d******0
发帖数: 296 | 1 Case 1
Opening scenario:
Sharon Smith, a 48-year-old female,comes to the clinic complaining of
abdominal pain. Married with four children.
Vital signs:
BP:135/70 mmHg
Temp:98.5 F
RR:16/minute
HR:76/minute, regular
Protocol:
Knock three times with confidence, a smile, walk in and say:
Good morning, Ms Smith. I am Dr. Dora, and I am here to see you today as
your physician. Nice to meet you .Shake hands. Is everything in the room
alright for you? Let me cover you with this to make you a little more
comfortable (Cover drape). Ok, Ms Smith, what caused you to come in today?
“I have
abdominal pain.”
I am sorry to hear that, I shall try my best to help you .could you tell me
more about your pain?
OLIQRAAA
O onset/duration/progression(every case)
When did it start? “It
started two weeks ago.”
What were you doing when it occurred? “I was
cleaning my house.”
Did anything unusual happen before it start? “No, I
didn`t notice anything unusual.”
Did it get worse, better or stay the same. “ It
is getting worse.”
L location /site( some cases)
Would you please tell me where exactly your pain is. Show me with one finger
if possible
“ It is here
(points to the epigastrium). ”
I intensity/Quantity( all cases)
On a scale of 1 to 10, 10 as the worst pain you ever had, how bad is your
pain?
“It is 7,
sometime it goes to 0. ”
Is the pain there all the time, or it comes and goes?
“I don`t have
the pain all the time, It comes
and goes. But the
pain happens at least every day. ”
Q quality
Is it a dull ache (sharp, stabbing, burning, pulsating, cramping, pressure)
“It is burning”
R radiation (pain)
Does the pain move anywhere? “No, It doesn’
t move.”
A Aggravating factor
Is there anything that make it worse? “it was getting
worse when I was hunger, and
also fatty meals, like pizza will make it worse. ”
A Alleviating factors
Is there anything that makes it better?
“food such as cookies
and milk will decrease the pain ,
usually the pain will
decrease or stop completely when I
eat, but it comes back
after 2-3 hours ,”
Do you take medicines to relieve the pain? Such as Tylenol ?
“I do take Maalox,
ibuprofen to relieve the pain.”
A Associated symptoms
In addition to the pain, do you have any other symptoms? Do you have fever
, nauseous, vomiting, diarrhea or constipation?
“ Sometimes I feel
nauseated when I am in pain. Yesterday I
vomited for the first
time.”
Oh, I see. You vomited once. What was the color of the vomiting , was it
sour or bitter?
“It was a sour ,
yellowish fluid.”
Was there any blood in the vomitus? “No, no blood.”
Any weight or appetite changes? “No”
PAMHUGSFOSS
Before the past medical history:
Okay, Ms Smith, I would like to ask you some questions about your health in
general .is that OK with you?
“OK”
P previous event
Have you ever have similar problem like this before? “No, the first
time”
Have you ever have any infections? “I had a urinary
tract infection one year ago,
treated with
amoxicillin and
arthritis in both knees. I take ibuprofen
for pain.”
Have you ever had HTN, DM , high cholesterol, and heart disease, and cancer
? “No”
A Allergy
Are you allergic to anything? “No”
M Medications
Do you take any medicines? “just Maalox,
ibuprofen.”
Do you take oral contraceptives or birth control pills? “No”
Do you take any vitamins or herbs? “No”
H (his)
Have you ever had surgeries or been hospitalized?
“I had two C-sections. And hospitalized for 3 days
each”
U:Do you have any problems with your urination? “No”
G:Do you have any problems with your bowel movement? “No”
S:Do you have any problems with your sleep? “No”
F family history
Before the family history:
Now, let’s talk about your family health
Do you have any kids? “I have 4 kids,
they all healthy”
Does anyone in your family have similar problem as yours? “No”
Are your parents still alive?
“My father died at 55 of pancreatic cancer. My mother is alive and
healthy.”
Nodding, I See
O OB/GYN
All right, Now I need to ask you some personal questions so that I may
understand your health in general, whatever you tell me will be kept
confidential.
When was your last menstrual period? “2 weeks ago,”
Is your period regular? “yes, 4days every month.”
Any change in your period recently? “No”
S Sexual history
Are you sexually active? “Yes, I am sexual activity with
my husband(laughs).”
S social history
Before the social history:
Thank you, now let me ask you about you work, and social life.
What is your occupation ? “I am a housewife.”
Before asking questions about smoking alcohol, and recreational drugs。
Okay, Now I need to get some information about your lifestyle,
Do you smoke or drink alcohol? “No”
Do you illicit to any drugs? “No”
PE
Ms Smith , thank you for answering all these questions. Now I would like to
perform a quick general physical exam, and then take a close look at your
belly. Is this OK with you? Just before exam. Is there anything you
would like to tell me which I haven’t asked you. Excuse me for a moment, I
need to wash my hand first.------- Wash hand-----
Ok let‘s begin by checking your eyes.
During the physical exam, before any maneuver:
Now, I need to look in your throat to see if there is any redness and
swelling. Please say “ah” .
Now, I need to listen to your heart, I will need to put my stethoscope on
your chest. Please breathe deeply in and out, again, and again.
Now, I will take a close look at your belly. Dose it hurt? How about here?
And here?
Closing:
Thank you, Ms Smith, I have finished my physical exam, now I would like to
sit down and talk over what I am thinking so far. Let me summarize：first,
you told me that you had pain for two weeks, it is burning,and it is getting
worse when hungry and eating with light food will alleviate it. You also
had vomited yellowish sour fluid once, and you don’ t have any fever or
diarrhea. Is this right? Base on what you told me, and my physical
examination. I think that you may have an ulcer. However, there are other
possibilities which may also cause your symptoms, such as stomach infection.
To be more certain, I would like to run some tests. This tests include
rectal exam, some blood work, stool work. Also I will order ultrasound
examination of your abdomen, (“what is that word ultrasound mean” ), which
is a machine that use a sound we can not hear as an energy to test the
inside of your belly. If there are problems of your organs, We can see those
on a screen. Is that clear? (“yes”). And possibly upper endoscopy, which
involves examining your stomach by means of an optical instrument passed
through your mouth. As soon as we get the results of the tests back, I will
come back to discuss the diagnosis and treatment options with you. Also
ibuprofen will worse your pain, please stop taking it. Do you have any
question for me? (“No, Thank you, Dr”)
OK,Ms Smith, Thank you very much,-----shake hands-----, Take care!
Patient note:
History
HPI (history of present illness): 48 yo F, with intermittent, burning ,
non-radiating epigastric pain that started for the first time 2 weeks ago.
The pain occurs at least once a day, 2-3hous after meal. It is exacerbated
by hunger or heavy fatty meal and alleviated by light food and
antacids. It reaches 7/10 in severity and then diminishes to 0/10. It is
sometimes accompanied by nausea. The patient vomited yellowish,sour fluid
once yesterday, no blood in it. No fever, diarrhea, or constipation. No
changes in weight or appetite. No changes in stool.
ROS(review of systems): negative except as above.
Allergies: NKDA.
Medications: Maalox.
PMH(Past medical history): arthritis in the knees, treated with ibuprofen.
UTI last year, treated with amoxicillin.
PSH(Past Surgical History): Two c-sections.
SH(Social history): No smoking. No Et-OH, no illicit drugs. Sexally active
with husband only.
FH(Family history): Father died of pancreatic cancer at age 55.
Physical Exam: Patient is in no acute distress.
VS (Vital signs): WNL (within normal limits)
Chest : NO tenderness. Clear breath sounds bilaterally.
Heart: RRR (Regular Rate and Rhythm), normal S1/S2, No murmurs, rubs, or
Gallops.
Abdomen: Soft , nondistended, C-section scar,epigastric tenderness without
rebound. +Murphy`s sign, + BS(bowel sounds?). No hepatospleenomegaly.
Differential diagnosis diagnostic workup
1. Peptic ulcer disease 1. Rectal exam. Stool for
occult blood
2. Cholescystitis. 2. AST/ALT / Bilirubin/ALP
/Lipase
3. Gastritis 3. U/S (ultrasound)
abdomen
4. Gastric cancer 4. Upper endoscopy
5.H.
pylory antibody | s********o
发帖数: 3319 | 2 是原创吗？比我的强很多哈，简直让人难以置信 ：） | q****i
发帖数: 1395 | 3 做好人做到底吧，能不能给个原文下载？
【在 d******0 的大作中提到】
: Case 1
: Opening scenario:
: Sharon Smith, a 48-year-old female,comes to the clinic complaining of
: abdominal pain. Married with four children.
: Vital signs:
: BP:135/70 mmHg
: Temp:98.5 F
: RR:16/minute
: HR:76/minute, regular
: Protocol:
| d******0
发帖数: 296 | 4 刚考完step1，着手准备CS.前天在skype和一前辈练习，因为没有准备，完全不知从哪
里问起，被鄙视了，痛定思痛，必须得认真准备，才能对得起家人和朋友的支持。以上
case1是我根据前辈提供的模板结合FA 的提示综合而成。本来是想传上来请考过的，以
及未考的同僚改进完善的。上传时不能传word文档，我就只好拷贝进来。
如果大家要下载，我把它转成PDF格式看看。
希望您能提出宝贵的修改意见，我们好认真背诵。
接下来，我再准备 case2. | d******0
发帖数: 296 | 5 不好意思，原文在我单位电脑里，当时上传word文档一直未成功，就直接拷进来了，排
版很差，我明天上班时再整理一下。 | s********o
发帖数: 3319 | 6 可以找几个志同道合的同学一起准备哈
尽可能地采用FA上面的句子，一模一样的。病人听得最多的就是那些句子，这样就算咱
们有口音也不会影响病人的理解。
【在 d******0 的大作中提到】
: 刚考完step1，着手准备CS.前天在skype和一前辈练习，因为没有准备，完全不知从哪
: 里问起，被鄙视了，痛定思痛，必须得认真准备，才能对得起家人和朋友的支持。以上
: case1是我根据前辈提供的模板结合FA 的提示综合而成。本来是想传上来请考过的，以
: 及未考的同僚改进完善的。上传时不能传word文档，我就只好拷贝进来。
: 如果大家要下载，我把它转成PDF格式看看。
: 希望您能提出宝贵的修改意见，我们好认真背诵。
: 接下来，我再准备 case2.
| d******0
发帖数: 296 | 7 多谢老大鼓励，居然给了我10个伪币，这就是传说中的包子吗？开心呐。。。。。。 | s********o
发帖数: 3319 | 8 再接再厉好好写，将来还能得到更多的包子，也许 ：）
【在 d******0 的大作中提到】
: 多谢老大鼓励，居然给了我10个伪币，这就是传说中的包子吗？开心呐。。。。。。
| l*******8
发帖数: 290 | | s*h
发帖数: 1538 | 10 Mitbbs的设计不太合理，不方便使用。
个人建议，最好是用Google Doc，这样在线可以供多人浏览，提供链接即可。google支
持word文档的浏览编辑，也支持PDF的浏览，但是不支持pdf编辑。 | m***i
发帖数: 898 | 11 SUPPORT AND FOLLOW YOU! | d*********g
发帖数: 13 | 12
great post!
【在 d******0 的大作中提到】
: Case 1
: Opening scenario:
: Sharon Smith, a 48-year-old female,comes to the clinic complaining of
: abdominal pain. Married with four children.
: Vital signs:
: BP:135/70 mmHg
: Temp:98.5 F
: RR:16/minute
: HR:76/minute, regular
: Protocol:
|
|
