Mrs Jones is 43 and presents to her GP with stomach pain. When describing the pain she points to her RUQ and says it “comes and goes”.

a What other questions would you want to ask her about the pain?  

 

MaxMark

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a What other questions would you want to ask her about the pain?  

Clinical Skills!! - SQITAS

1.Can you describe how the pain feels? E.g. stabbing, dull, achy etc.

2.If you had to rate the pain from 1-10 (10 being the worst pain

imaginable) what would you give it?

3.How long have you had the pain?

4.Does anything make it better?

5.Does anything make it worse?

6.Have you noticed any other symptoms in relation to the pain

 

MaxMark

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b Due to your excellent history taking skills you have discovered that the pain is worse on eating fatty foods. The GP suspects gallstones. What are the risk factors for this?

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Max.Mark

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b Due to your excellent history taking skills you have discovered that the pain is worse on eating fatty foods. The GP suspects gallstones. What are the risk factors for this?

GI:Most memorable are:•Female•Forty•Fat•Fertile•Fair

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c Mrs Jones is overweight. What potential psychosocial factors have been suggested for people being overweight in low SES?

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c Mrs Jones is overweight. What potential psychosocial factors have been suggested for people being overweight in low SES?

HiC:•Affordability of food•Availability of food•Personal preference within the household•Lack of motivation•Lack of education – not a good one to pick

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d Which diagnostic technique for gallstones can also be used as a treatment? Name one risk associated with this.

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d Which diagnostic technique for gallstones can also be used as a treatment? Name one risk associated with this.

GI:Endoscopic Retrograde Cholangiopancreatography (ERCP)

Risk: acute pancreatitis

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e After recurrent episodes of gallstones the doctors suggest removing her gall bladder. Calot’s triangle must be avoided during surgery. What are the boundaries and why is it avoided?

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e After recurrent episodes of gallstones the doctors suggest removing her gall bladder. Calot’s triangle must be avoided during surgery. What are the boundaries and why is it avoided?

GI:Contains the cystic artery

Medially: common hepatic ductInferiorly: Cystic ductSuperiorly: Inferior edge of liver

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f After surgery Mrs Jones is recommended to reduce her dietary intake of fat. What are the six essential nutrients?

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f After surgery Mrs Jones is recommended to reduce her dietary intake of fat. What are the six essential nutrients?

Molecules:Essential:•Water•Calories (fat and carbs)•Essential amino acids•Essential fatty acids•Vitamins•Minerals

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