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lovelypony: case presentation 学习笔记/讨论
作者:USMedEdu
发表时间:2011-02-23
更新时间:2011-03-12
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发信人: lovelypony (pony), 信区: Pre_Resident_Club
标 题: case presentation 学习笔记
发信站: BBS 未名空间站 (Tue Feb 22 20:03:05 2011, 美东)

昨天第一次参加了由现任斑竹chipmunk和元老knockingdown主持的case presentation,觉得收获很大,后面慢慢的把自己的学习笔记贴出来,后面的同学看了可以少犯些我们犯过的低级错误,这样前辈们也可以省些力气。前辈们牺牲自己宝贵的私人时间,聆听我们支离破碎,毫无章法的presentation ,耐心细致的指出错误,提出建议,pony真的觉得没有更好的语言来表达自己的感激之情。就希望能抛砖引玉,大家能互帮互助,提高我们CMG的整体水平,这样前辈们的心思也算没有白花,希望大家都能来补充和指出错误,多谢了!

要present一个case,结构一定要完整。
1. CC: 第一句话永远是chief complaint,怎么样用一句话简明扼要的把CC说好了,还是要花大力气的。CC应该只是一句话,但要包括下列4个基本元素:The patient’s age and sex;The patient’s active ongoing medical problems;The patient’s reason for presentation;The duration of symptoms。这个我们练习CS的时候都练习过了,但是要怎么很好的口头表达清晰还是要再练习。CC里面一定要涵盖patient最重要的信息,不能在后面HPI或者PMH的时候给attending一个big surprise,从CC里attending大概就知道patient的主要毛病了。

2. HPI:三段论:阳性症状+阴性症状+workup

先说阳性症状,按照时间顺序叙述,而且要详细。这时候我们CS背的OCD FP, LIQR AAA就上吧,CS还是有用的,嘻嘻~

阳性的说完了再说阴性症状。注意阴性症状的阐述也很重要,要包括3部分:一是有没有全身症状,二是同系统其他症状(比如说cough是 respiratory系统,就要再详细说有没有phlem,chest pain, dyspnea, wheezing, etc.),三是risk factors.

阴性症状说完了就可以说workup了。

3. PMH:这时候CS的PAM HUGS FOSS就可以上了,这个pony也有待practice,这么多信息有点啰嗦的说,好像挑些重要的说说?有待前辈指点。

4. PE:也是三段论:总体印象+阳性体检+阴性体检。这里pony还是有点糊涂,如果是一个full-size presentation的话,是先把阳性的说了,再按系统说阴性体征呢,还是就按照系统一个一个系统的说?

开始先给一个总体印象:general description and vital signs。这个昨天鼠大大专门强调了,我们昨天present一个A-fib,这个很重要,第一印象决定patient是stable还是 unstable,直接决定后面的诊疗计划呢。

然后all abnormal findings:

最后是normal findings, include only those essential to the understanding of the chief complaint

5. lab:这个直接从网站摘抄的:

•Include all abnormal labs, with comparison to previous value
•Among normal labs, includes only those relevant to the chief complaint
•Any labs presented should appear in traditional order (electrolytes/creatinine/glucose, complete blood count, other chemistries, urinalysis, CXR, ECG, gram stains and analysis of body fluids)

6. A&P:这个网站上写的很好,大段抄袭。

1).Begin with a positive statement of the patient’s problem。

2).Ask yourself "At the moment I am presenting the case, what is the principal unresolved issue?"
a.If the principal unresolved issue is diagnosis, your assessment focuses on differential diagnosis。
b.If the principal unresolved issue is therapy, your assessment: (i) states the diagnosis or problem, (ii) states which therapy you gave or plan to give, and why you made this decision, (iii) states which complications you might anticipate.

3).If you are presenting the morning after overnight call, the case presentation usually ends with a 1-2 sentence summary of what happened overnight, after implementation of your initial decisions.

present case应该是基于记忆的,和attending一定要有eye contact,尽量避免看note。

先发一部分,后面有空了慢慢改,见谅。


一楼主要是结构问题,二楼留给一些琐碎的笔记:

Can’t say qd (outdated), have to say once daily. Even for prescription.
Can say UTI, 不一定非要说urinary tract infection.
3 vessel CABG的念法是:Triple vessel cabbage, NOT three vessel, or C-A-B-G.
Can say IV push or bolus, which is different from drip.
Can say drip, don’t have to say intravenous drip.
Can say two-D echo, don’t have to say two-dimension echo.
Say D/C or discontinuous, don’t say cancel. D/C stands for discharge too.
Can say either P.O or oral.


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※ 修改:·lovelypony 於 Feb 22 20:15:40 2011 修改本文·[FROM: 164.107.]
※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 164.107.]


发信人: meganli1998 (megan), 信区: MedicalCareer
标 题: Summary of CS talk by lovelypony
发信站: BBS 未名空间站 (Sat Mar 12 11:51:48 2011, 美东)

首先感谢pony百忙之中为我们精心准备的CS talk. 我还没开始准备CS, 可能有些地方不得要领, 错误和疏漏之处请指正.

Spoken English: Practice more. Be confident.
Time management: history taking (7min)+ physical examination(3-4min)+closure
(2min).
Show empathy: appropriate expression & movement instead of just saying “I
am very sorry”.
History taking: chief complaint (2-3min. Repeat ~ 3 major points)+
differential diagnosis (FA mini-case is more than enough). You must be very
proficient. No pause, no thinking.
Physical examination(3-4min): Don't try to cover all the systems. ~2 systems
. Don't touch patient's gown. Respect privacy. Don't tell the patient the
result. Just say "OK" instead of "it looks normal to me".
Closure (2min): 1)show appreciation: thank you... 2)summarize: 3-4 points.
No numbers (You may recall wrong). Usually don't summarize physical. 3)give
patient an impression, usually the simplest one. Don't use medical
terminology.
4)Next step: for example: Take a picture of your chest.
5)Consultation: quit smoking, etc.
6)Do you have any more questions for me?

Test center doesn’t really matter.
Make sure no spelling error on patient note.
Brief family history taking is still required for emergency case.
Practice history taking & PE for 3 weeks before taking (New Jersey) Kaplan
Course. Then practice 1-2 more weeks. Ready for test.
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※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 99.92.]


发信人: mei5 (mei), 信区: MedicalCareer
标 题: Lovelypony cs talk SUMMARY
发信站: BBS 未名空间站 (Sat Mar 12 11:33:17 2011, 美东)

First thank you lovelypony gave us the talk and it is very valuable.

I summarize as the following\; If it is not correct, correct me. It is my
understanding.

1. time management is the key. When u do practise, try to have it done by
14 min.

2. SPE: don’t look down urself. Be confident and try to practise as much
as can and make the ur own protocol and talk it with smooth way.

3. Empathy: very important and try as sincere as possible. Don’t just
say \”I am sorry” u need to add real content with the appropriate
situation. For example: don’t ask \’how can I help you’ when u see SP is
in the pain state, u may say ‘I can see you are in the pain, …..’

4. Questions of history: focus on HPI, c/o with details. DDX :ask 3-4.
then pam hugs foss. FHx:quick ask if it is not related to c/o. Oby:ask last
period if it is not related to c/o.

5. PE:focus 3-4 min. one system related to c/o, another related system.

6. Closure:very important. Include:thank you for answering my qs, brief
summary, (try to avoid numbers as details), your impression(simple better),
next step(use lay language).counselling. Do u have any question.
Add more info if you can recall. Good luck .

--

※ 修改:·mei5 於 Mar 12 11:35:56 2011 修改本文·[FROM: 172.129.]


发信人: jenny2006 (jenny2006), 信区: MedicalCareer
标 题: Pony CS talk undetailed summery,请同学们补充
发信站: BBS 未名空间站 (Sat Mar 12 11:42:44 2011, 美东)

Time management 最重要

练习时用timer7,10,14, after taking history7,after PE10,after closure14.

Show sympathy,根据病人需要表示关心

急诊:如呻吟,咆哮病人,sense of emergency

Do physical examination as fast as possible,动作表情配合语言
HPI 问得细一些,CC问2-3分钟。额外3-4个问题鉴别诊断。
PAMHUGSFOSS要很熟练,由潜意识出来,不要有1秒钟停顿。
查体:至少2个系统.

Closure:现感谢一下,3-4points,复述时尽量避免数字,怕记错。尽量避免
terminology,必须用就接着解释。

Consultations smoking,alcohol 先写在右上角,以免忘了

最好问Do you have any more Qs for me? (重要!)

鉴别诊断:4-5个。

不好意思,两个孩子醒了,请同学们补充。
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※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 76.231.]

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