CASES

Family Medicine
Victoria Sünkel gr 4a
Fatma Mohammed 4a
Twenty years old woman comes to Family Medicine
Clinic with 39,5oC fever, headache and malaise. In
physical examination BP 125/80, HR 90/min regular,
vesicular soud over the lungs, throat pink, meningal
signs negative. What will be your proceeding.
General history taking (when did it start, what are her symptoms, pain in joints,
family members? anything making it worse or better, associated symptoms?
Diarrhea?Nausea? )

General examination, Skin examination (Petechiae, Rash), palpation of sinuses, short

neurological exam for the headache)

Examination of lymph nodes and oral cavity - bacterial? if suspected, swab!

prescription of painkillers for the headache + fever (Paracetamol), sick leave from
work for a week to get rest, explain her need to rest properly

If culture from swab comes back positive, ask her to call in 3 days in case she needs
an antibiotic
 Fifty-eight years old man visits his family doctor and
states that two days ago he had blood during urination.
This ailment appeared only once. Later urine was clear. In
physsical examination: BP 135/80, HR 76/min regular,
lungs- normal vesicular sound, abdomen soft and painless,
Goldflam’s sign negative. What will be your management.
History taking (detailed urological), Injury/accidents preceding event? Sport activity before? Sexual
activity? STDs? Pain on urination? Pain during the bleeding episode? Itching? foreign body
administration? Lacerations of the penis noted ?

Additional questions - beetroot consumption? Any new medication, also over the counter? Check
fever, ask to describe the color properly

Blood sample to be taken to check for hemolysis, anaemia, creatinine

Detailed physical examination - external urethra intact? bruising or similar? frenulum? skin lesions?
also examine rectum for haemorrhoids

USG - Prostate (to exclude malignancy or inflammation)

Abdominal USG to exclude bladder tumor , cystoscopy

Urine analysis - sediment, stix and culture, possibly cytology

 Sixty-two years old woman treated for hypertension with
indapamide arrives to outpatiency clinic for routine checkup
and drug continuation. She doesn’t complain for anything.
Maybe has been a bit weaker for some time. In physical
examination: BP 125/80, HR 80/min completly irregular,
normal vesicular sound over the lungs.
Common side effects of Indapamide are 1.fatigue, 2.low potassium,
3.orthostatic hypotension

Patient should be evaluated for 2 and 3, blood samples taken and checked for
other causes of fatigue as well (anemia, iron levels, MCV, TSH, T3,4)

Bp levels are quite good, but the irregular heart beats need check by Echo and
ECG to evaluate cause

Holter ECG or 24 bp measurement should be done

Detailed history about stressful environment, sleep behaviour, eating habits

should be done
 Sixty-five years old man cured for hypertension with
perindopril 5mg comes to family doctor because two days
ago during work in a garden he felt pain in chest which
lasted three minutes. Then he stopped working and the
suffering hasn’t returned later. During medical visit BP
135/85, HR 80/min regular, normal vesicular sound over
the lungs.
Detailed history taking, family history of CAD, Angina etc, claudication, events
of breathlessness, stairs

Blood testing for blood lipid levels, troponin

Exclude that the chest pain was of cardiac origin

Echo, ECG

Schedule for Nuclear medicine Cardiac Perfusion study or if suspected

occlusion of coronary artery to Cath Lab

Provide patient with Nitrous Oxide, inform about Sildenafil !!!!

For preventive examination concerned with cardiovascular health arrives fifty-
five years old woman. Family interview regarding stroke and myocardial
infarction is negative. The patient doesn’t smoke, is physically inactive.
Weight 80kg, height 164cm, BMI 29,7, BR 130/85. Lab tests: total cholesterol
221mg%, triglycerides 208mg%, HDL cholesterol 56mg%, LDL cholesterol
123mg%, glucose 132mg%. What will be your advices.

History - Medication, Chronic diseases, Alcohol consumption, Diet (salt,fat),

fam history of diabetes, claudication? breathlessness, sleeping/snoring?
Headaches in the morning? Vision problems?

Physical examination of skin (tags, acanthosis nigricans, open wounds)

Doppler of the peripheral vessels, BAI, sensitivity of extremities?

Advice urgently for change in diet/lifestyle, prescribe methformin to aid weight

loss, check for Thyroid gland disorders, give info about weight loss groups,
different diets (Keto?)

Prescribe Statins, check for Hb1Ac, schedule appointment with Neurologist

and Opthalmologist, check if patient needs dietician
 Sixty-seven years old man complains for dark urine
and pale stool forvtwo days. He has a mild bellyache.
BP 135/80, HR 76/min regular, lungs – normal
vesicular sound, abdomen soft and painless during
physical examination. His skin is slightly yellowish.
When did it start, episodes before? diet and exotic travels, family history of
cholelithiasis, pancreatic disorders, tumors, Intake of Alcohol?

Most likely Mechanical Cholestasis due to obstructed Gallducts

Perform USG to find offending Stone, determine location and size

Check for further Cholelithiasis and Pancreas obstruction

Schedule for surgery if the stone is not likely to be washed away

exclude tumor (Klatskin tumor, Pancreatic head tumor, Cyst, Liver tumor)

Take Blood samples and check for BR levels, BV levels conjugated and
unconjugated Hemoglobin, hemolysis - EOSINOPHILS to exclude ascariasis