PBL 1 session 2

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PBL 1 session 2 by Mind Map: PBL 1 session 2

1. Step 6

1.1. Review session 1

1.2. Report new knowledge

1.2.1. basal metabolic rate Thyroid gland physiology & relevant anatomy dysfunction

1.2.2. diagnosis of anxiety and relation to BMR

1.3. 30 minutes

2. Step 8

2.1. Diagnostic decision

2.1.1. Hyperthyroidism - grave's

2.2. Mechanism

2.2.1. autoimmune antibodies causing over activity of thyroid gland

2.3. Presentation

2.3.1. anxiety, sweating, tremor, exophalmos, warmness, led lag, enlarged thyroid

2.4. Supporting data

2.4.1. thyroid function and scan

2.4.2. history and physical examination

2.4.3. family history

2.5. 10 minutes

3. Step 7

3.1. Inquiry plan and info gathering

3.1.1. History of presenting complaint lost 3 kg in the last month breathlessness and muscle weakness on exertion, feeling unfit normal apatite feeling anxious for the last month perspires when nervous and develops tremor irritable eyes feeling gritty and a little puffy

3.1.2. Previous medical / surgical history asthma as a child, no attacks since early teens

3.1.3. Drug history / allergy non, just asthma history

3.1.4. Family history maternal grandmother had thyroid condition no family history of psychiatric disorders

3.1.5. Social / occupational history no smoking occasional glass of wine married for 18 months no kids

3.1.6. Systemic review

3.1.7. Physical examination vitals BMI pulse is 110 regular BP 140/50 temp 37 inspection anxious fine tremor in the hands moderate proximal muscle weakness eye lid have some puffiness, lid lag on testing no pretibial myxoedema palpation moderately enlarged thyroid gland warm hands some palpable lymph nodes on both sides of the neck cardiovascular exam JVB normal auscultation chest clear abdomen normal nervous system brisk and symmetrical

3.1.8. tests results thyroid function thyrotoxicosis thyroid scan increased uptake CBC pregnancy liver function renal function calcium, creatinin

3.2. 50 minutes