This is a presentation made by MSU students to be presented to the specialist during their posting in HRPZII Kota Bharu, Kelantan.
Very good summarised guide for PLAB 2
this are the thing u ask ur patient.....by dharmendra sapkota
History Taking in a Jaundiced patientFull description
Taking History in medicine
Full description
History Taking Proforma_2
For Junior Interns' Use
From Uni of Leeds
OSCE station - depression history Systematic approachFull description
obstetrics
History taking
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Includes post traumatic stress disorder and OCDFull description
aFull description
obstetrics
gagal ginjal kronikFull description
Case TakingDescription complète
ESRD Diagnosis
Diagnosis - When where you diagnosed? - How many years have you had kidney problem? - What is the cause of kidney problem? - Can you tell me how were you diagnosed with CKD? AKI/ pick up on blood test - What symptoms did you had? Blood in urine/frothy urine, were you not producing any urine or was it an incidental finding on a blood test? Possible causes: HTN, DM, GN (SLE, vasculitis), PCKD, Obstruction: Prostate problem/stones
Recent events Baseline “Over the years do you develop any symptoms?” symptoms?”
Anaemia -fatigue, SOB Fluid overload - Leg swelling - Dyspnoea - Orthopnea - PND
Clinic - Who look after your kidney? - When was your recent clinic day? - Do you know your baseline creatinine? when they dip your urine? - Any protein in the urine when - BP reading recently? Measure at home? What is the value? What treatment have you had for your kidney? - How long have you been on dialysis
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HAEMODIALYSIS How many times per week do they dialyse and how many hours is each treatment? What is the patient’s current access for dialysis (e.g. an arteriovenous fistula, a PTFE graft, or a tunnelled dialysis catheter)? Any issue with the fistula so far? Infection or blockage? Do you know your your BP at the end of session? BOTH How much urine do they pass, if any? What is their dry (aka flesh, target, post-dialysis) weight? What is their daily fluid allowance? Do they adhere to a renal diet? Do they receive erythropoietin injections? Who performs these? Have they always been on the same modality of dialysis? Are they ‘listed’ for deceased donor transplantation? Have they previously received a transplant? How are they coping with dialysis? PERITONEAL DIALYSIS Do you do them overnight or during the day? How many exchanges do they perform? How many litres is each exchange? Do they need assistance to perform an exchange? Do they measure their own blood pressure at home? What have the readings been recently? Is the exit site of their dialysis catheter clean and dry? Are the dialysis bags clear or cloudy on drainage? When was their last episode of peritonitis? Ever experience any fluid leak?
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TRANSPLANT Are you listed from transplant? Any plan for transplant in the future? When was transplant performed? From live donor or deceased donor? What immunosupression are you taking? 1. MMF [mycolat] 2. Tacrolimus (Prograf) 3. Prednisolone 4. Septrin/Valganciclovir 5. PPI/Ranitine??? Have you had any rejection period? What mode of dialysis you were on prior to transplant?
Transplant related - Previous skin cancer, blood cancer, cervical cancer - Opportunistic infection: BK virus, CMV, PCP pneumonia - Rejection episode? - hyperPTH ELECTROLYTE ABNORMALITIES - uric acid: allopurinol CARDIOVASCULAR DISEASE - Any heart issue? Chest pain or heart attack? pericarditis - Are you on aspirin or statin - Fluid overload?
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RENAL ANAEMIA EPO injection Iron & folic acid
BONE DISEASE Bone density affected by your kidney? Any report of high calcium or low calcium - Bone protection: calcium & Vit D - Cinacalcet - Parathyroid sx? - Phosphate binder [sevelamir]
