Long cases in medicine
,Content overview
Introduction
Acute fever
Pyrexia of unknown origin
o Management of infective endocarditis
o An introduction to hematological malignancies
Diabetes mellitus
Hypertension
Chest pain
o Management of Ischaemic heart disease
Shortness of breath
o Management of heart failure
o Management of COPD and bronchial asthma
o An introduction to diffuse parenchymal lung disease (DPLD)
o Approach to a patient with anaemia
Fever with respiratory symptoms
o Management of LRTI
Chronic cough and hemoptysis
o Management of tuberculosis
o Introduction to bronchial carcinoma
Edema
o Management of nephrotic syndrome
o Management of nephritic syndrome
o Management of chronic kidney disease
Swelling of the abdomen
o Management of chronic liver disease
Jaundice
o Approach to the assessment and management of jaundice
Joint pain
o Management of rheumatoid arthritis
o Management of SLE
Bleeding and bruising
o Management of haemophilia
Lower limb weakness
o Management of GBS
o Management of spinal cord disease – compressive and non compressive
o Approach to the diagnosis and management of peripheral neuropathies
Hemiparesis
o Management of stroke
,Introduction to the long case
Taking a good history
The most important aspect of the long case is the component on history taking. The history
should have all the usual components and have a good flow
Components of the history
Presenting complaint
History of the presenting complaint
This is the most important aspect of the history. First describe all the symptoms, their onset and
progression
Now think of the differential diagnosis for the presentation
Ask direct questions related to each differential diagnosis
The history of presenting complaint will therefore contain components of the past medical
history, surgical history, family history and social history
Spend most of your time to complete the history of the presenting complaint as this is usually
the only component that the examiner is interested in
Review of the systems
Most of the symptoms associated with the systems will be asked during the history of the
presenting complaint
Past medical and surgical history
Drug history
Allergic history
Family history
Social history
This will be an important component in some long cases. Especially chronic diseases. The
following is a guide to take a detailed social history
Introduction to the patient and the family
Personal habits of the patient
Describe the impact of the disease on the patient
Impact on the disease on the other members of the family
Support available – from the immediate family and the extended family
Medical facilities available
Examination
The key is to perform a quick and targeted examination
, Do the examination after completion of the history of presenting complaint and ask the other
details during the examination to save time
Presenting your case
Be confident in presentation
You will be asked to present a summary at the end
Prepare a problem list
Define the medical and non medical problems and list them in order of priority
Prepare a differential diagnosis for your medical problems
,Content overview
Introduction
Acute fever
Pyrexia of unknown origin
o Management of infective endocarditis
o An introduction to hematological malignancies
Diabetes mellitus
Hypertension
Chest pain
o Management of Ischaemic heart disease
Shortness of breath
o Management of heart failure
o Management of COPD and bronchial asthma
o An introduction to diffuse parenchymal lung disease (DPLD)
o Approach to a patient with anaemia
Fever with respiratory symptoms
o Management of LRTI
Chronic cough and hemoptysis
o Management of tuberculosis
o Introduction to bronchial carcinoma
Edema
o Management of nephrotic syndrome
o Management of nephritic syndrome
o Management of chronic kidney disease
Swelling of the abdomen
o Management of chronic liver disease
Jaundice
o Approach to the assessment and management of jaundice
Joint pain
o Management of rheumatoid arthritis
o Management of SLE
Bleeding and bruising
o Management of haemophilia
Lower limb weakness
o Management of GBS
o Management of spinal cord disease – compressive and non compressive
o Approach to the diagnosis and management of peripheral neuropathies
Hemiparesis
o Management of stroke
,Introduction to the long case
Taking a good history
The most important aspect of the long case is the component on history taking. The history
should have all the usual components and have a good flow
Components of the history
Presenting complaint
History of the presenting complaint
This is the most important aspect of the history. First describe all the symptoms, their onset and
progression
Now think of the differential diagnosis for the presentation
Ask direct questions related to each differential diagnosis
The history of presenting complaint will therefore contain components of the past medical
history, surgical history, family history and social history
Spend most of your time to complete the history of the presenting complaint as this is usually
the only component that the examiner is interested in
Review of the systems
Most of the symptoms associated with the systems will be asked during the history of the
presenting complaint
Past medical and surgical history
Drug history
Allergic history
Family history
Social history
This will be an important component in some long cases. Especially chronic diseases. The
following is a guide to take a detailed social history
Introduction to the patient and the family
Personal habits of the patient
Describe the impact of the disease on the patient
Impact on the disease on the other members of the family
Support available – from the immediate family and the extended family
Medical facilities available
Examination
The key is to perform a quick and targeted examination
, Do the examination after completion of the history of presenting complaint and ask the other
details during the examination to save time
Presenting your case
Be confident in presentation
You will be asked to present a summary at the end
Prepare a problem list
Define the medical and non medical problems and list them in order of priority
Prepare a differential diagnosis for your medical problems
