Session 2 base

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Session 2 base by Mind Map: Session 2 base

1. 25 percentile

2. Step 7

2.1. Medical History

2.1.1. Problem formulation

2.1.2. History of presenting complain Ahead of time for his routine 3-month follow-up appointment Attended at a local Medical Centre the day before Diarrhoea for the last 2weeks, now 10/day - prior to this, once or twice /day Abdominal pain for over a week Stool is watery with no mucous or blood No tenesmus Near faecal incontinence experienced several times in the last 2 weeks Stool specimen collected for microscopic examination Commenced metronidazole 7kg weight loss over the last 6-8 months Unable to carry out normal exercise program

2.1.3. Medical history AIDS diagnosed 6 years ago Prior to this, not aware that he was HIV +ve Presented with painless lump in left axilla, diagnosed as Burkitt's Lymphoma CD4 count at this time was 600 cells/mm3 Referred to an Oncologist. Given 6 courses of CHOP (Cyclophosphamide, Vincristine, Doxorubicin, Prednisone) CD4 count fell to 300 cells/ mm3 - commenced on Zidovudine (AZT) and Trimethoprim/Sulfamethoxazole (TMP/SMX) 6 months later considered tumour-free - CD4 count 500 cells/mm3 Prescribed lamivudine (3TC) stavudine (d4T) and saquinavir (a protease inhibitor) as combination therapy however diarrhoea led him to intermittent use of the therapy 2 years later, CD4 count is 200 cells/ mm3, with rising HIV viral load Experienced mild hyperglycaemia (BSL 8.2 mmol/L) and lipoatrophy of face and upper arms Current medications: Triple anti-retroviral therapy - Abacavir, Zalcitabine (ddC) and Indinavir; plus TMP/SMX and Azithromycin Most recent CD4 count is 40 cells/ mm3 Most recent HIV viral load is 480,000 copies per ml (PCR assay) Until AIDS diagnosed, had never had a serious medical illness Appendicectomy at age 16 Personal History

2.1.4. Family history Parents separated when he was 10 Lived with his mother in Orange (NSW) before moving to Sydney when he was 20 Has not spoken to his father since their separation - he now lives in rural Victoria Has not told either of his parents of his AIDS condition No siblings No family history of malignancy

2.1.5. Personal history Occupation - Clerk Prior to AIDS diagnosis, keen runner, competing regularly in Sydney City to Surf Homosexual man who states he has had approximately 15 male sexual partners/contacts in the past Does not smoke Drinks socially Has not used recreational drugs, IV drugs or had a transfusion Is careful with his diet - predominantly vegetarian, with occasional chicken or fish Regularly reads the gay press

2.1.6. Social / occupational history

2.1.7. Drug

2.1.8. genetic predisposing factors

2.1.9. Systemic review

2.1.10. Past history

2.1.11. Family history

2.1.12. Personal and social history

2.2. Physical Examination

2.2.1. General Moderately dehydrated Sunken cheeks, upper arm fat loss, protuberant abdomen Adherent white plaques on tongue and palate (oral candidiasis)

2.2.2. BMI height 160 weight 50

2.2.3. vitals BP 115/70 Temp. 37.4 RR Pulse Rate 90 JVP

2.2.4. Endocrine

2.2.5. abdominal

2.2.6. GU

2.2.7. CNS

2.2.8. CVS

2.2.9. MSK

2.2.10. respiratory

2.2.11. Reproductive

2.2.12. Ophthalmology

2.2.13. GI

2.3. Investigation

2.3.1. Test Results

3. Step 8

3.1. Diagnosis

3.1.1. CRYPTOSPORIDIA infection diarrhea in AIDs patient

4. Step 6

4.1. Review session 1

4.1.1. Formulate learning objectives

4.1.2. Formulate learning objectives