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Drop in your queries,will try to answer - buffycoat

Heard about the recent chicago cases:

1. Acute Cholecystitis ( asked for painkiller )
2. Patient feeling low ( NO FINDING : thought she was feeling weak due to the electrolyte imbalance --> diuretics likely )
3. Phone case : 8 yo child with abdominal pain ( challenging question the mums grandmum thinks that the child is faking it , what would u say doc ?
4. WITHDRAWN ( depression )
5.Nosebleeding ( irritated 18yo boy ....patient coz his mum dragged him into this he did not want to get himself examined )
6.Diagnosed case of Osteoarthritis knee joint flaring up of pain in the knee joint again ....
7. Racing of heart 17 yo female ( cocaine abuse....... she said no to recreational drugs and when asked her do u do drugs then she gave the history )
8. BACK PAIN ( CHALLENGING QUESTION : i have a wedding to attend next month , will i be allright ?
9. heel pain ( challenging question : can i and my wife go for a trip to florida ?)
10. shortness of breadth
11. cough with fever , sputum production
12. diabetes with diarrhea

Prepare well.

Good luck
Earlier Chicago cases:

1 Acute pancreatitis+ weight loss_along with new onset DM focus on the pancreas part.
Smoker.Typically describes a pancreatic pain.

2 Nasal bleeding takes Flonase for hay fever,black young guy had little accent difficulty in the beginning.Had a h/o cocaine snort but not then
Nasal exam showed Inf turbinate hypertrophy
Challenging question: My mother is worried about my bleeding likely answer: This is alarming she has a reason for worry but Am not in a better position of what's going on,would like to run some tests, will be informing you.

3 Hip pain + back pain h/o accident with abdominal +left hip + knee injury.took Tylenol but did not work ,advil(Ibuprufen) works.
Undergone splenectomy Scar+ over abdomen do not miss it.
Compare with the normal side.

4 h/o passing out young Caucasian while playing soccer likely Arrythmia.
Challenging q: Will I be able to play soccer coz my match is coming shortly?
Probable answer-looks like u r having heart problem so Without doing some test
I can't really speak upon. If the tests are negative ,after excluding other threatening conditions you may play.But I will let u know.

5 history of feeling tired(Depression)
Just got demoted in his job. Triggers new batchmate not obeying him. feels burden on his wife. No suicidal thought.
Challenging q : Will I get well?
Probable answer: I cant say for sure but I will try my best to help you.I will have to talk with your family. Do not forget to do Mini mental status exam.
Ask if he needs a counselor.

6 Fatigue (Obstructive jaundice picture)-dark urine pale stool.
Had h/o sexual exposure

7 Palpitation off and on. No h/o chest pain or thyroid disease. Female but sexually active with a girlfren (This is USA guys hahah)
Challenging q: Can I attend my fren's wedding?
Probable answer: Unless I am done with important tests to rule out your cause,I really can't advice that but if you are found negative then of course you can attend.

8 Pain on right side???? I was blank.Lady gripping her right subcostal area.
Was in great pain told that I will have my nurse give you medicine to control pain but please let me ask you few q n do relevant exam to know what the pain is really due to .
And I went on with the protocol q.
Only on past history she told that she had bladder infections 2 times 3 yrs ago.Then I could take a deep breath.
Again she griped her subcostal area I repeated the medicine nurse-after exam thing with little tap on her shoulder.Then she complied. Check for CVA(Renal angle) tenderness

9 Fat Caucasian with lower abd pain+ bleeding .h/o sexual exposure.Had previous history
Of PID. Dizzy+ so gait examined.
Asked whether will get any help?
Answer: Donot worry .Will go thru exam and tests .will let you know.Will do my best I can.

10.Hypertensive refill ..heavy accent (sound echoes in his mouth for me) Out of the pills 2 wks back. No side effects.Used to take water pills but now Enalapril so ask for ,BP latest .Blood lipid level checked or not?
Do not miss the pills,modify your life style.
Denies Xray chest being done so tell check urine n chest to be Xrayed.
Has to come for follow up for vision test.
Do not forget to do fundoscopy.
Difficult patient I had.

11. DM with diarrhea may b autonomic neuropathy or simply gastroenteritis.
Donot forget to check the vibration sensation in the lower limbs-as absent in ankle but present in the knee.
Counsel for foot care n vision follow up mainly.

12.Cough with fever gripping left side of the chest.Tells it hurts on deep breathing.
Offer him a tissue or a cup of water never miss that.

buffy coat;
i took my exam back in june

did not have time to close/coucil for 2 cases; maybe did a painful manouver once; made sure i did good on the rest of the cases..............
do i have a chance in passing Sad
Please let me know; some people say they did bad but actually did ok but say otherwise; i am not sure where i stand right now??? really appreciate feedback; i cant focus on the rest of the exams because of this :/
How do we ask for immunization history of a child?
shud we ask " is the immunization of the child up to date?
or is there any other way to ask the ques?
csdoctor: You have high chance of passing..from my side if you have been honest to describe your mistakes.Nobody scores 100% I bet you need 50% to pass...I think if you have done well in other 10 are fine.

For others:Time factor always jeopardize closure n counseling. So focus on relevant history and physical examination then spare time


Immmunization history-->Have you been visiting your child doctor?( yes) Did he say that your child has been completely immunized or has completed all the vaccine shots ?///// According to him is the vaccination of the child up to date? ----> All of these would sound good...choose yourself..
can i use abrev like MRG for no mumurs rubs and gallops?
Buffycoat thanks a lot for for ur reply. i have one more ques though..
how do we ask for growth n develpomental milestone in a pediatrics case?
isy2007: Do not use that sort of abbreviations...MRG does not exist....Donot be lazy to write no murmurs,rubs or will have enough time for that.

srija: Developmental milestones q: Do you think that your child has developmental delays as compared to the child of same age group?
or As compared to the child of the same age group, do you think your child has difficulty attaining the normal development?

I think that will do...
New cases in Chicago as of 21st July:

1.Fatigue ( Depression)
2. Difficulty micturition ( BPH)
3. Dizziness
4. Nasal Bleeding
5. Cough (COPD exacerbation)
6. Fatigue ( obstructive jaundice)
7. Dry cough
8. Fatigue ( abd pain)
9. Left knee pain

rest I haven't heard yet.

will be posting soon.....

G luck
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