approach to long case1

8/4/2019 Approach to Long Case1

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Approach To Long Case

Prof. AR ALTAHAN MD, FRCP

KKUH


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The Long Case

Long case is an Essential Modality inthe Assessment of Trainees

It is used to Explore Most aspects ofTrainees Abilities

Assesses overall performance


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Approach To Long Case

Long Case Includes :History Taking

Physical exam

Differential Diagnosis Formulation

Plan of Investigations & Management

Clinically relevant medical knowledge

Assessment Involve each one of theseSteps


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Long Case Content

Ability to take Proper History

Attitude to Patient ( Establish Rapport )

Ability to Analyze each SymptomNeed to define symptoms & signs

Attempt a Differential Diagnosis of eachindividual Symptom


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Long Case Content

Ability to take Proper History (Cont..)

Ability to include Relevant Past, Family,Social, Family history , and SystemicReview.

Will Assess Background TheoreticalKnowledge

Concentrate on the Main signs


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Long Case Content

Ability to take Proper History (Cont..)

Ability to formulate a proper differentialdiagnosis by end of history Presentation

Diff.Diagnosis is a continuous dynamicprocess


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Long Case Content

Ability to perform proper Examination

Approach to Patient

Perform a

Planned

physical examProfessionalism in eliciting Signs

Proper Analysis of Signs ( definition)

Concentrate on Main Signs

Correlate Findings with impression fromhistory


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Long Case Content

Formulate a concise Summary

Main points in History

Age & Sex

Time & Mode of Onset

Relevant Symptoms

Course of the Illness

Relevant other pointsMain Findings (Signs)


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Long Case Content

Formulating Differential Diagnosis

1- Patho-Physiologic Diagnosis:-Myopathy

-Encephalopathy

2- Lesion Localization ( Anatomical D.)

3- Etiological Diagnosis


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Long Case Content

Formulating Differential Diagnosis

The main differential

Starting from general to more specific Pros & Cons of each diagnosis

Assesses the organization of thoughts& common sense


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Long Case Content

Plan of investigations

Relevant investigations in order of :

Priority Simplicity

complications


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Long Case Content

Plan of management

Different modalities in order of :

Benefit & urgency Side effects

Complications


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Tips

Be Courteous to the Patient

Finish your exam 15 minutes earlier

and proceed to: Prepare a Concise Summary

Answer the following questions:

??????????????


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Long Case Tips

What is the differential diagnosis?

Start with:

General Categories Specific D.

Demyelinating MS

Vasculitis SLE

What investigations you will do? How would you manage the

patient?


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Long Case Tips

Try to give as direct and conciseanswers as possible

Remember That Questions areintended for Good Reason, To Exploreyour Knowledge and Abilities

Not to Trick you! Dont at any time give up!!


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Good Luck

approach to long case1

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