Family Medicine Clerkship Logbook G3 Final

PRACTICE
OF CLINICAL MEDICINE–II (MED-501)

Year 5 (Family Medicine clerkship Rotation)
CLERKSHIP
STUDENT
PERFORMANCE
EVALUATION

GROUP 3
Student Name ID
Hussain Jwad Aljubran 2180001511
Omar Abdulqader Bamalan 2180001260
Mohammed Hashim Al Hajji 2180001572
Mohammed Abdulmohsen Alsharit 2180003854
Ahmed Ali Alshaikhi 2180003664
Omar Marwan Bakhurji 2180002200
Khalil Ibrahim Sabbagh 2180006344

Mentor: Dr. Najwa A. Zabeeri
PRACTICE OF CLINICAL MEDICINE–II (MED-501)
E-LOGBOOK
FAMILY MEDICINE DOCUMENTATION CARD –LOGBOOK RESULTS

Student Name: Group 3 ID:
Total patients encountered: 53 Total problems encountered: 68

Age: Mean: 39.35 ± SD 16.64 Min: 2M Max: 75
Ranges: No. % Medical Problems No. % Medical Problems No. %
<1 Arthritis 1.4705 Dyslipidemia 2.94118
1 1.8 1 9
2
1-5 1 1.8 URI Anemia 2 2.94118
6-12 0 0 Depression Acid reflux 2 2.94118
13-21 8 15 Back pain 5 7.3529 Hypertension 4 5.88235

4
22-40 15 28 Obesity Fracture
41-65 26 49 Other ENT/Resp. H. Pylori 1 1.47059
over 65 2 3 Other neurological Hernias 2 2.94118
CHF/CAD 1 1.4705 Lumps 1 1.47059

9
Gender No. % Viral Syndrome Bleeding disorder 1 1.47059
Males Other female GU 2.9411 Vitamin D deficiency 1.47059

22 42 2 8
1
Females 31 58 Asthma Adhesive Capsulitis 1 1.47059
Allergies Knee Pain 2 2.94118
Nationality No. % Male GU 2 2.9411 Abortion 1 1.47059

8
Saudi 39 73.58 Abdominal pain
Non-Saudi 14 32.08 Other 1 1.4705
9
Cardiovascular
Headaches 3 4.4117
6
Medical Problems No. % Anxiety 1 1.4705
9
Otitis Media Pregnancy 4.4117
3 6
Contraception 1 1.470 Other Psychosocial
59
Family problems Sprains/strains 1.4705
1 9
Tendonitis/bursitis 1 1.470 Pharyngitis 1 1.4705
59 9
Bronchitis Cancer
Menstrual Disorder 1.470 Fatigue 2.9411
1 59
2 8
Arrhythmia 1 1.470 Sinusitis
59
Gastroenteritis Dermatitis
Ulcer/gastritis Other Metabolic
Acne 1 1.470 Thyroid 2 2.9411
59 8
Rectal bleeding COPD
Lacerations/abrasion Chest pain 1 1.4705
9
Dementia Dizziness/vertigo
Pelvic Pain/Infection UTI 1 1.4705
9
Breast Problems Alcohol/subst.

abuse
Conjunctivitis 1 1.470 Alcohol/subst. I certify that this logbook is my
59
abuse own original work at this
Diabetes 8 11.76 Alcohol/subst. rotation.
47
abuse
Adverse Drug Reaction Alcohol/subst. Resident's Signature
abuse
Occupational problems Vaginitis _________________________
1 1.4705
9
Health Maintenance 5 7.352 Other Skin 1 1.4705
94 9
STUDENT LOGBOOK
Never show patient name
Case No: 1 Date: 31/08/2021

Medical Record No. 149632 Age: 75 Sex: F Nationality: Saudi
Arabia
Type of New Acute Problem Chronic Problem X Antenatal Care
Visit:
Reason for Encounter: Follow up for Uncontrolled Hypertension
Problem List: Uncontrolled Hypertension
Controlled Diabetes
Dyslipidemia
Hypothyroidism
Osteoporosis
Percutaneous Coronary Intervention
My How to keep your track of thoughts in managing such patients with various chronic
Educational comorbidities?
Needs and How to catch upon the patient's worries and reassure them (if possible) or clarify a
Reflection: misconception?
Case No: 2 Date: 31/08/2021

Medical Record No. 428076 Age: 64 Sex: M Nationality Saudi
: Arabia
Visit:
Reason for Encounter: Follow up for Hypertension and Diabetes Mellitus
Problem List: Controlled Hypertension
Controlled Diabetes Mellitus
My How to empathize, no matter how strong-welled or independent the patient looks?

Educational When to screen with the PHQ2 and FOB test?
Needs and
Reflection:
Case No: 3 Date: 31/08/2021

Medical Record No. 1393915 Age: 56 Sex: F Nationality Saudi
: Arabia
Visit:
Reason for Encounter: Follow up for Headache and Diabetes Mellitus
Problem List: Controlled Hypertension
Controlled Diabetes Mellitus
GERD
Headache
My When is it recommended to screen for domestic violence?
Educational Side effects of PPI's?
Needs and
Reflection:
Case No: 4 Date: 31/08/2021

Medical Record No. 1534103 Age: 49 Sex: F Nationality Philippin
: e
Visit:
Reason for Encounter: Follow up for Headache
Problem List: Headache
Palpation
Dizziness
My Guidelines of diagnosing hypertension.
Educational Guidelines for treating and preventing hypertension.
Needs and
Reflection:
Case No: 5 Date: 31/08/2021

: Arabia
Visit:
Reason for Encounter: Chronic Cough
Problem List: Chronic cough
Hot flashes
Abdominal distention
Weight gain
Heartburn after meals
My What is the importance of 24-PH monitoring?
Educational Could H. Pylori be a cause of irritant coughs?
Needs and
Reflection:
Case No: 6 Date: 31/08/2021

: Arabia
Visit:
Reason for Encounter: Follow up for nausea started 3 months ago
Problem List: Nausea
Weight loss
Heartburn
My How to screen for eating disorders?
Educational
Needs and
How to diagnose Anorexia nervosa and bulimia nervosa?
Reflection:
Case No: 7 Date: 31/08/2021

: Arabia
Visit:
Reason for Encounter: Fatigue
Problem List: Fatigue
Burning sensation in both legs
Weight loss
My How can the psychological issues play a rule in different medical conditions?
Educational Chronic fatigue syndrome diagnosis?
Needs and
Reflection: Fatigue patient recommended education points and management?
Case No: 8 Date: 7/9/2021

Medical Record No. 1619515 Age: 1.5 Sex: M Nationality Jordanian
:
Type of New X Acute Problem Chronic Problem Antenatal Care
Visit:
Reason for Encounter: Scheduled Vaccination
Problem List: Vit D deficiency
My Saudi MOH immunization schedule?

Educational Vaccines' contraindications?
Needs and
Reflection: Vit D and immunity?
Case No: 9 Date: 31/08/2021

: Arabia
Visit:
Reason for Encounter: Follow-Up for an elevated B12 and referral to OB/GYN
Problem List: Fatigue, Chronic Diarrhea
Endometrial thickening
Elevation of Vitamin B12
My How to clarify abnormal results to the patients?
Educational Causes of elevated Vitamin B12 level?
Needs and
Reflection:
Case No: 10 Date: 31/08/2021

Medical Record No. # Age: 27 Sex: F Nationality Saudi
: Arabia
Type of New Acute Problem X Chronic Problem Antenatal Care
Visit:
Reason for Encounter: Painful lump in the hand
Problem List: Diabetes mellitus type II
Hypothyroidism
Painful lump in the hand
My How to investigate a lump and when do you refer?
Educational What are the red flags for a lump?
Needs and
Reflection:
Case No: 11 Date: 31/08/2021

: Arabia
Visit:
Reason for Encounter: Follow-Up For DM II
Blurred vision, Numbness
Knee Pain
Urgency with low urine output
DM II
My What are lifestyle and exercise modifications needed?
Educational Guidelines for screening of BPH (PSA or US)?
Needs and
Reflection:
Case No: 12 Date: 07/09/2021

Medical Record No. 1108962 Age: 54 Sex: M Nationality Egyptian
:
Visit:
Reason for Encounter: Follow-Up
Problem List: Chronic Conjunctivitis, history of cataract surgery in both eyes
Benign prostatic hyperplasia (incontinence, urgent, low urine stream)
Previous inner ear infection
Previous bronchitis
Prediabetic
My Approach to Inner ear infections?
Educational Management of bacterial Bronchitis? Type of antibiotics?
Needs and
Reflection:
Case No: 13 Date: 07/09/2021

: Arabia
Visit:
Reason for Encounter: Follow-Up For DM II
Problem List: DM, HTN, Thyroid Resected, dyslipidemia, meniscus tear.
Blurred vision, increased frequency of urination, pain and numbness in the
fingers
Fatigue, shortness of breath, dizziness.
My What are the Activities' modifications needed?

Educational
Needs and
Type of surgical, meniscal repair?
Reflection:
Case No: 14 Date: 07/09/2021

Medical Record No. 1638061 Age: 2M Sex: F Nationality SA
:
Visit:
Reason for Encounter: Scheduled Vaccination with umbilical hernia
Problem List: 2 vaccines were taken
2 vaccines will take it in this visit.
Reducible umbilical hernia
My The milestones for pediatric patients in 2 months of age?

Educational Approach to pediatric umbilical hernia?
Needs and
Reflection: Type of vaccines? and contraindications?
Case No: 15 Date: 07/09/2021

Medical Record No. 1242008 Age: 35 Sex: F Nationality Jordan
:
Visit:
Reason for Encounter: Follow up for diabetes type 2
Problem List: Diabetes type 2
Iron deficiency anemia
My What are the goals in gestational diabetes?

Educational Dose of elemental iron needed in pregnancy?
Needs and
Reflection:
Case No: 16 Date: 07/09/2021

: Arabia
Type of New Acute Problem Chronic Problem x Antenatal Care
Visit:
Reason for Encounter: Follow-Up for HTN, Obesity
Problem List: Hypertension
Obesity, trigger finger
Knee pain
My Management of trigger finger?

Educational Relationship between obesity and trigger finger?
Needs and
Reflection:
Case No: 17 Date: 07/09/2021

: Arabia
Visit:
Reason for Encounter: Sore throat for 5 days
Problem List: Sore throat
Fever
Headache
My How can we diagnose acute pharyngitis by centor criteria?

Educational How to differentiate between bacterial and viral pharyngitis?
Needs and
Reflection:
Case No: 18 Date: 13/09/2021

: Arabia
Visit:
Reason for Chronic lower back pain
Encounter:
Problem List: Lower back pain
Chronic constipation
Carpal tunnel syndrome right hand
blurred vision
Right Ear pain and left ear partial hearing loss
Fatigue
My Differential diagnosis for LBP?

Educational How to differentiate radiculopathy from myelopathy?
Needs and
Reflection:
Case No: 19 Date: 13/09/2021

: Arabia
Visit:
Reason for wrist pain
Encounter:
Problem List: Rheumatoid arthritis
Osteoporosis
Wrist pain
My How to deal with uncontrolled RA?

Educational Connections between OP and RA? (is it secondary to treatment or part of pathology?)
Needs and
Reflection:
Case No: 20 Date: 13/09/2021

: Arabia
Type of New x Acute Problem Chronic Problem Antenatal Care
Visit:
Reason for Encounter: Irregular heartbeats
Problem List: Palpitation
Night sweats
Left arm pain
Irregular heartbeats
My What are the indications for EKG?
Educational
Needs and
Typical vs atypical angina?
Reflection:
Case No: 21 Date: 13/09/2021

: Arabia
Visit:
Reason for Encounter: Follow-Up for fatigue
Tension headache
Renal stones
Vitamin D deficiency
How to approach renal stones?
My Indications for a double-j stent?

Educational
Needs and
Reflection:
Case No: 22 Date: 13/09/2021

: Arabia
Visit:
Reason for Encounter: Vitamin D Deficiency
Problem List: Vitamin D deficiency
Iron Deficiency Anemia
Diabetes Mellitus
My The use of multivitamin drugs in patients with vitamin D deficiency or iron

Educational deficiency anemia, is it beneficial?
Needs and Loading Dose needed for vitamin D deficiency?
Reflection:
Case No: 23 Date: 13/09/2021

: Arabia
Type of New x Acute Problem Chronic Problem Antenatal Care
Visit:
Reason for Encounter: Shoulder pain
Problem List: Shoulder pain
Knee pain
Headache
My The role of physiotherapy in knee pain?

Educational The relation between knee pain and back stiffness, is it rheumatological?
Needs and
Reflection:
Case No: 24 Date: 13/09/2021

: Arabia
Visit:
Reason for Encounter: Diabetes Mellites Follow-up
Problem List: Diabetes mellitus
Overweight
Hypertension
Back pain
My The role of reducing weight in controlling DM and HTN?

Educational Weight reduction and effects of decreasing LBP?
Needs and
Reflection:
Case No: 25 Date: 13/09/2021

Medical Record No. 1387873 Age: 56 Sex: m Nationality Non-
: Saudi
Visit:
Reason for Encounter: Follow up for diabetes type 2 and hypertension
Problem List: Diabetes type 2, Hypertension
Previous MI with CAS placement
Previous mal-rotated L. kidney, urolithiasis in R. kidney, urine hesitancy
Bilateral loin pain
My Examination of diabetic foot
Educational Role of herbal medicine in treating longstanding DM 2?
Needs and
Reflection:
Case No: 26 Date: 13/09/2021

Medical Record No. 1397909 Age: 41 Sex: m Nationality Non-saudi
:
Visit:
Reason for Encounter: Follow up for diabetes type 2
Problem List: Diabetes type 2
My Learn more details about lifestyle modifications to help DM2 patients who prefer
Educational them over medications
Needs and Indications for medications in patients who are managing their diabetes with life-style
Reflection: changes only.
Case No: 27 Date: 13/09/2021
Medical Record No. 1245354 Age: 36 Sex: M Nationality Non-saudi

:
Type of New Acute Problem x Chronic Problem Antenatal Care
Visit:
Reason for Encounter: Sore throat for 2 days
Problem List: Palpitation and hotness after eating
Dry skin
Hair loss
Chest pain
Stiffness in the whole body
Sore throat
My Treatment algorithm for Hair loss?
Educational differential diagnosis of sore throat?
Needs and
Reflection:
Case No: 28 Date: 14/09/2021

:
Visit:
Reason for Encounter: Right knee pain for 1 year and half
Problem List: Knee pain
My What is the best imaging modality for this knee injury?
Educational Red flags of knee pain and when to consider referral?
Needs and
Reflection:
Case No: 29 Date: 14/09/2021

:
Visit:
Reason for Encounter: Follow up for dyslipidemia
Problem List: Dyslipidemia
Smoking
My How to perform smoking counselling?

Educational
Needs and
Reflection:
Case No: 30 Date: 20/09/2021

:
Visit:
Reason for Encounter: Follow up for Acne vulgaris
Problem List: Acne vulgaris
My How to diagnose and manage Acne vulgaris?
Educational Complications if not treated?
Needs and
Reflection:
Case No: 31 Date: 20/09/2021

:
Visit:
Reason for Encounter: Follow up spontaneous bruising
Problem List: Multiple bruises
Episode of epistaxis
Menorrhagia
My Role of abdominal Ultrasound in bleeding disorders?

Educational Pt and aPTT abnormalities and differential diagnosis?
Needs and
Reflection:
Case No: 32 Date: 21/09/2021

:
Visit:
Reason for Encounter: Follow up for alpha thalassemia & IDA
Problem List: Alpha-Thalassemia
My How to differentiate between types of alpha thalassemia?

Educational Differences between alpha and beta thalassemia in clinical presentation?
Needs and
Reflection:
Case No: 33 Date: 20/09/2021

Medical Record No. 1222724 Age: 45 Sex: F Nationality Egyptian
:
Visit:
Reason for Encounter: Vaginal discharge
Problem List: Recurrent vaginitis
Painful intercourse
IUD implant
Vaginal discharge
My Educational What are the symptoms of vaginitis?
Needs and
Reflection: What are the adverse effects of IUD?
Case No: 34 Date: 20/09/2021

:
Visit:
Reason for Encounter: Low back pain
Problem List: Low back pain
My Common causes of LBP in young patients?
Educational
Needs and
Reflection:
Case No: 35 Date: 13/09/2021

: Arabia
Visit:
Problem List: Vitamin D deficiency
Prediabetic
IDA
My How to manage prediabetes?

Educational Connection between diabetes and IDA?
Needs and
Reflection:
Case No: 36 Date: 13/09/2021

: Arabia
Visit:
Reason for Encounter: Multiple Complaints
Problem List: Back Pain
Numbness of left the hand
Left ear pain
Right eye refractory reduction
Asthma
Hair loss
Chronic constipation
Post-COVID-19 Smell loss
My ENT examination
Educational Examination of CTS
Needs and
Reflection: Causes of hair loss
Case No: 37 Date: 14/09/2021

: Arabia
Visit:
Problem List: Shoulder Pain for 1.5 year
BPH, HTN, DM II, Dyslipidemia,
Heavy Smoker (Shishya) 3 per day for the last 15 years
My How to advice for smoking cessation

Educational What is the recommended screening tools for the patient?
Needs and
Reflection: When to refer for surgery in adhesive capsulitis?
Case No: 38 Date: 14/09/2021

Medical Record No. # Age: 29 Sex: M Nationality Saudi
: Arabia
Visit:
Reason for Encounter: Knee pain
Problem List: No deformity. No R.O.M. No disability
Asthma
ACL repair three years ago
Meniscal tear repair six months after the ACL repair
Knee pain
My Examination of ACL
Educational Examination of Meniscal tear (special test and their sensitivity)?
Needs and
Reflection:
Case No: 39 Date: 14/09/2021

: Arabia
Visit:
Reason for Encounter: Headache
Problem List: Cluster episodic headache?
Insomnia
My How to diagnose cluster headache?
Educational What initial investigation should you do for headache?
Needs and
Reflection: Cluster headache vs migraine?
Case No: 40 Date: 21/09/2021

: Arabia
Visit:
Reason for Encounter: Follow-Up for Fill-up medication
Problem List: DM
HTN
Coronary Stent
My The indications of starting Aspirin?

Educational How to differentiate true for false HbA1C elevation?
Needs and
Reflection:
Case No: 41 Date: 28/09/2021

: Arabia
Visit:
Reason for Encounter: Follow up for HTN and hypothyroidism
Problem List: Hypertension, hypothyroidism, dyslipidemia
Sleep disturbance
Irregular menstruation
My How to identify perimenopause symptoms?

Educational When to call a female menopausal?
Needs and
Reflection:
Case No: 42 Date: 28/09/2021

: Arabia
Visit:
Reason for Encounter: Palpitation and right foot numbness
Problem List: Cardiac arrythmia
Eczema
Anxiety
Palpitation
Right foot numbness
My Educational
Needs and
Is there a link between E-cigarette smoking and patient’s complaints?
Reflection: E-cigarettes and arrhythmias/pneumothorax?
Case No: 43 Date: 28/09/2021

:
Visit:
Reason for Encounter: Difficulty in urination
Problem List: Difficulty in urination & swallowing
Weak urine stream
Post-void drippling
My What are the differential diagnoses of enlarged prostate?
Educational
Needs and
Reflection:
Case No: 44 Date: 28/09/2021

Medical Record No. - Age: 40 Sex: F Nationality Philippine
:
Visit:
Reason for Encounter: Pregnant with vaginal bleeding
Problem List: First trimester Incomplete abortion
Vaginal bleeding
My Types of abortion?
Educational Management of abortion medically and surgically?
Needs and
Reflection:
Case No: 45 Date: 28/09/2021

Medical Record No. 1634198 Age: 31 Sex: F Nationality Hindi
:
Type of New Acute Problem Chronic Problem Antenatal Care X
Visit:
Reason for Encounter: Regular pregnancy F/U, GDM check
Problem List: GDM
Classic Migraine with visual aura
Back pain (strain)
My GDM management goals?
Educational How to approach a pregnant lady with GDM?
Needs and
Reflection: Complications of GDM?
Case No: 46 Date: 3/10/2021

Medical Record No. 1200927 Age: 55 Sex: M Nationality Algeria
:
Visit:
Problem List: Nocturia & Urinary incontinence
Proteinuria
Testicular cyst removal followed by erectile dysfunction
Postvoiding dripping, sensation of incomplete emptying
My How to approach Proteinuria and the causes of it?
Educational How to manage erectile dysfunction and what are the causes?
Needs and
Reflection:
Case No: 47 Date: 3/10/2021

: Arabia
Visit:
Problem List: Alopecia areata with no response to medication
Past surgical history of Bariatric surgery
My When to switch from minoxidil to topical corticosteroids?
Educational Bariatric surgery indications? And types?
Needs and
Reflection: The importance of checking vitamin B12 level?
Case No: 48 Date: 3/10/2021

Medical Record No. 1385629 Age: 48 Sex: M Nationality Indian
:
Visit:
Reason for Encounter: Follow-Up with new complaint
Problem List: Burning sensation & feeling of Acidity with water blushing twice daily
Back pain
HTN
Prediabetes
My The non-pharmacological management & the pharmacological management of
Educational GERD?
Needs and How to reestablish a rapport after a long period of not visiting the clinic
Reflection:
H2-antagonist vs PPI efficacy?
Case No: 49 Date: 5/10/2021

Medical Record No. 1416700 Age: 34 Sex: F Nationality Filipino
:
Type of New Acute Problem Chronic Problem Antenatal Care X
Visit:
Reason for Encounter: Antenatal care
Problem List: Dark urine
Back pain
Controlled by diet DM type II
My Diagnosis of UTI?
Educational How to differentiate from pre-existing DM vs GDM?
Needs and
Reflection: How to differentiate between placental sounds and the fetus pulse during US?
Case No: 50 Date: 03/10/2021

: Arabia
Visit:
Reason for Encounter: Right elbow pain for 1 month
Problem List: Right elbow pain
Burning sensation of feet
My Clinical presentation and physical examination tests and findings for lateral
Educational epicondylitis?
Needs and Treatment algorithm for lateral epicondylitis?
Reflection:
Case No: 51 Date: 05/10/2021

: Arabia
Visit:
Reason for Encounter: Right knee pain for 5 years
Problem List: Right knee pain & buckling
My How to diagnosis osteochondroma?
Educational
Needs and
Time until it turns to a Sarcoma?
Reflection:
Case No: 52 Date: 5/10/2021

Medical Record No. 985010 Age: 59 Sex: M Nationality Egyptian
:
Visit:
Reason for Encounter: Follow up for vertigo
Problem List: Vertigo
DM2
Past URTI and otitis media
My Physical examination to differentiate causes of vertigo?

Educational How to differentiate causes vertigo based clinical presentation?
Needs and
Reflection:
Case No: 53 Date: 05/10/2021

: Arabia
Visit:
Reason for Encounter: Follow up for hypertension suspicion
Problem List: Allergic rhinitis
External hemorrhoids
IBS
Constipation
My What are the secondary causes of high blood pressure?
Educational How can we rule out white coat syndrome?
Needs and
Reflection:
SHORT CASE WRITE-UP
Case No: 1 of 9 Date: 30/08/2021

File # 149632 Age: 75 Sex: ❒M Nationality: Saudi Arabian
❒F
1. Reason for encounter
or Chief complaint Follow up for her hypertension, diabetes and hypothyroidism.
2. Relevant history (Hx) 75 years old, female, retired teacher, from Al-Ahsa
(ICEE, ….) k/c of hypertension (on Co-Diovan)
controlled Diabetes type 2 (on metformin), dyslipidemia (on Atorvastatin)
hypothyroidism (on levothyroxine) and osteoporosis (on Alendronate)
Came to the clinic to review her current lab results and expecting
improvement.
ROS:
● Fatigue for a month, the patient says it's due to a personal, familial issue and
generalized hair loss for the past couple of months (⁓ 6 months)
● Rest is unremarkable
Past Medical Hx
● Bilateral foreign sensation in the eye (last visit, 3 months ago) improved with
eye Lubricants
● DM 2: controlled (HbA1c 6.8 %), diagnosed 1 month ago, compliant on
Metformin once per day
● Hypertension: uncontrolled (ABPM day mean 158.5/89), diagnosed 18-20
years ago, on Co-Diovan once per day
● Dyslipidemia: 18-20 years ago, compliant on Atorvastatin, no complains or
side effects
● Osteoporosis: compliant on Alendronate once per week, no complains or side
effects
● Hypothyroidism: compliant of Levothyroxine once per day, no complains or
side effects
Past Surgical Hx
● Laparoscopic cholecystectomy, ⁓ 35 years ago with no complications or ICU
admission
● S/P Coronary artery stent placement, 3 years ago with no complications
Family Hx
● Parents have Hypertension and are compliant to their medication, no HTN
associated complications
● Hypothyroidism in all siblings, patient is not sure about their compliance
Medications and Allergies

● Metformin
● Atorvastatin
● Levothyroxine
● Alendronate
● Co-diovan
● Aspirin (patient forgot to take it last visit 3 months ago)

● No known Allergies
Social Hx
Patient has a low sugar, low diary products, low meat diet
Moves around regularly with no set regimen of exercises
PHQ2 -ve
Non-smoker
ICE
● Idea: the patient has no thoughts about her conditions
● Concern: patient was concerned about her Alopecia
● Expectations: the results and clarification of labs
3. Relevant Physical Generally:

Examination (Ex) Consent was taken and privacy was ensured
The patient was vitally stable (except the uncontrolled HTN)
Sat oriented to TPP, no specific color or decubitus and no sign of distress
or agitation.
Neck examination:
● No signs of inspected swelling, erythema, scars or tethering and no
lymphadenopathy or tenderness
● Thyroid was palpable, soft with no nodularity, swelling or compressive
symptoms
Chest examination:
● Symmetrical, Bilateral, clear air entry with no added sounds

● normal S1 and S2 with no added sounds or murmurs
Neurovascular Lower limb examination

● On inspection there were no signs of atrophic changes
● Palpable strong pulses (DP and posterior tibial), No signs of DVT or edema
● Motor (power +5), Reflexes (+2), Sensation and proprioception intact
Metabolic syndrome
4. Differential Diagnosis
cushing syndrome
(DDx)
other Autoimmune diseases (e.g. AI pancreatitis type 1)
Patient was well-educated, open to discuss her regimen and cooperative to

5. Impression: have the talk about new or different therapies.
Uncontrolled HTN
Controlled DM
6. Problem List: Osteoporosis
(Patient: DLP
Biopsychosocial Hypothyroidism
+ family) S/P PCI, 3 years ago and stopped Aspirin intake 3 months ago (patient
forgot to take it from the pharmacy)
● Clarifications About Metformin and the clinical utility of the 500 mg,
bid rather than once a day, as that's of no known therapeutic
significance.
● Reassured the patient about the possible cause of alopecia and fatigue
(the possible correlation with the past year's TSH fluctuations) and
advised her to continue her drugs and observe for changes.
● Advised the patient about foot care and about Home BP device use (as
the patient complain that her readings in the house are lower than in the
7. Management plan &
center), that's why an ambulatory BP monitor was installed.
Intervention:
(CRAPRIOP) ● Prescribed additional (Amlor, 5 mg) and Re-prescribed (Aspirin),
discussed the possible adverse effects and alternatives.
● Referral to ophthalmology (for yearly check).
Plan:
CST
F/U after 3 months with labs (RFT, TSH, FT3/FT4, RBG/FBG/HbA1c,
lipid profile)
Rechecking the control over her HTN after the addition of Amlor
How to keep your track of thoughts in managing such patients with various
6. Questions & chronic comorbidities?
Reflection How to catch upon the patient's worries and reassure them (if possible) or
What did I learn? clarify a misconception?
What I need to learn?

I need to work on a more patient-centered approach.
Your reflection on the
experiences + Although, the Consultant was managing 3 clinics with different patients
EBM, Practice and diseases, she surprisingly was able to empathize, clarify and discover
management…. the patient's hidden worries.
7. Supervisor 's
Feedback
(Case discussed with) Supervisor's Name: Signature Date
I certify that this case write-up is my own original work at this Student's Signature:
rotation
Case No: 2 of 9 Date: 31/08/2021

❒F
1. Reason for
encounter or Chief Follow up for his Hypertension and Diabetes
complaint
2. Relevant history 64 years old, male, businessman, from Hail
(Hx) k/c of hypertension (on Co-Diovan)
(ICEE, ….) controlled Diabetes type 2 (on Juvana)
Came to the clinic to review his current lab results and expecting
improvement.
No active complaints or worries
On Review of systems the patient has nocturia with no other urinary
obstructive or irritative symptoms
Past Medical Hx
● DM 2: controlled (HbA1c 6.3 %), diagnosed ⁓14 years ago, compliant on
Juvana once a day with no complains
● Hypertension: controlled (138/81), diagnosed ⁓14 years ago, on Co-Diovan
once per day with no complains
● No DM or HTN associated complications except for an episode of
hypoglycemia last Ramadan and was treated at home with a bottle of juice and
didn't go to the hospital (that's the only time)
Past Surgical Hx
● Left inguinal hernia repair, 3 years ago with no complications or ICU stay
Family Hx
● All siblings have DM and HTN with no known complications
● Juvana
● Co-diovan
Social Hx
Patient has a low sodium, low diary products and low lipids diet
Exercises regularly (walk), but for the past period he stopped due to the hit
weather
Non-smoker, No alcohol
ICE
● Idea: patient expressed none
● Concern: patient expressed none
● Expectations: the results of labs and his current status

The patient was vitally stable
Sat oriented to TPP, no specific color or decubitus and no sign of distress or
agitation.
Chest examination:
● Equal, Bilateral, clear air entry with no added sounds
Abdominal examination:
● Soft and lax abdomen with no tenderness and no signs of distention or
organomegaly
● On inspection there were signs of atrophic changes (mild hair loss, fissured
nails, dry skin)
● Palpable strong pulses (DP and posterior tibial), No signs of DVT or edema
● Motor (power +5), Reflexes (+2), Sensation and proprioception intact
4. Differential Metabolic syndrome

Diagnosis (DDx)
Patient was a light-spirited gentleman with a conservative attitude towards
5. Impression: changing regimens or implementing a healthy lifestyle.
6. Problem List: Controlled DM and HTN

(Patient:
Biopsychosocial
+ family)
● Clarified proper foot care to the patient and educated the patient about
obstructive urinary symptoms and that if the patient has any symptom to
attend to the clinic for a prostate Ultrasound and PSA check.
● Reassured the patient about the labs (HbA1c/FBG, lipid profile).
● Re-Prescribed the patient's drugs.
Intervention:
● Preventive Screening by FOB test, as the patient refused all preventive
(CRAPRIOP) referrals at this period.
Plan:
CST
F/U after 3 months with labs (HbA1c, FOB test)
Ask PHQ2 on next visit
Discuss preventive referrals
Although, the patient was a well-gathered, independent man I could see in
6. Questions & his eyes the relief of knowing he's on the safe side of his disease.
Reflection I learned to empathize, no matter how strong-welled or independent the
What did I learn? patient looks.
When to screen with the PHQ2 and FOB test?
What I need to learn? The consultant walked in and had a quick personal talk with the patient,
Your reflection on the reassured the patient and got the patient out of the clinic with a smile.
experiences + Medicine in a nutshell.
EBM, Practice
management….
7. Supervisor 's
Feedback
rotation
Case No: 3 of 9 Date: 31/08/2021

❒F
1. Reason for
encounter or Chief Follow up for her Hypertension, Diabetes and Dyslipidemia
complaint
2. Relevant history 56 years old, female, housewife, from Al-Ahsa
(Hx) k/c of hypertension (on lisinopril and atenolol)
(ICEE, ….) Diabetes type 2 (on metformin and sitagliptin)
Dyslipidemia (on atorvastatin)
Came to the clinic for routine follow up and reviewing lab results.
No active complaint or worries
No history of macro/microvascular complication
No signs of hyperglycemia
Last retinal check was 4 years back
She takes all her medication at night
PHQ9 was only positive for sleep disturbances, which the patient reports that
the night awakening happened to her since she was young.
Review of system
● Heartburn especially when lying flat
● Sore throat, no other symptoms, and the patient says it is a familial issue
(tonsillar illnesses)
Past medical Hx
● DM for 7 years, and he first presentation was a diagnosed DKA, and ICU
admission for 1 week, in which they started her on insulin injection for 3
months after that then transferred her to (metformin and sitagliptin) in which
the patient has been compliant on and with no complains.
● HTN for 1 year, presented to the clinic after feeling episodes of dizziness,
headache and palpitations, her BP was above (160/85) and she was started on
Lisinopril and Atenolol.
● DLP was diagnosed with the HTN and was treated with Atorvastatin.
Past Surgical Hx
● Laparoscopic cholecystectomy 5 years ago with no complications or ICU
admission
Family Hx
● Brother had hypertension, compliant on his medications

● Lisinopril
● Atenolol
● metformin
● atorvastatin
Social Hx
Low sugar and lipid diet

A housewife, working in the house
Sometimes a secondhand smoker
No smoking or alcohol consumption or use of illicit drugs
ICE
● Expectations: the results of her labs and the medications use timing

BP 145/94, other vital signs are within normal range
Sat oriented to TPP, no specific color or decubitus and no sign of distress or
agitation.
Chest examination:
● Equal, Bilateral, clear air entry with no added sounds

Abdominal examination:
● Soft and lax abdomen with no tenderness and no signs of distention or
organomegaly
● Pulses are intact, power 5, monofilament -ve
Drug-induced esophagitis
4. Differential
Diagnosis (DDx)
metabolic syndrome
Menopause
Patient was friendly and kind, her son was with her during the visit and
5. Impression: clarified some points of her medical history, she has supportive family
6. Problem List: Controlled DM and HTN

(Patient: GERD
Biopsychosocial
+ family)
● Clarified to the patient, the use of anti-HTN drugs, taking lisinopril in the
morning and atenolol at night for better BP control and proper technique
to take a BP reading at home.
● Reassured the patient about the labs (HbA1c/FBG, lipid profile).
● Advised the patient about the availability of Janumet which is the
7. Management plan & combination of what she is taking, in which the patient agreed to the
Intervention: change with no concerns.
(CRAPRIOP) ● Preventive screening by FOB test.
Plan:
F/U and having a (Hba1c) check after 3 months
Prescribe Janumet, bid and Nexium
Patient refused mammogram and pap smear, consider ask the patient on next
visit
FOB test is sent and will be discussed next visit.
I learned that it is recommended to screen for depression for every patient

6. Questions & during their visit
Reflection
What did I learn?
The consultant empathized with the patient and asked if she had any
What I need to learn? concerns.
experiences + I need to work more on my history taking skills.
EBM, Practice
management….
7. Supervisor 's
Feedback
rotation
Case No: 4 of 9 Date: 31/08/2021

File # 1534103 Age: 49 Sex: ❒M Nationality: Philipino
❒F
1. Reason for
encounter or Chief Follow up for her Hypertension and a new complaint of Headache
complaint
2. Relevant history HPI:
(Hx) A 49-year-old married Filipino female presented to the clinic for a follow-up
(ICEE, ….) related to the headache that started three months ago. The patient stated that
her headache is episodic (1 hour), located at the back of her head not
radiating to any limb, dull in character, aggravated when she wakes up and it
is alleviated by taking her medication which is Valsartan,7 out of 10 in
severity.
No visual or sensory aura prior to episode
No neurological red flags
No fever, weight loss, visual defects, night sweats or neck rigidity
Past medical & surgical history:

The past medical history is unremarkable. Additionally, she took all her
vaccinations and never had blood transfusion. Also, she was not admitted to
the hospital or performed any surgeries.
Family history:
Her mother and father died (naturally during sleep). However, her mother
had a history of controlled hypertension and diabetes mellitus, with no prior
macro-/micro-vascular complications.
Drug:
Patient is on Valsartan sense her diagnosis which was from three months
ago, no allergies and not using any herbal remedies.
Social history:
Patient is neither smoker nor alcoholic. She is on a healthy diet which
contains a good amount of proteins and vegetables, No exercise. Finally, the
patient is working in a supportive environment as a housemaid.
ICE-Impact:
The patient is aware that she has hypertension. Also, she is concerned it may
affect her heart and causes serious heart diseases. The patient expected from
the doctor to refill her medications and perform the needed laboratory tests.
She added that her problem impacted her life negatively by reducing her
concentration.
Review of systems:
Unremarkable.
3. Relevant Physical
Examination (Ex) ● Vital signs: Pulse:120 BP:134/82 O2:100% Temp:36.9
● General appearance: The patient has a normal body built and she is mentally
oriented and aware, but drowsy looking and fatigued.
● Precordium examination was unremarkable.
(Couldn't perform a full examination due to the patient's status in which she had to
be transferred to the urgent care for close monitoring)
Uncontrolled Hypertension (depending on the apparent differences in Asian

parameters)
4. Differential Muscle pain
Diagnosis (DDx) Tension headache
Common migraine without aura
5. Impression: Her headache is most likely caused by hypertension.
Headache
6. Problem List:
(Patient: Hypertension
Biopsychosocial
+ family)
● Clarified to the patient the her headache is most likely attributable to the
elevation of her blood pressure.
● Reassured her that lowering the blood pressure to the optimal level will
resolve the headache
7. Management plan & ● Advised her about some lifestyle changes (e.g. DASH diet and
Intervention: exercising).
(CRAPRIOP)
● Re-Prescribed Valsartan, 80 mg, OID
Plan
F/U after 3 months and re-check CBC, lipid profile, HbA1C

Ask PHQ2 and assess anxiety levels
6. Questions & ● Guidelines of diagnosing hypertension

Reflection
● Guidelines for treating and preventing hypertension
What did I learn?

Your reflection on the ● Reviewing the guidelines
experiences + ● Learning the difference between urgent vs emergent hypertension
EBM, Practice
management….
7. Supervisor 's
Feedback
rotation
Case No: 5 of 9 Date: 31/08/2021

❒F
1. Reason for
encounter or Chief Follow up for her Chronic Cough
complaint
(Hx) A 51-year-old,married, Saudi, female presented to the clinic for a follow-up
(ICEE, ….) related to a chronic cough for the last three to four years. The cough is very
severe. The cough is not aggravated by anything as she stated. Also, the
cough is alleviated by using a nebulizer device to relieve the symptoms. The
cough is associated with weight gain, hot flashes (coming in unpredicted
episodes, no aggravating or alleviating factors and not related to stress, food
or coffee), and heart burns after meals.
No fever, night sweats, headache, paresthesia, abnormal uterine bleeding or
changes in striae color
Past Medical & Surgical History:
The past medical and surgical are unremarkable. She took all her
vaccinations. She has not undergone any blood transfusion.
Family History:
Family history is positive for multiple cancer cases like breast cancer, colon
cancer, pituitary adenoma, and pancreatic cancer.
Drugs:
The patient is on a corticosteroid inhaler and no additional drugs.
Furthermore, the patient has no allergies and uses no herbal remedies.
Social History:
The patient is a housewife with a great and supportive environment. Also,
the patient/her husband are neither smokers nor alcoholic. However, she is
not performing any type of exercises and her diet is not healthy.
ICE-Impact:
The patient thinks that her condition is because of seasonal infections. She is
concerned that her case may lead to any type of cancer. Additionally, the
patient expected the suitable examination for her case and screening for any
type of cancers that she might have.
She stated that her cough affected her in socializing with her relatives as they
might think that she has some sort of infection.
3. Relevant Physical General Appearance: the patient is overweight, and she is respiratory
Examination (Ex) distressed with a cough. Also, she appears fatigued
Respiratory Examination: was equal, bilateral transmitted sound.
Precordium Examination: apical pulse is palpable and not shifted, audible S1

and S2 with no added sound or murmur.
Abdominal examination: revealed a distended abdomen with No tenderness,

organomegaly or umbilical changes and normal bowel sound.
H. Pylori
GERD
4. Differential Asthma
Diagnosis (DDx) Peptic Ulcer Disease
Lung Cancer
Her cough is most likely triggered by irritants like H. Pylori infection caused
5. Impression:
an increase in the acidity which led to gastroesophageal reflux.
Chronic cough
6. Problem List: Hot flushes
(Patient: Weight gain
Biopsychosocial Heartburn after meals
+ family)
• Clarified to the patient that her cough is most likely caused by a trigger
which is caused by H. Pylori infection. H. Pylori infection was
confirmed by the tests that were performed.
• Reassuring the patient by eradicating her infection which might solve
the problem.
7. Management plan & • advise the patient that losing weight will play a significant role in such
Intervention: cases.
(CRAPRIOP) • Triple therapy to eradicate the H. Pylori (PPI + Two Antibiotics)
• Preventive screening by a pap smear and an MRI
Plan
F/U in 3 weeks and check CBC, PFT, CXR
Refer to KFUH for an MRI
6. Questions & The importance of 24-PH monitoring.

Reflection H. Pylori could be a cause of irritant coughs.
What did I learn?

Your reflection on the The regimes of H. Pylori infection.
experiences + The way of diagnosing H. Pylori infection.
EBM, Practice The complications behind untreated H. Pylori infection.
management….
7. Supervisor 's
Feedback
rotation
Case No: 6 of 9 Date: 31/08/2021

❒F
1. Reason for
encounter or Chief Follow up for nausea started 3 months ago
complaint
2. Relevant history 23 years old, female, single, from Al-Khobar
(Hx)
(ICEE, ….) Came to the clinic for follow up and reviewing lab results.
Still complaining of nausea but it’s getting better
No history of pain, vomiting, diarrhea, constipation and lower or upper GI
bleeding.
No history of any chronic disease.
No history of taking any medications.
No history of eating a specific food.
Through the 3 months she has lost 3 kg
Review of system
● Heartburn especially after eating
Past Surgical and medical Hx
● Medically and surgically free. No history of atopic conditions.
● Not on any medications. Took all her vaccinations. No prior blood
transfusion.
Family Hx
● Her grandmother has ovarian cancer.
Social Hx
Not working or studying
No smoking or alcohol consumption or use of illicit drugs
Review of other system:
Unremarkable.
ICE
● Idea: the patient expressed none
● Concern: that she might have the manifestations of IBS.
● Expectations: know the cause of her nausea
PHQ 2 -ve
3. Relevant Physical The patient is vitally stable.

Examination (Ex) General appearance: well body built, is mentally oriented.
Face: no jaundice nor cyanosis.
Chest: equal and bilateral air entry, no added sounds.
Cardiac: normal S1 + S2, no added sounds, no murmur.
Abdomen: soft and lax, no tenderness, no organomegaly.
Lower limb: no edema, or pulsations are present.
GERD
4. Differential Allergic reaction
Diagnosis (DDx) H. pylori infection
Psychological symptoms
IBS
Patient was friendly and kind. Her symptoms are most likely caused by
5. Impression: psychological reasons.
6. Problem List: Nausea

(Patient: Heartburn
Biopsychosocial
+ family)
● Clarified to the patient that most likely she has psychological reasons.
● Reassured her that the condition is getting better.
● Advised her about nutritional and eating healthy food and doing some
Intervention: exercise.
(CRAPRIOP) Plan
Set an appointment if the symptoms persist beyond 2 months
I learned that it is recommended to screen for depression and other

6. Questions & psychological conditions for every patient during their visit
Reflection
What did I learn?

The consultant empathized with the patient and asked if she had any
Your reflection on the concerns.
experiences + I need to work more on my history taking and examination skills.
EBM, Practice
management….
7. Supervisor 's
Feedback
rotation
Case No: 7 of 9 Date: 31/08/2021

❒F
1. Reason for
encounter or Chief Fatigue for 3 months
complaint
2. Relevant history 50 years old, single, female, administrative worker not known to have any
(Hx) medical illness.
(ICEE, ….) Presented to the clinic with fatigue for 3 months duration.
The patient reported that the fatigue did not improve in the last 3 months.
There is nothing that can improve or aggravate the fatigue.
Moving and Sleeping or napping don't improve it
No history of fever, night sweats, weight changes, appetite changes.
Review of systems
Burning sensation in both legs at the dorsum of feet, No Radiation, No
aggravating or alleviating factors, 4/10 in severity.
Past Surgical and medical Hx

Medically and surgically free. No previous hospitalization.
Took all her vaccinations. No prior blood transfusion.
Family Hx
Unremarkable.
Drug Hx
Not taking any medications.
No allergies.
No OCP use.
Social Hx
Administrative worker.
Physically active.
Following a weight loss diet (Not specified due to the patient's tiredness) .
No smoking or alcohol consumption,
ICE- impact
● Idea: thyroid problems and vitamin D deficiency
● Concern: increased thyroid problems and no weight loss despite following a
diet
● Expectations: finding a diagnosis for her condition
● Impact: the fatigue prevented her from doing most of her daily activities.
PHQ2 -ve
3. Relevant Physical The consent was taken, and the process was explained.
Examination (Ex) The patient is vitally stable.
General appearance: the patient looks well, alert, average body weight and
there are no signs of respiratory distress.
Thyroid and neck examination were unremarkable.

B12 deficiency
4. Differential
Diagnosis (DDx)
Diabetic neuropathy
Psychological symptoms
The patient was anxious about her weight plateau despite following a plan to
5. Impression: lose weight and was willing to try anything to lose weight.
6. Problem List: Fatigue limiting her daily activities

(Patient:
Biopsychosocial
+ family)
● Clarified to the patient that most likely her diet and lifestyle have a role
in her condition.
● Reassured the patient that fatigue is a common condition in the society.
● Advised her about diet (increasing amount of vegetables, fibers and
fruits) and sunlight exposure.
● Prescribed B complex and vitamin D (explained the doses and duration
of each).
Intervention:
(CRAPRIOP) ● Investigations were discussed (CBC, B12, TSH, Iron study, HBA1C, vit
D) and no significant abnormalities were recorded.
Plan
F/U in 6 months to asses her condition
Educate the patient on stress management, diet, sunlight, and exercise.
6. Questions & I learned that the psychological aspect is as important as the biological
Reflection aspect.
What did I learn?
What I need to learn? The consultant had a small talk with the patient explaining her condition and
Your reflection on the answering her questions.
experiences +
EBM, Practice
management….
7. Supervisor 's
Feedback
rotation
Case No: 8 of 9 Date: 6/9/2021

❒F
or Chief complaint Right forearm mass, started 3 years ago
2. Relevant history (Hx) 27 years old, female, Housewife, from Buqaiq
(ICEE, ….) k/c of controlled Diabetes type 2 (on Metformin and Sitagliptin) and
Hypothyroidism (on Levothyroxine)
Presented to the clinic with a right forearm mass that started 3 years ago,
gradually increasing in size, mild pain and tenderness, No erythema,
pruritis or discharge.
Affecting her daily activities in lifting objects as it causes uncomforting
pain.
The patient says she had it needle aspirated 3 times before in a PHC near
their house in Buqaiq, no post-aspiration infection or abscesses, and the
patient was referred by her PHC doctor, due to the availability of general
surgery consultation.
Review Of Systems:
● Weight loss, in the past 2 months, can't recall the amount
● Loss of appetite, in the past a few months, can't remember as it was pointed
out to her by her husband.
● Rest is unremarkable
Past Medical Hx
● DM 2: controlled (HbA1c was 12.5% and now 6.9 %), diagnosed for 5
years, compliant on Metformin and sitagliptin, twice per day
● Hypothyroidism: diagnosed 5 years ago, compliant on Levothyroxine
(75mcg/day) and in the weekends (100mcg/day), no complains or side
effects
Family Hx
● Both parents have DM, her father had Cataract and was treated
accordingly with no complication or other DM associated complication
● Hypothyroidism in all siblings, and are compliant

● Metformin
● Levothyroxine
● Iron, ferose
● Multivitamin supplements
● No herbal remedies
OB/GYN Hx
● No OCP use or IUD placement
● Patient reports that her menstrual bleeding increased (become more than 5
days of increased bleeding, while it used to be 2-3 days)
● No Hx of STD's or abnormal uterine bleeding
● Trying to have a child for 4 years now and didn't consult any clinic
Social Hx
Patient has a low sugar, low meat diet
Moves around and cleans the house regularly with no set regimen of
exercises
PHQ 9 was positive for:
● low energy
● low appetite
● sleep disturbances(can't sleep until after Fajer prayer, while laying on bed)
● Cognitive symptoms (can't focus or concentrate on things more than 5
minutes, forgets a lot of things)
Non-smoker
ICE
● Concern: The patient had no concerns
● Expectations: setting an appointment with the general surgery to remove that
mass

The patient was vitally stable
or agitation.
Mass examination:
A 3*3.8 cm distal, right forearm oval mass, firm to hard in consistency,
seems tethered to deep structures, regular margins, smooth surface,
increases in size during flexion with mild tenderness.
No erythema, pruritis or discharge
Lipoma
4. Differential Diagnosis sebaceous cyst
(DDx) schwannoma
Patient was cooperative, a bit anxious to talk about her marriage and age,
she seemed dependent on her husband and as if she is trying to tell us
5. Impression:
something but was unable due to her husband's presence.
6. Problem List: Controlled DM

(Patient: Hypothyroidism
Biopsychosocial Right Forearm mass
+ family) Infertility
● Clarified to the patient that the mass has some concerning feature and
that's why we'll perform an Ultrasound to check it.
● Advised the patient about sleep hygiene and about the presence of
Intervention:
(CRAPRIOP) fertility clinics to help them.
● Reassured her about the availability of elective surgeries now in KFUH
Plan:
Mass ultrasound
F/U after 1 month to review Imaging results
Referral to General surgery in KFUH
How to Diagnose and treat Lipoma?

6. Questions & Management of sebaceous cyst?
Reflection Link between hypothyroidism and infertility?
What did I learn?
What I need to learn? The fact that despite the patient's presenting complaint, the doctor showed
Your reflection on the genuine concern about her health in general.
experiences +
EBM, Practice
management….
7. Supervisor 's
Feedback
rotation
Case No: 9 of 9 Date: 7/9/2021

❒F
or Chief complaint Back pain, for one year
2. Relevant history (Hx) 27 years old, married, male, University lecturer, from Al-Ahsa
(ICEE, ….) Medically free,
Presented to the clinic with a Low back pain, a progressive, dull and
contracting in nature pain, increasing in straining activities, decreasing with
rest, varying in severity (sometime 4-5, or more than 10), no radiation to
lower limb, weakness, or red flags
Presented now to the clinic to have a second opinion after going to the
orthopedic clinic and being told that he doesn't have a Discogenic issue and
should continue on physical therapy.
The pain is affecting his daily activities in standing during lecturing time,
playing sports and shopping with wife.
Review Of Systems:
● No Red flags or neuromuscular symptoms
Past medical Hx
● Vit D deficiency, 2 years ago, followed the prescribed dose and then
stopped (out of a personal decision after feeling better), and the patient
can't remember the reason of vit D level analysis at that time.
Family Hx
● His father had the same pain, since he was young, and it was also not
diagnosed as there were no structural abnormalities
● Both parents have DM, for years now and are compliant on treatment.
● Several members of the family have back pain with unknown diagnosis

● Multivitamin supplements
Social Hx
Patient has no specific diet
Moves around the house regularly with no set regimen of exercises
Likes occasional sports and is mad because of his inability to do it more
frequently.
The pain affected his work (limiting his lecturing times)
Non-smoker and No alcohol
ICE
● Concern: The patient had no concerns
● Expectations: Getting an MRI of his Spine, because the Orthopedic clinic told
him his presentation doesn't indicate an MRI.
PHQ2 -ve

The patient was vitally stable,
On Gait: slight limping and genu varus of the right knee
or agitation.
Spine Examination: Patient was standing with no asymmetry or obvious
deformity, the Lower back was firm and tender, -ve Sraight leg raise and
Slump test
Lowe limb Neuromuscular examination: No obvious wasting or deformity

with the patient supine, no ROM limitation, power 5+, intact Sensation and
palpable pulses.
Lumbosacral muscle Strain or sprain

4. Differential Diagnosis Spondylolisthesis
(DDx) Spinal stenosis
Patient was a bit frustrated about his situation as no one seems to actually
5. Impression: help him and tell him exactly what's wrong with his back.
Non-specific lower back pain

6. Problem List: Vit D deficiency
(Patient:
Biopsychosocial
+ family)
● Clarified to the patient the necessity of physical therapy in elongate and
strength the lower back and pelvic muscles
● Reassured the patient that his presentation is mostly muscle-related
● Advised the patient that if at anytime he felt any of the red flags, he
should directly go to the ER.
Intervention:
(CRAPRIOP) Plan:
Lumbosacral Spine X-ray
Prescribe (Vit D, physical therapy and NSAID's, PRN)
Consider screening for HTN, DM and ask the PHQ9 in the next visit
F/U after 3 months
Approach to Non-specific lower back pain?
6. Questions & MSK Australian flag system?
Reflection Differential diagnosis of such a case?
What did I learn?

That managing such a patient might require more tan just focusing on his
Your reflection on the presenting complaint, there might a lifestyle cause of such a pain.
experiences + Can Lower back pain be an inherited condition?
EBM, Practice
management….
7. Supervisor 's
Feedback
rotation
Case No: 10 of 9 Date: 7/9/2021

❒F
or Chief complaint Allergic reaction to BCG vaccine
2. Relevant history (Hx) 1 y/o, boy, came with his mother, originally from Alahsa
(ICEE, ….) k/c of Atopic dermatitis (on Moistures)
Presented to the clinic with a left, brown deltoid swelling, and full body
macular, erythematous rash after the administration of the BCG vaccine
last week.
The mother says that it was red in color at the day of administration, which
was thought at the time to be normal, until now when it changed in color
and the boy start developing a hypernasal cry, increased irritability and
little to no sleep (at night and during the day).
Subjective fever by mother, no vomiting, change in defecation habit or
form,
Past medical Hx
● Atopic dermatitis, at 6 months of age after several rashes and continuous
clinic visits a diagnosis was made at 7 months of age, the mother was
advised to moisturize the baby multiple times a day and keep the boy
away from triggers.
Developmental Hx
● The boy met all his milestones and now is standing with support and the
mother says he can stand sometimes without support, sits without support.
Nutritional Hx
● The boy was breastfed for more than 6 months, the mother says she
sometimes uses formula (can't remember name), and she introduced semi-
solid food, the boy tolerates and is feeding less than usual in the past week
with no difference in activity or size.
Antenatal Hx
● The mother was started on Folic acid and iron in the first trimester, with
no history of GDM or gestational hypertension/ pre-eclampsia and
eclampsia
● The boy was delivered in normal vaginal delivery, no postpartum
bleeding, infection or blues
● The boy stayed one day in NICU, with no signs of respiratory distress or
known congenital anomalies (the mother can't remember his weight of
birth)
Family Hx
● The mother and his sister have Asthma, Atopic dermatitis and seasonal
rhinitis, and are treated accordingly with avoiding triggers (egg, nuts, dust,
milk, seafood)

● Vit D
● QV moisturizers
● No known Allergies but the doctor and mother anticipated it to be the same as
his mother and sister's triggers.
Social Hx
Parents are educated and are following doctors' instructions
No smokers or alcoholics around the baby
They're living in a flat in Dammam
The kid usually is active and plays around with his sister and mother (but
due to the swelling and agitation, they recently couldn't)
ICE (by mother)
● Idea: she knows it was secondary to the vaccine
● Concern: could it mean my kid has TB now?
● Expectations: relief the boy arm swelling

Examination (Ex) Consent was taken from the mother and privacy was ensured
The patient was vitally stable, and met the normal growth chart percentiles,
Had 10 fingers and toes, no syndromic features
Sat on bed agitated, crying and screaming (inconsolable), so we Examined
the patient in his mother's lap
The patient's whole face and trunk were covered with a macular,
erythematous, telangiectatic rash (irregular borders, doesn't seem to bother
the kid once palpated)
Palpable anterior fontanelle, normal ear lobes with no tags or tubercle, the
patient had the lower incisors growing, no clefts were observed or palpated,
Chest: normal, bi-lateral, equal, air-entry with no added sounds, apical

pulse was palpable and not displaced with no murmurs (auscultated or
thrills palpated)
Abdomen: soft and lax, with no signs of organomegaly or Hernia
Genitalia: grown, normal testicles with a circumcised glans and no sign of

hypospadias or genital ambiguity
Hip: -ve Barlow and Ortalini
Hypersensitivity reaction
4. Differential Diagnosis
Triggered Atopic dermatitis
(DDx)
The mother was worried that the boy will be severely ill because of a
5. Impression:
vaccine!
6. Problem List: Atopic dermatitis
(Patient: Vit D deficiency
Biopsychosocial
+ family)
● Clarified to the mother that this might be an allergic reaction to the
vaccine or secondary to his Atopic dermatitis.
● Advised the mother to apply continuous moisturization to the boy's
whole body.
● Preventive Screening CBC for Iron deficiency anemia
Intervention:
(CRAPRIOP) Plan:
Referral to pediatrics in KFUH
Prescribe vit D drops
Labs (CBC and vit D level)
F/U after the pediatrics appointment in KGUH clinic
Management of Atopic dermatitis?
6. Questions & Relationship between Vaccines and Dermatological disorders?
Reflection
What did I learn?

That Reason of the mother's worry was sought for and well-empathized
Your reflection on the with. Pediatrics stands as a part of medicine delivery to an extreme of age,
experiences + which is sometimes challenging.
EBM, Practice
management….
7. Supervisor 's
Feedback
rotation
Case No: 11 of 9 Date: 07/09/2021

File # 1584906 Age: 47 Sex: ❒M Nationality: Saudi Arabia
❒F
1. Reason for
encounter or Chief Sore throat started 5 days ago
complaint
(Hx) This is a 47-year-old male, medically free, married, living in Khobar, head of
(ICEE, ….) applied medical sciences college, returned from Jazan 2 weeks ago.
He presented to the clinic with sore throat that started 5 days ago, associated
with night fever (subjective), headache (tension), hoarseness, and loss of
appetite, aggravated with swallowing of cold drinks and relieved by
paracetamol and honey, severity 7-8 out of 10.
Systemic review:
The patient denied cough, runny nose, ear pain, wheezing, stridor, chest
pain, or shortness of breath.

No chronic illnesses or surgeries
completed vaccinations including covid-19 doses 1 year ago
No history of hospitalizations, ICU admission, or blood transfusion
Family history:
His wife has sickle cell disease, compliant on her medications with no prior
attacks
No genetic conditions run in family
Drug:
OTC paracetamol and honey
No smoking, alcohol intake or use of illicit drugs
Allergies unknown
Social history:
He is an athlete who do biking 15-20 km one day and another
regularly sleeps 5-6 hours
he is on no specific diet
ICE-Impact:
The patient thinks he got an upper respiratory infection from his brother
when he was in Jazan or from cold. The patient concerned that this problem
affects his travel to Athena next week. The patient expects to get his proper
treatment. His problem affected his work performance.
Review of systems:
unremarkable.
Firstly, consent was taken, and privacy was ensured
Examination (Ex) Vital signs: Pulse:70 BP:133/72 O2:99% Temp:38
General appearance: The patient has a normal body built and he is mentally
oriented and aware, no respiratory distress, he has hoarse voice.
Examination was remarkable for erythematous and edematous tonsils
Acute pharyngitis
Upper respiratory infection
4. Differential
Diagnosis (DDx) Acute tonsillitis
Common cold
Malaria
The patient has enriched medical background, as the consultant greeted him
well as if he was old friend. It could be his travel to Jazan has some link to
5. Impression: his sore throat either by transmission from his brother or from cold weather.
Sore throat
6. Problem List:
(Patient: Fever
Biopsychosocial Headache
+ family)
● Clarified to the patient that he has bacterial pharyngitis
● Advised the patient to do frequent hydration, avoidance of drinking cold
drinks, traditional medicine such as honey was encouraged, and frequent
hydration to prevent dehydration and compliance to the prescribed
Intervention:
(CRAPRIOP) antibiotic
● Prescribed Augmentin, normal saline nasal drops, loratadine and
pseudoephedrine, paracetamol and antiseptic mouthwash for 7 days
6. Questions & What is modified CENTOR criteria?

Reflection How to approach acute pharyngitis?
What did I learn?

I was amazed by how the consultant diagnosed the patient by just a quick
Your reflection on the look at his pharynx. I wonder if there were other related examination
experiences + findings to look in patients with acute pharyngitis.
EBM, Practice
management….
7. Supervisor 's
Feedback
rotation
Case No: 12 of 9 Date: 14/09/2021

File # 1638784 Age: 19 Sex: rM Nationality: Saudi
rF
1. Reason for
encounter or Chief Right knee pain for 1 year and half
complaint
(Hx) this is a 19 y/o Saudi male, single, college student, originally from south and
(ICEE, ….) living in Dhahran.
He presented to the clinic complaining of Right knee pain that started upon
twisting injury while playing football one and half year ago. At the time of
the injury, the knee was extremely painful, swollen, erythematous, and a pop
sound was heard by the patient. The patient confessed that he neglected the
pain and did not seek medical attention at that time as he was about to travel
that day and followed by covid-19 pandemic that restricted him from going
to hospitals. Before today he was on ongoing physiotherapy sessions for
months with his acquaintance and helped improve his knee pain.
Today visit, the knee pain is in the medial aspect, dull-aching, non-radiating,
aggravated by heavy exertion and relieved by topical analgesic, socking the
knee and rest, severity 3 out of 10 (better now compared to last year it was 8
out of 10). He also stated that he sometimes feels the knee giveaway. There
was associated morning stiffness that is relieved after 1-2 hours of rest.

the patient is not known to have medical illnesses
No surgical procedures were performed
No history of previous trauma, blood transfusion, hospitalizations, or ICU
admissions
His immunizations are up to date. He got his 2 doses of covid vaccines
Family history:
Unremarkable except for paternal hypertension
Drug:
Paracetamol PRN
Topical analgesia ointment and socking
Allergies status is unknown
Social history:
He is in no specific diet
He likes to play football with his friends, but his physical activities reduced
after the injury
He denied smoking, alcohol intake or use of illicit drugs
No herbal remedies were used, although he wished to use it earlier
ICE-Impact:
The patient thinks that his knee pain is related to that football injury. He is
concerned that this knee pain prevents him from playing football with his
friends again. He expects to get x-ray imaging for his knee.
Review of systems:
Unremarkable
PHQ2 -ve
Consent was taken and privacy was ensured
Examination (Ex) Vital signs were within normal limits
General appearance: The patient has a thin body built, came to clinic with walking
aid as needed, no respiratory distress
Inspection: no discoloration, deformities, asymmetry or swelling noted
Palpation: temperature was equal bilaterally, pulses were palpable, no bony
tenderness or knee effusion were noted
Full range of movements, no restrictions
All knee tests were negative; anterior drawer, MacMurray, varus and valgus stress
Osteoarthritis
4. Differential Ligamentous tear
Diagnosis (DDx)
Anxiety
This knee injury is surely related to that football game a year ago. Is it
possible that after a year and half his knee has recovered to the extent of not
5. Impression: showing any findings?
Right Knee pain

6. Problem List:
(Patient:
Biopsychosocial
+ family)
• Clarified to the patient that his knee is fine
7. Management plan & • Reassured the patient about the physical examination and X-ray taken of
Intervention: his right knee
(CRAPRIOP) Plan
Referral to PT
6. Questions & What is the best imaging modality for this knee injury?
Reflection
What did I learn?

Your reflection on the The doctor thinks that the patient’s knee is completely fine as his examination and
experiences + imaging are normal, probably he is just afraid and because of the fear of moving the
EBM, Practice knee freely, the patient’s think there is problem
management….
7. Supervisor 's
Feedback
rotation
Case No: 13 of 9 Date: 20/09/2021

File # 1624029 Age: 19 Sex: rM Nationality: Saudi
rF
1. Reason for
encounter or Chief Follow up for spontaneous bruising, for 2 years
complaint
(Hx) this is a 19 y/o Saudi male, single, college student, originally from Madina
(ICEE, ….) and studying in Dhahran.
K/C of Atopic dermatitis (on QV emollient)
She presented to the clinic 5 months ago with the same complaint and didn't
follow up until this visit, wanting to check her past labs.
The patient has multiple, flat, non-tender, blue/brown bruises on her left leg
and right thigh, different in sizes, ranging from a dime to a small lemon.
Not associated with pruritis, skin discharge, swelling or erythema
No Hx of trauma or starting new medications
No fever, LOW or LOA
Review of Systems:
3 months ago, in a PHC in Madina, she was told that she has orthostatic
hypotension and must take care in orthostatic activity without clarifying the
diagnosis or etiology.

Diagnosed with atopic dermatitis 9 months ago, no active complaint, patient
is compliant on QV emollient, with no other personal history of atopy.
No surgical procedures were performed
No history of previous trauma, blood transfusion, hospitalizations, or ICU
admissions
Her immunizations are up to date
Family history:
Father has T2DM and HTN, not following up or using any drugs
Her brother has Atopic dermatitis, for 3 years now and compliant, with an
Asthma exacerbation, one year ago (only time), requiring hospitalization for
a few days and maintenance inhalers.
Drug:
Allergies status is unknown
No herbal remedies were used
OB/GYN:
Not married, Menarche at the age of 12, with a regular (23 days) menstrual
cycle,
Abnormal uterine bleeding in the past a few months, fixed amounts but
longer than 8 days
No OCP use, or Hx of vaginitis or UTI
Social history:
She has no specific diet or exercise regimen
Her sleep lately was affected, because she misses her family back in Madina
PHQ 9 positive for (sleep disturbances, low mood, lost of interest, low
energy, decrease ability to concentrate or memorize)
She doesn't smoke, drink alcohol or use of illicit drugs
ICE-Impact:
She waned to know whether she has a vitamin deficiency or a clotting
disorder, because for her it's not acceptable to have such bruises
3. Relevant Physical Consent was taken and privacy was ensured

Examination (Ex) Vital signs were within normal limits
General appearance: The patient has a thin body built, no respiratory distress
or agitation
Inspection: of left leg there were 2, 2*2 cm, brown, flat, irregular bordered
bruises, No hirsutism or discharge.
Palpation: No tenderness, erythema or changes in skin texture
Hemophilia A or B
4. Differential Von Willebrand disease
Diagnosis (DDx) Hypothyroidism
Purpura simplex or ITP
The patient was relaxed and joyful, open to discussing different aspects of
5. Impression: her life, and was obviously missing her family back in Madina.
6. Problem List: Bruises

(Patient: Atopic dermatitis
Biopsychosocial Orthostatic Hypotension
+ family)
• Clarified to the patient that her presentation might take a while to
diagnose
7. Management plan & • Reassured her about her past labs.
Intervention:
(CRAPRIOP) Plan
Ordered a (CBC, TSH/FT4/FT3, von Willebrand factor, pt/aPtt) and
Abdominal Ultrasound
6. Questions & Causes of ecchymosis?

Reflection
What did I learn? Types of purpura?
When to suspect ITP?
What I need to learn? The doctor allowed us to take a full history and get a chaperone for the
Your reflection on the examination which felt like a responsibility that we're glad to have alongside
experiences + such great doctors.
EBM, Practice
management….
7. Supervisor 's
Feedback
rotation
Case No: 14 of 9 Date: 21/09/2021

File # 1639465 Age: 21 Sex: ❒M Nationality: Saudi
❒F
1. Reason for
encounter or Chief Follow-up for alpha thalassemia trait & IDA
complaint
HPI:
2. Relevant history 21 y/o Saudi female, single, college student, originally from Al-Ahsa and
(Hx) lives in Dammam.
(ICEE, ….) k/c of alpha-thalassemia trait since childhood
She presented to the clinic for follow up to review her lab results for iron and
vitamin D levels
She has no active complaints or worries
Review of systems:
Remarkable for right neck swelling that appeared 4 months ago when she
was taking her exams and disappeared after 1 week ago, No tenderness,
erythema or pruritis and No thyroid functional symptoms,
associated with right, localized, stabbing shoulder pain (The patient
mentioned that her sisters had this shoulder pain) 5/10 in severity, no
aggravating or alleviating factors.
PHQ2 negative
She has alpha-thalassemia since birth
No history of blood transfusion, hospitalizations, or ICU admission
Her vaccinations are up to date, including two covid-19 doses
No previous surgical procedures
Family History:
Her father has T2DM and hypertension, compliant on his medication
Her mother has HTN, compliant on her medication
She has 5 sisters and 2 brothers
Alpha-thalassemia in all family members (some trait & some disease) all are
treated with no complications
Drugs:
She mentioned taking vitamin D supplement from her sisters PRN
Other than that, she denied taking drugs, supplements, OCP or herbals
Allergy status unknown
Her menstruation is regular, no change in amount or color
Social History:
No smoking, alcohol, or use of illicit drugs
She eats healthy diet in home
She used to do aerobic and weight-bearing exercise 3-4 days a week in the
past year, but she stopped ever since, not feeling like it anymore.
Sleeps 8 hours a day, no complains of insomnia or interrupted sleep
ICE-Impact:
She thinks she has alpha thalassemia manifested as iron deficiency
She has no concerns
She expects to know her labs results and get supplements
3. Relevant Physical Consent was taken and privacy was ensured

Examination (Ex) Vital signs: Temp 36.6, Pulse 90, RR 18, BP 124/86 mmHg, SpO2 100
General Appearance: the patient looks well, alert, average body weight and
there are no signs of respiratory distress, No signs of a thalassemic face.
Respiratory Examination: bilateral equal air entry with no added sounds.
Precordium Examination: normal S1 S2 with no added sounds or murmurs.

Abdominal examination: soft lax with no tenderness or organomegaly.
Neurovascular lower limb examination: no edema, pulses are palpable,
temperature equal bilaterally, sensory and motor neurological exam is
normal.
Alpha Thalassemia trait
4. Differential
Diagnosis (DDx)
Patient was relaxed and open to discuss about her health.
5. Impression: I think she has familial hemoglobinopathy.
6. Problem List: alpha thalassemia trait

(Patient:
Biopsychosocial
+ family)
• Reassured the patient about her lab results
• Advised her to keep a healthy diet, exercise, and frequent hydration
Intervention: • Prescribe Vitamin D and explain dosing/duration
(CRAPRIOP) Plan
F/U in 3 months to re check iron profile and vitamin D levels
6. Questions & How to differentiate between types of alpha thalassemia?

Reflection
What did I learn?
What I need to learn? She is asymptomatic and does not have active complaints, as she has Alpha
Your reflection on the thalassemia trait, as a genetic disease in her family.
experiences +
EBM, Practice
management….
7. Supervisor 's
Feedback
(Case discussed with)

Supervisor's Name: Signature Date
rotation
Case No: 15 of 9 Date: 03/10/2021

❒F
1. Reason for Right elbow pain for 1 month
encounter or Chief
complaint
(Hx) A 45 y/o Saudi male, married office worker, originally from Al-Ahsa and
(ICEE, ….) living in Khobar, does not have any chronic illnesses.
He presented to the clinic complaining of progressive right elbow pain for 1-

month, non-radiating, associated with tingling sensation of the hand,
aggravated by exertion and relieved by rest, severity 5 out of 10
No fever, LOW/LOA or night sweats
No weakness, stiffness, decreased power/motor or sensation
Review of Systems:
Unremarkable except for bilateral burning sensation in plantar surface of feet
that began 2 years ago, often wakes him up at night, aggravated with
stillness, alleviated by walking.

He has no medical conditions
Varicose veins surgery for right leg 20 years ago
His immunizations are up to date including covid19 doses and annually
influenza shots
No history of blood transfusion, hospitalization, or ICU admission
Travel history negative
No history of trauma
Family History:
Remarkable for parents with T2DM & HTN, Compliant on their medications
with no diabetic complications or hypertensive crisis
Drugs:
He does not take any medications
Allergy status unknown
Sometimes taking Myrrh from his mother when feeling ill
Social History:
The patient denied smoking, alcohol or using illicit drugs
He eats mostly vegetarian diet and tries to avoid sugar and unhealthy food
He sleeps 5-6 hours daily, no history of insomnia or disrupted sleep
PHQ2 and GAD7 were negative
ICE-Impact:
He thinks his elbow pain is a result of inflammation or due to lifting heavy
weights. He fears that the elbow pain can be something serious. He expects
to do laboratory and radiological investigations to know the cause.
3. Relevant Physical Consent was taken and privacy was ensured.

Examination (Ex) Vital signs: vitally stable
General Appearance: patient sat comfortably, oriented to time place and
person with no special decubitus and no signs of distress nor agitation.
MSK Upper limbs examination:
Inspection: no signs of muscle wasting, deformities, scarring, swelling nor

erythema.
Palpation: tenderness at lateral surface of R. elbow.
Passive movement: positive Mill’s test in R. elbow.
Lateral epicondylitis
4. Differential
Diagnosis (DDx)
Carpel tunnel syndrome
Vitamin B12 deficiency
The patient is well educated and has read a lot from internet to know about
his problems. He seems comfortable with taking medications only when
5. Impression: needed and relying on CAM treatment.
6. Problem List:
(Patient: Right elbow pain
Biopsychosocial Burning sensation of feet
+ family)
• Clarified to the patient about his diagnosis
• Reassured that the diagnosis is not serious and does not require splinting
7. Management plan & • advised patient to rest with warm compression 3-4 times per day
Intervention: • prescribed paracetamol 5 mg PRN, topical Voltaren bid for 7 days
(CRAPRIOP) • Preventive Screening for fasting blood glucose, HbA1C and lipid profile
Plan
F/U after 1 week to re-assess the pain and review lab results
Clinical presentation and physical examination tests and findings for lateral
6. Questions & epicondylitis aka tennis elbow.
Reflection
What did I learn?
Revise and practice MSK examination of the upper limbs

What I need to learn? Approach to patients who are eager about seeking information about their
Your reflection on the health and health complaints. Are there any recommended and trusted
experiences + sources for patient education? If so what are they?
EBM, Practice
management….
7. Supervisor 's
Feedback
rotation
Case No: 16 of 9 Date: 03/10/2021

❒F
1. Reason for Follow up for hypertension suspicion
encounter or Chief
complaint
(Hx) A 29 Years old, Saudi, married, Male
(ICEE, ….) k/c of allergic rhinitis (on Fulticasone), IBS (on Movicol), and external
hemorrhoids (on high fiber diet)
Presented to the OPD 1 month ago with 148/89 with no associated symptoms
or active complains.
Review of Systems:
Unremarkable except for constipation, feeling of incomplete evacuation,
increased in stressful situations and decreased by Movicol, not associated
with blood or mucus per rectum.
Allergic rhinitis since childhood and for the past 2 months he used
Fulticasone, daily because of an exacerbation secondary to dust (other
triggers are spices, humidity, pets)
IBS for 5 years, constipation and colicky pain increasing with stress and
external hemorrhoids treated with high fibre diet, No active bleeding,
tenderness, or pruritis.
Childhood tonsillectomy with no complications or ICU stay.
No Hx of trauma, blood transfusions.
Took all his vaccines.
Family History:
His father and brothers have hypertension, none of them had hypertensive
complications or crisis.
Drug history:
Fluticasone (PRN) for allergic rhinitis.
Movicol (PRN) for constipation.
Taking anise(Yinson).
No allergies or illicit drug.
Social History:
Following gluten-free diet with high fiber and water consumption.
Walk 30-45 min per day
Sleep disturbance secondary to his work
No fear or anxiety.
PHQ2 negative
No Hx of travel.
No STD’s, smoking, alcohol
ICE-Impact:
Idea (he does not know)
Concern (hypertension)
Expectation (has the diagnosis or not?)
Minimal impact on his life.
3. Relevant Physical Consent was taken and privacy was ensured.

Examination (Ex) Vital signs: vitally stable (BP 125/79)
General Appearance: patient sat comfortably, oriented to time place and
person with no special decubitus and no signs of distress nor agitation.
Thyroid and neck examination were unremarkable.

Hypertension
4. Differential Familial hyperaldosteronism
Diagnosis (DDx) White coat syndrome
The patient is well educated and has read about the possible diagnoses.
5. Impression:
6. Problem List: Allergic rhinitis.

(Patient: IBS.
Biopsychosocial External hemorrhoids.
+ family) Constipation.
• Clarified to the patient about possible diagnosis of HTN.
• Reassured that there is nothing to worry about.
• Advised patient to continue exercising and follow DASH diet.
7. Management plan & • Preventive Screening for fasting blood glucose, HbA1C and lipid profile.
Intervention: Plan
(CRAPRIOP) F/U in 2 weeks with consultant to confirm the diagnosis
Put a 24-hour ambulatory blood pressure monitoring and check the mean in
next visit
How to diagnose and confirm the diagnosis of hypertension?

6. Questions & What are the measures taken to minimize white coat syndrome?
Reflection
What did I learn?
What I need to learn? I need to revise the screening as well as how to diagnose hypertension.
experiences +
EBM, Practice
management….
7. Supervisor 's
Feedback
rotation
STUDENT'S CLINICAL ENCOUNTER NOTES

STUDENT'S NAME:
……………………………………………………………………………………………………………………………………………………………………………….………… I.D.
Supervisor's Name: _________________________________________________________________________________________________________________
Case number: 1 of 3 Date: 22th Aug 2021

LONG CASE
Patient MR #: 876981 Male r Female r
Date/Time Clinical Notes
22/8/21 ID: A 22 year old Saudi male, single, college student, living in Dammam, not known
to have any medical problems
CC: Psychological problem started 8 years ago
HPI: His problem stated by him as (Visual cocaine) at which he describes it as
masturbation, once to twice daily. His issue started 8 years ago, and the problem got
worse with time especially during COVID 19 pandemic.
Psychiatric history: There are symptoms of depression and anxiety (Anhedonia,
fatigue, hyperphagia, disrupted sleep, feeling guilty, decreased concentration)
There are no symptoms of present or past manic or hypomanic symptoms.
There are no suicidal or homicidal, ideation or attempts.
No Hallucinations, delusions and No adverse life events.
PHQ 2 is positive for (loss of interest of things that were funny and enjoyable for
him previously).
PHQ-9: 15 (Moderate depression) and GAD-7: 7 (Mild anxiety)
Past medical and surgical history:
Medical history was negative
Adenotonsillectomy 10 years ago, with no complications or ICU stay
The patient was fully immunized and vaccinated with two doses for COVID-19.
No history of blood transfusion, hospitalizations, or ICU admission.
Family history:
Both parents have prediabetes, and on no medication just lifestyle modifications.
Family history of compulsions (sister who do ablution many times before praying
just to relax and not feel distressed during prayer)
Drugs and allergies:
He is not on any medications, supplements, or herbal remedies.
He has no known allergies.
Social history:
There is some sort of official relationship with his father but his relationship is
stronger with his mother. He eats unhealthy diet (junk food every day). He exercises
two times a week for 30 minutes (walking).
There is no history of smoking, alcohol, or using of illicit drugs.
ICE and impact:
He thinks his psychological problems is due to a deep-rooted issue that if he treated
it, he will be cured. He is afraid that his problem affects his future career and
marriage.
He expects an arranged referral to a psychotherapist.
His problem affected his social life significantly (can't go out with friends, or play
football, because large numbers causes him distress/discomfort, just related to
personal preference for a more personal activities).
Review of systems:
- Shortness of breath (sometimes when reciting Quran)
- Difficulty in urination, weak stream, incomplete emptying, post-void
drippling (the patient thinks it is because of prostate disease, related to his
original problem)
Physical examination
Vital signs: BP 138/79 mmHg, P 75, SpO2 100%, Temp 36.6, BMI 29.5
General appearance:
The patient was alert, conscious, and oriented to TTP. Overweight, mildly anxious,
not appearing to be in pain, and he is not cyanosed, jaundiced, or pale.
There is some mental block at which the patient stops before ending his sentences.
Neck: no signs of inspected swelling, erythema, scars, or tethering and no
lymphadenopathy or tenderness. Thyroid was palpable, soft with no nodularity,
swelling or compressive symptoms.
Chest: EBAE with no added sound.
Cardiac: normal S1 and S2, no added sounds, no murmurs.
Abdomen: soft and lax, no organomegaly, no tenderness.
Lower limb: no edema, palpable pulses, Intact sensory and motor neurological
examination.
Differential diagnosis:
Generalized Anxiety Disorder
Major Depressive Disorder
Hypothyroidism
Substance use disorder
Management:
• Clarified to the patient that he has a presentation of moderate depression and
mild anxiety after screening, then SSRI's and CBT availability (the patient
refused SSRI's and agreed on CBT)
• Advised a balanced diet and adequate hydration and educate the patient about
sleep hygiene and use of bed only for sleeping, and aerobic or resistance
exercise, 3-5 times per week, 30-60 minutes.
Plan
F/U after 1 week for lab results (CBC, LFT, RFT, Lipid profile, TSH, FBG, HbA1C,
25 hydroxy vitamin D, Urinalysis)
Referral to psychological clinic for CBT
PROGRESS NOTES
Date/Time Prob
SOAP
No.
29/8/2021 A 22 y/o Saudi male, not known to have any medical illnesses
Presented to the clinic for reviewing his lab results
No active complaints or worries
No improvement or decline of psychological symptoms
Labs:
- HbA1C: 5.8% (prediabetes)
- 25-hydroxy-vitamin D: 14.9 (mild to moderate deficiency)
- Urinalysis: dark yellow, positive epithelial cells, mucosal
threads, bacteriuria 2+ (No specific diagnosis)
Management:
Clarified to the patient about his diagnosis of prediabetes and the
nature of disease and management by lifestyle modifications at his
age and the association between vitamin D deficiency and the

presenting status
Reassure the patient about other lab results
Advise for continuing a healthy diet, exercise, and frequent hydration
Plan:
F/U after 2 months and Repeat urine culture and sensitivity
Prescribe 50,000 U Vitamin D once per week for 8 weeks
Referral to CBT after 3 months

STUDENT'S NAME:
……………………………………………………………………………………………………………………………………………………………………………….………… I.D.
Case number: 2 of 3 Date: 3th Oct 2021

LONG CASE
28/9/21 ID: 49 y/o, Tunisian, married, male, works as an instructor
K/c of Gout (on allopurinol)
CC: Left ribcage pain for 1 week and right hand paresthesia for 1 month
HPI:
The pain is in the lower left ribcage, localized with no radiation, dull aching pain,
increased by pressure and decreased by rest, 4/10 in severity.
The pain is localized in the distal, palmar tips of fingers, no radiation, increased by
work and decreased by rest, 5/10 in severity and very limiting to his ability to finish
his work on time adding to his stressful job.
No history of direct trauma or MVA
No muscle weakness, other sensory defects, or other red flags of nerve degeneration
No fever, LOW, LOA or night sweats
No skin changes over the area, No vesicles, erythema or pruritis
PHQ 2 is negative
Gout, for 2 years, he had only one attack affecting his right big toe, started on
Allopurinol 300mg, OID by his PHC doctor in Tunisia.
Right knee ACL repair 5 years ago, No active complaints, no post-operative

complications or ICU stay.
Left ankle Fracture, requiring multiple operation and blood transfusion after a
motorbike runover his ankle 3 years ago, still has limited range of motion, but no
active pain or complaint, no post-operative complications or ICU stay.
Left Hand, 5th phalanx amputation at the level of DIP, after an accident in a holiday
resulted in the loss of the distal part and couldn't salvage it.
He is fully immunized and vaccinated with two doses for COVID-19 and the rest of
them.
No history of ICU admission.
Family history:
Both his parents have hypertension and diabetes, all are controlled with no diabetic
complications or hypertensive crisis.
No known autoimmune diseases in the family.
Allopurinol 300mg, OID (prophylaxis for Gout)
No added OTC drugs.
No herbal remedies
Social history:
No specific diet or exercise regimen
Sleep has been difficult to maintain for the past year, with a total of non-refreshing 5
hours per day.
He has been feeling distant from his family and that's why he took them to a
vacation down to their relatives in Tunisia.
There is No history of smoking, alcohol, or using of illicit drugs.
No history of STD's.
ICE and impact:
I: vitamins deficiency (about his hand) or a tumor (his ribcage)
C: He is concerned the increased work stress and the possible tumor in his rib
E: He is expecting to do further tests to confirm what's wrong with his hand and to
know why is his rib hurting.
Review of systems:
- Unremarkable

Vital signs were stable with no hemodynamic instability
General appearance:
The patient was alert, comfortable, conscious, and oriented to TTP. He is obese, not
appearing to be in pain, and he is not cyanosed, jaundiced, or pale.
Chest/Cardiac: equal, symmetrical, bilateral air entry with no added sounds and a
normal S1 and S2, with no murmurs.
The pain was on the mid-axillary line on the 6th left rib, no skin changes or scars and
diffuse tenderness on palpating all around it.
Hand: No signs of muscle wasting, abnormal contracture or scars, on palpation of
finger tips the same paresthesia was reproduced, but Phalen's, Tinnel, and
compression tests were negative, no changes in soft touch sensation and
proprioception.
Differential diagnosis for his hand:
Vit B12 deficiency
Carpal tunnel syndrome
Differential diagnosis for his Ribcage:
Myositis
Unintentional trauma
Nodule
Beginning of Shingles
Management:
• Clarified to the patient that his hand symptoms might be secondary to vit B12
deficiency.
• Reassured the patient about the availability of B12.
• Advised the patient to apply warm compressors, 2-3 times a day and to stop
Allopurinol as it's not indicated as he has not active symptoms or pain in his toe.
In addition, explained the Gout-related diet as an alternative to decrease the risk
of future attacks.
Plan
F/U in 1 week to re-assess the symptoms and discuss B12 levels, vit D levels, CBC,
HbA1C, FBG results and CXR
PROGRESS NOTES
Date/Time Prob
SOAP
No.
10/10/2021 A 49 years, Tunisian, married, male, works as an instructor
K/c of Gout (on dietary changes)
Presented to the clinic to review his lab results, especially vit B12
levels as it was his main concern.
No active complaints or worries.
There is an improvement in his acid reflux symptoms.
Labs:
- CBC is normal
- HbA1C: 5.5%
- RFT: is normal
- Fasting glucose normal
- Vit B12 and vit D are decreased
CXR
Showed a 2*2 cm, cavitary lesion, with the main concern of past TB, in
which the patient stated that he has previously taken the 6 months regimen
when he was young (teens), and retook it in Tunisia 2 years ago after his
PHC doctor's recommendation.
Management:
Clarified to the patient that his hand symptoms might be caused by
vit b12 deficiency and/or vit D deficiency, and his ribcage pain is
best explained by the cavitary lesion and his past history of TB.
Advising the patient to keep Gout-related diet, sun exposure and
regular exercising for 5 times a week, 30-45 minutes, with no 2
consecutive days of rest.
Plan:
Prescribe vit b12 and vit D, explained the doses and duration of use.
Following up the patient after 6 months to assess the lesion.
Informed him about the signs of an attack, for an early visit to ER.

STUDENT'S NAME:
……………………………………………………………………………………………………………………………………………………………………………….………… I.D.
Case number: 3 of 3 Date: 3th Oct 2021

LONG CASE
03/10/21 ID: A 48 year old Indian male, married, Instructor, living in Khobar, known case of
hypertension (on Telmisartan), and prediabetic (on Metformin), Ectopic beats (On
Concor).
CC: Increased burning sensation and acidity in his middle chest two months ago.
HPI: His problem as he stated started two months ago but recently the episodes of
increased acidity and the burning sensation increased to twice per day at 2 am, and
developed to a point where it wakes him up at night. It is 5 out of 10 in severity and
it is aggravate by late meals, and spicy food. Also, alleviated by eating bread or
drinking milk or eating yogurt. It is not associated with changing of voice or cough
or fatigue or pain. But associated with water blushing.
PHQ 2 is negative
Medical history is positive for controlled hypertension and prediabetes for the past 5
years, diagnosed by regular check up with no active symptoms, compliant on
Telmisartan and Metformin, OID, with no side effects
Ectopic beats for 1 year, after presenting to cardiology clinic with a slow,
uncomforting palpitation, increased at rest with stress and relieved by active
movement, compliant on Concor, no side effects
Surgical history is negative
He is fully immunized and vaccinated with two doses for COVID-19 and the rest of
them.
No history of blood transfusion, hospitalizations, or ICU admission.
Family history:
His mother has hypertension and diabetes and his brother has diabetes, all are
controlled with no diabetic complications.

Telmisartan 40mg, OID (for Hypertension)
Metformin 500mg, BID (for prediabetes)
Concor 10mg, OID (for Ectopic beats)
No added OTC drugs.
No herbal remedies
Social history:
He is happily married and enjoying his career as an instructor.
He stated that he is facing some issues regarding his diet because of the long hours
of work and that his wife is working too, so there is no time to cook or have a
homemade meal. He is currently exercising twice daily for one hour at the gym for
the past week and he is frustrated that his weight is still the same regardless his best
efforts.
There is no history of smoking, alcohol, or using of illicit drugs.
ICE and impact:
I: He knows that these are symptoms of GERD
C: He is concerned that this issue might affect his sleeping schedule
E: He is expecting to do further tests to confirm his diagnosis and to do a check up
for his health regarding the diseases that he has.
Review of systems:
Unremarkable except for a knee pain during a treadmill exercising but no in free
walking or jogging.
Vital signs: BP 127/86 mmHg, P 78, SpO2 99%, Temp 36.6, BMI 34.51 RR:18
General appearance:
The patient was alert, comfortable, conscious, and oriented to TTP. He is obese, not
appearing to be in pain, and he is not cyanosed, jaundiced, or pale.
Neck: no signs of inspected swelling, erythema, scars, no lymphadenopathy or
tenderness. Thyroid was palpable, soft, symmetrical, not tender or swollen.
Chest: Unremarkable
Cardiac: normal S1 and S2, no added sounds, no murmurs.
Abdomen: soft and lax, no organomegaly, no tenderness, obesity is marked.
Lower limb: no edema, palpable pulses, Intact sensory and motor neurological
examination.
Differential diagnosis:
GERD
H. Pylori infection
Hypersensitivity of the esophagus
Management:
• Clarified that the current issue is an acid reflux which might resolve like the
previous episode but this time with the help of the medication.
• Reassured the patient that there are several solution for the acid reflux.
• Advised the patient to not eat directly before bed time for around 2-3 hours.
Trying to rise his upper body to reduce the acid reflux after drinking or eating.
Also, continue exercising as he does.
• Prescribed for him Valsartan 80mg, OID and Nexium and refilled metformin
500mg and Concor 10mg.
Plan
F/U in 1 weeks to re-assess the symptoms and discuss Lipid profile, CBC, LFT,
RFT, HbA1C, FBG results
Re-offer referral to cardiology regarding his ectopic beats and the possibility of
referral to GI if any of the alarming symptoms appear.
Referral to dietitian
PROGRESS NOTES
Date/Time Prob
SOAP
No.
10/10/2021 A 48 years old Indian male, known case of hypertension,
dyslipidemia, arrythmia, prediabetes, acid reflux, obesity.
Presented to the clinic for reviewing his lab results
No active complaints or worries.
There is an improvement in his acid reflux symptoms.
Labs:
- CBC is normal
- Lipid profile shows an elevation in LDL

- HbA1C: 5.9% (prediabetes)
- LFT is normal
- RFT: is normal
- Fasting glucose is abnormal
Management:
Clarified to the patient that he should pay a close attention to his
glucose level and the fact that he is at risk of developing diabetes
and the urgency to start Statins.
Reassuring the patient that by his lifestyle modifications and being
compliant to the medication, great outcomes are expected.
Advising the patient to keep contact with the dietitian and motivate
him to continue exercising.
Plan:
Atorvastatin 80 mg, OID and explained the mechanism of action
with the possible adverse effect and if the patient had Severe muscle
pain and/or severe right upper quadrant pain he should come directly
to the urgent care.
Following up the patient after 3 months.
STUDENT'S DAY CASE PRESENTATION
STUDENT'S NAME: ……………………………………………………………………………………………………………………………………………………………………………….…………

I.D.
Supervisor's Name: Dr Najwa Zabeeri
_______ __________________________________________________________________________________________________________

Group number: ……… 3 …………………………… Date: ………………………………………………………………………………

31/8/2021 56 years old, female, housewife, from Al-Ahsa
k/c of hypertension (on lisinopril and atenolol)
Diabetes type 2 (on metformin and sitagliptin)
Dyslipidemia (on atorvastatin)
Came to the clinic for routine follow up and reviewing lab results.
No active complaint or worries
No history of macro/microvascular complication
No signs of hyperglycemia
Last retinal check was 4 years back
She takes all her medication at night
PHQ9 was only positive for sleep disturbances, which the patient reports
that the night awakening happened to her since she was young.
Review of system
• Heartburn especially when lying flat, increases after food and at the
morning, relieved after sitting upright, no radiation, 4 in severity
• Sore throat, for years, with no other inflammatory symptoms, and the
patient thinks it is a familial issue (tonsillar illnesses)
Past medical Hx
• DMII for 7 years, and her first presentation was a diagnosed DKA,
and ICU admission for 1 week, in which they started her on insulin
injection for 3 months, then transferred her to (metformin and
sitagliptin) in which the patient has been compliant on and with no
complains. Her HbA1c (Last visit 6.9% → 6.8%). Doesn’t have any
signs or history of recent diabetic complications.
• HTN for 1 year, presented to the clinic after feeling episodes of
dizziness, headache and palpitations, her BP was above (160/85), she
was diagnosed and started on Lisinopril and Atenolol. Her BP (Last
visit 155/88→ 145/94).
Past Surgical Hx
● Laparoscopic cholecystectomy 5 years ago with no complications or ICU
admission
Family Hx
● Brother had hypertension, compliant on his medications

● Lisinopril
● Atenolol
● metformin
● atorvastatin
OB/Gyn Hx
• Her period stopped 5 years ago, G:3, P:3+0

• She had all 3 of them through normal vaginal delivery, no induction
or anesthesia, and no post-partum bleeding or infection
• Babies were on term, had normal birth weight, and no complications
or prolonged NICU stay
• Never used OCP’s and No history of STD’s or UTI
Social Hx
• Low sugar and lipid diet

• A housewife, working in the house
• Sometimes a secondhand smoker
• No smoking or alcohol consumption or use of illicit drugs
• PHQ9 was only positive for sleep disturbances, which the patient
reports that the night awakening is happening to her since she was
young and differed a little in the past 2 weeks.
ICE
● Expectations: the results of her labs and the medications use timing
Physical Generally:
Examination
Her BP 145/94, other vital signs are within normal range
or agitation.
• On Auscultating the chest: there was Equal, Bilateral, clear air entry
with no added sounds and a Normal S1 and S2 with no murmurs.
• Abdominal examination: Soft and lax abdomen with no tenderness
and no signs of distention or organomegaly
• Neurovascular Lower limb examination: No signs of Abnormal gait,
on inspection there were no atrophic change, normal cap refill and
Pulses were palpable. The tone was 2+, power 5+,and normal knee
jerk Reflex. Sensory (Monofilament –ve) and proprioception intact.
MANAGEMENT • Clarified to the patient the proper technique to take her BP readings
at home.
• Reassured the patient about her labs (HbA1c 6.8%, FBG 135mg/dl,
lipid profile, TFT,CBC) and ASCVD 6%, eGFR 68%,
Microalbuminuria (-).
• Advised the patient about the use of anti-HTN drugs, taking
Lisinopril in the morning and Atenolol at night for better BP control.
• Discussed with the patient the availability of Janumet which is the
combination of what she is taking, in which the patient agreed to the
change with no concerns.
• Taught the patient about the importance of foot care (Moisturize,
avoid extreme weathers, etc.), and regular checking of footwear.
• Explained to the patient the utility of Nexium in prevent her
heartburn and the way to take it before breakfast.
Plan:
F/U and having a (Hba1c) check after 3 months
Prescribe Janumet 50/850, BID and Nexium 40mg, OID

Patient refused ophthalmology referral, mammogram and pap smear,
consider ask the patient on next visit
FOB test is sent and will be discussed next visit.
GROUP-ASSESSMENT TOOL (SAT)

Please complete the questions using a number from 1 to 9 as applicable to YOU.

1–3 4–6 7–9 Unable to
How do you rate yourself?
Unsatisfactory Satisfactory Above average comment
Good Clinical Care
1 Ability to diagnose patient problems X
2 Ability to formulate appropriate management plans X
3 Awareness of your own restrictions X
4 Ability to respond to psychological aspect of illness X
5 Appropriate utilization of resources. e.g. ordering X
investigations
Maintaining Good medical practice
6 Ability to manage time effectively X
7 Technical skills (appropriate to current practice) X
Teaching and Training, Appraisal and Assessing
8 Willingness and effectiveness when teaching/ X
training colleagues
Relationship with Patients
9 Communication with patients X
10 Communication with carers and / or family X
11 Respect for patient and their right to X
confidentiality
Working with colleagues
12 Verbal communication with colleagues X
13 Written communication with colleagues X
14 Ability to recognize and value the contribution of X
others
15 Accessibility X
16 Reliability X
17 Overall how do you rate yourself X
Do you have any concerns about your clinical abilities and judgement? rYes r No
Anything going especially well?
Our clinical skills have improved during this rotation but not even close for perfection.
May this rotation be an introduction for more development in our clinical sense in the near future.
Please describe area’s you think you should particularly focus on for development
Holistic approach of history taking and focused physical examination.
Date: Student 's Signature:

TUTOR ASSESSMENT TOOL (TAT)

Student Name: ID:
Please complete the questions using a number from 1 to 9 as applicable to this student.
1–3 4–6 7–9 Unable to
How do you rate your student?
Unsatisfactory Satisfactory Above average comment
Punctuality and attendance

Unjustified absence
Late attendance
Early leaving
Mid-disappearance
Others
Disruptive behavior
Use of mobile
Side talks
Inattention
Sleepiness
Frequent complainer
Others
Participation
Initiative
Assignments complete
Assignments in time
Attitude
Toward tutors
Toward colleagues
Toward administrative staff
Accessibility
Reliability
Working with colleagues
Communication with colleagues
Respect to colleagues
Ability to recognize and value the
contribution of others
Please describe area’s you think you should particularly focus on for development
Assessor's Name: Signature:
Date: Student 's Signature:

STUDENT EXPERIENCE AND REFLECTION DURING FAMILY MEDICINE CLERKSHIP
Please describe your experience
Family Medicine rotation exceeded my expectation. It was one of the excellent rotations I
have ever been into. In addition, I benefited from how to approach patients in very
comprehensive and easy way, and the fact that it focuses on the patient as a whole brings sorts
of comfort to the patient which was special.
(Hussain Al Jubran)
A speciality that pushed me to have a wider skillset and experience. Although, my love for
surgery is far greater, I,ll always be grateful for the medical knowledge given in this rotation.
(Omar Bamalan)
Being able to tailor both plan and management to each patient’s unique situation (illness)
and dealing with a variety of cases and different age groups led me to the appreciation of such a
speciality,.
(Mohammed Al Hajji)
I personally learnt a lot from this experience and Alhamdulillah I had the chance to look
closely at the family medicine speciality. Great environment and huge support from our great
doctors and the topics are very interesting.
(Mohammed Alsharit)
This rotation taught me to look at patients as a whole, not only as sick patients. Family
medicine is one of the specialities that value the relationships with the patients.
(Ahmed Alshaikhi)
A journey full of knowledge and diversity. I hope to see future family doctors in all primary
care centers across the kingdom.
(Omar Bakhurji)
From its patient-centered approach to the preparedness of family physicians to handle a

wide variety of compliants, I have grown fond of family medicine after our rotation in it. So
much so that I wish it was my first ever exposure to clinical medicine.
(Khalil Sabbagh)

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PRACTICE

OF CLINICAL MEDICINE–II (MED-501)

FAMILY MEDICINE DOCUMENTATION CARD –LOGBOOK RESULTS

Total patients encountered: 53 Total problems encountered: 68

6-12 0 0 Depression Acid reflux 2 2.94118

13-21 8 15 Back pain 5 7.3529 Hypertension 4 5.88235

over 65 2 3 Other neurological Hernias 2 2.94118

CHF/CAD 1 1.4705 Lumps 1 1.47059

Males Other female GU 2.9411 Vitamin D deficiency 1.47059

Allergies Knee Pain 2 2.94118

Nationality No. % Male GU 2 2.9411 Abortion 1 1.47059

Breast Problems Alcohol/subst.

Case No: 1 Date: 31/08/2021

Case No: 2 Date: 31/08/2021

My How to empathize, no matter how strong-welled or independent the patient looks?

Case No: 3 Date: 31/08/2021

Case No: 4 Date: 31/08/2021

Case No: 5 Date: 31/08/2021

Case No: 6 Date: 31/08/2021

Case No: 7 Date: 31/08/2021

Case No: 8 Date: 7/9/2021

My Saudi MOH immunization schedule?

Case No: 9 Date: 31/08/2021

Case No: 10 Date: 31/08/2021

Case No: 11 Date: 31/08/2021

Case No: 12 Date: 07/09/2021

Case No: 13 Date: 07/09/2021

My What are the Activities' modifications needed?

Case No: 14 Date: 07/09/2021

My The milestones for pediatric patients in 2 months of age?

Case No: 15 Date: 07/09/2021

My What are the goals in gestational diabetes?

Case No: 16 Date: 07/09/2021

My Management of trigger finger?

Case No: 17 Date: 07/09/2021

My How can we diagnose acute pharyngitis by centor criteria?

Case No: 18 Date: 13/09/2021

My Differential diagnosis for LBP?

Case No: 19 Date: 13/09/2021

My How to deal with uncontrolled RA?

Case No: 20 Date: 13/09/2021

Case No: 21 Date: 13/09/2021

My Indications for a double-j stent?

Case No: 22 Date: 13/09/2021

My The use of multivitamin drugs in patients with vitamin D deficiency or iron

Case No: 23 Date: 13/09/2021

My The role of physiotherapy in knee pain?

Case No: 24 Date: 13/09/2021

My The role of reducing weight in controlling DM and HTN?

Case No: 25 Date: 13/09/2021

Case No: 26 Date: 13/09/2021

Case No: 27 Date: 13/09/2021

Medical Record No. 1245354 Age: 36 Sex: M Nationality Non-saudi

Case No: 28 Date: 14/09/2021

Medical Record No. 1638784 Age: 19 Sex: M Nationality Saudi

Case No: 29 Date: 14/09/2021

Medical Record No. 1514340 Age: 41 Sex: M Nationality Saudi

My How to perform smoking counselling?

Case No: 30 Date: 20/09/2021

Medical Record No. 1604535 Age: 21 Sex: F Nationality Saudi

Case No: 31 Date: 20/09/2021

Medical Record No. 1624029 Age: 19 Sex: F Nationality Saudi

My Role of abdominal Ultrasound in bleeding disorders?

Case No: 32 Date: 21/09/2021