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 AMC Clinical exam preparation

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Points : 42144
Join date : 2013-12-26

PostSubject: AMC Clinical exam preparation   Sat Dec 28, 2013 1:53 pm

amc clinical exam prep

A 40 year old lady thinks she is getting flu and she feels unwell. She has hot flushes and temperatures. ( GP setting )

Task- History, P/E, Management

Me- How can I help you?
RP- I am feeling unwell, hot and aches and pains. I think I’ve got flu doctor.

Me- How high is your temperature? Any excessive sweating? Any chills and rigors ?
RP- I really feel hot but don’t know how high it is. Sweating a lot. No Chills and rigors.

Me- Do you have runny nose, cough, sore throat, noisy breathing?

Me- Any pain in your tommy?
RP- Yes, on my right flank, doesn’t go anywhere, aching in nature, not related with food or movement.

Me- How is your pee?
RP- Yes, I frequently go to toilet these two days and I felt sort of incomplete weeing and then once I have an urge to empty my bladder, I have to run to the loo otherwise I wet myself. No change in colour of urine and not smelly.

Me- Any nausea , vomiting ?
RP- Nauseous and can’t eat and drink well but didn’t throw up really.

Me- Bowel motions?
RP- It is ok

System review- normal

Me- Any significant past medical problems? On any regular medications? Allergic to any medications? Any urinary tract infections before? Any kidney problems ? Any significant medical issues in family?
RP- No to all.

Me- When was your last period, sexual history,.. ?
RP- 2 weeks ago. No possibility of pregnancy. On OC pills. No menopausal symptoms. On stable relationship. No STD or PID before. Pap smear not overdue yet. No vaginal discharge or abnormal bleeding.

Me- Do you smoke ? Do you drink alcohol?
RP- No

Me- Can I examine you after washing my hands?
RP- Yes

Examination findings

GC- A bit unwell. Mild dehydration. Temperature 38 C. Other vitals normal.
CVS, Respiratory, CNS examination- NAD
Abdominal examination- Tender over right flank. No Rebound. Kidneys not ballotable. No bladder distension. Not tender over SPA.

WTU- nitrite positive, large leucocytes, 2 plus proteins, 1 plus blood
BSL- normal

Me- Any other blood results with us today ?
Examiner – What do you want ?

Me- FBC, U&El, LFT, ESR, Urine for MCS
Examiner – I will send them off.

Me- I am going to talk to my patient now.

Me- Well, Mrs X, you are getting infection in your kidney and bladder which we call pyelonephritis in medical terms. Do you want me to explain with picture? RP says YES. Examiner says NO, carry on!

It is a very common infection in females cos the front wee passage of females are shorter than males and it give very easy access of bugs from your back passage.

It is very treatable condition. But, you need hospital admission because you need treatment with intravenous antibiotics and fluids for few days. When you get better, you will be discharged on oral medications.
We will repeat the urine sample 2 weeks later.

Examiner- What additional test will you do on reaching the hospital ?
Me- USG abdomen and pelvis

Me- When you are discharged from hospital, I am very happy to follow you up and will advise you some simple measures to prevent urinary tract infections.

Bell rang.
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Points : 40301
Join date : 2014-02-17

PostSubject: Re: AMC Clinical exam preparation   Mon Feb 17, 2014 3:21 pm

and what was the outcome?
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AMC Clinical exam preparation
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