Pepsci Recall

Download as doc, pdf, or txt
Download as doc, pdf, or txt
You are on page 1of 3
At a glance
Powered by AI
The document discusses several clinical cases and questions about managing patients. Key things to consider are rational drug therapy, involvement of other healthcare professionals like pharmacists, and assessing fall risk in elderly patients on multiple medications.

Perform an ECG, recognize ST elevation consistent with AMI, urgently transfer to hospital for treatment such as thrombolysis or PCI.

Emphasize lifestyle changes like diet, exercise, smoking cessation. Adjust medications, involve dietician/social worker due to social issues. Monitor for complications.

GENERAL QUESTIONS 1. Please tell us about yourself 2. Why did you decide to come to Australia? 3.

What sort of patients do see at your current practice? 4. Do you have a patient recall system at your practice; can you tell us about it? 5. What is the importance of having a good patient recall system? 6. What do you know about the Practice you are planning to join; and why did you decide to join this Practice in particular? 7. If you find out that the patient recall system at your new practice is inadequate, what will you do about this? 8. Are you familiar with the concept of continued professional development? 9. Do you know of any means of participating in continued professional development in this environment? 10. If you had a difference of opinion with one of your colleagues at work, what will you do about this?

CLINICAL QUESTIONS 1. You are the only Doctor at the Practice on a Sunday afternoon, and Mr. X, a 56 yrs old Man is brought in by his friend to the Surgery. He is having some chest pains after playing around of golf. He is anxious, sweating, and seems to be in some discomfort, but is able to respond adequately to your questions. How would you manage him? Further Hx.: Pain is crushing in nature, radiates to neck and lt. shoulder; associated palpitations and dizziness. Was told by a GP to take aspirin tablets daily, but he doesnt adhere to this. Not on any other medications. Examination: B.P. 140/95mmHg; Pulse 104/min regular; (When I said I would do an ECG, I was presented with the ECG) ECG ST elevation in leads II, III and aVF. (Essentially an inferior acute myocardial infarction; went on to discuss around the management of an acute MI) Other questions: a) His friend offered to take him to the hospital immediately in his vehicle, to obviate the delay in arrival of the ambulance. What would you do? b) What equipment is it necessary to have at ones disposal at the Practice for a patient of this nature? (Answer Defibrillator)

2. Mr. A, a 62 year old diabetic patient has come in to see you today for review of his results. He is a widower living alone, as his children live out of town. He is on Metformin 500mg B.D, though he does not take the medicines regularly. His wife died 3 years ago. Results: HbA1c 9.1% Total Cholesterol 6.6 mmol/L HDL - 0.9 mmol/L LDL - 3.5 mmol/L Triglyceride - 2.2 mmol/L HDL/LDL ratio Question: How would you manage this patient? Other significant findings on Hx and examination: Very poor diet Smokes 10 cigarettes per day Takes Alcohol about 8 units per day Minimal physical activity Very little social support BP 150/90 mmHg BMI 30.2

3. 18 months old girl with 3 days hx of cough brought into the surgery by parents. The child has poor appetite and vomited once. The immunization is up to date. The sister was treated for cough at your Practice 2 weeks ago. How would you manage the patient? Significant findings on examination: Temp 38.4oC Resp rate 42/min Mildly dehydrated Mild crepitations in both lungs Decreased breath sounds in the left lower lung No rash Other questions: a) Differential diagnosis? b) What would you tell the parent of the patient is wrong with their child?

c) If you thought that this was a relatively mild cough, how would you advise the childs parents? 4. A 73 yrs old man, brought in for renewal of his medicines scripts. The patient has become more forgetful of recent. He is taking the following medicines: a) b) c) d) e) f) g) h) i) j) k) Amiloride Hydrochloride Amiodarone tablets Digoxin tablet Irbesaran tablets Furosemide tablets Warfarin tablets Prednisolone tablets Amytryptiline tablets Tramadol capsules Slow K tablets Several others (cant remember all, about 20 drugs in total)

Also a list of conditions for which he is being treated Cardiac failure Hypertension Previous Atrial fibrillation About 5 other medical problem(cant remember all) NOTE: Essentially this question is about rational drug therapy, drug interactions and drug side effect profile; as well as patients fall risk assessment at home. Also the use of available resources to rationalize the drug therapy of such a patient (e.g involvement of the Pharmacist, used of pre-packed or blister packed drugs specifically for the patient etc)

You might also like