Adelaide 9 April 2005

Case 1: ADHD
You are about to see the mother of a 6-year-old boy whose teacher is complaining that he is
very disruptive and inattentive in class.
Your task is to take further relevant history from the mum and outline your management
plan.

I started by asking her since when is this problem going on and if the problem is only at
school or at home also.
The mum said that he was always like this, very disruptive and active and very hard to
control. They have tried everything with him but nothing seems to work. She said that at the
beginning she thought his behavior is normal until she had a baby girl who is exactly the
opposite of her brother.
Q. Any problems making friends?
A. No, but he can't keep them too long.
Q has he got any problems with his general health?
A. No, he's been very healthy, only he is always full of scratches and bruises.
Q. Any problems during the pregnancy?
A. He was very active baby, kicking all the time, not like the second pregnancy.
Q. Anyone else in the family with the same behavior? A. Yes, my husband is the same, is
very hard to make him do something or to get his attention easily.
At tins point I told her that we call this ADHD and that are many things that we can do for
her son, I acknowledged that it must he very hard for her to deal with the situation. I told her
about few discipline rules that they can try at home (from Patient Education) and that I want
them to see a specialist who will assess the boy.
She asked if there is any medication for this, I told her about "brain stimulants"(without
naming them) and how they work and the bell rang.
NOTES:
Q. Is he forgetful? Distracted easily? Is he talking too much? Is he loud? Doing things
without thinking?
Psychological Mx: Parents education (Your children has an impairment that prevents them to
act like other children. They are not “Just bad” although they can do bad things. Telling
children that they are naughty and punishing them is not helpful. Small time-out for major
misbehaviors is appropriate. Try to get their attention while talking to them. There is an
educational program for parents called Triple P: Positive Parenting Program, which they can
participate) and support groups+ CBT for child by child psychotherapist (Helps them to
focus on the task at hand, improving motivation and discouraging off-task activities)
Drug Therapy which is the most effective treatment (Stimulants): Dexamphetamine and
Methylphenidate
Note: Most children lose Weight and appetite while on stimulants.
As a rule children do not grow out of ADHD, but the symptoms might decrease.

Case 2: CROUP
A 2-year-old boy had a cold since yesterday and now his dad came to see you because the
boy has difficulty breathing; he has inspiratory stridor at rest and he's using his accessory
muscles but no cyanosis.
Task was to explain to the dad what the problem is, give DD and management. (No further
Hx).
I greet the dad and I told him that what is happening with his son is called CROUP- I explain
to him exactly what it means and what is the mechanism of the disease, and I told him that
the child has to be admitted to the hospital.
Q. What are they going to do in hospital?
Give him nebulized adrenalin and steroids and monitor his vitals, He might need oxygen as
well, depends on his oximetry. I said trial no antibiotics would be needed as this is a viral
infection and he didn't insist about that.
Q. What does this Adrenalin do?
A. Helps him breathe more easily, by reducing swelling in his air tubes, I finished this task
earlier and the examiner asked me if I have covered everything. , I had a look again at the
task and I realized that I haven't talked about DD. So, I turned to the dad and said that it
could also be a foreign body aspiration, or simple cold, but this are unlikely and from the
history is pretty straightforward that we dealing with a case of croup. Dad was happy. REZA
(DD: Epiglottitis, Tracheitis, F. Body)
Notes:
- Remember home advises and again damn leaflets

Case 3: Encopresis
A 6-year-old boy is soiling his pants lately. The parents can't tell you much about this toilette
habits because the boy uses the toilette by himself now (this was funny).
Task is to take history from the mum, Ix from examiner and outline your management.

Q. Since when this problem?

A. 6 weeks ago
Q, Is this the first time?
A, No, it happened before, a year ago, and we went to see a Dr. and they discovered that the
boy has a tear at the back passage and they fixed him up and he was fine after until six weeks
ago.
Q. And does he pass a formed stool in his pants or not?
A. No, just soiling.
Q, what about his diet? Does he drink enough fluids?
A. Yes, I think he does.
Q. Is he complaining of any tummy pain or pain in his back passage?
A. No.
Q. Has he been sick before?
A. No, except when he had that tear.
Q. Immunization up to date?
A. Yes.
Q. Is he taking any medication?
A. No.
Q. How is his schoolwork? Doing fine?
A. Yes he's ok but his peers are making fun of him now because of his soiling.
I drew a picture to explain to the mum what actually is happening. And I told her about
micro enema and laxative and about developing good toilette habits.
She asked me if I am going to do the enema or the pediatrician. I suggested the pediatrician
Then she asked what else could I give if enema and laxatives don't work? I didn't know what
to say, but I said that medication to soften the stool and bell rang.
NOTES:
1. the aetiology of encopresis is almost always physiological, and a consequence of faecal
retention.
2. GP should also inquire about how the child and family are coping
3. Careful palpation of the abdomen sometimes reveals palpable stool in the left iliac fossa.
A rectal examination is not necessary
4. The diagnosis of faecal retention is made by a plain abdominal X-ray.
Manage:
1. A high-fibre diet with adequate fluid intake.
2. Regular sitting on the toilet. The child sits on the toilet three times a day for about five
minutes, preferably after each meal
3. Behaviour modification ( Rewarding )
4. Stool softeners such as lactulose (Duphalac), paraffin oil (Parachoc) or poloxalkol drops
(Coloxyl drops); or bowel stimulants such as bisacodyl (Durolax) or senna (Senokot or
Nulax) can be used either singly or in combination. There is little indication for enemas
and suppositories
5. Regular follow up and encopresis clinic and remember the LEAFLET
Where treatment is not successful or is prolonged, it is almost always due to poor adherence

Case 4: THREATENED ABORTION

A 26 year old lady comes to see you in your GP setting with vaginal bleeding after 8 weeks
of amenorrhea. Take Hx, Results of examination and Investigations and management plan.
Q. How much are you bleeding?
A. Not much, only spotting on my underwear.
Q. Any clots? (Or pregnancy products? If yes then: incomplete abortion)
A. No
Q. Any pain in the tummy?
A. No
Q Any discharge?
A. No
Q. How was your period before this?
A. Normal, regular, no bleedings in between,
Q. Do you have any bleeding problems?
A. No.
Q. Are you sexually active?
A. I am married.
Q. Could you be pregnant?
A. Well, we were trying to have a baby.
Q. And have you had any difficulties getting pregnant?
A- No, actually I had a pregnancy test at home and was positive.
Q. Have you had any trauma or any intercourse before this bleeding started?
A. No
On examination everything was normal, on PV exam cervix closed. I said I want to do U/S.
The result was available showing a sac in the uterus; I turned to the patient and said that what
you are experiencing is THREATENED ABORTION (without cervical dilatation). It might
settle by itself (75%) and let’s hope that this is the case with her or it may become a complete
abortion. (She has increased risk of subsequent PROM and preterm delivery, so book in a
hospital with good neonatal care.)
So I said that she needs rest, not to do any hard work and that I want to repeat U/S in 2 days
(?????) just to assure her that fetus is viable and everything is ok.
Then she asked if there is any medication that I could give to stop her losing the baby. I said
that if she is going to have an abortion, then she will have one, medication usually doesn't
work. But, in this case I completely forgot to ask about her Rh (Which probably was
negative). **DO NOT FORGET Rh**
Note. If cervix was dilated then No intercourse because of infection risk.
Note. Suction Curettage < 12weeks, Dilatation Evacuation for 12-23 weeks
Note. In Incomplete abortion if the retained products are small (<15mm) then expectant
management, otherwise medical abortion.

Case5: PPH
A lady has just given birth 20 minutes ago and she is still losing blood (about 1250 ml
overall if I remember well). You are at home and the nurse is calling you from the hospital to
let you know the problem. You are able to get to the hospital in 10 min. Task: Ask the nurse
over the phone further Hx and give her appropriate instructions Tell the examiner the causes
of PPH.
It was funny because the "nurse" was in front of me but I had to pretend that I talking on the
phone. I started by asking vital signs. BP was low and there was tachycardia.
Q. Was she given any medication during labor?
A, No because she declined any medication.
Q. Placenta was delivered? Is it complete?
A. Yes placenta is delivered and is complete
Q. Have you tried to feel her uterus? Is it contracted?
A- I tried and uterus feels lax not contracted.
Q. Did she have episiotomy? A, Yes and it was repaired after.
Q, how big is the baby? Is he ok? A. Baby ok. 3800kg
Q- From her records, does she have any bleeding problems? A. No
Q- Any other medical problem like Asthma, Hypertension, or…? A. No
Ok, (here are a few things that I want you to do. Give her oxygen and insert IV canula.

Nurse said I couldn't put canula. I asked what the reason is and she said she is not registered
to do that. Ok, I said I will do it when I come. So, I continued: take a sample of blood to
check FBE, U/E, clotting profile and for Group cross match -Also I need you to check
bedside clotting time for me. Let the blood bank that we might need blood. Give her
Oxytocin (Syntometrine (if not hypertensive) one ampoule or Ergometrine 0.25mg or
Syntocinon 10IU) and massage the uterus. (She said, yes I can do that). If she still bleeds
repeat the dose of Oxytocin and continue to massage the uterus till I get there.
What will you do Dr when you get here? I will put IV canula and if she is still bleeding I will
give her Misoprostol (PG E1)800mcg PR. Do you know from her notes if she is asthmatic?
No she is not. And let's hope that after’ all this she will be fine. If not, we will inform the
theatre she might need operation. Than I told the examiner the cause’s of PPH: uterine atony,
laceration to vagina and cervix and bleeding problems.
Case 6: DVT
A young lady had her first baby 2 years ago and she had pregnancy complicated with DVT
and PE. Now she comes to see you because she wants to become pregnant again.
Take further relevant Hx ant outline Mx.
Q- Overweight? Renal or Liver or other medical problem? Any varicose veins? Immobility
periods? Smoking, Alcohol? Age? Medications.
From the Hx nothing relevant. I tried to exclude the risk factors for DVT but she didn't have
any. She couldn't elicit any positive family Hx because she didn't know.
In first pregnancy she was treated with heparin and after delivery with warfarin for 6
month .She was fine after that. So, I told her that she might have some inherited form of
clotting disorder and that we have to check for that. Also the pregnancy will make her more
likely to develop clots. I referred her to specialist and I told her that pregnancy would be
considered high risk. The specialist might consider giving her prophylactic heparin.da Also
she will be monitored in a high risk clinic and all the measures (like early mobilization and
stockings) will be taken care of during pregnancy and delivery so she will be less likely to
develop clots again, also I told her about general advice, like folic acid and good antenatal
care.

Case 7: Weight Loss

A 68 y old lady is complaining of tiredness and wt loss. Hx, examination, Mx

Q. Since when do you feel tired?

A. I've been feeling like this for 3 month now since my husband died, I can't do anything
because I am so tired.
Q. And how much wt have you lost? A. About 5-6 kg in last 3 month.
Q. Do you have any problems sleeping? A, No, I sleep fine.
Q. Do you still enjoy doing things that you used to do? A. I can't do anything now because
feel tired.
Q. Do you get SOB?
A. Not really, but after I am doing something is becoming a little bit hard for me to breath,
Q. Any cough or chest pain? A. No
Q. Any tummy pain? A. No
Q. Bowel habits? A. I can't say that I am constipated but I am going less then usual
Q. do you notice any blood in stool, or toilette paper? A. No
Q. Have you had any health problems like heart problem, high blood pressure and
Hospitalizations for any reason or on any medication? A, No
On examination, pt is pale, on abdominal palpation there is a mass about 7cm/6.5 cm in right
iliac fossa. PR normal.
I said to her that at this point I am very concerned and I am thinking of worse.
What is in my mind now is something very serious like cancer. That's why I want you to see
a specialist and he will do a colonoscopy for you, which means a tube via back passage to
see exactly what is going on in your bowels, I said that this growth might leak blood even if
there is no blood visible in stool, and this is the reason for which she feels tired, because of
anemia. She was very quite and said that she wasn't expected to hear this. For this case I
forgot to mention follow up for her son because he will have increased risk of colon CA. But
I asked her if she has any other concerns and she said no. She was very upset because she is
so tired that she can't do anything. Also I didn't mention about iron tablets but I said that once
she will see the specialist further management will be taken from there. (Remember to do the
blood tests first and also stool exam for occult blood)

Case 8: Shingles
A 45 y old childcare worker comes to see you with a painful rash on her trunk. Mx
At the beginning I had no clue about what can it be but when I started to ask more about rash
she said she has it since yesterday and with her hand was pointing below the breast and rib
cage on the left.

This was when I actually realized what it is.

Q. Since when do you have tins? A. Yesterday.
Q. Is painful and itchy? A. a little bit itchy but is very painful, actually more like burning.
Q. Before this rash appeared did you have any pain in that area? A. Yes I had pain just here,
below my ribs for 2 days before this rash came on.
Q. Have you had chickenpox as a child? A. Yes.
Q. Do you live alone? A- No, with my husband.
Q. and your husband is ok? Any health problems? No chemotherapy or Radiotherapy? No
other disease that can make his immunity low? A. No, he's fine.
Q. Do you have contact with any pregnant women or children? A. With children because I
work in childcare center.
On examination everything was fine. Examiner showed me a picture with the rash, which
was typical for HERPES ZOSTER. So, I turned to the pt. and told her that she's got
SHINGLES. I made the correlation with the chickenpox that she had as a child and told her
that the same virus is causing this problem,
I considered Acyclovir because the rash was less than 72 h.
I said that her husband should have ZEG to protect him??? (It is advisable in
immunocompromised individuals), and she should take some days of from work as she
could-spread the virus to kids. Gave her advice about' Calamine and how she should take
care of skin (patient education). I also told her about neuralgia after healing but hopefully
will not be her case.
Note. VZV contact in pregnancy: If you had chickenpox in the past no action required. If not
blood test for Ab. If negative should receive IG, preferably within 4 days of contact.
Chickenpox dangerous for baby <20week and 7 days before and after delivery.
Case 9: SUPRACONDYLAR FRACTURE
An 11 years old child has fallen on her elbow. Have a look at the X-ray. Provided and tell the
Dx to her mother and answer any questions from the mother and the examiner. The
examination of the hand is normal.
3 X-ray were given and I could see a SUPRACONDYLAR FRACTURE.

So, I went inside and I started to explain to the mother about supra condylar fracture and that
I need to call orthopedic surgeon to have a look. The fracture was not displaced, so I said that
the girl will have to have a cuff, and collar and stockinet vest with elbow flexed for 4-6
weeks, I mentioned that if the # was displaced she probably would have needed operation.
Then the mother started to ask me question; what is the girl going to do with school? Is it ok
for her to go to school? A, I am happy to provide you with a letter for the school. That is ok
for her to go to school as far as she doesn't do anything to expose her arm more.
Q. But how is she going to write, because she is right handed? A. Well, I said, she wouldn't
be able to write, but at least she can assist to the lessons and she can catch up later with
writing.
Q. When would you like to see us again? A. In 24 hours to see how everything is going
(circulatory status) and then in 4 weeks time. But if anything happens, like the arm becomes
swollen or finger blue and numb please come straight away.
The examiner asked what would be the most important injury that I would be worried about.
I said radial artery injury (though I think is brachial artery in fact) with ischemia to the
forearm (flexor compartment with severe pain) and radial, ulnar and median nerve
neurapraxia. Elbow stiffness will resolve without specific therapy.

Case 10: hepatitis C

A young lady went to give blood to the Red Cross and she was discovered to be hepatitis C
positive. Now she comes to see you for counseling.
Take a short relevant history and discuss Mx with the pt.

I started by asking about risk factors for hepatitis and she said that many years ago she used
to inject herself drugs and she used to share needles with other people. Apart from this
everything, else was fine. Now she wasn't taking drugs anymore. She was married and
wanted kids.
Then I told her about what being hepatitis C positive means, that is going to be chronic
disease (in 75% of cases), and that I would refer her to specialist because she needs blood
test to assess her liver function and she might need liver biopsy, Also, depends on the results
of the tests (genotype and viral load) she might need medication, Interferon and Ribavirin. I
also mentioned few things about safety at home. I told her that her husband is unlikely to get
hepatitis from her, but still there is a slightly chance be could get it. I offered her vaccine for
hepatitis A and B and told her to avoid taking any medication before she checks with her Dr.
Though I mentioned that it would be a chronic disease I didn't say a word about cirrhosis
(20%) and hepatoma. After I finished I asked her if she had any concerns and she said no.
Advices: Avoid alcohol – No blood donation – No shared needles or toothbrush or razor or
nail clippers – Cover up all wounds – Safe sex

Case 11: MUMPS ORCHITIS

A 26 year old man comes to see you complaining of a swollen testis. He has 2 boys and one
of them had mumps a while ago, 2 days ago your patient had himself swollen face and this
morning he woke up with left testis swollen and painful. Tell him what is happening and
your Mx, No further Hx.

I went: inside and I started by telling him that he has MUMPS ORCHITIS,
I explained to him that mumps is very common in children but when you get it as adult
things might not be that simple and actually now he is experiencing a complication of the
disease. He needs rest; maybe take few days off from work. No antibiotics because is caused
by virus. I talked then about fertility (because he and his wife wanted more kids) and I said
that his affected testis might become atrophied after this, but overall his fertility is unlikely to
be affected (even if both testes are affected) because he still has the right side to produce
normal sperm. He asked why this happened to him. (Happens in 25% of post pubertal males
3-4 days after protitis) I said because everyone is different and has a different immune
system. Not anyone who gets mumps will have orchids. What other complications? I said
pneumonia???? NOOOOOO (but I think I should have said pancreatitis) and aseptic
meningitis, Abdominal pain, Encephalitis, Deafness.

Case 12: BELL'S PALSY

This was a case about BELL'S PALSY. It was a young man who felt a pain behind his ear
and after a while his left side of the face became funny. You have diagnosed him as having
Bell’s palsy and your task is to counsel the patient about your DX and MX.

Inside was a young man who was keeping his left side of the face covered by his hand.
I started by explaining to him that we have some nerves in our brain and one of them is
affected. (Muscles on one side of the face become paralyzed because of the fault in the nerve
that controls these muscles.) The real cause for this is not known, there are only theory about
it, maybe viral infection.
What can be the possible causes he asked? A. may be some viral infection or trauma, or
swelling of the ganglion of the nerve and could it be stroke?
Well, it is true that in stroke this nerve may be affected but definitely this is not the case with
you. Do I need to see a neurologist?
Not at this point But if also the other side of the face becomes affected or if you develop
other worrying symptoms then yes I will send you to neurologist, What can I do then? How
long facing to be like this? (80% get full recovery) It depends, maybe few weeks, maybe
more (6 month). Medication usually doesn't work so; the best way would be to wait because
this condition is self limiting. (I forgot completely about Prednisone).
I mentioned about care for his eye, which he would have to cover his eye at night to prevent
damage and to eat soft food if the drop of his mouth is bothering him and massage and facial
exercise. Use of heat on the face will help. (Like face washer soaked in hot water). Just
remember that your problem soon will be settled.
Notes: Associations: HSV, DM, HTN, Thyroid disorder
Mx: Prednisolone 50 mg daily divided for 4 days then tapered over a week
Operation an option

Case 13: Diverticulitis

A mid 40's y old lady is complaining of pain in her lower abdomen. The pain increase and
decrease for few weeks now. But last night the pain was so bad that she couldn't sleep. Her
abdomen is distended and she is nauseated, not vomiting. She hasn't had breakfast. After the
birth of her children (20 years ago) she was always constipated.
Task is to perform an abdominal examination, summarize the findings and tell your
provisional DX and DD.

That was not a real patient. She was lying down with her abdomen uncovered. I said that I
am going first to give her something for pain and then I am going to examine her tummy.
On examination there was tenderness in left and right iliac fossa. Murphy sign negative.
When I said I want to auscultate the abdomen examiner said *there are no sounds*. PR was
normal and U/A not available.
Should ask about: rebound, guarding, any scar sign, orifices for hernia, any subcutaneous
bleeding (Grey turner or Cullen), degree of distension, any mass esp. tender, Liver and
spleen
Then I said that I think this is DIVERTICULITIS which has complicated giving her all these
problems, now she needs antibiotics and fluids to make her stable (she was also dehydrated)
and then she will need operation.
In this case I haven't had time to talk about DD or Investigations because bell rang; I said
something about colonoscopy but haven't had time to mention something else.
Notes: Severe pain + silent abdomen → Peritonitis
Complications: Bleeding, Perforation, Abscess, Peritonitis, Fistula, Obstruction
DDx: Appendicitis, Colon or Ovary cancer, Pyelonephritis
Inv: FBE + BC, CT with contrast (oral and IV), Abdominal X-ray, U/A
If antibiotics and IV fluids didn’t work after 48 hours then she needs operation.

Case 14: PERIPHERAL VASCULAR DISEASE

This was an old man who was a heavy smoker for many years and now he is complaining of
pain in his calf when he walks. Task is to perform an adequate physical examination and give
provisional Dx and answer examiner's questions.
That was a real patient.

On examination I couldn't feel the pulse of dorsalis pedis on the right. All other pulses were
present, it was PERIPHERAL VASCULAR DISEASE.
The examiner asked me: what are the most important clinical investigations that you could
do for this patient. I said ankle-brachial index and I explained how you do it (color Doppler
ultrasound). Angiography is just considered when the operation is contemplated. I finished
this station well ahead and I wanted to say something about MX but examiner said no MX is
required in the task. ** NO B BLOCKER**
Notes: FBE is important to R/O polycythemia or thrombocytosis, ECG (AF), BSL, U/A
Advices: stop smoking, all the lifestyle advices, Always check if the patient taking beta
blockers, Wt loss, foot care (Podiatrist), Exercise, Aspirin 150mg daily
Refer to vascular surgeon when unstable claudication, recent onset or deteriorating
Examination: Both acute and chronic ischemia:
1. Remember 6 P’s, Paralysis and muscle pain are ominous signs, Cap return, check for
irregular pulse (AF)
2. Skin: color changes, Hair distribution, wasting, temp
3. Pulses: 4 pulses
4. Pitting edema is 3 places
5. Burger’s test: raise legs 60 degree for 1 min. pallor. Then hanging from the bed and notice
color return and any unusual rubor (dusky red) skin
6. Auscultation for bruits on abdomen and femoral
Management of acute: heparin IV + emergency embolectomy + lifelong anticoagulation

Case l5: CONVERSION DISORDER

A young woman of 17 y old and her family are suffering at the bedside of their mother who
is in the terminal phase of liver disease and is awaiting her liver transplant (being on waiting
list for that). The 17 y old daughter couldn't speak any more after she heard her mother
screaming in pain a while ago.
Take further Hx from the girl (be aware that she cannot speak, she will only move her head
indicating yes or no), tell what can be the cause of inability to speak in a 17 y old girl and
outline Mx.
So, I started by asking her:
Q- Is this the first time when it happens to you?
A. Yes (nodding the head)
Q. Can you make sounds?
A. Yes (she said something like "aaaaa")
Q. Can you cough?
A. Yes she did cough,
Q. Do you feel any lump in your throat that it makes difficult for you to talk?
A, she said no,
Q. Before this happened have you had any kind of problems like sore throat, any problems
with your voice? She said no again.
Q. Apart from this have you had any other health problems and any hospitalizations?
Taking any medication? A, No
At this point I wanted to examine her and the examiner said that everything is absolutely
normal.
Then I turned to her and I said that I am really sorry for what is happening to her mother
right now and it must be a very difficult time for her and for the whole family. Because she is
suffering so much, her body tries to react and to express these feelings by making her unable
to talk. I said that there is nothing wrong with her vocal cords or her throat but I really
believe that she cannot speak; I know that she is not pretending. I said then, we call this
CONVERSION DISORDER.
I referred her for counseling or care coordinator and offered counseling for the other
members of the family as well. She only had a question: she wrote on a piece of paper; "Can
I go now and see my mum?"
I said yes, you can go but first I would prefer you to speak to the person that I was talking
about and then you can go to see the mum. Is it ok for you? She said yes, and the bell rang.

Case 16
This was a case that I haven't had many ideas about it, so, check it out.
Is about a young man who was diagnosed with schizophrenia 2 years back and now he just
had a relapse and his GP gave him Risperidone, 2 in the evening and 2 in the morning. After
this he is feeling very dizzy and he skipped his morning dose.
Task is to ask examiner a focused physical examination and to explain to the patient what is
going on and outline further Mx.
Like I said I had no many ideas about it so I started by asking neurological examination
which that was a normal. Then CVS exam-that was normal as well.
Then I said eye exam- the examiner said that I am going beyond a focused examination.
At this point I didn't know what to ask any more, because I knew there must be some clue
from the examination but what? ..
So I tried to explain to the patient that must be some side effect from medication and that I
want to ask a psychiatrist opinion about that. He said he doesn't want to see any doctor, only
me because he trusts only me. He also asked how come that this medication is making him
dizzy? I am sorry but I am not familiar with the mechanism of action of this particular drug.

Note: Atypical antipsychotics interfere with glucose metabolism so all the patients started on
these medications should be routinely checked for diabetes, BP, lipids and prolactin levels
every 6 month. Should ask about polydipsia, polyuria and….
*Risperidone also causes hyperprolactinemia so should ask about galactorrhea