Aaron Samuels, who is your patient for last 7 years
- 32. AAA
- 33. Guideline
- 34. 5 A’s approach Hello Aaron, How have been from last week? Hmm, you are excited about
- 35. Risk factors Can be completely asymptomatic, but occasionally can give back or tummy pain. Familial Smoking
- 36. The better news in your case is, it is It is still serious and we need
- 37. >5cm – Is it dangerous Doctor? Can I travel? When it is more than 5cm, you
- 38. Case 5 You are a HMO in the psychiatric department of the major hospital. You have
- 39. History CONFIDENTIALITY HOPC Psychiatry H/O - PTSD, depression, suicidal ideas HEADSS – alcohol, drug use is
- 40. Acute Stress Disorder is the term used when symptoms develop within the first month after a
- 41. Management DO YOU WANT TO REPORT THIS TO THE POLICE, so that the person who assaulted
- 42. Case 6 GP, 24 years old woman who is pregnant come to see you complain of
- 43. History Any injury, any infection, any pain any exposure to very loud noise Did you need
- 44. Physical examination Inspection -External ear - pulling ear -pain? -Press mastoid bone - tenderness ( cholesteatoma)
- 45. Examination Special test -Tunning fork ( 256 Hz) -Rinnie -mastoid and ear which one better? -Weber
- 47. weber’s test
- 48. causes of Sensorineural deafness -Cochlear degeneration -Acoustic neuroma -Drug -Ototoxicity - Streptomycin -Fracture of petrous temporal
- 49. Otoscelerosis Otosclerosis Common causes of hearing loss in adult -stapes bone stick to oval window, Normally
- 50. Management hearing contain 2 parts - air conduction and nerve conduction. your cases is air conduction
- 51. Case 7 A young woman at 10 weeks’ gestational age comes to see you in your
- 52. History GM, I am Dr. XYZ… how are you today? I understand that you are here
- 53. History Reassure her that she will be monitored. Antenatal screening should be discussed with all pregnant
- 54. First trimester screening test Combined Test- ■ A non-fasting blood test which is done at 9-13
- 55. risk factor Information from the ultrasound scan is reported to the pathology laboratory to allow the
- 56. 2nd trimester screening test 15 -17 weeks-solely blood tests. – Triple test (a, b, e) (detection
- 57. In high-risk pregnancies, diagnostic tests: ■ CVS – Done ideally at 11-14 weeks. – A needle
- 58. patient questions Are the tests painful? Many women find the diagnostic tests uncomfortable, and they are
- 59. Case 8 In a GP setting. An 17 year-old boy complaining of pain in the tummy
- 60. Differential Duodenal injury Local abdominal hematoma Gall bladder injury Testicular torison UTI Gall stone Strangulated inguinal
- 61. History Vital stability of the child – B.P. -100/60, P.R- 120, RR- 35 & O2 –
- 62. History BINDS – Heel prick test was done ?( thyroid) Any concern about development? Family situation
- 63. Physical examination General appearance – distress & in pain , no signs of dehydration VS: -
- 64. Explanation Your son has a Duodenal injury in the tummy as I could see bruise patch
- 65. Case: 10 26 year old John has been brought by the police from a local pub
- 66. Assess patient’s injury, offer pain management CONFIDENTIALITY History Can you tell me what happened at the
- 67. At hospital -> ever seen by a psychiatrist. Yes. I think there is nothing wrong with
- 68. Psychosocial H/O Home : Left home at 16 years. No contact with parents or siblings. Employment
- 69. Management Difficulty to treat because of late presentation and lack of insight In this patient, get
- 70. ANTISOCIAL PERSONALITY DISORDER (DSM V)
- 71. a mental disorder where a person shows no regard for right or wrong and is not
- 72. Symptoms Deceitfulness Non Conformity no respect for the law and have no boundaries. Impulsivity Aggression Irresponsibility
- 73. Reference https://wayahead.org.au/mental-health-information/fact-sheets/ mental-illness-and-related/antisocial-personality-disorder/
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