1. Step 6
1.1. Review session 1
1.2. Report new knowledge
1.2.1. structure of the adrenal gland
1.2.2. physiology of cortisone
1.2.3. cuishing syndrome
1.2.3.1. pathophysiology
1.2.3.2. causes
1.2.3.2.1. medication induced
1.2.3.3. symptoms
1.2.3.4. diagnosis
1.2.4. the difference between cuishing and psuedo-cuishing
1.3. 30 minutes
2. Step 8
2.1. Diagnostic decision
2.1.1. iatrogenic cushing syndrome
2.2. Mechanism
2.2.1. long term administration of steroid due to asthma
2.3. Presentation
2.3.1. weight gain
2.3.2. moon face
2.3.3. dorsal fat bad
2.3.4. hairtisium
2.3.5. acne
2.3.6. stria
2.3.7. hypertension
2.3.8. depression
2.4. Supporting data
2.4.1. hormones assay
2.4.2. biochemstry
2.4.3. physical exam and history
2.5. 10 minutes
3. Step 7
3.1. Inquiry plan and info gathering
3.1.1. History of presenting complaint
3.1.1.1. moved from house 4 y ago
3.1.1.2. inncreased asthma
3.1.1.3. initialy controlled
3.1.1.4. 4 admission over the last 6 month -acute asthma--
3.1.1.5. high prdeisolone therapy
3.1.1.6. emotional labile
3.1.1.7. gained 12 kg
3.1.1.8. hungry
3.1.1.9. binge eating
3.1.1.10. self vomting
3.1.1.11. embarrsed to do excercise
3.1.2. Previous medical / surgical history
3.1.2.1. doagnosed since 5 y old
3.1.2.2. age 10 start medication
3.1.2.3. oral steroid therapy
3.1.2.4. upper limit
3.1.2.5. rounded face and chubby
3.1.2.6. the weight went up and the height went down
3.1.2.7. red strie at breast ,hip,axilla
3.1.2.7.1. nos sport or swimming
3.1.2.8. use peak flow meter
3.1.2.9. age 13 start to control her asthma her self
3.1.2.10. menarche
3.1.2.10.1. 14 y and one month
3.1.3. Drug history / allergy
3.1.4. Family history
3.1.5. Social / occupational history
3.1.5.1. with parent ,2 younger brothers
3.1.5.2. moved to states 4 y ago
3.1.5.3. different house same school
3.1.5.4. father smoker
3.1.5.5. comments on his daughter weight
3.1.5.6. mother concern about asthma attack
3.1.5.7. noboyfriend
3.1.5.8. selected friend
3.1.5.9. not smoking
3.1.5.10. tried dope
3.1.5.10.1. ilicit
3.1.5.11. alcohol once or twice
3.1.5.12. no class activity
3.1.5.13. no concentration in class
3.1.6. Systemic review
3.1.7. Physical examination
3.1.7.1. unhappy
3.1.7.2. w 83 >97 percentile
3.1.7.3. h 152 3 percentile
3.1.7.4. breast tanner stage 4
3.1.7.5. bP 145/92
3.1.7.6. P 88 regulat
3.1.7.7. no goiter no anemia
3.1.7.8. round plethoric
3.1.7.9. seborrhoea
3.1.7.10. increased facial hair
3.1.7.11. loss of supraclavicular space
3.1.7.12. cervicle pad
3.1.8. tests results
3.1.8.1. peak flow meter is 78%
3.1.8.1.1. mild air flow limitation