Publisher: Ms Lesley
Pocock
Medical Director:
Emeritus
Professor Neil E. Carson
Click
for CV
|
|
 |
||||||||
|
|
World CME
Library - of Interactive case presentations & titles
list
Special Case Presentations Preview Child Health Emergencies - Case 5 Five year old James is rushed to your clinic after he 'collapsed' at school. James has peanut allergy and apparently ate some when sharing food with a friend... Diabetes Type 2 - A Pacific Islander, had his left fore foot amputated two months ago. He presents with a two day history of shakes. Hypertension and Heart Failure - Case 4 'Dot' is 24 weeks pregnant and is staying with her sister whom you know well. She hasn't felt well and feels tired, and this is the reason for her holiday. She has noticed worsening of ankle swelling, but nothing more. The abdomen is as expected for dates, but her BP is elevated 160/95. Integrated medicine - Mrs Jones, is brought to your surgery by her daughter Zoe. Zoe explains that her mother is becoming very forgetful. Mrs Jones has hypertension and diabetes type 2. Metabolic Disturbances - A young female is found unconscious in a laneway and is brought to your surgery. She is gaunt and unkempt. You notice needle marks on her arm and suspect she is a heroin addict. Topics list Case
presentations will be continually added until 'all presentations' in general/family
practice are covered.
|
|||||||
|
All
case studies require writing of individual child & adult asthma plans 14 week male infant with dry, recurrent, hacking cough and three day history of fever and rhinorrhoea and difficulty breast feeding. 3 year old girl admitted to hospital previous night with difficulty breathing. Her mother presents you with a note from the Emergency Department advising she was put on Ventolin Tyson is a talented athlete and presents to have his asthma checked before travelling to compete in a tournament Paul, a 23-year-old apprentice glazier, complains of nocturnal shortness of breath, cough and intermittent wheeze over the last 6 months. 36 year old Jackie says her 'asthma is good at the moment' 36 year old male presents breathless and barely able to speak 31 year old mother with two asthmatic children asks about preventive measures Eric is a 68-year-old man with multiple problems including asthma, ischaemic heart disease, hypertension and glaucoma. Over the last few months he has noticed increasing shortness of breath and wheeze. Mrs. Williams is a 68-year-old woman who complains of a dry cough which she says is worse at night and upon arising in the morning. It has become more frequent over the last few winter months.
Case
1 Case
2
Case
3 Case
4 Case
5 Case
6 Case
7 Case
8 Case
9 Case
10
These case presentations will be added September 2005 The following related videos can be found in the Video Library on this website: Child positioning - Vastus lateralis; Needle angle - intramuscular injection; Diphtheria; Documentation; Hepatitis B; Intramuscular injection technique - Deltoid; Influenza B; Location of vaccination site - Deltoid; Location of vaccination site - Vastus lateralis; Measles virus; Administration of OPV by mouth; Needle gauge, length and angle; Pertussis; Polio virus; Child positioning - Deltoid; Pre-immunisation preparation; Vaccines which should NOT be frozen; Storage of vaccines; Subcutaneous injection technique; Administration techniques; Intramuscular injection - vastus lateralis; Tetanus. Case
1 Case
2 Case
3 Case
4 Case
5 Case
6 Case
7 Case
8 Case
9 Case
10 Case
11 Case
12
(Case
studies include ECGs for each patient) A male aged 45 asked for "a check up, a cardiograph and tests for blood fats". A 47-year-old man arrives without an appointment complaining of central chest pain. He tells the receptionist "he thinks he is having a heart attack".
A female, aged 39, has had several illnesses in recent years, including
depression and anxiety. She is divorced, has 4 children and is receiving
a pension. A male aged 59 has suffered chest pains for years. He has difficulty in describing them and thinks they are "sharp and present over the heart". A male aged 18 seeks help to enter the police force. An earlier application to enter was rejected because of attacks of palpitations occurring over years. A male bank employee aged 53 says his wife made this appointment. He says she is worried because he had a chest pain two weeks ago and since then he has felt tired and a little short of breath on walking. A male aged 67 has been treated "for his heart" for some years before consulting you for the first time. Sometimes he notices his heart "thumps" at night and occasionally this keeps him awake. He takes digoxin 0.0625 mg b.d., but often doubles this "when his heart plays up". He says this helps. A male aged 65 has had hypertension with moderate non-compliance to treatment for years. He now complains of increasing shortness of breath. An elderly female, living alone, fell and fractured a neck of femur. She admits to having "fainted" twice recently but denies any other symptoms. It was noticed that her pulse rate was 50/min.  Authors: Dr Chris Cooper, Professor Michael Kidd Oliver Cathy Omar Ellen Fatima Vera Emmanuelle Mick Ray Robyn
Case
studies include full colour graphics and/or video A previously well 3 year old boy with a spreading red rash around his left armpit. There are blistering lesions that leave shallow weeping sores. A thirteen year old boy who presents with itchy feet.. Most of the toenails have become thick and chalky with the changes starting at the distal end and progressing proximally A three year old girl with a circular red lesion on each leg. Both lesions are annular with central clearing. A three week old baby with a perianal rash. It is erythematous with a poorly defined edge, and with patches of epidermal erosion on the convex part of the buttocks. A three year old girl who presents with little lumps on her face. These are skin coloured pearly papules, some with central umbilication. A nine year old boy with a red lump on his finger. The lesion is a bright red vascular nodule with a moist epithelial surface. A 28 year old teacher has a 9 month history of an intensely itchy rash over the flexural aspect of his right ankle. A 36 year old office worker has a 12 week history of a rash around and over his left ear. This has been spreading and becoming increasingly irritating despite twice daily applications of Kenacomb Otic ointment. 65 year old man presents with a 3 week history of an eruption over his anterior chest wall. This is an irritating rash of short duration in a man with no previous rashes. A 75 year old man has a 3 month history of itchy rashes over his legs. These started while he was in hospital with congestive cardiac failure and a chest infection but have persisted since he returned home, 10 weeks ago. A 26 year old woman presents with a three month history of an asymptomatic rash over her legs. The eruption 3 years earlier was most likely due to the same condition. A two year old girl, who has recently returned from a holiday at a tropical resort, has a 3 week history of an itchy lesion which has progressed steadily in a linear direction over her right foot. A 9 year old girl has a 2 month history of a facial rash. Topical steroids have not helped, and may even have aggravated this eruption.  Authors: Professor Stephen Boyages, Professor Steven Colaguiri; Professor Lesley Campbell, Professor Mark Cooper, Professor Stephen Twigg A male presents with burning feelings in his feet and he is worried he may have gangrene and will lose his feet as his father did. Mr Mark Davis is a 66 year old man whom you have been managing for almost twenty years . For most of that time you have found him to be hypertensive and despite your best efforts his BP control has been 'sub-optimal'. A 50 year old man with diabetes tells you he is having 'marital difficulties of a sexual nature' A male patient whose early morning urine sample shows a high albumin to creatinine ration (ACR). A 55 year old man presents with increasing symptoms of fatigue and day time somnolence. Stephanie brings her mother who is visiting from Hong Kong. She advises Mum was recently admitted to hospital where she was told she'd had a heart attack. A 55 year old woman has an acute itch in her genital region. 55 year old Mario is a new patient. He was diagnosed with diabetes at the age of 50. A 54 year old woman who has had type 2 diabetes for the last ten years is having trouble with weight gain. A woman presents asking for a 'test for diabetes'. A 45 year old obese woman presents with recurrent thrush. A male patient who has had diabetes type 2 for three years presents with tiredness, polyuria and polydipsia for the last few months.  Author: Dr Jack Marshall (full program and database of ECGs, and major reference section)  Author: Mr Maurice Brygel - General Surgeon Medical and surgical education on hernias. Includes colour graphics. Videos on hernias are in the Video Library, on this website. This link will bring you to the Melbourne hernia site
Case
2 Case
3 Case
4 Case
5 Case
6 Case
7 Case
8 Case
9 Case
10  -
bridging the gap between complementary and conventional medicine Author: Professor Avni Sali More cases to be posted during 2005 Alzheimers Mrs Jones, is brought to your surgery by her daughter Zoe. Zoe explains that her mother is becoming very forgetful. Mrs Jones has hypertension and diabetes type 2.
(Related
video: 'Physical examination of the back' can be found in the Video Library
on this site) 23 year old male student has had intermittent low back pain for 8 months, increasing in severity and worse on rising in the morning. He presents walking stiffly with knees bent. 30 year old policeman says he has had low back pain for five years, worse on standing with recent intermittent pain down buttocks and posterior aspects of both thighs. He fell playing cricket, three months previously. A 28 year old plumber has had unilateral back pain for two weeks. He injured his back lifting heavy pipes. Pain is 'deep and aching' and occurs during exercise or activity. A 39 year old wife and mother has had pain in the low back and the left leg for seven days. The ache is dull, but severe at times. She felt her back 'give' when pulling out a shrub from her garden. A 62 year old motor mechanic has had low back pain for 6 months. He is involved in heavy manual labour and had a motor vehicle accident at ages 21 and 43. The pain occasionally radiates to his buttocks. A 45 year old dressmaker has had pain in both thighs for three hours after she had forceful spinal manipulation with a direct thrust applied to the back, earlier in the day. She is incontinent of urine has difficulty walking and has anaesthesia in the perineal area, thighs and buttocks. A distressed 58 year old man presents with several hours of severe pain and parasthesiae down the right leg to the foot. He cannot recall injuring his back but has had a past history of back pain . All movements are restricted, especially flexion and extension. 67 year old man presents with pain in his left leg for four months. He has no history of injury but a long history of back ache. The pain is 'burning and numbing'. A 46 year old female teacher has had central low back pain for 12 months. It is worse when she does housework or gardening and in the mornings. Range
of MCQs for study and revision purposes.
A 67 year old war veteran consults you for the first time. He complains of shortness of breath on exertion. From his history and examination you suspect chronic obstructive airway disease. A 19 year old university student attends because he is worried about breathlessness and agitation. He has a past history of asthma, and is currently sitting for his exams. A 6 week old male infant is brought to you by his mother who is concerned about his vomiting. Vomiting started at three weeks, initially in small amounts and after feeding. There is no bile in the vomit. A 73 year old long term patient has been treated for congestive heart failure for 7 years. Recently he has become short of breath again. Maria is 54 with type 1 diabetes and presents after collapsing at home. She is barely conscious and tachypnoeic, but otherwise well. You do a blood gas examination. A woman phones to tell you that her husband, who has been a patient of yours for many years, has had a severe pain in the center of his chest for the past hour. She says she thinks he is having a heart attack. A 65 year old patient has high blood pressure and chronic renal failure. He returns for his blood pressure check and plasma potassium levels. You note that on his latest electrolyte study, his CO2 is lower than normal. A two year old girl is brought to see you by her mother who says she has had diarrhoea for about a week and her weight has dropped from 16kg to 14.5kg. She has passed about 6 watery stools a day. A four year old boy is brought in by his mother who thinks he may have swallowed his grandmother's arthritis medication. He is dazed, pale and sweaty and feels sick. He vomits on presentation and becomes unconscious.
Author:
Mr
Maurice Brygel (General Surgeon) Principles of physical examination of lumps, tumours and masses
Author:
Mr
Maurice Brygel (General Surgeon) Principles of local anaesthesia
Author:
Mr
Maurice Brygel (General Surgeon)
Physical examination and excision of sun cancers
and skin tumours
 Author: Dr Bambi Ward (Related videos include: 'Subcutaneous fluid injections' and 'Use of a syringe driver'. These can be found in the Video Library of this website.) A 50 year old woman was diagnosed diagnosed with breast cancer six years prior. She elected to have alternative therapies as well as a short course of radiotherapy and chemotherapy. She declined surgery at the time. 73 year old Peter was diagnosed with prostate cancer soon after marrying for the second time. He underwent a TURP and had localised radiotherapy to the prostate area. Harry is a 62 year old married man who has been a heavy smoker for 40 years. A chest X-ray shows an apical opacity in his right lung. A CT guided biopsy indicates that he has adenocarcinoma of the lung (Stage IIIB). A 37 year old unmarried woman presents after finding our she has widespread metastatic carcinoma of the ovary. She has moved to your region, to live with her mother.  Author: Professor Dominic Thyagorajaran (Title has extensive video of patients with Parkinson's and conditions that mimic Parkinsons' disease.) What is Parkinson's disease? What is Parkinsonism? How common is idiopathic Parkinson's disease? What are the risk factors for the disease? What is the history of the disease? What are the clinical features of idiopathic Parkinson's disease? What are the effects of the disease? What is the differential diagnosis? What is the cause and pathophysiology of idiopathic Parkinson's disease? What are the principles of treatment? 
Authors: Professor Peter Kerr, Dr Steve Chadban (Related video of 'How to perform home renal dialysis' can be found in the Video Library on this website.) A 26 year old female nurse developed an episode of simple cystitis. After treatment she returns in two weeks complaining that on retesting of her urine at the hospital where she works, she has persistent microscopic haematuria although symptoms settled promptly. A 22 year old woman presents complaining of typical symptoms of UTI - dysuria, frequency and occasional flecks of blood in the urine. A dipstick shows nitrites and blood. A 50 year old mother of three who works as a secretary complains of swollen ankles. She has noted a weight gain if 5 kg over the past month, but is otherwise well. Examination reveals a well looking woman. She has pitting oedema to the knees bilaterally. A 72 year old woman has been attending for 20 years. Apart from hypertension and occasional acute illness, she has been well during that time. Her BP levels have been increasing however, despite general good health. Andrew is sixty-six and you have been managing him for over twenty years. He has hypertension and his blood p0ressure control is 'average'. Andrew is a smoker and has required a 'statin' for cholesterol in recent years... A twenty eight year old married woman calls requesting a home visit. She has severe abdominal pain and vomiting and when you arrive she is distressed and rolling around in pain... Mrs Barlow is 76 and a long standing patient. She has had mild angina, hypertension and borderline glucose intolerance for many years. She has also had a sigmoid colectomy for diverticular disease. You are aware she has renal impairment... Joe, a new patient, was diagnosed with diabetes at age 55. His sugars have been reasonably controlled but he had an eye check which shows background retinopathy. Mrs
Jones is 55 with longstanding rheumatoid arthritis, gout and hypertension.
Three weeks ago she developed tonsillitis. You treated her with penicillin
V 250mg qid. Two weeks later she developed a skin rash, sore joints and
general malaise...
James a 21 year old student developed pain on micturition seven days a go and has had a white discharge from his penis for the past three days... Nineteen year old Cindy has been feeling unwell for two weeks. She has lower abdomen and pelvic discomfort, backache, vaginal discharge and frequency with dysuria... Jane presents with very tender red sores on her external genitalia, which have appeared over the past 24 hours. Sdhe feels unwell and lethargic and is feverish... Darren has discovered several small lumps on his penis. His general health is good... Gerry has lost a lot of weight, is feeling unwell and has a dry irritating, unproductive cough... Rob has a sore on his foreskin which won't heal and is getting bogger. On inspection it is a non-tender ulcer with firm edges to touch... Mary presents with a profuse vaginal discharge which has an unpleasant odour, with vulval soreness and dyspareunia. Examination reveals a frothy greenish grey vaginal discharge... Trevor presents with a ten day history of a pruritic rash in his pubic region. Examination reveals tiny moving organisms... Fred presents with sores on his scrotum and penis which have been present for two weeks. Jimmy presents with intensely itchy genitals. A few isolated inflamed nodular lesions are present on the penis and scrotum.  Authors: Emeritus Professor Neil Carson, Professor Malcolm Horne, Dr John O'Sullivan Each case has video of each presenting patient - these can be found in the Video Library Pam tells you about a funny feeling she has had in her arm and leg, mainly on the left side, and sometimes she says, her leg will give way on her... Maureen consults you about her 78 year old mother who has moved in with her. Her mother has noticed that her right hand is clumsy and her speech difficult... Joan slipped out of her chair and passed out for 15 minutes three days ago. When she woke she could neither move her left side nor speak... Max comes in for a company health check. He says he is well, plays golf and smokes about fifteen cigarettes a day. You detect a systolic bruit on the left side... John a patient for many years rings you on his mobile phone on the way home from work. He describes how twice during the day his speech went and could not write with his right hand. He says he is starting to really worry ... Sixty-eight year old Mrs Williams describes how she lost the sight in her left eye yesterday. It came back after half an hour but was 'sort of blurry'... Jill comes in with her husband. She woke up with weakness in her left side and the left side of her face did not look normal. Tom was well until this morning when he suddenly developed vertigo, nausea and vomiting. He also noticed unsteadiness when going to the toilet... Rob comes to talk about his wife who has just had a subarachnoid haemorrhage (SAH). He says Pat his wife is only 35 - he says she is too young to have had a stroke... Rudy is helped into the office by his wife. He says he arrived home from overseas and felt constipated and went to the toilet. All of a sudden he had a headache, started to perspire, and lost his equilibrium. It came on very suddenly...  Authors: Emeritus Professor Carson, Dr Kerry Hancock, Dr Jack Marshall, Dr Chris Cooper, Professor Michael Kidd, Dr Con Meehan, Dr Rod Phillips, Professor Stephen Boyages, Professor Steven Colaguiri; Professor Lesley Campbell, Professor Mark Cooper, Professor Krishna Sudhir, Dr Bambi Ward, Professor Dominic Thyagorajaran, Professor Peter Kerr, Dr Steve Chadban, Professor John Murtagh, Professor Malcolm Horne, Dr John O'Sullivan This program covers a 'week in general practice'. Every 'half day' a presentation also requires you to provide an 'individual patient care map', following ten basic steps. Jess, a 24 year old nurse presents two weeks after consulting you re her cystitis. You had prescribed amoxicillin and the symptoms settled quickly. She tells you that on re-testing her own urine at work, she noticed persisting micro-haematuria… A 65 year old woman with frequency of micturition, nocturia one or two times a night, urgency and stress incontinence on coughing or sneezing presents. Examination reveals a mild cystocoele, a first degree utero-vaginal prolapse and a small retrocoele… Mrs
Jackson, a longterm patient presents with a mild frontal headache which
she has for about a week. The headache comes on at the end of the day
but is relieved by rest and paracetamol. She also mentions occasional
dizziness… Jackie, 36, says her asthma is 'pretty good at the moment'. She has not had an asthma review for over 15 months… Helen, aged 18, is a first time mother. Her baby John is 5 weeks old and Helen asks for a postnatal check. Helen asks about the 'baby's needles'… Brad, a 10 year old boy has not done well at school as he has difficulty adjusting to the classroom routine and does not get along with his peers. Brad says "it isn't my fault'… Tan is 56 and was diagnosed with type 2 diabetes five years ago. He presents with 'burning feelings on and off in his feet'. He is worried about losing his legs to gangrene as his father did… Olive gives a history suggestive of early Parkinson's disease… You
have treated Andrew, 66 for hypertension over a 10 year period. His hypertension
has not been well controlled despite being on 2 prescribed therapeutics.
To your surprise his serum creatinine is 230 mmol/l (N 220)… George, aged 59, consults you with chest pain which you diagnose as angina, You have decided to prescribe glyceryl trinitrate (anginine)… Care Map for George Dianne, 23 has just recovered from a chest cold, which started 2 weeks ago. She has since felt tired and depressed and is disinterested in her work and marriage… Anne, 68 tells you she lost her vision yesterday, in her left eye, for around 30 minutes. She is concerned about going blind and is angry that you could not see her when she called… You now proceed with the cause of Anne's clinical problem… Mrs Chan was admitted to hospital with chest pain. This was diagnosed as a mild heart attach and Type 2 diabetes was also found… Osita, 55, presents complaining of somnolence, tiredness and minor weight loss. On systems review he admits to recent nocturia. He has brought a urine sample which shows glycosuria++… Joan, aged 55, describes how her arm started to 'feel funny' about a week ago… Mick, aged 45, has been tired for three weeks and requests a tonic to 'pep him up' a bit. Physical examination is normal… Mrs
Leach, 74 requests a medical check. Examination reveals the following
cardiovascular findings: Abdul is 59, with recently diagnosed early Parkinson's Disease. He returns to your surgery after seeing a neurologist… Nick aged 67, had colon cancer diagnosed 7 days ago. Yesterday he had surgery which was incomplete due to the presence of secondaries in the liver and elsewhere… Care Map for Nick Michelle 23, complains of a lower abdominal pain for the last two or three days. Michelle and her partner use no contraception and her last normal period was six weeks ago… Sascha, aged 22 is a nurse. She tells you that yesterday a colleague at work checked her blood pressure and despite several measurements it remained at 156/96… Angus, aged 52, requests a complete health check, in particular an ECG and a cholesterol test. The ECG shows Right Bundle Branch Block (RBBB)… You saw Lois, aged 16, three weeks ago. She was complaining of tiredness. Her periods started at age 12 and are regular but heavy. There were no other problems in her history or physical examination. Her Hb was 8 gm and her red cells were hypochromic and microcytic. You prescribed ferrous sulphate 3 tablets daily. Today she still feels tired and her Hb is 8.3gm… Care Map for Lois Ms McTavish consults you about her 13 month old daughter. She has seen a poster advising MMR vaccination (mumps, measles, and rubella) and says she has heard that you can catch these diseases by having the injections. She also wonders why it is necessary for her daughter to have MMR when these diseases 'are uncommon these days'… Mrs Yelena Trofimova, a secretary, presents complaining of swollen ankles. She has noticed a weight gain of 5kg over the past month but is otherwise well. Examination reveals a well looking woman but she has pitting oedema to the knees bilaterally… A 47 year old man arrives without an appointment. He tells the receptionist that he 'thinks he is having a hearty attack'. Asn ECG was recorded by the clinic nurse. It shows elevated ST segments in leads 2, 3, AVF, V5 and V6. There are tiny Q waves (not pathological) in these leads… Mr Clarke, 50, requests a health check. He has attended you in the past for minor infections and trauma… Twenty-eight year old Kathleen is married and telephones you saying she has severe abdominal pain and vomiting. She asks for a home visit. On arrival you find a distressed woman rolling around in obvious pain… Kai, a talented basketball player has had asthma since he was a toddler. His patents thought it would be a good idea to have his asthma checked as he has been using his blue puffer more than usual. Dot aged 23, consults you while she is on holiday with her sister. Dot is pregnant for the first time and is concerned about worsening swelling of the ankles… Care Map for Dot A 59 year old man has suffered chest pains for years. He has difficulty describing them but says they are 'sharp and present over the heart'. Sometimes they occur while eating and are worse as the day goes on… Mrs Barlow is 76. She has had angina, hypertension and borderline glucose intolerance for many years. You are aware that she has renal impairment.. Six months ago her serum creatinine was checked in hospital after a small AMI - is was 230 umol/l. Judy has hypertension and missed her last BP check because of the distance she has to travel to see you… Fred, 38, and Simone, 35, come to see you to discuss contraceptive and sterilisation options…
We encourage family doctors to write their own interactive cases, especially on less common problems, and submit them for publication by clicking here. To assist the process we have provided the following templates : Patient presentation screen (Type the details of your presenting patient here: Age, sex of patient; new/existing patient; patient history; presenting symptoms etc) Establish diagnosis Provide Multiple Choice questions to establish differential diagnosis. This can include the ordering of tests and further history taking. Provide feedback on each choice as to why it is correct or incorrect. Patient management/care Provide further sets of multiple choice questions to establish optimum patient care. Patient care includes addressing presenting symptoms, the cause of the symptoms and long-term prevention, as appropriate. Patient care also includes patient education and preferably education that motivates the patient.
Eighteen year old Denise, a student says she would like to commence the oral contraceptive pill... Thirty five year old June presents for a routine smear test... Sixty seven year old Iris is fifteen years post menopause. She complains of frequency of micturition and says she is incontinent when she sneezes or coughs... Peter and Mary consult you as they have been trying for a pregnancy for twelve months... Sabrina, a 44 year old mother of three children, presents with a history of heavy periods for six months... Nineteen year old Amanda is having difficulty with her heavy periods, having to take two days off work every month... Twenty five year old Bridget is keen to get pregnant. She ceased the oral contraceptive pill four months ago and has not menstruated since... Simone 35 and Fred 38 wish to discuss sterilisation... Irene
a fifty-four year old woman complains of hot flushes, joint pain, headache,
depression and decreased libido...
|
||||||||
(full
program with case examples)
(full
program)
