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 Exam 3rd wk April, lets go  
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  #21

Reviewed fever and weight loss

and jaundice in a neonate (case 39)

 

long morning in OR Friday. Happy Good Friday!! Jesus died for me, I am so excited!!! 


  #22

Read cases on adolescent weightloss and adolescent depression.

For depression, remeber SIGECAPS

S-Sleep/Sex

I-Interest in doing things they love/feeling hopeless

G-Guilty

E-Energy

C-Concentration

A-Appetite/Wt

P-psychosis/psychomotor

S-Suicide


  #23

good luck ..nice worknod


  #24

confidence wrote:
good luck ..nice worknod


 

Thanks!!! In barely 2 wks, I'll get to knock it out, so cant wait!

Did nothing over Easter, and I'll step it up and do at least 4 cases each day this week outside of rotations. Goal is to be through all cases by the end of this week and spend last week reviewing.


  #25

read FA case 24, woman with wt gain. Smoker, key is cessation, counsel, exercise, diet, hypothyroidism, pregnancy. Check heent, neck-thyroid, chest, heart, abdomen, dtrs


  #26

did fa case 23, loss of consciousness. Did PN too


  #27

This evening so far...

Practiced real phone case, FA case 39, 5 day old baby with jaundice.

 

Read Kaplan cases: childhood enuresis, SOB in 9 yr old child, cancer checkup


  #28

Did FA case 11 and practiced it. Doing ok, I just need to spend a few secs making sure I am organized and learn to spend only 15 mins on H&P. Right now I feel like I am taking my time and I still can do it in 15mins, so obviously if I put more of an effort can do it in about 14mins.


  #29

Update on cases covered in FA (or similar content in Kaplan complex cases)

 

So far in FA, covered Cases 1, 2, 4, 6,7, 8, 9, 10,11, 13, 14, 15 (depression, still need to practice more), 16 (domestic violence), 18, 20, 23, 24, 27, 28, 29, 30 (enuresis), 31 (MVA), 33, 39, 41

 

In Kaplan complex cases, I read

Ankle and Back pain, sore throat, MVA, left arm weakness , PPT, Pre-employment physical, sudden ab pain and syncope, vaginal bleeding, personal problem, htn, menopause med refill, fever and wt loss, adolescent wt loss, adol depression, bed wetting, diabetic checkup, child with vomiting and diarrhea, breaking bad news, smoking 

NEED TO REVIEW

1) Depression

2) Dizziness PE

3) DD in FA

4) Practice Joint Pain ROM

---When in doubt for DD put tumor LOL, for workup when in doubt put CBC

-----A smile and confidence can go a long way, even if nervous or unsure on the inside, smile and talk slowly so as to gather thoughts. 




Edited by DrOO4 on Apr 11, 2012 - 1:46 AM

  #30

1) Going to watch CSEvideo on nosebleed (dont see corresponding case in FA), I see it in kaplan's complex cases. 

 

Before watching, things that come to mind (DD) are trauma, sinusitis, URI, alcohol, drugs

Think, what can cause nasal bleeding: Liver problems, meds, allergies...

For workup, I'm thinking, XR-sinus, CXR, CBC, U/A. urine toxicology

Systems to examine: HEENT, Chest, Heart, Ab (if time?)

I'll watch the videos, and post my thoughts afterwards.


Edited by DrOO4 on Apr 11, 2012 - 9:59 PM

  #31

Post watching video, I was right, I would add to the DD : Alcoholism, hepatic encephalopathy

To the workup, I'll add : CBC, INR, 

                                          EtOH, AST/ALT, Alkaline phosphatase, bilirubin levels

                                          Cocaine Levels

                                           Abdominal Ultrasound

 

def do HEENT, Chest, Heart, Abdominal, quick Neuro (Cranial Nerves, Mental status: Name, location, date) and check gait.


  #32

Patient note for Epistaxis (done in a little under 9 mins)

 

 

HPI: 31 yo M c/o intermittent Epistaxis from L. nostril, which started 3 weeks ago. Pt denies any trigger but reports a slight trauma on the football field. Pt states bleed is bloody red and nothing alleviates the bleed. Bleed is aggravated by dry temps. Pt denies any bruises, lacerations, fever, infections, cough, runny nose, nausea/vomiting, pain, skin changes, fatigue or surgeries. Pt bleeds when he blows nose or sneezes. Pt has history of increased bleeding post dental procedures.
ROS: negative except as above
Medications: Tylenol
Allergies: Cats, Dogs.
PMH/PSH: None
FH: No family bleeding history
SH: 1 PPD for 5 yrs, Not interested in quitting. 1 beer everyday 2/4 CAGE, smokes pot and cocaine. College student, Sexually active, uses condoms.
 
Physical Examination
GA: Patient is irritated, has tissue in Left nostril incase of bleeding.
VS: WNL
HEENT: Nares-no active bleeding. No bruises. Pharynx clear.
Neck: Supple, No LAD
Chest: Clear breath sounds B/L
Heart: Normal s1/s2, no murmurs, rubs or gallops
Abdomen: Soft, non-distended, non-tender, +BS in all 4 quadrants, no Hepatosplenomegaly
Neuro: Alert and Oriented, CN 2-12 intact. Motor: 5/5 in all extremities. 
Gait: Normal. 
 
Differential Diagnosis
Liver failure
Hepatic encephalopathy
Trauma
Cocaine abuse
Von Willebrand disease
 
 
 
Workup
CBC, INR
CT-head, CT-sinus
ALT/AST, Bili, Albumin
Abdominal US
Cocaine level, EtOH levels, urine toxicology



Edited by DrOO4 on Apr 11, 2012 - 11:42 PM

  #33

Updated FA cases I've covered, did FA case 21 (Knee pain). 

 


So far in FA, covered Cases 1, 2, 4, 6,7, 8, 9, 10,11, 13, 14, 15 (depression, still need to practice more), 16 (domestic violence), 18, 20, 21, 23, 24, 27, 28, 29, 30 (enuresis), 31 (MVA), 33, 39, 41

focusing on joints today (so should add FA cases 3, 37, 38, plus shoulder pain)

tomorrow its memory/confusion/syncope/parkinson(tremor)/schizophrenia plus female issues (rape, sleeping problems, pain during sex, menstrual problems. Also review breaking bad news (2x time doing this)

Sat it'll be referrals, checkups, life insurance, obesity, and kids kids kids)

Goal is by Monday (last week) to be going thru FA again as well as Kaplan cases, almost through with those. 


  #34

Went through mini cases for hip pain, watched cse video on hip pain, PN


  #35

good luck for your exam..wish you all the best


  #36


confidence wrote:
good luck for your exam..wish you all the best

 

Thanks, how is your CK studying going? Mine is taking a break till post CS.. I plan on taking it 1st wk of August. Also busy with rotations, during surgery now, which is really good, cause I am learning so much, I have such amazing preceptors. Surgery is teaching me not just surgery but GI, Skin, among other stuff.

Back to CS

 

I was in clinic today and it was AMAZING!!

I saw and treated

1) 52 yo M c/o "colon problems" and pain in L. wrist that radiated upwards. Pain was 8-9/10 in severity. Smoker 1PPD for 35yrs. On examination, pt has cyanosis and clubbing. 

Hx Gout, HTN, hemorrhoids

DD: Carpal tunnel syndrome, OSA (turns out he does have a cpap that he doesnt use), Gout, COPD, Osteoarthritis, RA, anal fissures, diverticulosis, hemorrhoids, Colon CA

Workup: EMG, XR-wrist, MRI-wrist, Polysomnography, CXR, Rectal exam, stool culture, stool for occult blood, colonoscopy (last one was 5-6 yrs ago), abdominal CT, CBC, U/A

 

2) 39 yo F c/o anxiety attacks post verbal fight.

Hx: Ovarian cyst

DD: Factitious disorder, Domestic violence, Depression, bipolar I, arrhythmia, 

Workup: CBC, Electrolytes, Urine toxicology, TSH, Mental status exam

 

3) 54 yo F c/o trigger finger and vertigo

 

4) 39 yo F f/u for an ear infection. 

her ears were clear, no discharge (from hx and exam), she had a hx of migraines, no fever, headaches, denied everything LOL

DD: Migraines, Sinusitis, Factitious disorder

Workup: CT-head, MRI-brain, CT-sinus, LP, CBC, Electrolytes, LP

 

5) 47 yo F presents with 3 day hx of fever, chills, severe headaches. Taking cipro, has lower back pain, nausea and vomiting

GA: Febrile and Shivering, in acute distress

DD: Cystitis, Pyelonephritis (maybe cause of back pain-kidneys retroperitoneal), Influenza, Pneumonia, Pancreatitis, Nephrolithiasis

Workup: Pelvic exam, Urine culture, U/A, CBC, AST/ALT, Bili., Alk Phosp, CT-Abdomen

 

6)43 yo M f/u c/o L. shoulder pain, post MVA that happened 2 mths ago. 

DD: Fracture, Muscle strain, Rotator cuff injury

Workup: XR-L. shoulder, MRI-L. shoulder, XR-skeletal survery, CXR, CT-Abdomen, CT-Chest, BUN/Cr, U/A

 

Obviously cases were complex, but it was good to get the brain overly thinking. Downside was no drapes or gowns, but I was able to write PNs while talking to the Patients easily, and I knew what systems I wanted to examine. Also I didnt bother with meds, left it to the doctors, focused on doing stuff the CS waynod




  #37

 


Updated FA cases I've covered, did FA cases 26 (alongside csevideo)--pain during sex

 

So far in FA, covered Cases 1, 2, 4, 6,7, 8, 9, 10,11, 13, 14, 15 (depression, still need to practice more), 16 (domestic violence), 18, 20, 21 23, 24, 26, 27, 28, 29, 30 (enuresis), 31 (MVA), 33, 39, 41

 

I'm a bit behind due to spending time at the clinic, so agenda has moved up a day, Saturday I'll have all day at my disposal, I plan on covering the following

 

memory/confusion/syncope/parkinson(tremor)/schizophrenia plus female issues (rape, sleeping problems, pain during sex, menstrual problems. Also review breaking bad news (2x time doing this)




  #38

my ck is on truck... done with the first reading ..now i'm doing kaplan q bank along with mtb2 and3...i expect to sit for it arround sept ...my big pb is cs i dont know how will be the new version ...you are very lucky to have your rotation now good luck you will do itnod


  #39

confidence wrote:
my ck is on truck... done with the first reading ..now i'm doing kaplan q bank along with mtb2 and3...i expect to sit for it arround sept ...my big pb is cs i dont know how will be the new version ...you are very lucky to have your rotation now good luck you will do itnod


 

You'll blast CK out of the water!! Are you applying this year? Dont you want your CK score out before ERAS opens Sep 15?

I dont think new version will be bad, just that for Diff Diagnosis options, you have to now give evidence from H&P as to why you chose it.  When do you plan to take yours?

Yes, definitely the rotations do help, especially for CS, I'll just see it as another day seeing patients in the clinic, no major anxiety there, just ready to be done, so I can get back to CK studying,


  #40

Did FA case 25, alongside corresponding csevideo (amenorrhea)

I practiced mine and was able to do it in 14minsnod Questions were easy to remember as a female, prob harder for guys to remember pregnancy/menstrual cycle stuff.

 


Edited by DrOO4 on Apr 14, 2012 - 2:26 PM




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