01-01-2009, 07:32 PM
@ atlh , we SHOULD ask those qs for every case
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OET & Step 2 CS
telephone cases.. - blessings4everyone
telephone cases.. - blessings4everyone
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telephone cases.. - blessings4everyone
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01-01-2009, 10:59 PM
This is the note I made during my preparation, I don't know I posted before or not . I had taken help from forum posts. so not all my notes are mine, thanks from forum members.
Bed-wetting (Enuresis ) Tell me more about it? When did bed wetting start? Has the child always wet the bed or it began recently? Or Has your son ever been dry at night before? Or Has he started bed wetting after being dry for a long time? Is there any particular time when these episode come out? Does he have any day time wetting? does he wet his pant during the day? Or Is your child dry during the day? How often does your child child wet the bed?How much volume of urine does he void during each episode?large or small How many times in the day does he void urine?What is the quantity of urine during each void? What is the average quantity of his fluid intake during the day? Does he drink excessive amount of fluid before going to bed? does he hold urine until last minute? And Does he ever have to run to the bathroom? Does your child complain of pain or other symptoms when urinating? Does he experience any difficulty in initiating or stopping the stream? Does he ever complain of dribbling or burning while urinating? Does he complain of a feeling of incomplete emptying of bladder? Does the bed-wetting seem to be triggered by certain foods, drinks or activities ? Does the bed wetting increase in the time of stress? Is anything that reduces the problem? How is his sleeping habit? does he snore? Does he have any problems with bowel movement? Does your child have any fever/ belly pain/ back pain? Have u tried any intervention or drugs in the past? ( Rewards/ diaper/ alarm system/ periodic waking/ restricting fluid) PMH: Does he ever have Sleep apnoea does he ever had any type of Neurological or gait abnormalities., DM,Sickle cell disease Does he suffer from repeated UTI? Is your child currently taking any medication? All HO: Is he allergic to anything? PSH & Hospitalization: Does he have any surgery or experience an injury to Nervous system? Birth HO: Did your child have any problem at birth? FH: Is there any family history of bed wetting?Did you or your husband have the problem of bedwetting as a child? I am asking this because it tends to run in family. Social HO: Children often tend to wet the bed as a result of some stressful event in their lives. Is your child facing any major life changes or other stresses? ¢ Are you aware of any incident that could be causing these symptoms in your child?starting a new school, problem at home? ¢ Would you describe your child as playful and social or shy or quiet? Could you tell me how this problem has affected you and your family? How is the bedwetting treated within the family? Does the bedwetting cause shame? How many children do u have? What are their age? If you're divorced, does your child live in each parent's home and does the bed-wetting occur in both homes? How much drinks (like juice ) does he take before bedtime?Does his drink contain caffeine or alcohol? Immunization HO: Last time check up: Growth & Developmental HO: Investigation UA and Urine culture first morning urine gravity ultrasound kidney,bladder Xray kidney Closure Miz xyz, I believe your son™s condition is probably an isolated symptom but I would like to run some test to make absolutely sure he does not have an underlying infection or a more serious medical problem, we can then discuss his treatment option after the test result.. In the mean time I recommend u two things 1- to limit fluids before bedtime and encourage double voiding ” urinating at the beginning of the bedtime routine and then again just before falling asleep ” may help. You may want to encourage your child to delay daytime urination as well. If the bladder isn't completely full, the urge to urinate may fade within a few minutes. With practice, this simple "stretching exercise" may help your child's bladder hold more urine at night. 2-Help child to cope and support him. Children don't wet the bed to irritate their parents. Because your child's bed-wetting is involuntary, it's illogical to punish wet nights or reward dry nights. Try to be patient as you and your child work through the problem together. DO u have any question for me? What Causes bed wetting? No one knows for sure what causes bed-wetting, but various factors may play a role. Most children outgrow bed-wetting on their own ” but some need a little help What are the complication Complications? Does it pose any health risk? Although frustrating, bed-wetting without a physical cause doesn't pose any health risks. The guilt and embarrassment a child feels about wetting the bed can lead to low self-esteem, however. Rashes on the bottom and genital area may be an issue as well ” especially if your child sleeps in wet underwear. To prevent a rash, help your child rinse his or her bottom and genital area every morning. It also may help to cover the affected area with a petroleum ointment at bedtime Treatments and drugs Most children outgrow bed-wetting on their own. If there's a family history of bed-wetting, the child likely will stop at the age the parent did. If your child is still wetting the bed by age 7 ” and is motivated to stop ” we recommend more aggressive treatment. Moisture alarms These small, battery-operated devices ” available without a prescription at most pharmacies ” connect to a moisture-sensitive pad on your child's pajamas or bedding. When the pad senses wetness, the alarm goes off. Ideally, the moisture alarm sounds just as your child begins to urinate ” in time to help your child wake, stop the urine stream and get to the toilet. If your child is a heavy sleeper, another person may need to listen for the alarm. If you try a moisture alarm, give it plenty of time. It often takes two weeks to see any type of response and up to 12 weeks to enjoy dry nights. Moisture alarms are highly effective, and they may provide a better long-term solution than medication does. Medication If all else fails, your child's doctor may prescribe medication to stop bed-wetting. Various types of medication can: Slow nighttime urine production. The drug desmopressin acetate (DDAVP) boosts levels of a natural hormone (anti-diuretic hormone, or ADH) that forces the body to make less urine at night. The medication is available as a pill or nasal spray. As of December 2007, however, only the pill form is approved to treat bed-wetting. DDAVP has few side effects. The most serious is a seizure if the medication is accompanied by too many fluids. Change a child's sleeping and waking pattern. The antidepressant imipramine (Tofranil) may provide bed-wetting relief by changing a child's sleeping and waking pattern. The medication may also increase the amount of time a child can hold urine or reduce the amount of urine produced. Imipramine has few side effects for bed-wetters. Caution is essential, however. An overdose could be fatal. Calm the bladder. If your child has a small bladder, an anticholinergic drug such as oxybutynin (Ditropan) or hyoscyamine (Levsin, Levsinex) may help reduce bladder contractions and increase bladder capacity. Side effects may include dry mouth and facial flushing. Sometimes a combination of medications is most effective. There are no guarantees, however, and medication doesn't cure the problem. Bed-wetting typically resumes when the medication is stopped. Alternative therapies Therapies such as massage, acupuncture and hypnosis have been touted as helpful treatments for bed-wetting. More research is needed before such therapies can be proved effective, however. Adopt good habits. Limit your child's fluid intake during the evening. Make sure your child urinates before going to bed ” and perhaps again when you turn in for the night. Remind your child that it's OK to use the toilet during the night if needed. Use small nightlights so that your child can easily find the way between the bedroom and bathroom. Be sensitive to your child's feelings. If your child is stressed or anxious, encourage him or her to express those feelings. When your child feels calm and secure, bed-wetting may become a thing of the past. Put your child to bed earlier. Perhaps surprisingly, an extra 30 minutes of sleep a night helps some children stop wetting the bed. Plan for easy cleanup. Cover your child's mattress with a plastic cover. Use thick, absorbent underwear at night to help contain the urine. Keep extra bedding and pajamas handy. Enlist your child's help. Perhaps your child can rinse his or her wet underwear and pajamas, or place these items in a specific container for washing. Taking responsibility for bed-wetting may help your child feel more control over the situation. Celebrate effort. Don't punish or tease your child for wetting the bed. Instead, praise your child for following the bedtime routine and helping clean up after accidents. With reassurance, support and understanding, your child can look forward to the dry nights ahead. DD A small bladder. Your child's bladder may not be developed enough to hold urine produced during the night. Inability to recognize a full bladder. If the nerves that control the bladder are slow to mature, a full bladder may not rouse your child from sleep ” especially if your child is a deep sleeper. A hormone imbalance. During childhood, some kids don't produce enough anti-diuretic hormone, or ADH, to slow nighttime urine production. Stress. Stressful events ” such as becoming a big brother or sister, starting a new school or sleeping away from home ” may trigger bed-wetting. Urinary tract infection. A urinary tract infection can make it difficult for your child to control urination. Signs and symptoms may include bed-wetting, daytime accidents, frequent urination and pain during urination. Sleep apnea. Sometimes bed-wetting is a sign of obstructive sleep apnea, a condition in which the child's breathing is interrupted during sleep ” often because of inflamed or enlarged tonsils or adenoids. Other signs and symptoms may include snoring, frequent ear and sinus infections, sore throat and daytime drowsiness. Diabetes. For a child who's usually dry at night, bed-wetting may be the first sign of type 1 diabetes. Other signs and symptoms may include passing large amounts of urine at once, increased thirst, fatigue and weight loss in spite of a good appetite. Chronic constipation. Sometimes children who don't have regular bowel movements retain urine as well. This can lead to bed-wetting at night. Anatomical defect. Rarely, bed-wetting is related to a defect in the child's neurological system or urinary system. .
01-01-2009, 11:06 PM
I am posting notes of some cases that I prepared with neeraj note and rehellohie and other forum members . Again would like to emphasize, I don not consider myself as a MASTER in CS but it was helpful to me . Posting it hoping someone might find it beneficial. Read at your own risk!!!
Child with fever when did it start?did u measure? How high was the temperature? how long has it lasted? - anything that makes it better, worse. -chills -Any shaking? Does he look playful or lethargic? how has he been acting: is he playful or quiet and not interacting Is he thirsty? Is he eating drinking well ? is he wetting diapers? associated symptoms Any ear pulling? Any discharge from ear? Any redness of the eye? Any difficulty in taking food? Any stiffness of the neck? Any rash in the skin? Can you describe the rash? When did u notice rash? Since it™s occurance has it spread to other parts? Any breathing difficulty? is he using his stomach muscles to breath... or do you see any retractions (i dont know how to ask this...).. Any sound coming out of the chest?any wheezing? Any difficulty swallowing, Any cough? Any phlegm with cough? Whats the color of the phlegm? What is the amount of phlegm? (Is it teaspoonful, table spoonful or a cup) Is there any blood in it? Any nausea? Any vomiting? What was the color of Vomitus? What does it contain? Is there any blood in it? Is there any pain in the tummy? what about his bowel movement? changes in bowel or urinary habits Is there any blood in stool? Is his urination ok? Does he cry while he urinates? Any contact with ill person? Does he attend to any day care centre? Do you think that he may have got this disease from day care? Can you pls give me the phone number of the day care center so that I can check is there any out break? birth history Tell me about his birth event? Is there any unusual event or injury? Is his growth normal like other children? Do you have a growth chart? Is his height ok? Is his teething/teeth erruption ok? Can he speak? Do you take him regularly to any paediatrician? Did anytime the paediatrician tell you that your little ____ has any problem? Has he been always a sick child or healthy? Is his immunization upto date? Can you show me his immunization card? Ok, I will review it later on/ Dont forget to bring it next time, ok? Tell me about his diet? How long have you breast fed him? When you started weaning? Did he accept the food normally? Any change in appetite? Any weight change? Tell me about his sleep? Is there any illness in the past? any allergic to any drug? have you given any medications to him ? Is he currently taking any medication on regular basis? any over the counter drug? Has he ever been hospitalized for any surgery? So let me summarize now. Your son has ----- and ------ and ----- So I am thinking about some possibilities. It may be simple upper respiratory tract infection or ear infection caused by a virus or bacteria. I need to examine him to be absolutely sure and he may also need few testslike blood test, urine test, throat culture, and chest xray. So would you please bring him to the hospital? When you are going to bring him? Althought I am suspecting viral infection but I still need to make sure that he does not have anything else. Most viral infection clear on their own but bacterial infection need antibiotic. And usually respond well to treatment. counselling Humidify the air. Adding moisture to the air prevents your mucous membranes from drying out. This can reduce irritation and make it easier to sleep. Double your fluid intake. Fluids help keep mucus thin and easy to clear. Gargle with warm salt water. Mix 1/2 teaspoon of salt in a full glass of warm water, gargle, and then spit the water out. This will soothe your throat and clear it of mucus. Children who had febrile convulsions performed as well as other children in terms of their academic progress, intellect, and behavior at 10 years of age The risk of epilepsy after febrile convulsions is much less than reported in many hospital studies, and if febrile convulsions cause brain damage that leads to later epilepsy this is a rare occurrence -has a fever has very hot, flushed skin, has a history of current or recent infection loss of bladder/bowel control. shaking and twitching of the body skin may take on a bluish cast. During a seizure, breathing stops. After the seizure, which can last up to three minutes, breathing resumes spontaneously copious drooling the body may be very still, or very limp the eyes may roll back ¢ FhO febrile convulsion they suffer frequent illnesses, which include high temperatures ¢ The attack often begins with the child losing consciousness, and shortly afterwards the body, legs and arms go stiff. ¢ The head is thrown backwards and the legs and arms begins to jerk. ¢ The skin goes pale and may even turn blue briefly. ¢ The attack ends after a few minutes and the shaking stops. The child goes limp, and then normal colour and consciousness slowly return. ¢ Some children regain consciousness faster than others. Do not intervene while the attack is taking place except in the circumstance outlined below. Carefully turn the child's head to one side to prevent choking. In the past, it was common to place a stick in the child's mouth to prevent bites to the tongue or lips. This should never be attempted, as it may result in lasting damage to the teeth. When the fit subsides, keep the child in the recovery position, ie lying on its side. If fits are prolonged or follow each other rapidly, call an ambulance. The first time a child suffers febrile convulsions they should be admitted to hospital. If the child has suffered attacks on earlier occasions, hospitalisation is not always necessary. However, it is always important, for example, to determine whether the convulsions are only due to a harmless viral infection. Make sure the child is not too hot by removing extra clothing or bedclothes. If the room temperature seems high, open a window, but bear in mind that the child should not get too cold either. Give the child plenty of cold drinks. Some doctors advise parents to give the child mild painkillers such as paracetamol (eg Calpol) or ibuprofen (eg Nurofen for children). This lowers the temperature by between 1 and 1.5ºC. It is important to give the recommended dose only.
01-01-2009, 11:09 PM
Telephone case
I™d like to get a few details from you about your child. What is his name? How old is he? Miz X , I am told your son is having diarrhea! Do u want to tell me more about it? How long is he having this problem? How many times a day is he passing stool or How frequent does it come prior to this problem how many times he use to pass stool? what does the stool look like/ Is it loose or watery Is it worst in a particular time of the day Can u see any blood in it. How much blood? Is it gross or only streaks on the stool surface? ... Does it appear at the beginning, at the end, all through the motion, or only on the toilet tissue?" any mucus or slime at all “ How does it smell?" Is there any other problem along with this symptom? any tommy pain at all Does he have any Fever?, Runny Nose? Rash, ? Cough, ? Ear Discharge? Vomitting, ? Rash ? is he passing urine? Does he look playful or lethargic? Is he thirsty? Was he in any contact with sick person? Does he attend to any day care centre? Do you think that he may have gotten this disease from day care? Can you pls give me the phone number of the day care center so that I can check is there any out break? Tell me about his birth event? Is there any unusual event or injury? Do you take him regularly to any paediatrician? Did anytime the paediatrician tell you that your son has any problem? Is his immunization upto date? Can you show me his immunization card? Tell me about his diet? How long have you breast fed him? When you started weaning? Did he accept the food normally? Tell me about his sleep? Has he been always a sick child or healthy? Is there any illness in the past? is he allergic to any drug? Is he currently taking any medication? how about any over the counter drug? Has he ever been hospitalized for any surgery? Mrs xyz, I am concerned about your child™s health.. I believe he is having viral gastroenteritis that is viral infection of gut .but there might be other cause that may have caused diarrhea. I need to check him physically and order some tests like blood test and urine test to be absolutely sure. According to what u have told me, he seem to be dehydrated and need early treatment.. So pls try to bring him as early as possible so that we can start necessary treatment, In the mean time keep him sipping pedialyte . if u don™t have pedialyte then u can make ORS at home. Do u know how to make ORS? Just Mix Water - 4 Cups. Salt - 1 TeaSpoon and Sugar - 8 TeaSpoons Encourage him to drink plenty of clear fluid including water, broths and juices every day. But, avoid apple and pear juices until you feel better because they can make your diarrhea worse. Avoid caffeine and alcohol. Eating gelatin may also help. I also recommend u to add semisolid and low-fiber foods gradually as his bowel movements return to normal. Try giving soda crackers, toast, eggs, rice or chicken.and Avoid giving certain foods such as dairy products, fatty foods, high-fiber foods or highly seasoned foods for a few days. Have u understood everything we have discussed today? Are ther any special concern you have? Ok, mrs xyz, we will meet again when u arrive here. good bye and take care. DD G astroenteritis U RI/UTI Malabsorption M eningitis, Measles, Mumps A cute Otitis Media S epsis S carlet fever investigation Electrolyte Rota virus enzyme assay Stool leukocytes culture Parasitology UA blood culture Challenging q What are the sign of dehydration? If she gives you positive signs of dehydration (Dry skin, sunken eyes and not passing urine - you may ask her to hurry and call 911 for transport) Can I give otc drug to stop diarrhea? Diarrhea caused by viral infections typically ends on its own without antibiotics. Over-the-counter (OTC) anti-diarrheal medications may slow diarrhea, but they won't speed your recovery. Certain infections ” bacterial and parasitic ” may be made worse by OTC medications because they prevent your body from getting rid of what's causing the diarrhea. Also, these drugs aren't always safe for children. Check with your doctor before giving these medications to a child. If the mom has no time / no car / no one else to get the kid - ask her to call 911
01-02-2009, 01:08 AM
Thanks a lot ramri. u had posted some notes previously too. these are a bit different.
01-03-2009, 09:29 AM
really appreciated her/his contribution in here...
01-03-2009, 04:38 PM
dementia in elderly.. how to go ahead..
telephone case...son wants what can be done right now for management...??
01-03-2009, 05:10 PM
pedialyte what is this??
how to pronounce this..??
01-03-2009, 09:09 PM
its ORS solution , pronounce it similarly to pediatrics , just replace 'trics' with 'light'
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