pls somebody post the basic min. HX & PE Forgetfullness case protocol....so that we can finish in 15 mins incl. closure/counseling...
i'm taking 18 mins to finish it.
thanks a lot
First have the DDX in mind:
degenerative/untreatable: alzheimer, pick, lewis, hungtington, creutzfeldt
vascular(multiinfarct)
Metabolic: vit b...
infections: neurosyphillis, HIV
Tumor
Heavy metals: Wilson...
endo: hypothyro
-onset/duration
-What kind of things fo you forget
-Death shaft (bathing-dressing-feeding-transportation-shopping-cleaning-managing money)
-Assess depressed mood: feeling sad? nervous?
-NS: headache,confusion, seizure, visionpbs, speech pbs, numbness/weaknessgait
-Endo: cold intolerance, skin changes
-Gu: difficulty urinating, incontinence
-CV: lightheadeness, palpitations, chest pain
-Respi: cough, sob,
-GI : nausea, vomiting, abdo pain, change in BH
-Gen: fever, weight loss, appetite changes
PRIORS
J
ask few questions and ask them in a calm manner. if u try and ask all questions u might run out of time and then u will appear to be in hurry. that will create a very bad impression on the SP
better to ask few questions and be smooth
this is how i do it..
mnemonic to remeber the d/d (an old man watching the play DANTE)
D=DEPRESSION,diet
A=ALZHEIMERS
N=NPH
T=TRAUMA,TIA,TUMOUR,THYROID
E=EMERGENCY PLAN
HISTORY= ASK QUESTIONS RELEVANT TO THE ABOVE D/D ONE QUESTION WUD SUFFICE FOR EACH D/D HOWS UR MOOD(DEP),DO U HAVE TROUBLE WALKING OR URINARY INCONTINENCE FOR NPH AND THEN ASK IF HE HAS SOME1 TO TAKE CARE OF DURING EMERGENCY N COUNCIL HIM ON SOCIAL WORKER N MEETING WITH HIS FAMILY ETC
PHYSICAL EXAM=
check hands look into eyes, ophthalmoscopy
MMSE ask abt memory,oreintation n judgement..thats more than enough
do neuro exam ,palpate for thyroid,auscultate heart n lungs..
n obviuosly dnt forget abt pamhugsfoss
