DIFFICULT KEY INFO PROBLEM/DISCUSSION HYPOTHESIS FURTHER INFO LEARNING ISSUE

WORDS
• Pn. Fatimah, • Getting tired easily due • Heart Defects • Marriage • Causes of
35 Y/o to lack of sleep, lack of • Stress status/ someone to
Female, food intake, burnout, • Anaemia condition be tired.
complained heart defects, pregnant, • Diabetes • Medication • Relation
of getting underlying medical • Pregnant • Family Hx between food
tired easily condition i.e., anaemia, • Cancer • Occupation intake with
for the past 2 effects of medication, • Side effects • Menstrual getting tired
month chronic condition such of drugs History easily.
• In 2 weeks, as diabetes and cancer. • Chronic • Social History • Management
the disease • Vitals of
symptoms • Bmi exhaustion.
• Thalassaemia
worsened
• Obesity • Pregnant?
• It was
• Eating • Relying
difficult for
disorder i.e., Disease
her to
anorexia and • Physical
complete
bulimia. Exams
daily
• Asthma • Additional
activities.
• PCOS Exams.
• Sleep Apnoea • Past history of
hospitalization
and any
procedures.

TRIGGER 1
DIFFICULT WORDS KEY INFO PROBLEM/DISCUSSION HYPOTHESIS FURTHER INFO LEARNING ISSUE
• Per rectal – • pt passes foul • Bleeding in bowel -Peptic Ulcer • Blood test • Anatomical
internal exams smelling black • Possible viral / -Anaemia (FBC). remark of the
of the rectum. tarry stool for bacterial infx -Adverse drug • Blood abdomen
• Belching- 2 months. • Side effects of reaction. smear. area.
Burping • Hx of bloating, medication. -Chronic • ABG.
• Guarding- belching, • Ulcer in stomach. disease. • Xray to • Stool – type,
Abdominal epigastric • Long term NSAID epigastrium causes,
muscle tenses discomfort. causes injury that area. colour.
when • Basketball might cause peptic • Endoscope
palpating. player, with hx ulcer. • Effects of
• Rebound of frequent • Mild tenderness dt NSAID. PK,
tenderness - falling inflammation in the PD, MOA.
Presence of sustaining abdomen area.
pain when injury. • No constipation. • Synergic
pressure is • No cough of effect with
removed from fever. antacid.
abdomen. • No hx of blood
• Epigastrium- in urine nor • Types of
Upper part of sputum. anaemia
abdomen • Normal
below ribcage. mances. Good • Causes of
• Antacid- appetite. tenderness in
medication to • Normal diet, epigastrium.
neutralize no loss of
acidic gastric weight.
juice. • Osteoarthritis
to the right
knee.
• Prescribed
NSAID and
took for over 2
 years over
counter.
• Pt is a teacher,
married with 2
children (5 and
8 yo).
• Pallor, No
jaundice.
• Normal vitals
• Limited range
of movement.
• Overweight
BMI.
• Right knee join
is swollen.
• No
inflammation
• Mild
tenderness in
epigastrium.
• No rebound
tenderness,
normal bowel
sound.
• Per rectal exam
shows black
stool.
• Normal cns
exams.
TRIGGER 2
 DIFFICULT KEY INFO PROBLEM/DISCUSSION HYPOTHESIS FURTHER INFO LEARNING ISSUE
WORDS
• Mean - Tests for
Corpuscular anaemia.
Volume-
average size - -Iron
of RBC. deficiency,
• Mean type ,
Corpuscular condition,
Hb- Avg how it affects
Amount of Hb mcv , mch.
in RBC.
• Occult- - Statistic,
hidden blood. latest
• Microcytic- treatments.
small size of
RBC.
• Hypochromic-
reduced
amount of
RBC.
• Antrum-
lower part of
organ.

TRIGGER 3 & CASE CLOSURE.