log book-medicine edited

8/4/2019 Log Book-Medicine Edited

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Asian Institute of Medicine,

Science and Technology

Faculty of Medicine

MBBS PROGRAMME

Log Book - Medicine



TABLE OF CONTENTSPAGE #

1. Preface 1

2. Certificate 2

3. An Introduction to ClinicalExamination 3

4. List of Cases presented. 4

5. Case Records Page nos:

(i) Case No: 1

(ii) Case No: 2

(iii) Case No: 3

(iv) Case No: 4

(v) Case No: 5

(vi) Case No: 6

(vii) Case No: 7

(viii) Case No: 8

(ix) Case No: 9

2



(x) Case No: 10

(xi) Case No: 11

(xii) Case No: 12

(xiii) Case No: 13

(xiv) Case No: 14

(xv) Case No: 15

(xvi) Case No: 16

(xvii) Case No: 17

(xviii) Case No: 18

(xix) Case No: 19

(xx) Case No: 20

(xxi) Case No: 21

(xxii) Case No: 22

(xxiii) Case No: 23

(xxiv) Case No: 25

(xxv) Case No: 25

6. Problem Bases Clinical (Learning)Exercises

3



Preface This Log book will be a record of the clinicaltraining and experience that you shall obtain

during your junior clerkship. It contains noteson scheme for history taking and physicalexamination that is aimed at sharpening yourskills in performing clinical work. The juniorclerkship is an important first phase of youractive clinical posting and builds on the “walk-through” that you had it in the seven weeks

exposure you had it in the hospitalenvironment during your second year. You areurged advised to read up variousrecommended textbooks on clinical methodsduring the course.

During the twelve week of posting this year,

you are expected to present at least six longcases jointly with one of your colleagues. Allthe six cases should be recorded in this logbook and be subjected to evaluation by clinicalteacher. A total number of fifteen cases during

junior clerkship and Ten cases during SeniorClerkship should be recorded by each of you.

In addition to the clinical cases record must bemade of all the P B L sessions that areconducted during the posting.

The cases that you will be exposed to shallcover a range of general medical problemsthat will provide ample opportunity to develop

your communication skill and to learn andappreciate Clinical history taking and Physicalexamination. Accurate record of the history

4



and examination of each case that you areinvolved in should be made in this log book inas much as they will form a part of yourcontinuous assessment.

CERTIFICATE

This is to certify that

Mr/Ms ________________________

has attended Clinical Postingsin Medicine during the Junior

Clerkship, from…..…… 200.. to ………. 200..,examined patients and

presented clinical cases and recorded as mentioned in this

Log book.

5



____________

____________ Date Signature

Head, Department of Medicine

CERTIFICATE

This is to certify that

Mr/Ms ________________________

has attended Clinical Postingsin Medicine during the Senior Clerkship, from

6



…..…… 200.. to ………. 200..,examined patients and

presented clinical cases and

recorded as mentioned in thisLog book.

________________________

Date SignatureHead, Department of Medicine

Introduction to Clinical Examination

The sole purpose of medical practice is to relieve suffering dueto disease, which makes diagnosis mandatory. In order toachieve this, one needs to develop a friendly and sensitiveapproach to patients so as to understand them with regard totheir social and family history. It is important not only toelucidate the problems posed by disease but also apply theirclinical skills to advice patients and families how to managethese problems which is achieved by constant practice of theskills by combination of study and experience. Appropriate skills

are needed to elicit the symptoms from the patient'sdescription and conversation and the signs by observation andby physical examination. It is also important to respect patient’s

7



rights For example, if a patient indicates that he or she does notwish to discuss certain topics, or to be examined fully, this wishmust be respected. Remember always that the communicationis a two way process. To arrive at a proper diagnosis it isnecessary to establish the clinical features by clinical history andexamination. This forms the clinical database, and interpretationof the database leads to diagnosis.

It will be comfortable for the patient if the clinician himself brings into the clinic with offer of greeting. The response of thepatient to questioning will in cases reveal the clinical condition.Another aspect is the surroundings in the office, which should bepleasant and patient friendly. It is important that the doctor paysfull attention while the patient presents himself. It is also goodto exchange pleasantries with accompanying persons. This willprovide some more information about the social background,

education level, etc., of the patient himself. After the initialinformal preliminaries, the doctor can proceed to presentingclinical problem. It is better to maintain a slight sense of formality and neutrality in the relationship but make it clear thatyou want to hear what the patient has to say and you will inspireconfidence by this. It is a good to get at least some informationon personal, marital status, employment, basic family & socialand medical history including allergies etc., these details willhelp the doctor to discuss symptoms and problems.

Getting Started:As conversational skills are central to proper history it isimportant to remain flexible and to be prepared to change yourapproach if it seems that a new start is needed. Encouragepatients either to start from the beginning, or to describe theparticular problem that worries them the most. Expectingpatient’s to be open, you must make it clear that you will also beopen with them. If you feel there is a cloud developing in yourrelationship with a particular patient, try gently to find out whyand clear it.

OBSERVE YOUR PATIENT

The communication process is to enable you to makeassessment of patient's general demeanour.

Personality and Presentation.

Sign of disability, physical or mental?

What clues does the gesture convey?

The general approach and psychological

feelings. Is he or she expressing all the facts orwithholding certain things.

the gait.8



the voice (whether normal or hoarse).

Make it clear to your patients that you expectthem to speak freely and give their own account of theproblem. Avoid suggesting symptoms until the patienthas finished this description, when you may wish toobtain more detail or to enquire specifically about

certain symptoms not so far mentioned. If there arepoints that are not fully described, or which you thinkare important, do not be afraid to ask directly for moreinformation. However, recognize that this will interruptthe patient's flow of recall, and that you will then needto restart the spontaneous description that youinterrupted.

While making notes, try to keep eye contactwith the patient. Listen to the patient’s complaints;make up your mind of what is being said and record

enough to help you remember the important points.Later, you can write up a fuller account of the historyand pertinent points based on the weight placed onvarious items and, most importantly, what the patientactually said. What patients say, word for word, is oftenas important as any later reconstruction of the history.

Direct but relevant questions form an essentialcomponent of history-taking. It is rather ideal to bringup those direct questions once the patient hascompleted expressing the complaints. If you are not

sure of something or noticed any abnormality, ask formore details directly. These can again be brought inmore detail while examining the patient. After a clearunderstanding of the case and presentation, it is alwaysgood to start examining symptom wise starting from theprimary complaint.

Try and relate the history from the preliminaryinformation you have obtained as regards to thepatient's occupation, past medical history and family

history to the symptoms. Use common and colloquial words that patientcan understand. Use words like passing urine, motionetc., rather than using medical terminology.

Another important but difficult to establish, isthe ‘functional disorders’ which needs careful anddetailed interrogation.

Exaggeration of symptoms may pose problemwhile interrogating the patient though the symptommay be true. This has to be sympathetically approached

but firm in approach so as to analyse the depth of thesymptom.

9



It is important to establish good and reasonablerelationship with the patients, which might not be easyin some “Difficult and angered” patients, which mightbe because of distress or disbelief. Adopt a soothingattitude and keep reassuring the patient.

Some time during integration the patient may

introduce unrelated information without context butcould be a clue to the underlying disease state.

Information obtained from a concerned andobservant relative is often helpful.

ANALYSIS The main objective of the history is to analyse the disturbance of function and structure responsible for the patient's symptoms.Symptoms always have a physiological or anatomical basis.Certain physiological symptoms have to be properly analysed or

will lead to erroneous diagnosis. The most common examplesare thirst, passing of large quantities of urine etc; which shouldbe correlated with other symptoms. Even if there are anynegative data it should also be analysed.

PAIN is one of the commonest complaints which bring thepatient to the doctor. Systematic analysis of this symptom isimportant and a standard approach is essential for theevaluation of the same.Simple questions like Where is the pain? What is the nature of

pain? How is the pain relieved?, will be helpful assessing pain. The other leading questions with regard to radiation of pain,severity, timing and duration and character, occurrence or aggravation and relief will be useful in proper understanding of the symptom.

PAST HISTORY It is important to go through the past history in light of thecurrent illness. But make sure that the patient's description of the diagnosis of an earlier illness is consistent and likely to be

correct check on the treatment he or she had and possibly trychecking the information from the earlier physician or hospital.Check on the medication including the non prescribed and nonproprietary drugs and also about alternative or herbalremedies-some of the latter can be powerful and may produceserious unwanted effects such as renal failure. You should alsoconsidering asking about sexual habits and drug abuse if deemed necessary. It is equally important to know whether ispatient had any allergies for drugs or otherwise.

SPECIAL QUESTIONS FOR WOMEN

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Certain information regarding the menstrual and obstetric andgynaecological history is important and essential. Others shouldinclude intake of oral contraceptives or other hormones etc.,

OCCUPATIONAL HISTORY Another important aspect of history taking is regarding thepatient’s occupation and exposure to toxic and industrialpollutants.

GENETIC HISTORY The genetic history has become necessary because of role of genetic factors in many diseases. They could be inherited withdominant or recessive or sex linked. Mitochondrial inheritance incertain brain and muscle disease is also well understood.Inherited disorders are generally more common in populations inwhich first cousin marriages are common, as happens in isolated

communities, and among certain religious groups, especially insome Muslim communities. Diabetes and Coronary ArteryDisease especially lipoproteineamias show inherited factors intheir causation.

THE PHYSICAL EXAMINATIONAfter going through the exercise of history taking, record all thesalient and important features. After having completed thehistory taking, the doctor should proceed to the physicalexamination: the routine combined with specific, relevant to that

patient. The examination should be thorough but without muchdiscomfort to the patient. The depth of examination should bedecided based on the severity of the condition. Start theexamination in a manner that is relevant to the patient'ssymptoms but develop a systematic approach to each functionalsystem in order to gain information that is both complete andrelevant.

GENERAL APPROACH The examination room should be well lit, warm and exclusiveambience. Make the patient comfortable.First inspect the physique and expression, to rule out anyobvious physical disability / skeletal disorders / obesity/wasting / malnutrition etc., Information regarding the patient'shealth can be gained looking at the face. Nephrotic Syndromes,Congestive Cardiac Failure, Anaemia are some examples.

The next is to look at the skin for examination of pallor, colour, pigmentation, cyanosis (Central and Peripheral) and cutaneouseruptions etc.,

11



The skin is dry and inelastic in dehydration - the skin can easilypinched up.Pallor is a sign of anaemia and best observed in conjunctiva.Cyanosis is best observed in finger nails.

The next is to observe for the presence of oedema. Oedema of face is characteristic of early phase of acute nephritis, which ismost marked when the patient rises in the morning.Dependent oedema, which is typically around the ankle anddorsum of foot, is present in Congestive Cardiac Failure, and inconditions associated with a low plasma protein level such asmalnourishment etc., The other types of oedema arelymphedema, venous obstruction etc., The lymphedema doesnot pit on pressure.‘Pitting’ is demonstrated by applying sustained finger pressureon the swelling (odema) and on release it will leave adepression.

There can be localised oedema in angioneurotic oedema andurticaria.

THE HANDS AND FEET: The Hands and Feet of the patient should be examined next. The strength of grip, state of the joints, the character of thenails, the presence or absence of finger clubbing (obliteration of angle between nail bed and skin), koilonychias (soft, thin andbrittle and spoon shaped).the presence of nail bed infarcts,staining, tremors, erythemas, petichia are to be observed.

THE NECK should be inspected and palpated next. Swellings inthe neck are usually best felt from behind. Cervical nodes andthyroid gland, submandibular salivary gland or any masses areto be noted down.Observe the trachea from front for any deviation.Pulsations in the vessels must be noted. Any arterial pulsation isboth seen and felt as a distinct thrust, whereas venouspulsation can be seen but not felt as a thrust.

THE BREASTS The examination of breast is a necessary feature of generalexamination of every woman especially nulliparous women,spinsters and women with a family history of breast cancer.Examine the symmetry, nipple, areola and the skin forulceration, discharge, retraction of nipple, and peau de orange(orange peel appearance). Palpate each breast with palm inall the quadrants of breast for any mass lesion and its relation todeeper structures.Male breast is examined for any mass, and it is likely to be fat or

a palpable disc of breast tissue beneath the areola in youngerindividuals or gynacomastia.

12



AXILLAEAxilla is examined for any enlarged lymphnodes.The arm is then lowered in the flexed position to restacross the examiner's arm and palpation is continuedfrom downwards along the chest wall using fingers.

TEMPERATUREBefore taking the temperature, the thermometer should bewashed in antiseptic solution or in cold water, and well shakenso that the mercury is brought down and after takingtemperature it should be washed well. The thermometer mustbe accurate and use a thermometer (either be in the centigrade(Celsius) scale or Fahrenheit scale) which ever is familiar. The

thermometer is kept well below the tongue and held firmly withthe lip in adults and grown up children and in infants the axilla isthe choice. It should be kept for a full minute. For collapsed,comatosed and elderly patients, rectal temperature can berecorded.

FEVERA rise in temperature beyond the normal (37’C or 78.4’F) iscalled fever or pyrexia. The fever could be ‘continuous’ whenfever does not fluctuate more than about 1'C (1.5'F) during 24

hours, but at no time touches the normal. Fever is ‘Remittent’when the daily fluctuations exceed 2'C, and ‘intermittent’when fever is present only for several hours during the day.When a paroxysm of intermittent fever occurs daily, the fever isdescribed as quotidian; when on alternate days, it is tertian;when two days intervene between consecutive attacks, it isquartan. These classical types are of fevers are notencountered frequently.

PULSE

Count the pulse for a full half minute when the patient is at restand composed. The rate in health during the stress of a medicalexamination varies from about 60 to 80 beats / minute. Thecommon causes of a rapid pulse are recent exercise, excitementor anxiety, shock, fever and thyrotoxicosis. A slow pulse ischaracteristic of severe hypothyroidism and of complete heartblock.

RESPIRATIONCount the patient's respirations for a full minute, starting when

the patient's attention is elsewhere. It is convenient to do thiswhen the patient thinks you are still counting the pulse. Thenormal rate in an adult is about 14-18 / minute. Observe the

13



breathing and record if it is noisy. The noisy breathing could bebecause of obstruction in the nasal passages, larynx, trachea,bronchi. Also observe the pattern of breathing.

ODOURS The odours can also give some leading information. The smell of alcohol and paraldehyde are easily recognizable on the breath.

The odour of diabetic ketosis has been described as 'sweet andsickly'; that of uraemia as 'ammoniacal or fishy'; and that of hepatic failure as 'mousy', but too much reliance on suchdelicate distinctions is unwise. Halitosis (bad breath) is commonin patients whose dental hygiene has been poor, and isassociated especially with chronic gingivitis (periodontal or gumdisease).

ROUTINE PHYSICAL EXAMINATION

The object of a routine examination is to check the differentbody systems to exclude abnormality. In considering symptomsrelated to the patient's presenting complaint a more focusedand detailed examination is necessary.

EYESThe examination of the eye forms an important aspect of examination and consists of the following:Simple tests of visual acuity: compare one eye against the other.Look for Exophthalmos or enophthalmos, Ptosis and oedema of

the lids.Conjunctivae: Anaemia (pallor), Jaundice (yellowishdiscolouration) or InflammationPupils: Size, Equality, Regularity, Reaction to light,AccommodationEye movement: Nystagmus, Strabismus.Ophthalmoscopic examination of the fundi and ocular chambers.

FACEFacies, jaw movements, Facial symmetry or asymmetry, Rash,

Features of endocrine disease or hyperlipidaemia.

MOUTH AND PHARYNX(torch and tongue depressor should be used)Breath odours Lips: colour and eruptions Tongue: protrusion andappearance Teeth and gums (if patient has dentures, noticewhether they fit properly and reasons for wearing)Buccal mucous membrane: colour and pigmentation.

PHARYNXMovement of Soft Palate. State of Tonsils.

NECK

14



Movement, pain and range, Veins, Lymphatic glands, Thyroid,Carotid pulses and bruits.

UPPER LIMBSGeneral examination of arms and hands.Fingernails: Clubbing or Koilonychias.Pulse: Rate, Rhythm, Volume and Character.Blood pressureState of the arterial wall of radials and brachialsAxillae: Lymph glands.Muscles: Muscle wasting, Fasciculation, Tests for power, tone,reflexes and coordinationCutaneous sensation: check all modalities to exclude root ornerve lesions

Joints: movement, pain and swelling; rheumatiod nodules andxanthelasma at elbows.

THORAXExamine Anterlorly and laterally for:

Type of chest, asymmetry if any,Breasts and nipples,Respiration: rate, depth and character,Pulsations, Dilated vessels, Position of trachea.Look for and palpate apex beatPalpate over precardium for thrills.Palpate respiratory movements

Estimate tactile vocal fremitusPercuss the lungs.Auscultate the heart soundsAuscultate the breath soundsEstimate vocal resonance.Cervical and Axillary glands.

Examine Posteriorly (patient sitting) for:Respiratory movementEstimate tactile vocal fremitus

Percuss the lung resonanceAuscultate the breath soundsEstimate vocal resonanceMovements and deformities of the spinePalpate from behind: cervical glands and thyroid.Look for sacral oedema.

ABDOMENInspection: size, distension, symmetry.Abdominal wall: movement, scars, dilated vessels

Visible peristalsis or pulsationPubic hairHernial orifices

15



Palpation: Tenderness, Rigidity, Hyperaesthesia,splashing, masses, liver, gallbladder, spleen,kidneys, bladderPercussion: masses, liver, spleen, bladderAuscultation: bowel sounds, murmursImpulse on coughing at hernial orificesInguinal glandsMale genitalia: penis, scrotum, spermatic cord;female genitalia: examine if relevantAbdominal reflexesRectal examination when ever indicatedGynaecological examination when ever indicated.

LOWER TIMBSGeneral examination of legs and feet, Stance, balance and gait,Oedema of feet and ankles, Varicose veins,

Muscles: muscle wasting, fasciculation, tests for power, tone,reflexes (including plantar response) and coordination Joints: movement, pain and swelling, Peripheral pulses, Temperature of feet

Formulating a Diagnosis:On complition of the history and examination, the clinician hasusually come to a working diagnosis. This is supported by furtherinvestigations and subsequent progress of the disease.Sometimes it is difficult to diagnose a patient’s problem which

may be linked to inexperience or the disease is in a stage of resolution or may be in early stages of presentation. It isworthwhile working on the diagnosis by first indentifying thesystem involved.

List of Case Presentations

S. NoDate of

Presentation

WardClinical

DiagnosisPage no:

Signature of Consultant

Case 1

Case 2

Case 3

Case 4

Case 5

16



Case 6

Case 7

Case 8

Case 9

Case 10

Case 11

Case 12

Case 13

17



S. NoDate of

Presentation

WardClinical

DiagnosisPage no:

Signature of Consultant

Case 14

Case 15

Case 16

Case 17

Case 18

Case 19

Case 20

Case 21

Case 22

Case 23

Case 24

Case 25

18



Case No 1:

Name of the Patient:

Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:

a. Presenting Complaints with Duration(in Chronological order)

b. History of Present illness

c. Past history (from Childhood)

19



d. Previous treatment / drug intake / Drug abuse/ drug allergy if any

e. Family History

f. Occupational history

g. Menstrual history

Age of Menarche

Menstrual history

Obstetric history Para …….. Gravida ……….

Age of menopause

h. Daily habits/routine

i. Systemic enquiry

j. Physical Examination (General)

20



k. Systemic examination ( Should include examination of all the relevant systems)

l. Summary of the Case

m. Provisional Diagnosis:

n. Laboratory Investigations (Clinical lab and Imaging)

o. Definitive Diagnosis

21



p. Suggested Treatment

q. Follow-up.

Date:

22



Case No 2:


Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:





23



e. Family History



Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry



24








25



q. Follow-up.

Date:

Case No 3:


Age:

Sex:

26



Occupation:

Race:

Religion

Nationality

Place:





e. Family History

27





Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry



28








q. Follow-up.

29



Date:

Case No 4:


Age:

Sex:

Occupation:

Race:

Religion

Nationality

30



Place:





e. Family History


31




Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry




32







q. Follow-up.

33



Date:

Case No 5:


Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:


34






e. Family History


35




Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry




36







q. Follow-up.

37



Date:

Case No 6:


Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:


38






e. Family History



Age of Menarche

Menstrual history


Age of menopause

39




i. Systemic enquiry





40






q. Follow-up.

Date:

41



Case No 7:


Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:



42





e. Family History



Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry

43








44





q. Follow-up.

Date:

45



Case No 8:


Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:




46




e. Family History



Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry


47



k. Systemic examination ( Should include examination of all the relevantsystems)





48




q. Follow-up.

Date:

49



Case No 9:Name of the Patient:

Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:




50




e. Family History



Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry


51








52




q. Follow-up.

Date:

53



Case No 10:


Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:





54



e. Family History



Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry



55








56



q. Follow-up.

Date:

Case No 11:


Age:

57



Sex:

Occupation:

Race:

Religion

Nationality

Place:





e. Family History

58





Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry



59








60



q. Follow-up.

Date:

Case No 12:


Age:

Sex:

Occupation:

Race:

61



Religion

Nationality

Place:





e. Family History

62





Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry



63








q. Follow-up.

64



Date:

Case No 13:


Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:


65






e. Family History


66




Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry




67







q. Follow-up.

68



Date:

Case No 14:


Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:


69






e. Family History



Age of Menarche

Menstrual history

70




Age of menopause


i. Systemic enquiry




71







q. Follow-up.

72



Date:

Case No 15:


Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:

a. Presenting Complaints with Duration

(in Chronological order)


73





e. Family History



Age of Menarche

Menstrual history


Age of menopause


74



i. Systemic enquiry






75





q. Follow-up.

Date:

76



Case No 16:


Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:



77





e. Family History



Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry

78








79





q. Follow-up.

Date:

80



Case No 17:


Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:




81




e. Family History



Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry


82








83




q. Follow-up.

Date:

84



Case No 18:


Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:




85




e. Family History



Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry



86








87



q. Follow-up.

Date:

Case No 19:Name of the Patient:

88



Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:





89



e. Family History



Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry



90








91



q. Follow-up.

Date:

Case No 20:


Age:

Sex:

Occupation:

Race:

92



Religion

Nationality

Place:





e. Family History

93





Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry



94








q. Follow-up.

95



Date:

Case No 21:


Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:


96






e. Family History


97




Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry




98







q. Follow-up.

99



Date:

Case No 22:


Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:


100




Age of menopause


i. Systemic enquiry




102







q. Follow-up.

103



Date:

Case No 23:


Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:

a. Presenting Complaints with Duration

(in Chronological order)


104





e. Family History



Age of Menarche

Menstrual history


Age of menopause


105



i. Systemic enquiry






106





q. Follow-up.

Date:

107



Case No 24:


Age:

Sex:

Occupation:

Race:

Religion

Nationality

Place:



108





e. Family History



Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry

109








110





q. Follow-up.

Date:

111




e. Family History



Age of Menarche

Menstrual history


Age of menopause


i. Systemic enquiry


113








114




q. Follow-up.

Date:

115



Problem Based Clinical Excercises

Record the summary of all PBL sessions:

116



117



118



119



120

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