PATIENT DATA

'What about my baby?'

Presenting Problem

Mrs Leong Tring is a 41 year old woman who presents to the GP complaining of nausea and vomiting.

History of Present Condition

  • She feels nauseous especially in the mornings, and often vomits - it seems to wear off by about midday
  • She is otherwise well but this problem is really getting her down
  • It started about 4 weeks ago when she thought it might have been something she had eaten. Then it seemed to get better, but for the last 2 weeks it has been getting worse again
  • No diarrhoea
  • She seems to be eating OK and hasn't lost any weight
  • Nothing much seems to make it better or worse, so she just tries to get on, but it is making it difficult for her to work normally, and she is anxious about losing her job as a secretary

General Health Status

  • She has not been to the doctor for a long time - she is in good health and looks well
  • Married for the past 10 years, husband is a computer technician
  • No children
  • Immigrated from South East Asia with her husband 15 years ago

What might be the cause of her problem? What pathophysiological mechanisms and/or clinical conditions might be involved?

What would you do next?

When you have a plan, PROCEED

 


Web demo notes:

This additional information represents the patient's own story of what they have noticed, as well as the general background/context of the patient's past health. The student seeks to identify from the story those elements that might lead towards one hypothesis rather than another.

The student should now aim to identify their own lead hypotheses as to the nature and cause of the current problem. Think especially in terms of basic mechanisms and of where normaly processes can go wrong. Then use these as a basis for formulating the next enquiry steps, to identify the key questions to which you need answers to move towards the diagnosis, and think ine ach case of the answers you might get, and what these would mean in the context of this enquiry.

In this case you would be expected to come up with a list of hypotheses something like the following:

  • GI irritation, infection, diet components, ulcers, poisoning, drugs
  • GI obstruction, restriction, intussusception, hernia, volvulus etc
  • Inflammation of abdominal organs - pancreatitis, hepatitis, appendicitis, cholecystitis etc
  • Metabolic/hormonal - diabetes, pregnancy, hypoadrenalism, uraemia
  • Central nervous system - psychogenic, motion sickness, migraine, drugs, meningitis, Meniere's, raised intracranial pressure etc
  • Miscellaneous - pain, infections, pyrexia, irradiation etc

and from that you would be expected to think of further questions to ask the patient along the lines of those which follow:

  • Diet and Bowels- seeking evidence of any unusual dietary intake, recent changes, potential for contamination etc; change in stools/motions, frequency, consistency
  • Drugs/Medications - seeking evidence of prescribed, recreational, legal and illicit drug taking
  • Abdominal status - seeking evidence of pain, discomfort, inflammation, distension etc
  • Metabolic/hormonal - seeking evidence of abnormal breath odours, intercurrent infections (urinary, skin, chest etc), missed periods etc
  • CNS - seeking evidence of fits, faints, sensory disturbances, balance problems, headaches, vertigo etc
  • Now click on the PROCEED button below to move on.

What might be the cause of her problem?

What would you do next?

When you have a plan, PROCEED