PLAB 2 Demo Case - Dr Aman Arora | Full Consultation Example

okay so Dr Lucas here going to do a quick case um hi who are you going to be male female uh male male name John Cole John Cole so we're going to do an example 8 Minute case let's say I'm in GP setting um let's think I've got some past medical history let's say you haven't got that much to go on um tension headache migraine something like that maybe in the past uh on any meds um should I be on some trip times yeah okay says s t let's say you had a prescription last a year ago sure um not been into the practice for two years three years it looks like fairly F Well fairly new presentation U what else we need to know nothing else really John Cole John Cole great 8 minutes on the clock okay hi is it Mr John Cole yes John Cole doctor thank you for seeing me hi doctor I'm in one of the doctors in the practice thank you for coming how are you helping today uh not great doctor I've had a a cough for about 3 weeks now I just can't shift it um I'm bringing up some horrible stuff and my wife's told me I've got to come in okay yeah cough very very important to get it checked out can be lots of different reasons for it happens it's good that you've come your wife mentioned coming we'll talk about um there in a second but good glad you're here um tell me a bit more about this cough in your own words what's been going on what's the story so I think it's getting worse um I've tried some overthe counter remedies they they haven't shifted it okay uh and I'm bringing up quite a lot of Gunk and horrible stuff okay okay so again important things to come and see us about I mean people do cough things up and it can mean lots of different things so I'm really glad you've come to see it you mentioned two or 3 weeks yes okay let's try and narrow the story down a little bit you mentioned a cough what how do you describe the cough is there any way you can think uh it's wet I'm bringing up yellow material um making me a bit shorter breath at times have sort of coughing pits okay okay so again a couple of important things there to pick up on you pck you mentioned coughing up stuff yellow has it been yellow since the beginning is that changing in color uh yellow since the beginning okay thick th sorry questions but they're useful for us nothing unusual like any blood okay I never really had this before or have you no okay fine so no blood which is good couple of other yes no questions really just that we T tend to ask just to make sure nothing's going on of any woring nature um some of them might be related to cough some of them not um we talked about blood any fevers at all you've noticed maybe been a bit hot and cold but I haven't taken my temperature okay getting worse better same same for the whole period okay for any kind of lumps and bumps that youve noticed maybe around the neck or under the arms no good not F off your food no eating and drinking okay good any recent travel abroad that can sometimes be important I wish yeah we all wish stuck here in the cold Winters um fine um weight loss you noticed nothing like that at all good you mention not bringing up any blood you did mention shortness of breath is that happening when you cough or is it generally when you're out just when I'm coughing if I cough a lot I feel a bit breathless fine no wee at all no and when you're kind of walking on the flat or going upstairs ises that cause you to be shorter breath no okay and often with shortness of breath you think about things like pain in the chest as well you notice anything like that no good so nothing going down the arm into the jaw nothing that comes on when you're exerting yourself walking Etc good and nothing strange like pain when you take a deep breath in no okay and a funny question but definitely related any problems in the legs for example either pain while you're walking or any swelling or tempers at the back of the legs good so all that seems fine okay generally you said you're eating and drinking okay not vomiting no okay tummy feels okay yeah good excellent thank you sorry for asking you lots of lots of questions there let's get R an idea about what's going on in your mind then so you've had this for two 3 weeks now what kind of thoughts we going to do M don't know if it's a chest infection maybe reasonable yeah reasonable thought I think a lot of people think particular this time of year in the winter chest infection so we'll we'll have a look at you and see if that could be going on it may well be anything particularly worrying you I noticed you don't really come to see us very often so anything on your mind at all yeah I mean I I just don't want to get into hospital at Christmas time I want to get well yeah that seems very reasonable I think who would want to go in on at Christmas time so yeah it's good that you've come let's try and see if we can uh stop that maybe happening if there's something that we can do for that and obviously You' mentioned some remedies and things and treatments you mentioned home and we'll talk about what they are in a second but was there anything particular that you thought that we could do when you came today don't know if I need antibiotics maybe very reasonable if you're think an infection that is certainly sometimes we do treat it with antibiotics maybe once we check to we can see now you did mention um some treatments that you tried yourself just tell me what kind of things they were what was the impact of them uh just cough syrup okay didn't didn't change it didn't really touch it not need anything like power SE for example for the temperatures uh I tried some um but not the cough no yeah absolutely okay fine um and I've looked at your notes I can see that you don't really take many medications you take something for your migraine yes that all under control that's all fine doctor no new medications that you've tried for anything else cuz sometimes cough can be caused by certain things and because we sometimes treat and you mention antibiotics any allergies that we need to know of any lung problems running the family chest problems heart problems lung problems good fantastic thank you lots of questions asked there I'd like to if it's okay maybe examine you but before we do just a of about the impact about what has happening with you you mentioned home you mentioned wife who else is around with you at home uh daughter daughter okay 18 okay fine and what have they been saying about this cough anything at all get to the doctors's fine do they have any thoughts as to what could be going on any worries uh I don't know not really to okay fine and what about has it been impacting work in any way what you do for J so so no time off work which is good I I work in a carpet Factory so a lot of dust around okay think that's been irritating me okay so that's interesting dust can make it a little bit worse as well um but is the dust situation changed or has it been the same over a long period of time long period of time just feel more sensitive to it okay with my chest and one important piece of question a question to ask you mentioned dust carpet fitting have you been working in buildings where that's bestos Etc in the past don't know okay okay fine it's just something we tend to think about when people come in with coughs but um it's good that you have it so you mentioned home you mentioned work a couple of habits can make things like coughs worse particular like smoking you've probably been asked before no Never Smoke Never Smoke okay and certainly because we're thinking about maybe treating this things like alcohol can impact certain types of treatment can ask if you drink at all One Beer a week if I'm lucky okay is it impacting you in terms of hobbies for example in any way whatsoever uh no no okay fine fine so otherwise sounds like you're getting on with life as normal it's just a bit irritating and it's been there for a while so you want to play great makes a lot of sense um before we talk about what we can do about it do you mind to have a quick look at you yeah sure what i' be hoping to do is maybe have a first have a quick listen to your chest listen to your heart all the cardiovascular and spiritual system check a few numbers oxygen levels breathing rate heart rate blood pressure temperature and have a quick feel maybe around the size of your neck would that be okay absolutely great so it's SK thank you so much for letting me examine you I know I asked you a lot of questions as well I I appreciate you spending some time I'm going through all of those reassuringly nothing worries me too much from looking at you your temperature is good your heart rate's good your oxygen levels are perfectly fine I'm happy with all that side of things good when I listen to your chest I did hear a few little crackles actually what we call crackles at the base of the lung so actually you did mention a chest infection and I agree with you I I think you have got a chest infection we do see a lot of them at this time of year I don't think there's anything too worrying like I said your numbers are seem fine your story doesn't highlight anything alarming of any nature and I think it's something that we can quite easily treat which I'd like to do um chest infection you've mentioned before is that something you have heard of have you have much experience of these in the past you want me to go through what it is uh no I think I understand it okay okay so there's two main types we have a a viral chest infection we have a a bacterial chest infection and I think given that you've got the crackles there given that you've got the the fleem that you're bringing up and given that it's been three or so weeks we're probably very towards thinking about treating it as a bacterial chest infection so I'd like to talk about a couple of things first you some antibiotics I'd like to go through what we'd like to prescribe some side effects how they work and the plan with those but also you mentioned work seem to be triggering it at the moment you mentioned the dusty environment and I wonder whether maybe talking about a little bit of time off might be useful just while you maybe treat this and we can talk about implications around that as well going forward and also before you leave I'd like to talk about a couple of symptoms just to stay ahead of lookout for that would mean you come and see me if things get worse cuz chest infections can change and get worse even though we're treating you so if that's okay I'd like to focus on those main things but because you've got the symptoms because it's been there for a while let's maybe start with the treatment first right the guidance for this tend to suggests an antibiotic called amoxicilin okay you mention you're not allergic to anything which is great it's a 500 mgram tablet which you take three times a day for 5 days okay so I'd like to start that if that's okay yes have you heard of that before do you have any questions about the treatment no I'm happy with that okay so maybe we can get that prescribed before you leave today and like I said maybe work how do you feel about a bit of time off I know it's was a busy time of year like you said I would help to get me back on my feet a bit okay okay and are you self-employed or [Music] or

Channel: Dr. Aman Arora - Arora Medical Education

Views: 14,435

Keywords:

Id: C3u6NVGpPYk

Length: 9min 54sec (594 seconds)

Published: Wed Dec 13 2023