21 Scenarios contain the text: 'reactive' |
| Title | Description |
|---|---|
| Reactive arthritis | A 22 year old NZ European man presents to the Emergency Department with knee and ankle pain. He fell down the steps at home during the weekend. Further history reveals he has had burning pain on urination for over a week. On examination he has redness of the eyes, a swollen left knee and tenderness at the heels. D/O: Musculoskeletal System (•••), Rheumatology (•••), Immunology (••), Infectious Diseases (•) PTT: Musculoskeletal |
| Acute chest pain | A 75 year old Māori man presents to the Emergency Department with central chest pain. It has been present for the past 40 minutes and came on while he was resting. He feels terrible. D/O: Cardiology (•••), Cardiovascular System (•••), Emergency Medicine (•••) PTT: Cardiovascular, Seriously ill patient |
| Diplopia | A 66 year old Māori woman presents with intermittent double vision which has been gradual in onset, but steadily worsening and has now become constant. She had cataract surgery 2 years ago with good vision in each eye postoperatively and she has had reasonably controlled type 2 diabetes for 10 years. D/O: Neurology (•••), Ophthalmology (•••), Endocrinology (••) PTT: Eyes |
| Epistaxis | An 86 year old NZ European woman calls an ambulance when she develops a nose bleed that 'just won’t stop'. Her daughter, who lives with her, has tried pinching the end of her nose but that has not helped. You are asked to obtain some more information from the daughter. She tells you that her mother has been complaining of a blocked nose for the past few months and has had intermittent small nose bleeds. D/O: Emergency Medicine (•••), Otorhinolaryngology (•••) PTT: ENT |
| Postoperative complications | A 75 year old Chinese woman had an anterior resection (large bowel operation) 4 days ago. She develops fever, abdominal pain and has not opened her bowels since surgery. She has an intravenous cannula in her forearm and one in her foot. She also has an indwelling urinary catheter. Her heart rate is 130 beats per minute, her blood pressure has fallen to 90/50 mmHg, and her temperature is 38.3°C. She is breathing rapidly. You are the on call junior doctor and are asked to review her. D/O: General Surgery (•••), Infectious Diseases (•••), Anaesthesiology (••), Cardiovascular System (••), Digestive System (••), Urology (••), Ethics (•) PTT: General duties, Homeostasis |
| Sudden loss of vision and headache | An 83 year old NZ European woman presented with a 1 month history of new onset headache, jaw claudication and one day history of sudden loss of vision in the left eye. On examination, she was noted to have reduced vision in the left eye of count fingers only, a left relative afferent papillary defect, constricted visual fields on confrontation testing and a pale swollen left optic nerve. She underwent a temporal artery biopsy which revealed significant inflammation. D/O: General Practice (•••), Ophthalmology (•••), Rheumatology (••) PTT: Eyes |
| Sudden painless loss of vision | A 74 year old South African male presents with sudden painless loss of vision in his right eye. This occurred shortly after waking. He has no associated symptoms and no past ocular history of note. His medical history includes hypertension, atrial fibrillation, and he is a smoker. On examination, the best visual acuity was measured at 'count fingers only' in the right eye and 6/9 in the left eye. There was a right relative afferent pupillary defect. On ophthalmoscopy of the right eye, there was narrowing of the retinal arterioles, whitening of the retina and a cherry-red spot at the macula. D/O: Ophthalmology (•••) PTT: Eyes |
| Upper airway disease | A 65 year old Chinese man is seen by a GP on a house call. His breathing has become more difficult over time. Now he is making a harsh noise when he breathes in. D/O: Emergency Medicine (•••), Otorhinolaryngology (•••), General Practice (••), Ethics (•) PTT: Seriously ill patient |
| Child with sore joints | A 5 year old Niuean girl is brought to the local Emergency Department as she has difficulty walking. On examination she has tenderness in her left ankle and her right knee is tender and swollen. D/O: Hauora Māori (•••), Orthopaedics (•••), Paediatrics (•••), Rheumatology (•••) PTT: Child health, Musculoskeletal |
| Groin lump | You are on an attachment in a General Practice and are asked to see a 25 year old Samoan man with a lump in his left groin. It has been there for 3 weeks and is not getting any smaller. He is otherwise fit and well. D/O: Digestive System (•••), Gastroenterology & Hepatology (•••), General Surgery (•••), Oncology (••), General Practice (•) PTT: Digestive |
| Inflammatory low back pain | A 25 year old NZ European man presents to his GP with low back pain. The pain has been present for more than 18 months but increased in intensity over the last 3 months. There is pronounced early morning stiffness lasting over 2 hours and nocturnal pain such that he is awake most nights. Ibuprofen relieves his symptoms. He has a past medical history of a painful red eye on two separate occasions and bilateral Achilles tendonitis. There is no family history of arthritis, but his sister has Crohn's disease. He smokes 20 cigarettes per day and works as a forklift driver in a warehouse. D/O: Musculoskeletal System (•••), Rheumatology (•••) PTT: Musculoskeletal |
| Knee pain | A 70 year old Māori woman with a 1 year history of worsening knee pain underwent a left total knee joint replacement 6 weeks ago. She is a local kaumātua, helping to run a training programme for Māori youth, and usually plays bowls twice a week. She now presents with 5 days of increasing pain and swelling in this knee. She had a rigor and when she measured her temperature last night it was 38.8°C. Her left knee is markedly swollen, hot to touch and she cannot walk because of the pain. D/O: Infectious Diseases (•••), Musculoskeletal System (•••), Orthopaedics (•••), Rheumatology (•) PTT: Musculoskeletal |
| Musculoskeletal lump | A 15 year old Samoan boy presents, to a specialist clinic you are attending, with a slowly enlarging lump on his left proximal tibia. It has recently become mildly tender but there are no other signs of inflammation or infection. Subsequent medical evaluation reveals this to be a malignant musculoskeletal tumour. D/O: Musculoskeletal System (•••), Oncology (•••), Orthopaedics (•••), Paediatrics (•••), Palliative Medicine (•••) PTT: Musculoskeletal |
| Neck lump | A 72 year old NZ European man comes to the Pre-Admission Clinic before a knee replacement operation. During the examination you notice a lump in his neck. He says that he has not noticed it and feels well. D/O: Anatomical Pathology (•••), Endocrinology (•••), General Practice (•••), Otorhinolaryngology (•••), General Surgery (••), Haematology (••) PTT: ENT |
| Swollen and tender joints | A 40 year old Fijian Indian woman presents to her GP with a several week history of painful, stiff joints in her hands and feet. It takes her over an hour in the morning to 'get going'. She is feeling much more tired than usual and has lost 3 kg in weight over the last 2 months. Clinical examination revealed 22 swollen joints (all the MCP, PIP and wrist joints) and 22 tender joints (all the MCP, PIP and wrist joints). The metatarsal squeeze test was positive. D/O: Musculoskeletal System (•••), Rheumatology (•••) PTT: Musculoskeletal |
| Compromised airway | A 54 year old Tongan man with known nut allergy presents with difficulty breathing. His throat feels swollen and he is very distressed. It all started when he ate at a restaurant. D/O: Emergency Medicine (•••), Immunology (•••), Intensive Care Medicine (•••), Otorhinolaryngology (•••), Anaesthesiology (•) PTT: ENT, Seriously ill patient |
| Gout / acute pain and swelling of knee | A 56 year old Samoan man is admitted to hospital with an acute myocardial infarction. He has a history of hypertension treated with a thiazide diuretic, type 2 diabetes that is diet controlled, hyperlipidaemia and high alcohol consumption. Three days following his admission to hospital he develops acute pain and swelling of his knee. D/O: Musculoskeletal System (•••), Rheumatology (•••), Hauora Māori (••) PTT: Musculoskeletal |
| Headache, morning stiffness and shoulder pain | A 70 year old NZ European woman sees her GP with a 6 week history of aching and morning stiffness in the shoulders, hip girdle and neck. This has slowly worsened and in the last 2 days she has developed a severe headache with scalp tenderness. Her body mass index (BMI) is calculated and is 18. You organise an erythrocyte sedimentation rate (ESR) and the result is 66 mm in 1 hour (normal 0-30). D/O: Musculoskeletal System (•••), Rheumatology (•••), Anatomical Pathology (••) PTT: Musculoskeletal |
| Lymphadenopathy and splenomegaly | A 60 year old man presented to his GP for a repeat prescription of his usual medications. On examination, he was found to have palpable lymph nodes (up to 2cm in size) in his cervical, axillary and inguinal regions. The spleen was palpable 4cm below the costal margin. On further questioning, he told his GP that he first noticed some lymph nodes in his neck about 6 months ago, but they had not changed in size or troubled him. He felt well in himself. A full blood count showed a lymphocytosis of 15 x 109/L and the presence of smear cells. D/O: Haematology (•••), Immunology (•••), General Practice (••), Anatomical Pathology (•), Ethics (•) PTT: Blood and lymph |
| Painful hands in the cold | A 37 year old NZ European woman presented to her GP with a recent history of painful 'weak' hands. She has also been quite lethargic the last few weeks, complains of low mood and aches all over her body. She has had Raynaud's phenomenon since her early teens which she manages by avoiding cold exposure and she is not prescribed any regular medications. On examination she has a positive Tinel's sign bilaterally. D/O: Musculoskeletal System (•••), Rheumatology (•••) PTT: Musculoskeletal |
| Pneumonia | You visit an 80 year old NZ European woman with the GP you are shadowing. She has a fever and is coughing up purulent sputum. She is in a private hospital because of advanced dementia and has been a resident for the past 3 years. A mobile chest X-ray taken in the private hospital shows 'confluent shadowing in the left lower lobe and a left-sided pleural effusion'. The GP sends her to the local Emergency Department and contacts her family. The patient has an advance directive stating that if she becomes very unwell she should not be 'kept going by machines', although her family is not comfortable with letting her die at present. D/O: Geriatric Medicine (•••), Infectious Diseases (•••), Microbiology (•••), Respiratory Medicine (•••) PTT: Infectious disease, Respiratory |
| Title | Description |
