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Points : 42144
Join date : 2013-12-26

PostSubject: AMC Clinical exam preparation   Sat Dec 28, 2013 1:57 pm

amc clinical exam

A 15 year old girl, whose mom was diagnosed with metastatic liver cancer, was praying with family at the bedside of mom when she heard her mom shouting out of pain. She suddenly lost her voice from that time.
Task- History, P/E, Management

Me- Hello, I understand that you have lost your voice. Here is a paper and pen for you. I am going to ask you some questions and please just answer by nodding or shaking your head. If you want to ask me something, pls write in this paper.

RP- Nodded head.

Me- Can you still make some sounds and coughing?
RP- Yes

Me- What I understood was you were praying for your mom and you heard her shouting out of pain then you lost your voice. Is it correct?
RP- Yes

Me- Do you have any recent flu like symptoms like fever, runny nose, sore throat, cough, hoarseness of voice?
RP- No

Me- Do you have any problem with swallowing? Any choking? Any weakness in muscles? Any waterbrush? Any heartburn?

Me- Did it ever happen before?
RP- No

Me- Apart from that, everything well? Eating and drinking well? Sleeps well?
RP- Yes

Me- Any significant medical problems with you in the past? Any surgical operations? Are your periods regular? Is your period overdue?
RP- No to all.

Me- Any smoking, drinking alcohol ?
RP- No

Me- Any depression before? Any family history of mental health problems?
RP- No

Me- Any family history of problems with voice or cancer of larynx?
RP- No
Me- Any excessive usuage of voice of before that?

Me- Do you feel depressed?
RP- Writes that she is just very sad for her mom.

Me- I really appreciate your sorrow and please accept my sympathy for your mom too.
Do you have any particular concerns with your mom ? Or you are just feeling sorry for her pain?
RP- Yes

Me- Well, I will discuss with her specialist. We surely have something to manage her pain and to let her pass the rest of her days as comfortable as she can.
Please also let me know if there is anything that you want us to do for your mom.
RP- Yes

Me- Whom do you live at home?
RP- Wrote father and sisters.

Me- Are they supportive and understanding to you?

Me- That’s good. We can talk about what sorts of social and other helps we can offer you and your family later. Now if you don’t mind, can I examine you?

Me- General appearance, Vitals- NAD ( I didn’t remember to ask her mental state briefly ).
ENT examination- Examiner asked me to do it on my own. I did throat examination with tongue depressor and he gave me the rest of examination findings all of which are normal.

Me- Any facility for direct laryngoscope?
Examiner- No

Me- I want to talk to my patient.
Well, Miss X, I have just examined you. Good news is all is good.
I believe you have lost your voice when you suffered intense emotion on hearing your mom’s pain. You know our mind and body are connected to each other. Our body tends to reflects in different ways what the mind is suffering. With you, it presented as loss of voice. I know you really lost your voice. What I just wanted to point out is that there is no serious underlying physical problems with your throat.
However, I will refer you to ENT specialist to properly look into your voice box and cords in the throat just to make sure that everything is fine.

And I am going to refer you to Psychologist to teach you some relaxation techniques . He will also teach you CBT( I explained like in Scenario 2 ) .
And I can talk with your school principal regarding your condition if you want me to do so. I am able to write a medical certificate for you too.

For your mom, I am going to liase with her specialist right now and will let you know what we can offer more. We definitely can make her better with continuous pain relief.
And if you want, I can ask social worker to come and talk with you when you get better and see what other helps you might need.

Me- Any other concerns with you?
RP- Writes that” Will I get better tonight ? “
Me- It is hard to say exactly. But, when your mom got good pain relief, you will feel better emotionally and you will regain your voice as well.
One thing sure is that you will definitely regain normal voice. It is just hard to say the exact time.

Is there any other concern I can help you ?
Finished this station very early.
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