Comprehensive Guide to Common Medical Conditions and Treatments

Posted on May 15, 2024 in Medicine & Health

Consultation

Steps for Effective Patient Consultation:

  1. Describe and clarify the reason for the patient’s arrival.
  2. Collect the patient’s history and perform a physical examination (Hx + PR).
  3. Identify the patient’s attitude towards their disease/complaints.
  4. Establish and agree with the patient on the necessary tests and treatment (Tx).
  5. Complete the consultation with clear instructions and follow-up plans.

Motivation

Motivational Interviewing (MI)

Motivational Interviewing (MI) is a brief, patient-centered counseling method that can facilitate changes in a patient’s behavior.

How to Implement MI:

  1. Evaluate the patient’s motivation for change.
  2. Step I – Precontemplation: Assess the patient’s desire to change. For example, “On a scale of 1 to 10, with 1 being no desire to change and 10 being fully committed, how committed are you to quitting smoking?”
  3. Step II – Contemplation: Encourage the patient to make a decision and take action to implement it. Support their desire to change their behavior.

Influenza Treatment (Flu Tx)

Neuraminidase Mechanism of Action (MOA):

  • “Cleanses” the virus from the cell by removing residues of host sialic acid.
  • Facilitates the removal of virions from the cell.
  • Protects viruses from aggregation after leaving the cell.
  • Prevents the virus from being inactivated by respiratory tract mucus.

Tamiflu:

Time to Symptom Alleviation:

  • 0 hours: 3.8 days
  • 6 hours: 3.5 days
  • 12 hours: 3.1 days
  • 24 hours: 2.3-1.2 days
  • 36 hours: 1.2 days

Who Should Take Tamiflu?

  • Immunocompromised patients or residents of retirement homes who exhibit clinical symptoms similar to influenza.
  • Unvaccinated patients in high-risk groups who contract influenza or a similar illness, including:
    • Patients with comorbidities (chronic heart failure, chronic obstructive pulmonary disease, chronic kidney or liver failure, diabetes)
    • Elderly individuals
    • People susceptible to infectious diseases

Standard Antiviral Therapy:

  • Lasts for 5 days
  • Oseltamivir (Tamiflu) 75mg * 2 orally
  • Zanamivir (Relenza) 10mg * 2 inhaled into the nose

Influenza Vaccination:

Recommended for:

  • Patients in palliative and long-term care units, including nursing home patients.
  • Patients who are 65 years and older.
  • Adults and children older than 6 months with chronic diseases and those with immunosuppressive conditions.
  • Family members of vulnerable patients.
  • Pregnant women.
  • Medical staff.
  • Parents who have children younger than 6 months.
  • People who work in large social groups (e.g., teachers).

When to Change Treatment (Ax)

  • Acute symptoms (fever, pain) persist for more than 48-72 hours.
  • Antibiotics cause side effects.

It Could Be Viral:

Urinary Tract Infection (UTI) Treatment Considerations:

  • C-reactive protein (CRP) levels
  • Duration of symptoms
  • Frequency of urination

Viral vs. Bacterial Infections

  • Middle Ear Infection (Otitis Media): Bacterial infection is more common than viral infection. Streptococcus pneumoniae is a common bacterial cause.
  • Pharyngitis: Viral infection is more common than bacterial infection. Group A beta-hemolytic Streptococcus is a common bacterial cause.
  • Sinusitis: Viral infection is more common than bacterial infection. Streptococcus pneumoniae is a common bacterial cause.

Low Back Pain

Duration Classifications:

  • Acute: Less than 6 weeks
  • Subacute: 6-12 weeks
  • Chronic: More than 12 weeks

Types of Low Back Pain:

Reflective PainRadicular Pain
  • Deep, dull
  • Poorly localized
  • Rare sensory disorder
  • Reflex disorder
  • Sharp, electric
  • Well-localized
  • Sensory disorder (dermatomal)
  • Muscle weakness
  • Reduced reflexes

Origins of Low Back Pain:

MusculoskeletalOther Organs
  • Hip arthrosis
  • Ankylosing spondylitis
  • Psoriatic arthritis
  • Compression fracture
  • Gynecological disease
  • Prostate pathology
  • Kidney disease
  • Oncological diseases
  • Aortic pathology

Tests for Low Back Pain:

  1. Physical Examination (PE): Includes history, pain type, accompanying symptoms, inspection, and neurological examination.
  2. X-ray: Limited findings.
  3. CT/MRI: If there is no improvement in 6 weeks.
  4. MRI: First-line imaging for surgical intervention.

Treatment (Tx) for Low Back Pain:

  • Paracetamol
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Weak opioids
  • Tricyclic antidepressants
  • Anti-epileptic drugs
  • Peripheral muscle relaxants

Fever

Types of Fever:

  • Subfebrile: Temperature rise to 38°C
  • Febrile (average): 38-39°C
  • Febrile (high degree): 39-41°C
  • Hyperpyretic: >41°C

Fever of Unknown Origin:

  • Fever lasting for more than 3 weeks
  • Temperature rises up to 38.3°C or above
  • Fever without a clear cause after 1 week of thorough examination

Matching:

ECG Findings:

  1. Thorax: ECG – T wave high, symmetrical, pointed or negative
  2. Acute uncomplicated posterior wall myocardial infarction: ECG III, avF derivation – Pathological Q wave, ST elevation, and transition to positive T wave
  3. Pulmonary artery major branch embolism: ECG III derivation – Pathological Q wave, avR and V1, rsR’, ST elevation, and transition to negative T wave

Medication Dosages:

  1. Morphine: No maximum daily dose
  2. Acetaminophen: 3000-4000mg per day
  3. Tramadol: 400mg per day

Adolescence:

  1. Physical development: Symptoms of sexual maturation
  2. Cognitive development: Formation of abstract thinking
  3. Psychosocial development: Striving for independence

Polymorbidity

  1. Patient Level: Polymorbidity can lead to social isolation, psychological stress, disability, and cognitive impairment.
  2. National Health System Level: Polymorbidity can result in high healthcare costs due to reimbursement, extended hospitalization, and rehabilitation needs.
  3. General Practitioner (GP) Work: Polymorbidity can lead to frequent, not always rational use of health services, increased time costs, and the need for a holistic approach.

Antibiotic Use (Ax Use):

  1. Group A beta-hemolytic Streptococcus: Phenoxymethylpenicillin
  2. Mycoplasma pneumoniae: Clarithromycin
  3. Haemophilus influenzae: Amoxicillin

Examination Results:

  1. IgM antibodies against the relevant pathogen: Mycoplasma infection
  2. Normal leukocyte count: Acute obstructive viral bronchitis
  3. CRP > 50mg/L: Bacterial-induced otitis

Causes of Long-Term Fever:

  1. Lyme disease: Infections
  2. Lymphoma: Oncological diseases
  3. Lupus erythematosus: Systemic connective tissue diseases
  4. Sarcoidosis: Granulomatous diseases

Symptoms Associated with Prolonged Fever:

  1. Lymphadenopathy: Infectious mononucleosis
  2. Skin rashes: Lyme disease
  3. Cough and respiratory failure: Tuberculosis
  4. Nausea, vomiting: Trichinellosis

Tasks of the GP During Consultation:

  1. Involve the patient as much as possible in understanding the problem, and evaluate the patient’s thoughts and expectations.
  2. Determine the interrelation of the presented problems and identify the main problems.

Systemic Infections Causing Long-Term Fever:

  1. Tuberculosis
  2. Infectious endocarditis
  3. Bacteremia of uncertain origin

Problems in New Families:

  1. Significant differences in genetic roots and cultural traditions (e.g., religion, education, status, nationality, age).
  2. History of divorce and serious family problems in both families.
  3. Pregnancy before marriage.
  4. Disagreement with their families.

Teenagers Vulnerable to Suicide Risk:

  1. Recent experience of a severe loss.
  2. Long-term, unresolved serious problems at home.
  3. Previous suicide attempts.
  4. Alcohol or drug abuse.

Non-Vertebral Causes of Lumbar Pain:

  1. Kidney tumor
  2. Chronic prostatitis
  3. Lowered kidney (renal ptosis)

Causes of Cough in Oncological Patients:

  1. Angiotensin-converting enzyme (ACE) inhibitors
  2. Throat tumor
  3. Superior vena cava (SVC) syndrome

WHO Recommendations for Influenza Vaccination:

  1. Residents of nursing and supportive care institutions
  2. Individuals with chronic obstructive pulmonary disease (COPD)
  3. Persons older than 65 years

Characteristics of Viral Respiratory Infection:

  1. Fatigue
  2. Cough
  3. Fever
  4. Hoarseness

Principles of Primary Health Care (PHC):

  1. The family doctor coordinates the patient’s healthcare.
  2. PHC is continuous and inclusive.
  3. PHC is based on teamwork principles.
  4. PHC focuses on both the treatment and prevention of disease.

Impact of Peer Groups on Teenage Development:

  1. Encourages engagement in risky behaviors.
  2. Favors self-esteem.

Cases:

  • Family doctor + pancreatic cancer: Treatment: Morphine + metoclopramide
  • Lung cancer + VAS 5: Treatment: Increase morphine + Glycopyrrolate (GCD) + No oxygen
  • 45-year-old + depressed + nasal congestion: Treatment: Systemic decongestant, complete blood count (CBC), etc.
  • Mother + 5-year-old + temperature 38.8°C: Treatment: Right lung pain, amoxicillin + antipyretic, X-ray
  • 88-year-old + disease: Treatment: Investigate for mental health problems + social assistance
  • 75-year-old + chronic condition: Treatment: Educate about the three lines of treatment
  • 16-year-old + hates school: Treatment: Issue physically examined, assess suicide risk
  • 72-year-old + fever: Treatment: Refer for inpatient diagnosis for pain, consider tuberculosis
  • 16-year-old + sexually active: Treatment: Provide birth control pills + explain condom use
  • 58-year-old + left flank pain: Treatment: Positive straight leg raise test