Rob has been on the podcast way back in December when we chatted about the evils and virtues of Vitamin D. Since then Rob has been busy working as a GP, writing the RACGP written examination yep, I know, you would think the bloke writing the exams is a total douchebag… turns out the opposite is true!
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The aim of this podcast is to share some clinical cases, not so much to Stump the Chumps see IM Reasoning for that but more to show how a prudent senior GP might think their way through a clinical problem. At least that is what I told Rob… now to try and fool that clever fella! I have presented this case in stages — broken by horizontal lines — the idea is that you stop at each line and consider what is important, the differentials what you need to think about in the next phase.
Clearly there will be some questions you need to delve into later as more information becomes available. You are working in your suburban GP clinic.
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Your next patient is Marli. Marli is a 16 year old, final year highschooler. You have not seen her since she was a little kid. She presents with her mother whom you know quite well. Marli is currently on study break leading into her final TER exams and her family have high expectations….
She has no ongoing medical problems and is quite fit, doing performance gymnastics up until final year school. She has no other background issues. Today she presents with a bruise on her forehead. She tells you that she collapsed in the bathroom this morning and bumped her head on the vanity… she cannot recall anything for a few minutes.
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This happened after she sat on the toilet to urinate then stood up. Mum was in the next room and heard her fall and saw her on the floor.
Mum observed her laying on the floor and had what seemed like 2 or 3 brief jerky movements of all four limbs. After that she rapidly regained consciousness and sat up. She was a bit dazed for 20 seconds. Mum says it was about 30 seconds in total between her initial fall and being alert again. The head bump is small, no laceration over the left eyebrow. She did not notice any palpitations or nausea. There was no antecedent painful or particularly emotional events.
She has started doing regular exercise running to help with exam stress. She has had a few episodes where she has felt light-headed on exercising but not actually fainted. She has had some heavy menstrual periods in the last 18 months and was advised to take iron supplements by the school nurse. She takes these sporadically. She has not had any infective sounding symptoms such as fever, cough, coryza, dysuria… she has no abdominal pain or other symptoms. Marli is happy to talk about her private life with Mum in the room, she says she has not ever been sexually active.
It is very helpful.
I must say before doing this diet please go on there website and read all you can about this diet. I did very well but I am still doing it. I made the mistake starting before the holidays. That made it harder. One bite of something can mess you up for a couple of days. This is a long diet it takes several weeks to do it right. But it is a good diet. J Jul 11th Great little reference to carry around.
Alle boeken van schrijver The Hcg Diet (1-10)
While this is certainly not a complete guide to the diet, it is a great miniature reference book to have with you throughout the day so you don't have to carry around the bigger HCG Weight Loss Cure Guide of which I also have and use all the time. This book does not tell all about the diet, but has the basic "diet page" out of the Dr. This chart is soo helpful, especially on maintenance. I'd definitely recommend this book to those on the protocol as a little carry around reference, especially during maintenance.
Brown Jul 11th Fabulous!!! I am on my second round of the HCG protocol and was so happy to run across this book. I wish I would have had it the first round. Such a convenience to be able to have with me on the go.