Step 2CS Vaka sorusu örnekleri

Bir forumdan alıntıladığım Step 2CS vaka sorusu örnekleri.
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1. ELDERLY PATIENT (>50 YRS ) WITH BACK PAIN
Hello Mr. XYZ, good morning/good afternoon. I am Dr ABC, one of the physician in this hospital. Its nice to meet you (shake hand). I am here to ask you a few questions and give you physical examination. Before that let me drape you first so you feel more comfortable. Can you tell me the reason for coming to the hospital today? Could you please describe to me exactly more about your problem? LIQORAAA L. Can you show me exactly where the pain is? I. On a scale of 1 to 10, with one being the least painful and 10 being the most painful, which number would you describe your pain? Q. How do you describe your pain? Is it sharp, burning, crushing, or heavy feeling? O. when did it start? -- How did it start? -- how has it progressed over this period? -- Is it continuous or intermittent? R. Does it move any where else, such as your legs? A. A: is there anything that makes your pain better? A: is there anything that makes your pain worse? A: Do you have any numbness or tingling in he legs. --Do you have any weakness in the legs? --Do you leak any urine without your knowledge? -- Have you ever had any bowel movements without your knowledge? -- Do you have a fever? -- Have you had any trauma to your back? Summarize chief complain and other important points… Now I will ask a few question regarding your health in past. Is that okay with you? P- Did you have similar complain in the past? Have you had any bone fractures? Do you have pain in other joints? Did you use steroid medicines in past? Do you have any other medical problems? A: Are you allergic to anything? M: Are you taking any other medications? In case of old female pt usually over 60 ask about Did you receive any hormonal pills? How about vit-D or calcium supplementation? --T: have you ever been involved in major trauma? --S: Have you ever undergone any kind of surgery? H: Have you ever been hospitalized? Sleep: Do you have any problems sleeping? F: : Ok Mr. XYZ, now I would like to ask few questions regarding your family health. Is that ok with you? Do any of your family members have osteoporosis or back problems? Are your parents living? Sexual history: Ok Mr XYZ, now I would like to ask few questions about your sexual history. Please understand it will be kept confidential between you and me. Try to be as honest as possible. Is that ok with you? Are you sexually active? Social history: Ok Mr XYZ, now I would like to know about your social habits and personal life style. Is that ok with you? Appetite: How is your appetite? Diet: can you please tell me about your diet? Weight: Has your weight changed recently? Do you smoke? How much and for how many years? Do you drink? How long have you been drinking? D: Are you currently taking any type of over the counter medications? Any prescription medications? Have you tried HRT? Have you ever tried any recreational type of drugs? Occupation and exposure: Do you work? What type of work you do? Is it stressful job? Are you exposed to any health hazards in your work or personal life? Exercise ( counseling only if u have time): Do you exercise regularly? Stress: Do you have any stresses from your family? Thank you very much for the information you gave me. PE: Wash your hands Perform proper draping techniques. Check for spinal tenderness. Check for paraspinal tenderness. Check for lower extremity pulses. Check sensation of both lower extremities. Do complete motor and reflex testing of both lower extremities. Do straight leg raising testing. Check the lumbosacral spine range of motion. Check the gait. Examine without gown, not through the gown. Counseling: Explain physical findings and differential diagnosis. Explain further workup. Advise the patient to take or continue the Vit D and calcium Demonstrate and explain the importance of doing range of motion exercise. DD 1. Disk prolapsed 2. Osteoporosis with vertebral body fracture 3. Muscle strain 4. Pathologic fracture 5. Degenerative joint disease 6. Malingering 7. Metastatic prostate Ca (in males) Inv: 1. X – ray lumbar spine 2. Dexa scan 3. Calcium, phosphate, alkaline phophatase, protein electrophoresis, and acid phosphatase as needed 4. MRI spine as needed 5. CBC and ESR as needed.

2. SHOULDER PAIN
Hello Mr. XYZ, good morning/good afternoon. I am Dr ABC, one of the physician in this hospital. don’t shake hand because he will supporting his painful hand with opposite hand. I am here to ask you a few questions and give you physical examination and see what I can do to help you.
Can you tell me the reason for coming to the hospital today?
Could you please describe to me exactly more about your pain?
LIQORAAA
L. Can you show me exactly where the pain is?
I. On a scale of 1 to 10, with one being the least painful and 10 being the most painful, which number describe your pain?
Q. How do you describe your pain?
O. when did it start?
-- How did it start?
-- how has it progressed over this period?
-- Is it continuous or intermittent?
R. Does it move any where else?
A. A: is there anything that makes your pain better?
A: is there anything that makes your pain worse?
A: Do you have any numbness.
-- Do you have any tingling.
--Did you notice any swelling or redness after fall?
--Do youhave pain in any other part of your body?
--Are you able to use your arm?
-- Do you feel any weakness?
-- Do you have a fever?
Summarize chief complain and other important points…
Now I will ask a few question regarding your health in past. Is that okay with you?
P- Did you have similar complain (any problem with your shoulder) in the past?
Do you have any other medical problems?
A: Are you allergic to anything?
M: Have you taken any medications?
H: Have you ever been hospitalized?
U: Do you have any problems with your urination?
G: Do you have any problems with your bowels?
S: Do you have any problems sleeping?
F: : Ok Mr. XYZ, now I would like to ask few questions regarding your family health. Is that ok with you?
Are your parents living?
Has anyone in your family had medical problems?
Sexual history: Ok Mr XYZ, now I would like to ask few questions about your sexual history. Please understand it will be kept confidential between you and me. Try to be as honest as possible. Is that ok with you?
Are you sexually active?
Social history: Ok Mr XYZ, now I would like to know about your social habits and personal life style. Is that ok with you?
Do you smoke? How much and for how many years?
Do you drink? How long have you been drinking?
Have you ever tried any recreational type of drugs?
Here, ask another open ended question for social and occupational history.
Tell me something about your life at work and home?
All right thank you for being cooperative. Now I am going to give you physical. Before I do, is there anything you would like to ask me? I would be happy to answer any questions.
**Doc please be gentle with my arm.
I know you are in pain. I will do my exam as gently as I can. Does that sounds good.
Please excuse me for few seconds while I wash my hands.
Expose the joint properly while draping the other parts.
Always start with local examination ie painful sholulder.
Before inspection tell the patient that you are looking for redness and swelling.
Palpate and compare both joint.
Palpate for swelling, warmth and crepitus. Tell him that you will be very gentle. Say sorry if he complains of tenderness during examination.
Check range of motion in abduction, adduction, flexion, extension and internal and external rotation. Always adduct the patients arm across the chest (cross over test)
Check reflexes: pin prick sensation
Check the opposite arm
Check hand in detail
Look at the legs very quickly
Listen to the heart and lungs
Counseling
Explain the probable diagnosis, follow up after investigations and the availability of physiotherapy.
Diagnosis
Shoulder dislocation
Shoulder fracture
Rotator cuff tear
Subacromial bursitis
Ligament sprain
Inv
CBC
X – ray shoulder joint two views, incl elbow
X – ray hand two views
MRI of the shoulder
ANA and RF

3. HEEL/FOOT PAIN
Hello Mr. XYZ, good morning/good afternoon. I am Dr ABC, one of the physician in this hospital. Shake hands . I am here to ask you a few questions and give you physical examination and see what I can do to help you.
Can you tell me the reason for coming to the hospital today?
Could you please describe to me exactly more about your pain?
LIQORAAA
L. Can you show me exactly where the pain is?
I. On a scale of 1 to 10, with one being the least painful and 10 being the most painful, which number describes your pain?
Q. How do you describe your pain?
O. when did it start?
-- How did it start?
-- how has it progressed over this period?
-- Is it continuous or intermittent?
-- If intermittent
-- How often does it occur? How long does it last? How do you feel b/w attacks?
R. Does it move any where else?
A. A: is there anything that makes your pain better?
A: is there anything that makes your pain worse?
Walking?
Standing? After standing, how long it does it take for the pain to start?
A: Did you ever have any accidents /trauma involving your foot /heel?
-- Do you have a fever?
-- Do you have joints pain?
-- Where?
-- Do you ever have morning stiffness?
-- Did you ever have H/O diarrhea or any acute illness/ (Reactive arthritis)
-- Did you ever have any urethreal discharge?
-- How about an eye infection? (Reiters syndrome)
-- Did you ever get rashes? (Psoriatic arthritis)
-- What type of work you do?
-- Does your work involve any prolonged standing?
-- Do you have to walk a lot at your work?
Summarize chief complain and other important points…
Now I will ask a few question regarding your health in past. Is that okay with you?
P- Did you have similar complain in the past?
Do you have any other medical problems?
A: Are you allergic to anything?
M: Have you taken any medications?
H: Have you ever been hospitalized?
U: Do you have any problems with your urination?
G: Do you have any problems with your bowels?

F: : Ok Mr. XYZ, now I would like to ask few questions regarding your family health. Is that ok with you?
can u tell me something about yr parents health
Has anyone in your family had medical problems?
Does any body in your family has a history of RA?
How about any other joint disease?
Sexual history: Ok Mr XYZ, now I would like to ask few personal questions, whatever information u will provide will be kept confidential. Is that ok with you?
Are you sexually active?
Social history: Ok Mr XYZ, now I would like to know about your social habits and personal life style. Is that ok with you?
Do you smoke? How much and for how many years?
Do you drink? How long have you been drinking?
Have you ever tried any recreational type of drugs?
All right thank you for being cooperative. Now I am going to give you physical. Before I do, is there anything you would like to ask me? I would be happy to answer any questions.
I know you are in pain. I will do my exam as gently as I can. Does that sounds good.
Please excuse me for few seconds while I wash my hands.
Proper drapping.
Check the eyes for possible conjuctivits. (Reiters syndrome)
Inspect the foot.
Before inspection tell the patient that you are looking for redness and swelling.
Palpate of the entire foot (not just the heel) for any point for tenderness.
Palpate for swelling, warmth and crepitus. Tell him that you will be very gentle. Say sorry if he complains of tenderness during examination.
Check range of motion of the ankle and foot joints. Check for pain and restriction of movements.
Ask the patient to do the active dorsiflexion and planter flexion. Check for any tendon tenderness. (tendinits)
Listen to the heart and lungs
Counseling
I have to order an X – ray of your foot and ankle and some basic blood tests before we come to proper diagnosis. Meanwhile, I will try to help you get relief for your pain.
Rest your foot for two or three days.
Ice it for 30 mins. Do this every four hours.
Use soft heel pads.
Avoid excess weight on your heel.
Try over the counter Ibuprofen for pain relief.
You can also try using a padded foot splint.
Most of the time people will get better with these measures. If you don’t get better, or if your tests show abnormal results, we will sit together and discuss the other possible options. Is that ok with you?
DD
Planter fasciitis
Calcaneal periostitis
Painful heel pad syndrome
Bone tumors
Rheumatoid arthritis
Reiters syndrome
Inv
CBC with differentials
ESR
X – ray of foot and ankle 3 views
Rheumatoid factor assay

4. Terminal ill patient
"Mr. XYZ please tell me what bothered you to come in here? (I am having pain in my epigastrium)
I have been informed that you have been diagnosed with cancer. Is that correct? (yes) Could you please tell me more about your cancer? (I have pancreatic cancer, diagnosed 3 months back)
I am very sorry to here that (Thank you doc). I know its very difficult, I can understand what you are going through.
But I want you to know that I am there to help you if you need anything and make you feel comfortable. ( Thanks you very much)

Can you please explain me little bit more about your pain? How severe is the pain in a scale of 1 to 10? Do you think there is anything that makes your pain less?

Do you have pain anywhere else? (Some times my back hurts)

Are you using any medications for your pain especially any narcotics or morphine? ( not much)
Do you have any other complaints other than pain? ( I am feeling tired most of the time)
How is you appetite? ( Its very much decreased),
Have you lost any weight? (yes; around 1-12 pounds in 3 months)
Do you have any fever? (no)
How are your bowel movements?
Do you have any problem urinating?
How is your mood? ( not good doc, I feel depressed)
Can you please tell me about your home situation? ( I don't have anyone doc, I live alone)
Do you have any one to help or support you like any friends or family members ( I have few close friends, yes they certainly help if I need)

My. xyz I will certainly help you in relieving your pain. I will prescribe some narcotics like morphine to relive your pain. I would also like you to be aware of certain things which will be necessary at some point in your life.
I am very sorry to ask you these questions but I hope you understand the situation. (Thank you doc, don't worry ask me)

Where do you want to live? Do you want to stay at your home or at nursing home? (I want to stay at home)

Are you aware about "hospice"? (not much) Ok let me explain about hospice. Hospice care is a choice you can make to enhance your quality of life in a terminal stage. You can also choose to die at home with the support of family, friends, and caring professionals. Over 90% of hospice care is provided at your home. The advantage of Hospice care is that the providers have the skills and resources to permit you to live as pain-free, as comfortable, and as full a life as possible. In addition to providing pain relief Hospice care emphasizes comfort measures and counseling to provide social, spiritual and physical support to you and your family. All hospice care is under professional medical supervision. So I strongly advise you to take Hospice care. ( Thank you very much Doc, You relieved most of my tensions)

Ok, are you aware of advance directives? (no not much doc). Ok, an "advance directive" or a "living will", will enable you to give your opinion on how you should be treated when you reach the terminal stage of the disease and not in a state to make a decision or you can give the right to take that decision to a loved one who you think will take a wise decision for you. Do you understand what I am saying? (yes doc)
Do you have any other questions? (No not much doc)
Examination:
Auscultate and palpate the abdomen.
Quick auscultation of the heart and lungs.
Look conjunctiva for pallor or jaundice


Hospice care is for people who are nearing the end of their lives. Hospice care is designed to relieve or decrease pain, or other symptoms, and provide as much quality time as possible with family and friends. But unlike other medical care, the focus of hospice care is no longer on curing or treating the underlying disease. The goal of hospice care is to provide the highest quality of life for whatever time remains. Hospice professionals often say that their focus is on caring, not curing, and that they treat the individual, not the disease.
Hospice professionals stress that the longer someone is in hospice care, the better chance of a peaceful and high-quality experience. Waiting until the very end and then rushing into hospice at the last minute can be traumatic for you or your loved ones, and does not allow time for symptoms to be properly managed.

Although most hospice care is provided at home, hospice is often available at nursing homes or assisted living residences. Some residential facilities designed specifically for hospice care also exist.

5. Stridor:

When did it start?
What was he doing when it started? (Eating peanuts or playing with toys?)
Was it sudden in onset or presented in a gradual manner?
(
How is it progressing now-Getting worse or constant?
Is the sound there all the time or does it come and go?
Do you know anything which may have caused it?
Do you know any thing which makes it worse or better?
Like feeding, crying, supine position, sleep?
When it is best heard-While inhaling air or while exhaling?
How would you grade its severity?
How is his breathing? ( harsh, raspy breathing)
Is he able to talk? (Choking?)
Can he talk? How is his voice (muffled or hoarse voice)

Does he have any other symptoms apart from stridor?
Like cough ?
Tell me more about cough-Can u describe how does it sound? Is it barking in nature? Does he brings up anything when he cough?
Have you seen any blood in cough?
Any fever?
Did he complain of sore throat
Did he complain or show any sign of Difficulty and painful swallowing
Have you noticed any drooling?
Have you noticed any blueness of skin?
Does he have any difficulty in swallowing food?
Is he crying? How is he crying? Muffled or weak?
Have you noticed any hoarseness of voice?
Does he snore at night? (Chronic case)
Does he have any pain in his belly? (No, he didn’t mention it)
Does he have any problems with his bowel movement? (He has constipation)
Does he have any problems with his urination? (No)
Does he have any problem with sleeping?
Did he have any infections before? (No)
Did you intervene in any manner or tried any treatment?
Did he have similar episode in the past?

Birth history
Did you have any problems with your delivery? (No, everything was fine)
Did he have any problem at the time and after delivery?
Family history

Is there any history of allergies in the family (Atopy-angioedema?)
Has he suffered from any psychological or social stress in the recent past?
PMH

Did he ever have similar episodes in the past? (No)
Has he ever been diagnosed with any medical illness before? (No)
Has he ever been hospitalized? (No)

MH
Is he taking any medications? (No)
Is he allergic to anything? (No)


Milestones questions (I use IDIOT mnemonic)

Are his immunizations up to date? (Yes)
How is his growth & development on the whole?
When was his last well-child check-up? (Six months ago, everything is fine at that
time?)

Mrs. Xxxx,I would like to give you my impression right now. First let me summarize
what you have just told me. You said ………... Is that right? (Yes)
Do u want to add anything else?

Mrs. Xxxx , according to the information I gathered from you, I’m considering a
possibility of foreign body aspiration. But sometimes such symptoms occur due to other cause too like some infections affecting airway . Other possibility is pneumonitis.

I would advice u bring the child to the medical center to rule out other causes. Which might need a physical examination and some blood tests and imaging tests such as a chest X-ray or a computerized tomography (CT) scan of your child’s lungs

Pulmonary function tests- a series of test to evaluate how well your lungs are working

Bronchoscopy procedure to view your airways and collect samples from your lungs by passing a flexible tube called bronchoscope through mouth or nose and then down into your lungs.

DD
Foreign body aspiration
infections such as whooping cough
epiglottitis
Laryngomalacia)

Meanwhile I’ll suggest you that please do not put finger in his mouth or perform any blind finger sweep because this may dislodge and push the foreign body more deeply if it is actually present.

Hope you understood whatever we discussed today?
Do you have any concern or question?

Alright then, I will see you once you get to the hospital. Take care.


NB: (First aid for the chocking who cannot breathe, cough or talk)
Age <1year: Back blows followed by chest thrusts
Age >1year: Abdominal thrust or Heimlich maneuver

6. Stress Incontinence:
When did you first notice?
How is it progressing?
How frequent does it occur in a day?
Is it consistently present or is it transient and intermittent?
When do you feel this incontinence? Does it occur at any specific time or situation ?
Is there any thing which makes it worse or better?
Does anything precipitate the event? Like coughing, sneezing or heavy
lifting, laugh, or exercise.
Do you leak every time you cough, sneeze, laugh or exercise? or only sometimes?
Do you wear absorbent pads?
Does it occur during sexual activity?
How it has affected your activities of daily living and general well being?
How it has affected your interpersonal relationship?

How much liquid or water do you drink every day?
How many times do you urinate every day? (Bothersome urination eight or more
times a day or two or more times at night = overactive bladder)

Did you ever notice a sudden and strong need to urinate immediately?
Have you noticed leakage or gushing of urine that follows a sudden, strong urge?
Did you notice it during the sleep? (Urge incontinence?)

Do you have frequent urinary tract infections?
Did you notice increased frequency,burning sensation in urine or painful urination?

PMH
Have you had any other medical problem, u would like me to know about?
Any operations?
Just a couple of questions I would like to ask They may not seem to be related to problem what u r experiencing right now but it will give me idea about your general health status.
Some of them r just yes or no answer I do apologize.
Have you ever had any heart problem? .. like angina, heart valve porblem
Any problem with breathing? .. asthma, emphysema, chronic cough?
Any history of Jaundice, DM in past , any dizziness…, fits.., heart burn digestion…..
Has there been any change in your bowel, bladder habit?

SH
Do you consume excessive caffeine
Do you play any sports like running or tennis?
What’s your height and weight? (BMI = Obesity?)
Do you smoke?
Do u drink?

Gynae history
do you have kids? How many?
Were they delivered Vaginally ? Was it a normal or forceps delivery? Do u have any idea how long was the labour? Was it very difficult delivery? I am asking this because nerve damage incurred during delivery of a child may lead to poor function of pelvic floor muscles or the sphincter.
In terms of medication,
R u on any medication on regular basis at present/ which one, how often? R u taking any over the counter medication, herbal medicine or vitamins?
A: Are you allergic to anything?

Moving on to family history …any history in the family of any illness that may be one or more person had?
Has any one in the family had similar problem
how is the health in your parent? Or r your parents in good health? If answered died, then what did your mother die of?


PE:
PICKLE
Abdomen and genitals
A neurological exam to identify sensory problems
Auscultate chest and heart


Work-up:
A urinary stress test (in which the doctor observes urine loss when you cough or
bear down on your abdomen)
Urine examination
Post void residue
Cystometry
CBC

Diff/diag;
1. stress incont due old age/weak pelvic floor/chron cough/heavy work
2. irritative incontinence due bladder cancer, stones in bladder,detrusor instability
3. overflow incontinence due to DM neuropathy
4. urinary infection
5. fistula

Mrs. Xxxx,First let me summarize what you have just told me. You said ………... Is
that right? (Yes)
Mrs. Xxxx , according the information I gathered from you, I’m considering a
possibility of stress incontinence.

Imagine you are holding on your hand a balloon full of water. The neck of the balloon is held closed between your fingers so that it does not leak. But if your fingers get tired and you squeeze the balloon just a little, the water will dribble out.
That is what happens to the bladder in the commonest type of problem involving
leaking - "stress incontinence". If the valve at the neck of the bladder (the urinary sphincter) and the pelvic floor muscles are not strong enough, then an increase of pressure on the bladder may be too much for them, and you will find some urine has leaked out. This happens especially with a sudden increase of pressure, for example when you cough or laugh or take exercise. It is because of problems with muscles and nerves that help to hold or release urine.

However, there are certain other causes like infection in urinary bag or any
neurological illness which may also lead to similar problem. In order to know more
about the problem I need to run a few investigations like a urinary stress test (in
which we observes urine loss when you cough or bear down on your
abdomen),
Urine examination
assessment of amount of urine within bladder after passing urine.
Cystometry –that is the measurement of pressure in your bladder and in the surrounding region during bladder filling. A catheter is used to fill your bladder slowly with warm water. Another catheter with a pressure-measuring sensor device will be placed in your rectum. This procedure, when combined with a voiding study, can identify problems with the urethra exerting too little pressure against bladder pressure.


Once the results of these investigations are available we will go over the
things in detail and I will tell you more about management and treatment options
available in your case.

Meanwhile I will suggest 2 things
First I want u to keep a voiding diary for a few days record when, how much and what kind of fluids you consume; when you urinate; and when you experience incontinence. Your diary may reveal patterns that may help to understand symptoms and identify contributing factors.

Second I would suggest to follow a few measures to relieve your symptoms or lessen episodes of stress incontinence.
Fluid consumption. Please restrict the amount of fluid taken per day and also
avoid caffeinated and alcoholic beverages.
Healthy lifestyle changes. Quitting smoking or losing weight may lessen your
vulnerability to stress incontinence and improve symptoms.
Scheduled toilet trips. More frequent voiding of the bladder may reduce the
number or severity of stress incontinence episodes.
Absorbent pads. You can wear absorbent pads or undergarments to protect your
clothing and avoid embarrassing incidents if you do experience incontinence.

7. sp dady who was concern about child leukemia in ER and came to see Doc.

I know this must be very difficult for u to see your baby in such state. Would u like to sit down and talk about your son condition. I would like to know from the beginning.Would u like to sit down and then we can talk about your child’s condition. Please tell me how the problem started.


Concern-dx

When was he diagnosed?
How was it diagnosed?
Do u have doubt about diagnosis?
Do u feel angry about doctor?
do u have any idea about treatment plan?
DO u have any idea about impact of treatment will have on their child’s body and self-esteem.
R u afraid of intensive treatment,
Do u have doubts about the diagnosis they are given about the treatment plan outlined for them, do u want to seek second opinion? I would also want u to know prolonged delay may harm your child’s chances for a good response to treatment. Once a diagnosis is confirmed, treatment should be started.

Child’s condition
Is he eating drinking well ?
Any difficulty swallowing
any fever?
Any breathign difficulty? Any nausea?
Any vomiting? what about his bowel movement? changes in bowel or urinary habits
Has he been always a sick child or healthy?
Any change in appetite?
Any weight change?
Tell me about his sleep?
any allergic to any drug? is he playful or quiet and not interacting

birth history
Tell me about his birth event?
Is there any unusual event or injury?
Is his growth normal like other children?
Do you have a growth chart?
Is his height ok?
Is his teething/teeth erruption ok?
Can he speak? Do you take him regularly to any paediatrician?
Did anytime the paediatrician tell you that your little ____ has any problem?

Is his immunization upto date?
Can you show me his immunization card?
Tell me about his diet?
How long have you breast fed him?
When you started weaning?
Did he accept the food normally?


FH of leukemia, bleeding disorder
congenital abnormality





Concern what cause
What do u think might have cause this condition to your child?

How are you feeling?
Do u blame yourself for what happened to your child
Do u feel your behavior or action may have contributed to your child having this life-threatening disease. Do u drink do u smoke? Do u thing this Could be "payback" for past sins or the result of drug or alcohol abuse?
Has their smoking caused the cancer?
Nothing u did or failed to do during pregnancy may have made a difference.

Have u thought about what is going to happen to jonny’s future?
We can give u all the information about the treatment plans and probable side effect of the drugs, and the impact of treatment on your son’s body.

Are u angry with the child whose illness is causing so many problems for the entire family or who is not cooperating with the doctors and nurses.


Coping

Do u have other children. Have u talk to them about your son.
How are other family members coping with the diagnosis?

Counseling
I can understand the distress that u r going through.

What I am going to do is that I will personally go and see your child in hospital and see how he is doing and what exactly is wrong with hime. Also I will discuss with treating paed about your child health.

I would like u to know that we have an excellent staff of doctors and nurses here at the hospital and that we are going to do our best to help your baby get better. Please don’t worry your child is in safe hand.



how you might be feeling after the diagnosis in your child. Of course you will feel sad. Every parent hopes and dreams that their children’s lives will be healthy, happy, and carefree. It is very normal feeling. Parents often report feeling overwhelmed by their child’s diagnosis. Unfortunately, parents cannot be spared these painful and unpleasant feelings and will experience them throughout their child’s illness.

Would like to stress the fact that U are not the only ones affected by a child's leukemia. Everyone in the whole family including your child is affected. The dynamics of the entire family undergo changes. u going to need to visit hospital quite often.
Your son’s life is going to be a little different now

encourage him to take an increasingly active role in management.
Stress the importance of lifelong care.
Help your child make wise food choices. Encourage your child to remain physically active. Any sign of even minor infection should be reported immediatley and agreeive treatement will be needed.
Make sure your child wears a medical ID tag.
Above all, stay positive. The habits you teach your child today will help him or her enjoy an active and healthy life with leukemia.

accepting that anger is a normal part of this process
expressing anger effectively
finding solutions when anger is justified
talking with other parents who have dealt with similar feelings
letting anger go and accepting that there may be no one to blame, and try to use the energy in positive ways
using psychosocial support staff to discuss angry feelings
join group of parents of babies with leukemia, or cancers
develop trust in the skills of doctors and other team members




Do u have any specific question or concern regarding any of the tests done in ER or any meds that child is on The hope that things will get better and that tomorrow will be brighter is alive in all human beings, no matter how difficult the struggles they face


seeking physical release of tension (walking, exercising, or sports)
finding private space to vent feelings such as shouting or crying

expressing feelings by writing a letter that you do not send or keeping a journal
It is important for them to remember that any Hope, for some, is bolstered And, in the end, they believe that they will be given the strength they need to manage.
seek facts about the diagnosis and treatment plan
learn about progress in treatment methods
give each family member a role in dealing with the illness
maintain a healthy balance between optimism and reality
find support in prayer and/or religious faith or philosophy of life
have confidence in one’s ability to manage whatever must be faced
share a sense of hope with one another
learn from the stories of others who have sustained hope in dealing with cancer
find creative ways to bring pleasure to each day
learn to tolerate the ebb and flow of hope
appreciate the beauty and wonder present in life each day
accept that we only have the present moment in which to live.

Where can my child receive the best available treatment?" COG or Children’s Oncology Group
The only potential cure for transplant


8. 65 yr old male patient with difficulty urinating

Vitals:

Mental Checklist of DD:
Benign prostatic hyperplasia
Carcinoma of prostate
Stone in the urinary tract (Obstructive)
Strictures of urethra
Carcinoma bladder
Sphincter dysfunction
Infection
Neurological dysfunction like spinal card trauma and Diabetes
Drug induced (anticholinergics)

HPI
Having difficulty in passing urine since 2 months

Ask this qt ‘Doc do I have prostate cancer?’
History:
onset
frequency of urination
flow
difficulty is in initiating or maintaining the flow
urgency
strain to pass urine
burning sensation
pain
nocturia
fever
any trauma to spine
any weakness in legs
blood in urine any time

Past History:
similar episodes in the past
sexually transmitted diseases or urinary tract infections

Examination:

Auscultated abdomen
Palpated abdomen à Suprapubic area (superficial and deep)
Palpated back (costovertebral angle)
reflexes in legs
perform rectal examination

Counseling:
importance of rectal examination
Explained how the beer intake may increase the frequency

DD:
Benign Prostatic hyperplasia
Prostatic carcinoma
Stone in urinary tract
Infection
Sphincter dysfunction

Investigations:
Per rectal examination
CBC
Urinalysis
Renal function tests and IVP
Prostate specific antigen (PSA)