Go through above for how long cases are marked. 1. information gathering. 2. interpretation and DD 3. plan 4 Knowledge
And how marks are given based on word categories and then the actual MARK..
Go though for list of all common long cases to be familiar for.
List is also found in clinical objectives booklet and caselists files etc.
Check exam method in main tree page for the main structure of the exams as well.
Remember no time at all. So gather a lot.
Need only to fit in with a DD. That is identify the type of case eg: peripheral neuropathy. And then list DDs for this and try to weight in. Eliminate or confirm. No need to arrive at a diagnosis. DDs will do. But reasons for.
Identify the case and then revolve around DDs. Can be multiple sets of DDs.
Must present fast and methodical.
Components to keep in mind 1. History 2 Exa mination 3. Problem list 4. DDs 5. Investigations 5. Initial plan of management 7. Summary
Sinhala only in examination commands of short cases. And in interiewing patient for history and examination. Examiner wont be watching in long case?
But have to take history fast to gather a lot of information and examination findings.
Must try to fit in with a long case template that you've learnt. Must know how to fit in from a clinical presentation and then take history and examine. That colombo long case book is enough as the other is too much.
They will ask for investigations needed and then say the results and we should intepret. So should know list of investigations, and how to DD and interpret based on this.
1. History and Examination
Must present fast.
It should be like a FAP case. Wholistic.
Problems should be also PICA and other psychosocial issues.
Present positive and negative findings
When taking H/E everything should revolve around DDs. First identify case presentation and then recall aetiologias and DDs of this. And then work around this. Eliminating and confirming. The main diagnosis is the clinical one and then DDs can be found out by H/E and investigation.
Must revolve around aeitology and pathology, and perpetuating factors and complications. Ask and examine for all of these aspects with regards to main clinical problem and DDs. Both health and psychosocial factors.
3. Problem list
Divide into acute and chronic. (like DM, HT)
Must devide into health and psycho-social also!
Should be wholistic like a FAP case with regards to whole household, occupation, family and life!
And need to address plan for everyone of this.
PICA!!!!!
(not a list of symptoms but problems!)
(problem list
history presentation and before examination!)cv
4. DDs
Based on main clinical diagnosis.
Can be clusters eg : vertigo, headache etc
And must be able to link up and form the whole picture.
And come up with causes to further investigate for
5 Investigations
To diagnosse and confirm
For complications
For prognosis and response to treatment.
“Basic Tests” ??
Have a list of basic tests. All in mind.
And what looking for in each.
Mention the results you
expects, and how those results
will help in differential
diagnosis
Better if Blood, Urine, Imaging
tests are mentioned in order
Learn a list of all investigations and so can just pick and choose,
6. Initial plan of management
Together with initial investigations. Must suggest plan for each problem.
Include even counselling and educating as well! And advising. And if how use non technical terms and show layman correlation.
Smoking and alcohol and psychiatry as well (psyhiatric refeeral to understand more). Insight and compliance. Family counselling.
And then medical management.
Need to know theory of the disease and treatment (path and pharm)
Immediate, Short term, Long
term
Non – Pharmacological
Pharmacological
Advising patient – in nontechnical terms please!
Mention drugs if you know them
Know common side effects of
commonly used drugs
Prognosis/Long term outcome
Pregnancy & counselling
7. Summary
Like as if telling about the patient to a consultant! A summary.
"presenting with" "been managed for" "known patient with"
Common mistakes ⇒
Taking too long to present the
History
Being slow in presentation
Giving unnecessary details &
wasting time
Not being organized with
History & Examination
Not having a Problem List and/
or DD ready
Poor theory knowledge
Not answering to the point
Go through long cases selection and examples to get a better idea of what will come and how it all links up and how the common case setup and thinking is like. Criteria to meet for it to be a long case! (eg alcoholism ⇒ cirrhosis ⇒ hepatoma ⇒ polycythemia ⇒ MI)
And how problem lists should be formed etc etc (watch videos etc)
Important points
Always ask when the patient was apparently well last! And mention when the patient was apparently well last.
If not apparently well last, then mention the state of the patient when admission. and before admission. Whether stable or how change and whether deteriorating.
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Like how poorni in horana base hospital told and how to present...
Rest of the stuff is the same. PMH, PSH, DH, ALlergy, fam and social. details and systemic inquiry also.
But PC and HOPC is different.
First write the story from the time the patient was healthy or if not how long bed bound and health status before this exacerbation.
And then the story of what changed and how developed this acute stuff and what happened.
Then describe all symptoms and symptom analysis like SOCRATES.
And then try to fit into a long case template.
And then consider DDs and try eliminating all of that and see.
Then come to primary diagnosis ... and then DD of this.
That is analyse the aetiology and risk factors and DD that.
Like DD the cause and then sub DD
And assess complications and other related stuff from management.
And then risk factors like DM, HT etc
And present like this.
Think about the anemia case that you did.
A diagnosis should have 1. primary diagnosis 2 qualifier 3 complicated by 4 no evidence of
Eg: Decompensated liver cell disease or cirrhosis complicated by portal hypertension. Theres nop evidence of hepatic encelopathy or SBP.
OR Nutritional deficient anemia complicated with unstable angina. (unstable angina precipiated with nutritional deificent anemia). There is no heart failure.
For CVS short cases. There is valvular heart disease. Type of murmur and description and best heard and associated features for distinction.
Must ace all four short cases for distinction (80% above), First class is 70 above average.
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Long case
First start with when apparently healthy. Or if not healthy state then state how went from apparently to that unhealthy state for how long eg bedridden for four years. And then what happened from that all the way to admission.
Then start with symptoms and analyse the symptoms each. Timing of symptoms - development and analysis.
Then arrive at a long case template and DDs
Then analyse for every DD and eliminate.
Then confirm DD and analyse for. Eg stigmata for liver disease.
1. Aetiologys for this case within a case.
2. Manifestations
3. Complications of this case within a case.
Then have the rest of the history ...
Then give the main diagnosies and problem lists acute and chronic.
Then how each will be investigated for and plan of management.
Then they will give investigation results and you should discuss how manage and stuff after that.
Liver failure regime. Bowel movements. Ascites. Portal hypertension.
Rectal bleeding can be secondary colon ca or portal hypertension.
And then when decided to release.
Should do objectives 1. Aetiology 2. Severity 3. Complications 4 associated 5. Management upto now 6 Dds and diagnosis
This is after story, apparently we'll, time line of symptoms and symptom analysis, Dds and exclusion.
....
Remember for peads social history is very important. All factors of social history.
So details and then presenting complain. And then history of presenting complain start with apparently well or bed bound. And then story. And with story can have symptom analysis of each. Must know how to analyse each symptom. Like Socrates. And fever. And then come to the case and then confirm and analyse for a diagnosis. And then eliminate other diagnosis. And then do more analysis. Aeitlogy, complications, risk factors. And then what has been done in admission until now. Then systemic inquiry and then the rest... How much detailed the rest will depend on the case................
Then 2. examiantion 3 DDs 4 problem list 5 summary
6) Investigations and how to interpret analyse them
7) Management
8) Ward round stuff? Any patholgy stuff like advise how to??
9) any emergency stuff?
10) discharge criteria
11) counselling and follow up
ALL ABOVE AREAS CAN BE ASKED IN THE LONG CASE!