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d/d d/d - djyoti
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05-16-2006, 03:24 PM
--appendicitis
uti pid ectopic ovarian cyst ovarian torsion chole gastro enteritis viral disease with pelvic lymphadenitis advice need to do dre later beata hcg pelvic exam cbc u/a
05-16-2006, 03:32 PM
add
diverticulitis nefrolithiasis intestinal obstruction/perforation +/- workup rectal exam pelvic exam for female patient CBC Electrolytes Ab xray CT abdomen US abdomen counselling explain symptoms explain workup and say further discussion of diagnosis will be at that point if suggestive of PID - safe sex practices ask if pt has any questions also in acute abdomen remember to check in abdomen exam murphy's sign mcburneys point pspoas and obturator test anything else we should remeber?
05-16-2006, 03:34 PM
asthma
check list cough fever rhinorrhea nasal congestion sore throat onset duration progression frequency -- timing --night day relieving exacerbating medications chest pain allergies severity inspiration expiration pain prior hospitalization family hx smoking alcohol occupation occupational exposure clubbing cyanosis palor lympadenopathy throat acessory muscle trachea symmetry movement deformity size shape palpation tenderness excursion tactile fremitus chest deformities position of diaphragm percuss diaphragm excursion auscultate sound resonannce whispering pectoriloquy aegophony d/d viral urti pnemonia laryngotracheobronchitis anxiety foreign body aspiration cardiac asthma chest xray cxr spirometry pulmonary fuction test cbc sputum culture abg
05-16-2006, 03:56 PM
carpl tunnel syndrome
pain location intenity duration quality asociated numbnees tingling relieing excerbating timing and frequeny fatigue/cold intolerance / hair loss / pallor / cynosis rubor ros question --palpitatitation sob headache dizziness past medical ill ness --heart/ breathing/ hypertension/ thyroid problem psh and hx of trauma in that area allergy medication past surgery trauma hospitalizations urinary bowel fh occupation --carpenter typist hammer/ sports/writer sexual sleep snoring recreational drug alohol smoking o/e see vitals examine for palor jaundice lymphnodes and then examine heart and lungs after that examine upper extremities bilaterally for motor sensory reflex and power and all range of motion concentrate on the wrist area dont forget tinnel sign and phalen s test sensory shuld include crude touvh fine touch and pain examine cervical spine smmetry deformities swelling redness active range of motion palpate for temp tenderness masses d/d carpal tunnel--tendonitis trauma sprain rheumatoid arthritis cervical spine disorder advice --cbc esr rf thyroid function test tsh t4 t3 free skull xray if ndocrine suspect beta hcg if pregnancy blood glucose level ana anti scl 70 counselling use of wrisrt splint nsaid surgery
05-16-2006, 04:00 PM
remeber one point in counselling that is to remember some screening recommendations even if unrelated to case
ie young female: pap smear older female mammogram older male: review for prostate please add more thanks
05-16-2006, 04:33 PM
cocaineabuse
what brings you if you know cocaine abuse is the problem social history comes first presenting complaint onset duration and progression and frequency and social history smoking how much alcohol how much drug use family situation specify drug method of use family situation work situation ability to function at work presence of support system now ros question--fatigue weight loss / sob/palpitation/dizziness/ numbness tingling / now pam hugs foss past medicl illness -- allergy medication hospitalization uriary bowel family history occupation--already done sleep --snoring--suicidal ideation -psychiatric history size a caps digfast sexual history partner preferance protection distress hiv status vitals general exam jvp repiration pattern thyrid cardiac detail carotid- heart lung abomen cns for pupil look for nasal look for alcoholic neuropathy look for liver problem on abdominal exam and look for stigmat aof liver disease d/d alcohol depression hiv anxiety thyrotoxicosis anemia cocaine induced cardiac ischemia cbc blood sugar drug screen tsh free t4 and t3 hiv status after permission counselling support group antideppressant may be neede just inform just inform the possibilities
05-16-2006, 04:35 PM
thanks zoya -
your points are taken by me --thanks everytime
05-16-2006, 05:05 PM
--a case of concussion
hi iam dr jyoti iam your working pahysician oday i wil ike to ask you some questions and help you what bring u presenting c/o onset duration progression preceding event what were you doing before what you do after how are you feeling intensity quality neck pain other part of body loos of consciousness how long dixzziness nausea vomiting postural hypotension palpitation fatigue weakness exacerbating relieving pamhugs foss soda past medical illness --previous episode/ psychiatric problen/ epilepsy / diabetes/ heart/ thyroid/ hypercalcemia psh and trauma previous hospitalization allergy medication urinary any incontinence following trauma bowel family history occupation stress sleep alcohol recreational drug sige a caps digfast epilepsy--bite / todds paralysis deja veu / incontinence metabolic history for unconsciousness --thyroid symptoms/ adrenal symptoms repiration questions sexual history -- if female gynae obs look for abuse history -support system --safe guard physical exam mmse orientation level of consciousness shortterm memory long term gait speech head exam--masse / bruises /echymosis/laceration/ tenderness tongue for bite injury ears for discharge all cranial nerve --field of vision pupil eomi whisper test wrinkle smile puff whistle cranial nerve 5 senasation -crude touch and fine touch clinch th eteeth feel masseter swaoow shrug turn head to pposite check muscle for power fasciculation atrophy see sesation coordination romberg shin tibia movement walk --heel toes reflexes vibration sterognosis 2 point discrimination point localization extnction finger nose knee heel shin dysdidochokinesis d/d grandmal postural hypotension diabetes substance abuse anemia pregnancy intracranial mass head ct head xray eeg ecg fbs electrolyte and calceum beta hcg if female drug screen
05-16-2006, 05:33 PM
a case of congestive heart failure
c/o onset duration/progression associted with --chest pain cough dyspnea severity aggravatiing allevating pillow/walking /climbing stair / how many timing previous episode cough sputum frothy ther rhinorrhea/sore throat trachetitis/aspiration/ asthma/ gerd/ swelling of body palpitation fatigue diet --salt appetite weight gain--swelling exercise fever-- pamhugsfoss oda past --heart disease/ htn/thyroid/ endocrine/dm psh and trauma and hospitaliztion - o2 therpy medications allergy medication urinary gastro -habit and blood in stool family --dm/htn/stroke/ thyroid/asthma o bs--cycle/regular irregular associated pain dyspareunisa --lmp previous pregnanct antecheck up cardiac problem/ postpartum cardiomyopathy stress sleep snoring depression and thyroid -cold intolerance fatigue occupation recreational drug alcohol cage smokingkd and duration wash hand clubbing cyanosis palor lympadnopathy throat lymph thyroid trachea jvd carotid aceesory muscle repiratory cardiac -- dont forget pmi/ heave and examine in both position also left lateral--use both diaphragm and bell abdomen for liver leg for edema you have above mentioned symptoms and signs and posibilitua re iamnot sure but i wil o this test d/d ccf cardiaac athma asthma anemia pneumonia gerd inv cxr ecg echo cardiac enzyme lipid profile stress test pft abg do you have any concern thanks |
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