Long Cases in Medicine

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