Brief Clinical Consultations: General Approach to Brief Clinical Consultations

2010 ◽  
Author(s):  
Gautam Mehta ◽  
Bilal Iqbal
Keyword(s):  
Differential Diagnosis ◽  
Clinical Assessment ◽  
Clinical Skills ◽  
Treatment Plan ◽  
Clinical Signs ◽  
Integrated Approach ◽  
Clinical Problem ◽  
Everyday Practice ◽  
Limited Information ◽  
Minute Interval

The new Station 5, Integrative Clinical Assessment involves two 10-minute encounters, each known as a ‘Brief Clinical Consultation’. Following an introductory referral, the candidate has 8 minutes to undertake a focused history and examination to solve a clinical problem, answer any questions the patient may have and explain their investigation and/or treatment plan to the patient. The remaining 2 minutes are spent with the examiners, to relate the relevant physical findings and differential diagnosis. Remember, you are not expected to take a complete history or conduct a complete and thorough examination, as you would in the other stations. Candidates should be prepared to encounter scenarios relating to: 1. Old Station 5 cases, i.e. skin, eye, locomotor, and endocrine systems. 2. Other stations of the examination (stations 1 and 3). 3. Medical problems encountered in everyday practice, i.e. chest pain, hypotension, jaundice, and deterioration in renal function. In principle, this station can include any possible inpatient and outpatient medical scenario, and therefore providing a comprehensive selection of cases will never be feasible. Some patients may not display a wealth of clinical signs, and this often occurs in everyday practice. The candidate should understand the key principles, and develop the art of integrative clinical assessment. This will ensure success in any clinical scenario provided. This integrated approach is a test of higher clinical reasoning and professionalism, rather than a simple test of clinical skills— this should be kept in mind when preparing for this station. The compilation of 20 cases in this section is designed to achieve this, and encourages the candidate to adopt a uniform style, and a thoughtful approach and strategy in tackling this station. • Explanatory referrals are provided in the 5 minute interval before the station. • Read these carefully, and identify the clinical problem(s). • Develop a differential diagnosis based on the limited information available, even before seeing the patient. • A preliminary differential diagnosis will initially help guide the focused history. • The history and examination should not be seen as separate components, where the history is followed by the examination. • Instead, both history and examination should be integrated.

scholarly journals The Weak Cat

2009 ◽  
Vol 11 (5) ◽  
pp. 373-383 ◽  
Author(s):  
Peter P. Nghiem ◽  
Simon R. Platt ◽  
Scott Schatzberg
Keyword(s):  
Differential Diagnosis ◽  
Treatment Plan ◽  
Age Groups ◽  
Clinical Signs ◽  
Abdominal Ultrasound ◽  
Fluid Analysis ◽  
Vertebral Anomalies ◽  
Neurological Conditions ◽  
Veterinary Hospital ◽  
Electrolyte Abnormalities

Practical relevance Weakness is recognized somewhat infrequently in cats, but is an important manifestation of neurological disease. The clinician must perform a complete neurological examination to determine the neuroanatomic basis for the weakness. As for all species, the neuroanatomic diagnosis allows the clinician to generate an appropriate differential diagnosis, to design a diagnostic plan, to prognosticate, and ultimately to develop a treatment plan. Clinical challenges The cause(s) of neurological weakness in the cat may be difficult to determine without access to advanced imaging modalities, cerebrospinal fluid analysis or electrodiagnostics. However, an accurate neuroanatomic diagnosis allows the clinician to pursue preliminary anomalous (vertebral anomalies), metabolic (eg, diabetes mellitus, electrolyte abnormalities) and neoplastic differentials via blood work, vertebral column and thoracic radiography, and abdominal ultrasound. Subsequently, referral to a specialty veterinary hospital may be warranted to pursue advanced neurodiagnostics. Audience This review provides a framework for generating a neuroanatomic and differential diagnosis in the weak cat. It also discusses the pathogenesis and clinical signs associated with the most common neurological differentials for feline paresis. As such, it is aimed at both primary health care and specialty veterinarians. Patient group The neurological conditions discussed in this review cause weakness in cats of all age groups.

Classifications and Clinical Assessment of Haemorrhoids:The Proctologist’s Corner

2020 ◽  
Vol 15 ◽  
Author(s):  
Arcangelo Picciariello ◽  
Petr Tsarkov ◽  
Vincenzo Papagni ◽  
Sergey Efetov ◽  
Daniel Markaryan ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Clinical Evaluation ◽  
Clinical Assessment ◽  
Adult Population ◽  
Preoperative Assessment ◽  
Classification Systems ◽  
Patient Treatment ◽  
Benign Condition ◽  
Haemorrhoidal Disease ◽  
Therapeutic Choice

BACKGROUND: Haemorrhoidal disease (HD) is a benign condition affecting a considerable part of adult population. HD can be considered a social and economic burden with high impact on patient lifestyle. Several new techniques and devices have been proposed for HD treatment; however, preoperative assessment is essential and the use of classification system is recommended. METHODS: In the last two decades many studies described the preoperative assessment and several attempts of classification for HD. This review focuses on the most relevant studies found in literature where classification systems and clinical evaluation with differential diagnosis have been evaluated. RESULTS: The knowledge of classification systems and differential diagnosis for HD has been shown to play a central role in the clinical assessment and in the best treatment choice. Although there are new challenging techniques and devices for HD treatment, a preoperative assessment is always mandatory. CONCLUSION: Preoperative clinical evaluation is essential for HD patient treatment and outcome. Classification systems are useful for the therapeutic choice and for researches on new medical or surgical treatments. In fact, the international guidelines advise several therapeutic options depending on the severity of the HD.

COVID-19: how nuclear medicine can provide a differential diagnosis in very dubious case

Coronaviruses ◽  
2020 ◽  
Vol 01 ◽  
Author(s):  
Maria Silvia De Feo ◽  
Viviana Frantellizzi ◽  
Giuseppe De Vincentis
Keyword(s):  
Infectious Disease ◽  
Differential Diagnosis ◽  
Ct Scan ◽  
Imaging Technique ◽  
False Negative ◽  
Clinical Signs ◽  
Negative Results ◽  
Infectious Disease Department ◽  
False Negative Results ◽  
99Mtc Hmpao

Background: We present the case of a 55-year-old woman, admitted to the Infectious Disease Department of Policlinico Umberto I, Rome, in mid-March 2020, with suspicion of COVID-19 infection. Objective: The rRT-PCR was negative and the following CT scan, performed to exclude false-negative results and help diagnosis, was inconclusive. Methods: It was decided to submit the patient to 99mTc-HMPAO-labelled leukocyte scan. Results: This exam led to the diagnosis of infective endocarditis. Conclusion: In the present pandemic scenario, 99mTc-HMPAO-labelled leukocyte scan represents a reliable imaging technique for differential diagnosis with COVID-19 in patients with confusing clinical signs, possible false-negative rRT-PCR results and inconclusive CT scan.

scholarly journals Uptake of exogenous estrogen as a differential diagnosis of ovarian-remnant-syndrome in a bitch: a case report

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Sebastian Ganz ◽  
Axel Wehrend
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Luteinizing Hormone ◽  
Clinical Signs ◽  
Menopausal Symptoms ◽  
Case Presentation ◽  
Estrogen Exposure ◽  
Exogenous Estrogen ◽  
Endocrine Parameters

Abstract Background Clinical signs of heat in bitches that have been previously spayed are often associated with the presence of ovarian remnant syndrome. The inclusion of exogenous estrogens as a differential diagnosis in this regard is often ignored and may lead to misinterpretation of the case. Case presentation Herein, we report a case of exogenous estrogen exposure over several months to a 6.5-year-old spayed crossbred bitch, weighing 8.4 kg. The bitch presented in the clinic because of suspected ovarian remnant syndrome. Castration was performed within the first 6 months after birth. Important endocrine parameters measured at the first appointment were Anti-Müllerian hormone (< 0.01 ng/mL), progesterone (0.36 ng/mL), estradiol-17ß (20.7 pg/mL), and luteinizing hormone (< 0.1 ng/mL). After an extensive conversation with the owner, it was revealed that she was using an estrogen spray because of severe menopausal symptoms. After the owner stopped using this spray, the symptoms of the bitch disappeared. Conclusion Therefore, the uptake of estrogens should be a differential diagnosis for symptoms of the ovarian remnant syndrome. A detailed anamnesis is crucial to identify the source of estrogen in the environment of the affected bitch.

The Psychiatric Interview and Mental Status Examination

2017 ◽  
Author(s):  
Donald W. Black
Keyword(s):  
Differential Diagnosis ◽  
Social History ◽  
Mental Status ◽  
Treatment Plan ◽  
Essential Elements ◽  
Comprehensive Treatment ◽  
Psychiatric Interview ◽  
Psychomotor Activity ◽  
History Of ◽  
Mental Status Examination

The interview and mental status examination are integral to the comprehensive patient assessment and typically follow a standard approach that most medical students and residents learn. The psychiatrist should adjust his or her interview style and information-gathering approach to suit the patient and the situation. For example, inpatients are typically more symptomatic than outpatients, may be in the hospital on an involuntary basis, and may be too ill to participate in even the briefest interview. Note taking is an essential task but should not interfere with patient rapport. The interview should be organized in a systematic fashion that, although covering all essential elements, is relatively stereotyped so that it allows the psychiatrist to commit the format to memory that, once learned, can be varied. The psychiatrist should start by documenting the patient’s identifying characteristics (age, gender, marital status) and then proceed to the chief complaint, history of the present illness, past medical history, family and social history, use of drugs and alcohol, medications, and previous treatments. A formal mental status includes assessment of the patient’s appearance, attitude, and behavior; orientation and sensorium; mood and affect; psychomotor activity; thought process, speech, and thought content; memory and cognition (including attention and abstraction); and judgment and insight. With the data collected, the psychiatrist will construct an accurate history of the symptoms that will serve as the basis for developing a differential diagnosis, followed by the development of a comprehensive treatment plan. This review contains 1 figure, 3 tables, and 12 references. Key words: assessment, differential diagnosis, interviewing, mental status examination, treatment plan

COMMITTEE ON NUTRITION

PEDIATRICS ◽  
1966 ◽  
Vol 38 (6) ◽  
pp. 1068-1076
Author(s):  
Keyword(s):  
Vitamin B6 ◽  
Pyridoxal Phosphate ◽  
Normal Population ◽  
Clinical Signs ◽  
Normal Activity ◽  
Limited Information ◽  
Adequate Intake ◽  
Time Data ◽  
Binding Properties ◽  
Adequate Diet

Because of the limited information available it is not possible to derive precise figures for daily requirements of vitamin B6 in infants and children at this time. Data currently available suggest that the daily need in childhood is 0.5 to 1.5 mg and in adolescence is 1.5 to 2 mg. The requirement in infancy is clearly related to protein intake and is 20µg/gm of dietary protein. Requirements of a few individuals will undoubtedly be higher than the estimates for the normal population. Some of these patients will manifest frank biochemical and clinical signs of deficiency which will usually be promptly reversed by administration of small additional amounts of pyridoxine. Another group of patients will require large amounts of the vitamin to balance the heritable alteration in binding properties of a specific apoenzyme requiring pyridoxal phosphate for normal activity. It would appear that most infants, children and adults will have little difficulty in achieving an adequate intake of vitamin B6 if they receive what is considered to be in other respects an adequate diet.

Some skin conditions in pigs: types, control and prevention

Livestock ◽  
2021 ◽  
Vol 26 (6) ◽  
pp. 300-308
Author(s):  
John Carr ◽  
Mark Howells ◽  
William Hersey
Keyword(s):  
Treatment Plan ◽  
Clinical Signs ◽  
African Swine Fever ◽  
Skin Lesions ◽  
Veterinary Surgeons ◽  
Careful Clinical Examination ◽  
Welfare Problem ◽  
Control And Prevention ◽  
Veterinary Surgeon ◽  
Skin Conditions

Skin conditions in pigs are common problems presented to the veterinary surgeon. A careful clinical examination, especially considering the age of the pig and the distribution of the lesions, all aids making an accurate diagnosis and treatment plan. Pain management is essential in clinical management. Sarcoptic mange is a condition that can be eliminated from pigs and should be considered a welfare problem. Ear necrosis and trauma injuries can be particularly problematic and must be treated aggressively. African swine fever (ASF) presents with a range of clinical signs including skin lesions, and all veterinary surgeons must be able to put ASF as a differential where appropriate.

Clinical case of recurrent vomiting in a child: diagnostic search from functional gastrointestinal disorders to piloid astrocytoma

2021 ◽  
Vol 19 (1) ◽  
pp. 78-81
Author(s):  
E. N. Voronina ◽  
◽  
D. V. Pechkurov ◽  
A. A. Tyazheva ◽  
E. V. Kozarez ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Nutritional Status ◽  
Clinical Case ◽  
Anxiety Symptom ◽  
Functional Gastrointestinal Disorders ◽  
Integrated Approach ◽  
Gastrointestinal Disorders ◽  
Wide Range ◽  
High Prevalence ◽  
Recurrent Vomiting

The urgency of the problem of recurrent vomiting in children is due not only to the high prevalence of this syndrome, but also to a wide range of reasons for its development. The article presents a clinical case of observation of a child with recurrent vomiting syndrome. It shows the dynamics of the disease, the importance of identifying such «anxiety symptom» as the nutritional status violation. In this case, the cause of vomiting of central genesis was not immediately taken into account, although differential diagnosis presupposes an integrated approach, and doctors' oncological alertness should be constantly preserved even in pediatrics.

In Support of Initial Parenteral Medical Management of Intrathecal Baclofen Withdrawal in Spasticity Patients

2021 ◽  
pp. 875512252110392
Author(s):  
Brian L. LaRowe ◽  
Vicki M. Nussbaum
Keyword(s):  
Case Reports ◽  
Treatment Plan ◽  
Correct Diagnosis ◽  
Treatment Protocol ◽  
Patient Characteristics ◽  
Clinical Problem ◽  
Clinical Situation ◽  
Intrathecal Baclofen ◽  
Wide Range ◽  
Baclofen Withdrawal

Background: Spasticity may present as a wide range of symptoms and conditions. With this protean presentation, a consensus regarding the best course of treatment does not exist. Those patients most severely affected may receive significant benefit from intrathecal baclofen delivery. However, this therapy may itself lead to patient injury in the event of withdrawal. Objective: Withdrawal from intrathecal baclofen may devolve rapidly into a situation in which the patient may incur significant morbidity and even death. A focused, prompt treatment plan would afford the patient the best possible outcome. Methods: The medical literature was reviewed for reports of plans of treatment of baclofen withdrawal and the results obtained. The nature of this problem does not lend itself to a typical study design, depending on case reports and basic pharmacological science application. The paucity of such reports severely limits categorical comparison of patient characteristics and clinical circumstances. Clinical situations, patient characteristics, and therapies were considered and compared. Outcomes of the varied treatments were evaluated for efficacy. Results: Inaccurate diagnoses, delayed correct diagnoses, and the absence of a consistent, treatment plan contributed to widely disparate outcomes. Prompt, correct diagnosis and intensive care unit–based continuous benzodiazepine infusion with titration led to a controlled clinical situation and maximized patient outcomes. Conclusions: Patients going through withdrawal from intrathecal baclofen achieved best outcomes when treated with a continuous infusion and titration of an intravenous benzodiazepine. A well-defined treatment protocol employing this management, reporting serial outcomes, would enable further refinement of the treatment of this clinical problem.

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