Tiredness

Question 1

Your patient is a 42 years lady complaining of tiredness
Task
1.Take history FOR 6 minutes and explain DD

Answer 1

History
start with open introducing yourself and saying how may I address you. How can I help you?
Tiredness -what do you mean by tiredness
>since when
>how long does it last ?is it whole day or particular time, Is it getting worse ?
>any aggravating or reliving factor
>How is it affecting your life
>Is it getting worse
>Do you have enough support?
>Explore DD- HEMIFADOC
*Hepatitis-Recent travel history, street food ,unboiled water
*Hypothyroidism-any weather
preferences, constipation, weight gain, amenorrhea, hair loss, dry skin. voice change(POSITIVE IN THIS CASE)
Endocrine -DM -do you feel hungry ,thirsty ,going to loo late night ?
*MALIGNANCY- weight change, lumps or bumps
*Infection-Fever. chest pain, SOB, Headache, Recent Dental procedure Rash
*Fatigue syndrome

Question 2

40 Yrs old man with tiredness in dayitme and difficulty in concentrating in his work
Task is
Take history and explain the provisional diagnosis to patient and investigation to patient

Answer 2

Regualr history taking strating from
introduction
Explore tiredness-since when, how long,
is it worse in any particualr time ,any aggravating and reliving factor
PATIENT COMPLAINTS THAT HE IS SLEEPY SO EXPLORE SLEEP QUESTION -HOW MANY HOURS YOU SLEEP,SLEEP HYGINE, DO YOU FEEL DIFFICULTY IN FALLING ASLEEP, DO YOU WAKE UP AT NIGHT, PARTNAR COMPLAINTS OF SNORING OR GASPING , DO YOU FEEL REFRESH AFTER WAKING UP
SADMA POCTS
PMSH
FH

Question 3

37 Years old lady came to emergency dept with c/o fatigues for last 2 weeks
Task -*Take History for 4mins
*PEFE will appear on 4 min
*Explain your provisional dx
*Discuss your initial mx

Answer 3

PEFE-General -mildly distress ans dehydrated
temP 38 BP -122/87
RESP -nl
CVS-SYSTOLIC MURMUR 2+/6+ IN MITRAL AREA
ABDO-SPLENOMEGALY
EXTERMITIES- TOES AND FINGERS PIC GIVEN SHOWING SPLINTER HG
ALSO H/O-RECENT DENTAL PRECODEURE ,HEADACHE,JOINT PAIN

DX IS IE- ADMIT AND ORDER -FBE,LFT,KFT,COAGULATION STUDIES,BLOOD CULTURES,ECG AND ECHOCARDIOGRAM
MENTION INVOLVING SENIORS
MENTION ORAL ANTIBIOTICS TREATMENT

Question 4

You are working in a tertiary hospital as HMO and a 17 years old female comes with tiredness for last few weeks and abdominal pain
Task-
Take history for 4 mins
PEFE will appear
Explain the dx and mx

Answer 4

PEFE
G/A- lathergic, dehydrated
Abdomen- generalised tenderness without any guarding and rigidity ,rebound tenderness
CVS & Resp normal
BSL-25mmol/l , UDT-KETONE AND GLUCOSE, no leukocyte or blood

History as usual and about pain explore SOCRATES- site,onset,character,radiation,association,timing,exacerbation,severity

Question 5

44 year old man with tiredness and recent weight loss
Take history for 4 mins
PEFE will appear
Explain differential with reasons

Answer 5

PEFE-TEMP -37,bp-sitting - 120/80, sitting 100/68
General - pigmented skin on palms and inside of mouth
neck exam -nl
abdomen,cvs,resp - nl

Question 6

You are a GP and your next patient is a 51 year old plumber c/o not feeling well for last 2 weeks,He is a known patient of your and has no significant pmsh.
Task -
Take history for 4 mins
PEFE will appear
Explain dx and ddx

Answer 6

PEFE- G/A- No lethargy ,skin discoloration,temp -38,bp 110/75,hr-120
CVS & RESP -NL
Abdomen -mild tenderness in UQ ,No tenderness, rigidity, guarding, organomegaly

positive in history -travel to thailand,street food,itching
if history of travel given explore - street food,sexual history ,tatto

Question 7

You are a GP and next patient is 61 year old lady with tiredness and loss of weight. She has a h/o admission to a hospital 8 months ago due to temporal arteritis.She doesn’t have headache now.
Task
take history for 6 min
explain dx and ddx with reasons

Answer 7

explore tiredness as before and weight loss -(did you measure how much you have lost, in how many months, appetite? intentional weight loss or not?)
explore about GCA-Headache,vision problem,shoulder stiffness/pain.,.pain on chewing)
are you compliant with medication,follow up ,treatment

positive findings-wt loss,nausea ,tiredness
GCA well controlled ,stopped prednisolone 6 weeks ago
Dx- secondary adrenal insufficiency