Very good summarised guide for your PLAB 2 preparation...
MEDICINE H&C Read task Carefully. HISTORY & COUNSELLING Read task carefully. Take history proper & discuss with patient. Take history & No discussion. Take History & D/D & Discuss with Examination. Take History & Discuss management with Examiner. • HISTORY TAKING • • • • • • • • • • • • • • • • • •
UNCONSCIOUS RED EYE WEIGHT GAIN HOARSNESS OF VOICE DIARRHEA LOSS OF CONSCIOUSSNESS HAEMETEMESIS DRY COUGH BACK PAIN FEVER VOMITING DIPLOPIA CALF PAIN ELDERLY CONSTIPATION KNEE PAIN HAEMOPTOSIS VERTIGO EARACHE
• COUNSELLING • • • • • •
EPILEPSY MULTIPLE SCLEROSIS ASTHMA CHRONIC RENAL FAILURE DIABETES COUNSELLING POST MI COUNSELLING
Unconscious: Management: Observe CT Scan 4minutes History taking Last Seconds: Differential P3 MAFTOSA
P1 ODIPARA O – Onset D – Duration I – Intensity P – Progression A – Alleviating R – Relieving A – Associated Symptoms Pain: Offer Painkillers. Vomiting, Diarrhea: Rule out dehydration: • Are you feeling excessively thirsty? • Are your lips gone dry? • Decrease urination : Passing less water than before? Blood Loss: Rule out Anaemia: • Always tired? • Racing of heart? • Shortness of breath? Meningitis: Fever, grade of fever, higher evening spikes. Vomiting. Neck stiffness. Photophobia: Is the light bothering you? Rash: Have you noticed any rash in your body? Subarachnoid Haemorrhage: Headache: Sudden, few hours. Worst headache in my life, in the back of my head. Associated: Vomiting, neck stiffness (is neck hurting you) GCA: Age: 60 years. Female usually. Unilateral painless one side. Temporal. When I comb, touching hair it worsens. Have you noticed any visual problems? Space Occupying lesion Worsening headache over time. Nausea, vomiting in morning, when you wake up in the morning? Have you noticed any visual problems? Have you noticed any numbness in your face or limbs? Acute Glaucoma Age – Old Headache feel it in the back of the eyes. Have you noticed any colour haloes? Medication: Steroids. Amytriptiline. Migraine Have you been diagnosed with a condition called migraine? Have you experienced any auras before this headache coming to you? Cluster Headache
Age – Middle age. Onset – It´s more in the night. One sided. It´s comes again and again, almost 12 weeks, every 2-4 weeks. Tension Headache Band-like headache. Gets worst by the end of the day. Sinusitis History of fever, running nose. Trauma IF THEY DON´T UNDERSTAND YOUR ACCENT: PATIENT SAYS: PARDON DOCTOR.
RULES OF ENGAGEMENT: Ruled out at least 5 differentials according to age. D/D: Trauma: Did you hurt yourself? Foreign Body: Do you think something has gone into your eye by accident? Conjunctivitis: Watering discharge from your eye? Pain in the eye in the morning? Anyone in the family suffering from something similar. Uveitis: Young patient, family history, back pain. Dx: Uveitis secondary to Ankylosing Spondilantis Acute Glaucoma: Old patient. Pain in the eye, coloured halos. Rheumatoid Arthritis: Pain or stiffness in joints in the morning. Reiter Syndrome: Privacy and confidentiality. Travel History – Thailand. Burning sensation when you passed urine? Joint pains. • Conjunctivitis. • Arthritis. • Urinary Tract Infection. Diagnosis: Conjunctivitis due to Reiter syndrome. Give Dx of symptom.
SLE: Have you noticed any rash in your face? Fever, Joint Pain. Inflammatory Bowel Disease: Altered bowel Habits.
WEIGHT GAIN • • • •
Hypothyroidism Cushing Syndrome PCOD Acromegaly
Hypothyroidism: Feel cold in the same moment as others feel normal. Decreased appetite. Tired. Dry hands. Constipation. Cushing Syndrome: • Bluish striae. • Facial hair growth. • Medication: Steroids. PCOD: • • • •
Trying hard to concentrate same last month. Periods history. Facial Hair growth. When was your last menstrual period? Is there any chance you are pregnant?
Hereditary: Family History Habitual: Diet History: Carbohydrates. Acromegaly: Male patient. Have you noticed any change in ring or shoe size. Increased sweating.
HOARSNESS OF VOICE Smoking. Vocal Abuse.
DIARRHEA Young patient. Acute: GE, Food Poisoning.
Ulcerative Colitis: I was admitted at a hospital, they gave some medication. Old hospital admissions for tummy. Travel/Family history. Cancer of Colon: Loss of weight, appetite, Family history. Blood in stools. IBD: Skin lesions. Blood in stools. Joint pain. IBS: Alternate bowel habits. After eating a meal I have to go to a bathroom. Malabsorption: Have you ever been diagnosed with Celiac Disease? Do you think that after eating a particular food you are having this problem? Hyperthyroidism: Weight loss. Heat Intolerance. Diarrhea. Diabetic Neuropathy : Have you ever been diagnosed with Diabetes? Lactose Intolerance : Are you allergic to any milk products?
Young patient: Trauma. Hypoglycaemia. Meningitis. >24 Stroke 5-6 Units/day. Have you ever been diagnosed with problems with your liver? Carcinoma: History of weight loss and loss of appetite. Fullness in epigastrium. Mallory Weiss Syndrome: Binge drinking. Oesophagitis: Do you feel any heartburn? When or after lying down or after eating your meal at night? Gastric erosion: Painkillers. Blood thinners. Instrumentation.
CHEST PAIN Diagnosis:
• Cardiac: ACS, Pericarditis. DAA. Stable Angina. • Respiratory: Pneumonia. Costocondritis. Pneumotorax. Pulmonary embolism. • Gastrointestinal: GERD. Gastroeosophageal reflux. Pleural Effusion: Pain relieved by lying in opposite side. Myocardial Infarction: • Painkillers firts. • Chest pain >30 minutes, doesn´t go with rest. Angina: Central chest pain