MDCC BW 2 Clair Poolman

Question 1

Answer 1

• Patients have mulitple conditions
• No one can know everything
• Standards (collaboratively)

Question 2

Name 5 principles that enhance team work?

Answer 2

• Communication
• Leadership
• Clear goals
• Shared

HINT : shared pur _ _ _ _ and goals clear ro _ _ _ and r es p_ _ _ _ b_ _ ty mutual t r_ _ t effective c_ _ m_ _ _ _ _ _ _ measuring out _ _ _ s

Shared

Question 3

Case 1:

• Behaviour worse over past month
• Ivy seems to have lost her spark
• Forgetful

Answer 3

Question 4

Patients Medical history:

LAst MMSE: was 30/30

Answer 4

g

Question 5

Answer 5

all the above

Question 6

What is your main priority in the consult with IVY and her husband

Answer 6

1. Establish if IVY and her husband are safe and can be managed as outpatients

Question 7

Q1

Answer 7

1. Behavioural/mood issues
2. Confusions and forgetfulness
3. Backpain

Question 8

Q2

Answer 8

Perform as risk assessment relating to suicide/Self harm

1) Risk to self

Risk to other

INtoxication

Vulnerability

Elder abuse

MEdications?

Question 9

Q3

Answer 9

Delirium!

Question 10

Q4

Answer 10

BACK PAIN: Red flags:

Neurological e.g need to do neuro exam for every patient

Question 11

Q5

History taking for - Behavioural mood/ Confusion-forgetfullness, Back pains.

Answer 11

Behavioural: Mood: ACE r - adenbrooke, HADS, BDS

Confusion/ forgetful- Hx most important- GPCog and MMSE. 4ATS, look for infections (do i need to refer this patient) are they safe at home.

Back pain: Chronic, social hx, Red flags, osteoporosis (need to re consider pred - think about all the side effects)

Question 12

Q 6 examination of this patient:

MSE

Physical examination, importance of ruling out a delirium, Need to do septic screen,

Back pain: Examine: inflammatory arthritis and back pain, hair skin nails, bowels, neuro in back pain: VIP!

If she has headache has PMR ask about headache - Why?

Osteoporosis tests?

Answer 12

Question 13

Examination: Summarize and be able to handover the patient?

BMI

Urine:

Systems examine:

Mild Depression:

MMSE: Minor issues with clock drawing

Answer 13

Summarizing findings:

Question 14

What are the DDx?

Are there some conditions which may present with all 3 complaints?

Answer 14

Question 15

Investigations for this patient?

Think always

1) Bedside
2) Bloods
3) Imaging

Answer 15

Question 16

Blood results

Answer 16

Infection: Macrocytic anaemia DDX (B12, folate, MDS)

Question 17

High calcium- think PTH, check

ALP- Where it is coming from? - e.g bone malignancy

Answer 17

Question 18

LFTs

Answer 18

Multiple myeloma?

What does this X ray show- SHows Osteoporosis and Wedge compression fracture (osteoporotic fracture) can be all 4

Osteopenia, osteoporosis

Question 19

Problems list for this patient?

Think of 6:

Answer 19

1. Wedge compression fracture #thoracic spine
2. Hypercalcemia
3. anaemia
4. protienuria
5. Confusion
   6.

Question 20

What do you think the possible diagnosis is?

List 4 DDx

Answer 20

1) Multiple Myeloma (CRAB)
2) Malignancies with body secondaries - Pathological and hypercalcemia (e.g Breast cancer with secondaries in bone)
3) Breats cancer

Question 21

Handing over the patient to the specialist: What you always need to handover?

Answer 21

Name Age, Anameic, high protein level, crush fracture, worried about haem malignancy, what investigations should i do in the meantime;

E.g Do Serum protein electrophoresis E.g Protein Studies; Free and light chains -

Question 22

What is the final diagnosis?

Question 23

Hypercalcemia

History: Examination, Investigations, Treatment

Answer 23