Always tired - session 2

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Always tired - session 2 by Mind Map: Always tired - session 2

1. Step 6

1.1. Review session 1

1.1.1. Summary of step 5

1.2. Report new knowledge

1.2.1. Anemia

1.2.1.1. Definition: reduction in hemoglobin concentration, with various normal values depending on different factors.

1.2.1.1.1. highest concentration during the newborn life

1.2.1.2. Causes and types (specially in elderly)

1.2.1.2.1. based on the size (MCV)

1.2.1.3. Risk factors (malnutrition)

1.2.1.3.1. vitamin deficiency in meals

1.2.1.3.2. chronic diseases

1.2.1.3.3. drugs

1.2.1.3.4. autoimmune diseases

1.2.1.4. Presentations (does it cause tiredness?)

1.2.1.4.1. acute onset patients come with more symptoms

1.2.1.4.2. symptoms

1.2.1.5. Diagnosis

1.2.1.5.1. history and PE

1.2.1.5.2. CBC

1.2.1.5.3. Aspiration

1.2.1.5.4. Biopsy

1.2.2. Pallor

1.2.2.1. causes

1.2.2.1.1. reduction in hemoglobin concentration

1.2.2.2. might come with jaundice in hemolytic anemia

1.2.2.3. common in all anemia tyoes

1.3. 40 minutes

2. Step 8

2.1. Diagnostic decision

2.1.1. megaloblactic anemia

2.2. Mechanism

2.2.1. decline animal diet consumption, no sources of folate and B12, with autoimmunity involvement

2.3. Presentation

2.3.1. recurrent falss

2.3.2. bruising

2.3.3. tingling

2.3.4. jaundice

2.3.5. high JVP

2.3.6. edema

2.3.7. systolic murmur in auscultation

2.4. Supporting data

2.4.1. CXR

2.4.2. biochemistery and test results

2.5. 10 minutes

3. Step 7

3.1. Inquiry plan and info gathering

3.1.1. History of presenting complain

3.1.1.1. by which did she present?

3.1.1.2. why did she present?

3.1.1.2.1. weight loss

3.1.1.2.2. breathlessness

3.1.1.2.3. decline health

3.1.1.2.4. memory decline

3.1.1.2.5. ankle swelling

3.1.1.2.6. faintness

3.1.1.3. associated symptoms

3.1.1.3.1. chest pain reliefed by gest

3.1.1.3.2. angina?

3.1.1.3.3. pale looking developed over months

3.1.1.4. exacerbation

3.1.1.5. progressive?

3.1.1.5.1. yes

3.1.1.6. blood loss?

3.1.1.7. falling?

3.1.1.7.1. bruising because of falling

3.1.2. Previous medical / surgical history

3.1.2.1. chronic disease?

3.1.2.1.1. kidney ?

3.1.2.1.2. hematological?

3.1.2.1.3. MI 5 years ago

3.1.2.1.4. mild child asthma

3.1.2.1.5. high thyroid stimulating factor

3.1.2.1.6. low T3 level

3.1.2.1.7. in the thyroxin therapy

3.1.2.2. surgeries?

3.1.2.2.1. spleenectomy?

3.1.2.2.2. BMT?

3.1.2.2.3. appendiectomy at age 12

3.1.2.2.4. cholesestomy at age 45

3.1.2.2.5. normal vaginal delivery?

3.1.2.3. accidents or falls?

3.1.2.4. malignancy

3.1.2.5. experienced the same symptoms?

3.1.2.6. menopause and pregnancy?

3.1.2.7. weight gain and fatigue 3 y ago

3.1.3. Drug history / allergy

3.1.4. Family history

3.1.4.1. father and mom died at age of 80

3.1.4.1.1. father MI

3.1.4.1.2. mom from pneumonia

3.1.4.2. mom had non insuline dependant DM

3.1.4.3. sister had thyroid problem

3.1.4.4. no history of anemia

3.1.5. Social / occupational history

3.1.5.1. her husband died 11 years ago

3.1.5.1.1. lived alone after that

3.1.5.1.2. visited by her friendes

3.1.5.1.3. 2 of her children visit her regulatly

3.1.5.2. diets?

3.1.5.2.1. suboptimal diet deteriorated

3.1.5.2.2. suib

3.1.5.2.3. breads and peskits

3.1.5.3. smoker?

3.1.5.3.1. never

3.1.5.4. minimal alcohol consumption

3.1.5.5. stopped to go the social club because of tiredness

3.1.6. Systemic review

3.1.6.1. appetite?

3.1.6.2. weight loss?

3.1.6.3. vision?

3.1.6.4. headache?

3.1.6.5. blood in the feces or urine?

3.1.6.6. any noticibale bleeding?

3.1.6.7. bleeding?

3.1.6.7.1. no obvious bleeding

3.1.6.8. restless syndrome

3.1.6.9. tingling sensation

3.1.6.10. mild cognetive deficiet

3.1.7. Physical examination

3.1.7.1. vital signs

3.1.7.1.1. wheight 52

3.1.7.1.2. hight 157

3.1.7.1.3. BP 165 / 60

3.1.7.1.4. PR 105

3.1.7.1.5. RR?

3.1.7.2. inspection

3.1.7.2.1. jaundice

3.1.7.2.2. marked pallor

3.1.7.2.3. no noticeable ulcers

3.1.7.2.4. several bruising in thighes and both arms

3.1.7.2.5. no spleenomegaly

3.1.7.2.6. mild ankle edema

3.1.7.2.7. JVP elevated 4 cm

3.1.7.2.8. degenerative neuropathy in hands

3.1.7.2.9. normal gate

3.1.7.3. paplation

3.1.7.3.1. no bone tenderness

3.1.7.4. ausculation

3.1.7.4.1. systolic murmer

3.1.7.4.2. cardical apex diceplaced 2 cm laterally

3.1.7.5. Neurological

3.1.7.5.1. dimineshed sensation to light tough

3.1.8. tests results

3.2. 40 minutes