pt Flashcards
Left arm feels like in fridge/freezer - feels cold - her sensation
No FAST symptoms
Duration: 5 years since heart attack
Onset: gradually
Progression: arm same, now started in leg
No fever, night sweats, weight loss, appetite loss, SOB/JP, tiredness
No issues with movement
S: left leg - lat thigh/left arm - shoulder to elbow O: 5 years @arm, 6 months C: cold (feels cold even in summer) R: non-radiating A: Warmth - sitting by radiator T: pretty much constant, even at night E: cold S: no pain, just cold
clicky neck (DCM? - does exercises) no headaches/dizzy, no anosmia, no dysphagia, no GI dx, no LUTS, no leg swelling, no pain/tingling in extremeties
PMH: MI 5 years ago
DHx: Clopi, Atorva, Bisop, Lansop, taking metronidazole
FHx: cancer (mum - ?mets, uncle - lung, sister-bowel, mothers brothers heart attacks instantaenous)
SHx: ADLs unaffected - still functional
No peripheral neuropathy, no psych dx, no lemon-tinged skin, no eye dx, no oropharyngeal ulcers, no glossitis,
no evidence of sub-acute degen of spinal cord
I: mini-stroke
C: not too concerned
E: wants a diagnosis
O/E:
Arm:
warm to touch, full ROM, no pain
Able to flex at elbow, lateral forearm fine, Shoulder abduction fine, inferior region of deltoid sensation fine, radial nerve distribution fine, no carpal tunnel symptoms, no frozen shoulder symptoms, no ulnar nerve issues, no high steppage gait
Power 5/5 b/l
Leg: feels ‘cold’ in lateral cutaneous nerve distribution
Full ROM, power 5/5 b/l
Plan:
Bloods - Iron profile, Folate, B12, Mag Phosphate
FBC U+E LFT Bone
Safety-netted: if feels unwell, seizures
Tested positive on 7th Oct
-Covid symptoms
Cough, temp , sleeping, family member positive, then positive on 7th, anosmia, taste, fever - all have resolved apart from cough.
been worried about dad that didn’t take rescue-pack. prescribed by Dr Sid on 7th Oct. Doxy + Pred
Doxy - just took 1, felt ‘panicky and palpitations’.
Pred - felt the same
Still feel SOB/cough, sentences complete, no accessory muscle use, NO exhaustion, no silent chest - not severe/life threatening.
Blue inhaler - 2-3xday
Pink Fostair - BD
Duration: Since 7Oct
SABA spacer, 4 puffs -> 2 puffs/2mins up to 10 puffs
Quadruple ICS - atm 4 puffs a day, so now 16 puffs/day - 14 days
Once subsided, SABA upto QDS/4-hrly - no more
Follow-up 48hrs
Tested positive on 7th Oct
-Covid symptoms
Cough, temp , sleeping, family member positive, then positive on 7th, anosmia, taste, fever - all have resolved apart from cough.
been worried about dad that didn’t take rescue-pack. prescribed by Dr Sid on 7th Oct. Doxy + Pred
Doxy - just took 1, felt ‘panicky and palpitations’.
Pred - felt the same
Still feel SOB/cough, sentences complete, no accessory muscle use, NO exhaustion, no silent chest - not severe/life threatening.
Blue inhaler - 2-3xday
Pink Fostair - BD
Duration: Since 7 Oct
Progression: stayed same
Timing - night is worse #diurnal
No chronic productive cough, no sputum, no hemoptysis, no fever, no sweats, no weight loss, no palpitations (apparently when take doxy/pred/panic attack from father’s illness gets it), no leg swellings.
feels tight chest - like asthma, slight wheeze - triggered cold, winter, cold drink, A/C
SHx: payroll administrator (no evidence of occ asthma), no pets, no post-nasal drip, no GORD symptoms
O/E:
SpO2 96, HR 96
Look: no accessory muscle use, no exhaustion
Listen: no silent chest, slight wheeze/ronchi on expiration
Plan:
SABA spacer, 4 puffs -> 2 puffs/2mins up to 10 puffs
Quadruple ICS - atm 4 puffs a day, so now 16 puffs/day - 14 days
Once subsided, SABA upto QDS/4-hrly - no more
Follow-up 48hrs
Rash not going away - comes and goes. For few months. Gotten worse - got tests coming up. Associated with itching and erythema. Previously had this issue. Sligthly painful and itchy, no bit of bleeding, ?blistering, no fever/malaise/weight loss/arthralgia. No atopy, No sig PMH. No herbal meds. No allergies. Non-smoker, non-drinker. Goes to school. No travel hx/sun exposure.
O/E: multiple umbilicated lesions with surrounding eythema and excoriation marks on palms and feet. pink/perly while papules with central umbilication 1mm multiple.
Advise:
Don’t itch.
Reassured that molluscum contagiosum is self-limiting.
Spontaneous resolution usually occurs within 18 months
Explained that lesions are contagious, and it is sensible to avoid sharing towels, clothing, and baths with uninfected people (e.g. siblings)
Encouraged not to scratch the lesions. If it is problematic, consider treatment to alleviate the itch.
Treatment is not usually recommended. Itching emollient/hydrocort 1%. Advised about fire-risk of emollients #paraffin
86F reports feeling of ‘numbness’ pain - hearing aid user
Otalgia, no hearing loss, no pre-AURICULAR nodes.
O/E: canal = red and inflamed, yellow debris
No fever, no night sweats, no weight loss, no appetite loss, no SOB/cough, no joint pain, no tiredness, no GI dx, no LUTS
PMH: OP, DM, HTN, chol
DHx: lots
FHx: none sig
SHx: none sig - fit and active
Duration: on and off for few years
Progression: same S: RUQ Onset: today after eating a heavy meal full of clarified butter C: shooting/sharp R: to scapula A: it just goes T: intermittent E: fatty foods S: 8/10
No fever, no night sweats, no weight loss, no appetite loss, no SOB, no joint pain, no headache, no dysphagia,
PMH: none, lipoma
DHx: none, no OTC/herbal
FHx: mum-cancer
SHx: ADLs unaffected
O/E:
Look: Lipoma @ right above costal margin
Feel: no pain illicited WHATsoever
Listen: bowel sounds present - normal
Ddx: Gallstones @CBD
Plan:
Bloods, AP-USS
Duration: blood in stool April 2019 Onset: suddenly incidentally Progression: not worsened - about once a month Intermittent Fresh red blood - not tarry Bleed @random - usually mornings No mucous.
No weight loss, no appetite loss, No fevers. Bit of tiredness. No dysphagia, no visual dx, no bloating, no constipation, no diarrhoea, no leg swellings
No pain/anal pruritus, no lumps/bumps @anus, blood streaked across stool. No feeling of tenesmus.
Not go anywhere b4
April 19: Blood in stool
Aug 19: Cambodia/Thailand
SHx: Teacher.
Eats sushi - raw fish
Cambodia last year (Ate anything and everything in Cambodia)
No hx of raw pork
O/E:
Look: none sig
Feel: RUQ soft nodular ?mobile structure
Listen: bowel sounds present
Plan:
Bloods + Stool MCS/Parasites etc
?Mebendazole
Dizzines
Duration: intermittent for few months - ‘foggy’ lack of energy
Onset: gradually
Progression - occasioanally gets worse
Slight hearing loss/muffling, tinnitus
No fever, no tinnitus, no saw throat, no odynophagia, no chest pain, no palpitations, no SOB/wheeze, no cough, no sputum, no fits/falls/LOC, no visual dx, no memory loss, no nuchal rigidity, no photophobia, no weakness/wasting/incontinence, no pain or numbness, no menieres symptoms, No BPPV symptoms, ?Vestib Neuronitis,
O/E:
Pre-auricular nodes, Earwax impacted.
slight hearing loss/muffling
Plan:
Sodium Bicarb
ENT referral
Fluclox
S: right flank O: 3 months ago loin pain started C: sharp R: non-radiating A: hot water bottle T: constant (when working as builder/joiner - no pain, when resting - pain, night - pain) E: night S: 7/10
No fever, no night sweats, no appetite loss, no SOB/JP, no hemoptysis, no tiredness, no nocturia, no dysuria, no haematuria, no suprapubic pain, no hesitancy, no headaches, no eye dx, no dysphagia, no GI dx, no leg swellings
thinks lost 7kg (was 15.5st and now 14 st), increased frequency, increased urgency, having to strain - push hard, feels weak stream - slow urine, feels post-micturition dribble, feels incomplete so has to wait 10 mins to finish
PMH: profoundly deaf and struggle with sight
Dx: no allergies, cocodamol (constipation) and lansoprazole
FHx: none-sig
SHx: ADLs at work unaffected, only when comes home or night feels pain. Admits to drinking 1 small bottle of water a day and lots of coffee x10/day.
O/E:
BP 130/70, SpO2 96, HR 75, RR 18
Look: fine
Listen: bowel sounds present normal
Feel: no pain elicited whatsoever but says feels at night
+ Leu ; +++ Ket
Plan: Co-Amoxiclav Urine MCS USS KUB Bloods Advised to avoid coffee and drink plenty.
Scrotal swelling
Duration: 4 weeks
Onset: incidentally checked (checks testicles once a month)
Location: right superior side - more towards front,
Non-painful, smooth round, half a pea-shape = epidydimal cyst
no nausea/vomitting, no salivary gland swellings
non-smoker 5-8 units, active,
Onset is chronic.
Presents as a painless, non-tender, soft, fluctuant, smooth, round nodule in the epididymis. It is usually small, but can become large.
no LUTS/haematuria no flank pain/mass, no trauma/hematocele signs
O/E:
Painless, soft, fluctuant, smooth, round nodule, in superior pole of right testicle
USS requested as it is not evident whether the scrotal swelling is testicular or extra-testicular on clinical examination
Trouble with nose - always blocked.
Oxymetazoline-use
Duration: 2-3 years (mild)
Onset: last few months gotten worse - now only breathing through mouth
Progression - gotten worse
No pain. Constant - night time worse. Has to spray oxyemetazoline b4 sleep.
Dust worsen.
C/o sneezing sometimes, itching, nasal congestion. In spring get itchy nose gets worse then too. Mouth breathing. Snoring. Worse @midday/b4 sleep (cant sleep without oxymetazoline) - same at home AND work. Has carpet at home.
No pain on sinusitis, taste unaltered, no discharge, no facial pain, no post-nasal drip, no coughing,
SHx:
ADLs - difficult to breath
Occupation - dentist (no gases used) ?use of face-mask #covid
No pets
PMH: no atopic conditions, prev MI, restless leg syndrome
DHx: aspirin, bisop, ramipril, statin 80mg, sertraline, ropinirole
FHx: son severe asthma
O/E:
Nostils bilaterally - no polyps - no bleeding - ?inflamed
Plan:
Nasal-irrigation with saline spray/pump
Avoid allergens
Plan:
Intranasal azelastine > Oral antihist
If not work, ?sodium cromoglicate
Mod-severe: intranasal csted
Mild-Mod:
Intranasal > PO antihistamine > NaCromoGlic
-Azelastine
Mod-Severe/Mild fail:
Intranasal csted
House dust mites - all the time Pollens: -Tree = spring -Grass = early summer -Weed = spring/summer/autumn
S: right shoulder O: gradually C: sharp/ache R: non-radiating A: nothing T: constant - worse when rest E: mornings S: 8/10
No fever, no night sweats, no weight loss, no appetite loss, no SOB/JP, no tiredness, no headaches, no dysphagia, has GI issues from the naproxen
PMH: none
DHx: naproxen (tramadol from friend… advised this is illegal)
FHx: none
SHx: work difficult, has pregnant wife, is not on contract - agency work. Warehouse worker - moving and lifting.
O/E: pain at scapula on palpation, full ROM.
Plan: PPI, Top Ibuprofen gel 10%.
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20M Neck Lump
S: Left Duration: 2.5 weeks ago Onset: incidental Progression: stayed same Painless, under left jaw - submandibular,
Mentions drenching bedsheets at night -night sweats, feels SOB (has some resp issue which is apparently undiagnosed - under Durham Resp consultants)
No fevers, no weight loss, no appetite loss, no joint pain, no tiredness, no generalised itching, no recurrent infections (no recent coughs or colds), no teeth issues, no drinking of alcohol, no pain on eating - unlikey salivary gland dx, no sore throats, no otalgia, no insect bites, no GI pain, no LUTS, no leg swellings.
PMH: the resp issue mentioned above DHx: 2 asthma inhalers, acne meds FHx: none SHx: sport and ex science No hx of UPSI No recent travellings Non-smoker
O/E:
round, smooth, painless rubbery mass - not tethered to underlying muscle @left side,
DDx:
Reactive > Lipoma > Lymphoma
Plan:
Reassured - if gets bigger/>5cm come into GP
USS-neck to assess for anything sinistger in light of night sweats episode.
S: RUQ pain O: intermittent, 4-years C: sharp 'cut' R: non-radiating A: T: intermittent E: walking, twisting body, worse on eating S: 6/10
Feeling feverish (literally sweating during consultation), night sweats (drenches bedsheets), feels SOB in morning for few years, feels tired, mentions stool has been slightly watery, vomitted 3 days ago
Mentioned coughing up blood a month ago (teaspoon-worth in morning), fresh bright red, no sputum, no recent URTI
Pushing urine hard - strain, post-micturition dribble, no hesitancy, feeling of incompleteness when passing urine
no weight loss, no joint pain, no haematuria, no nocturia, no dysuria, no suprapubic pain, no chest pain, no palpitations, no rashes,
ACE Ca ESR image CXR PSA TB - sputum sample? ?food poisoning
S: RUQ pain O: intermittent, 4-years C: sharp 'cut' R: non-radiating A: T: intermittent E: walking, twisting body, worse on eating S: 6/10
Feeling feverish (literally sweating during consultation), night sweats (drenches bedsheets), feels SOB in morning for few years, feels tired, mentions stool has been slightly watery, vomitted 3 days ago
Mentioned coughing up blood a month ago (teaspoon-worth in morning), fresh bright red, no sputum, no recent URTI
Pushing urine hard - strain, post-micturition dribble, no hesitancy, feeling of incompleteness when passing urine
no weight loss, no joint pain, no haematuria, no nocturia, no dysuria, no suprapubic pain, no chest pain, no palpitations, no rashes,
PMH: sickle cell, HTN
DHx: Lercanidipine ramipril
FHx: father liver problem
SHx: ADLs affected little bit by pain
ACE Ca ESR image CXR PSA TB - sputum sample? ?food poisoning
