1. Step 6
1.1. Review session 1
1.2. Report new knowledge
1.3. 30 minutes
1.3.1. The scribe does not have to write in this step!
2. Step 8
2.1. Diagnostic decision
2.1.1. metabolic syndrome with diabetes type 2 and hypertention
2.2. Mechanism
2.2.1. environment and genetic predesposition
2.3. Presentation
2.3.1. tirdenss
2.3.2. sleep disturbance
2.3.3. polyuria
2.3.4. leg edema
2.3.5. SOB
2.3.6. obesity
2.4. Supporting data
2.4.1. history and physical
2.4.2. blood glucose level
2.4.3. high BP
2.4.3.1. ECG
2.4.4. lipid profile
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. sleep disturbed and restless for a number of years
3.1.1.2. sleeps early while watching TV
3.1.1.3. getting up to pass urine at least twice in the last 6-9 months
3.1.1.4. difficulty concentrating during work
3.1.1.5. leg edema in long trip
3.1.1.6. gained 8-10 kg for the last year
3.1.1.7. getting breathless
3.1.2. Previous medical / surgical history
3.1.2.1. not significant
3.1.3. Drug history / allergy
3.1.3.1. penecillin allergy
3.1.4. Family history
3.1.4.1. suspects his father has high BP
3.1.4.2. mother was diagnosed with diabetes
3.1.4.3. increased weight in the family
3.1.5. Social / occupational history
3.1.5.1. too busy for exercise
3.1.5.2. 4 drinks per day for a long period
3.1.5.3. prior to 8 years he smoked a pack per day
3.1.6. Systemic review
3.1.7. Physical examination
3.1.7.1. VITALS
3.1.7.1.1. pulse 96
3.1.7.1.2. BP 150/105
3.1.7.1.3. RR 12
3.1.7.1.4. weight 130kg
3.1.7.1.5. height 177.8
3.1.7.1.6. weist 128
3.1.7.1.7. BMI 41
3.1.7.2. inspection
3.1.7.2.1. red face
3.1.7.2.2. adiposity
3.1.7.2.3. breathless after climbing to examination table
3.1.7.2.4. pharynx narrow and red with edematous uvula
3.1.7.3. CVS
3.1.7.3.1. dual heart sounds
3.1.7.3.2. JVB unable to be seen
3.1.7.3.3. absent pulses in left foot
3.1.7.3.4. bilateral mild edema
3.1.7.4. funduscopy
3.1.7.4.1. artery narrowing (grade I)
3.1.7.5. abdomen
3.1.7.5.1. straie
3.1.7.5.2. hepatomegaly (3cm)
3.1.8. tests results