Station 5 Wang Zhemin General - PowerPoint Presentation

1. Station 5Wang Zhemin

2. General3 min History + 3 min Examination + 2 min Counseling + 2 min DiscussionAcute Problem: Contextualised differentialsChronic Problem: Diagnose, evaluate features, complications, associationsConcerns: Explicitly elicitCounseling: Diagnosis/Differentials, Disposition, Treatment (symptoms, underlying), Follow Up/Discharge Advice

3. How to Study/Think?Approaches (top down): Breadth (types and content), patterns, thinking of paces diagnoses (guide inspection)Conditions (bottom up): Know enough (don’t need too much) about your PACES favouritesConcept of ‘opening doors’ and ‘moving up floors’

4. Knowing What is CommonGrave’s (7): Neck swelling, fever, periodic paralysis, agranulocytosisAcromegaly (7)Psoriasis (5): Joint PainSystemic Sclerosis (5): SOBAnk Spond (4): Back PainGout (4): Joint painOthers: Retinitis pigmentosa, MEN, NF, SLE, HHT, RA, Sjogren’s Tendon Xanthoma, DM, Hypothyroidism, TIA/hemiplegic migraine, CMT, Osteogensis imperfecta, ITP

5. Preparing for the UncommonApproachesCommonly missed aspects of familiar approachesUnfamiliar approachesConditionsPACES Favourites – Knowing how these can present in a station 5 scenario

6. Commonly missed things in familiar approachesHeadache: Hypertension, hyperviscosity, GCAChest Pain: OdynophagiaHypertension: OSA, drugs, vasculitisLower Limb Swelling: Thyroid disease, drugs (CCB)Abdominal Pain: Medical causes (hereditary angioedema, familial mediterranean fever)Diarrhea: VIPoma, carcinoid

7. Less familiar approachesTremors, choreaVisual problemsAmnesiaParasthesiaHand painWeight gainSweatingItchFlushingEye swellingRash: Raynaud’s, erythema nodosum, pyoderma gangrenosum

8. PACES FavouritesRheum + Endocrine conditions most commonNeuro conditions possibleWilson’s, PBC, Polyglandular Autoimmune Syndrome, MEN Syndrome, Amyloidosis, Retinitis Pigmentosa, HHT, NF, Tuberous Sclerosis, Sturge Weber, Acute Intermittent Porphyria, Osteogenesis Imperfecta, VHL, Peutz Jeghers, Carcinoid, Hereditary Angioedema

9. PatternsHeadacheHeadache + Hypertension: Pheochromocytoma, Hypertension causing HA, CCB use, Raised ICP with Cushing’s reflex, Pituitary tumours with 2’ endocrinopathy (acromegaly, cushing’s)Headache + BOV: GCA, glaucoma, BIH, SOL with visual tract compromise (pituitary tumour, cerebral SOL)Thunderclap Headache: SAH, cerebral venous sinus thrombosis, cervical artery dissection, reversible cerebral vasoconstriction syndromesHeadache with raised ICP features: SOL (rmb pituitary tumour), BIH, thrombosis/hemorrhageAbdominal PainIntermittent: Biliary colic, renal colic, constipation colic, gut claudication, acute intermittent porphyria, hereditry angioedemaDark urine: Ureteric colic, biliary obstruction, acute intermittent porphyria

10. ExamplesEasy: Inflammatory back pain secondary to psoriatic arthropathyHx of back pain inflammatory in nature – evaluate for autoimmune, infective, neoplastic causesHx yielding of rash suggestive of psoriasisConsider other cx of psoriasis – e.g. ILD, nail changesIntermediate: LL swelling from nephrotic syndrome from amyloidosis in patient with RAHistory of LL swelling sugestive of hypoalbuminemia Cause of hypoalbuminemia suggestive of nephrotic syndromeHistory of RA suggestive of possible amyloidosis; Ddx might include NSAID induced nephrotic syndrome

11. ExamplesDifficult: Polyuria secondary to diabetis insipidus from hypercalcemia due to hyperparathyoidism in MEN syndromePolyuria history Features of hypercalcemia establishedEvaluate for cause of hypercalcemia – malignancy, myeloma, TB, sarcoid, PTHExplore laterally to pick up other MEN symptoms or fam/personal hx

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