 I would be grateful for your opinion of and advice on the above-named patient.

A brief
outline of history, symtoms and signs is given below
 He presents with a 6 month history of intermittent episodes... in the left side of his head
associated with
 He links the onset of these symtoms with ...
 He did not seek medical attention och he does not report any loss of
 They are somehow suggestive of ......
 I would therefore be grateful for your assessment.
 I have not advised him to give up driving as he has never reported loss of consciousness

Procedure

 I take off some of the spinal fluid-

 You can lie down on you left
 I put a small plaster over the site of the lumbar puncture.
 Your headache was duet o
 The tests have shown
 Press the tuning fork onto the bones
 I use a pinprick to test sensation
 Touch a piece of cotton wool to the leg
 Wiggle the big toe up and down
 To look into ears
 To elicit deep tendon reflexes
 To rest skin sensation
 To examine with a light touch

Medical history

 Can you teel me, what are your complaints?

 Can you tell me whether you have had any childhood diseases?
 Have you ever benn in hospital, hospitalized, for anything or have you ever had an
operation?
 Have you had any major health problems since then?
 When were you first told that you had or diagnosed with? What were your symtoms?
 Are you receiving any treatment for your diabetes?
 Are you up to date with all your immunisations?Have you had your vaccinations?
 Let me have a look at the letter from your GP
 As far as you know, are there any illness that run in your family?
 And is your father still alive?
 How old was your father when he died or passed away?
 What did he died of?
 Did he suffer for a long time with his heart condition before he died?
 Did he have an ongoing heart condition?
 Do you have a job at the moment?
 How long have you been smoking?
 Have you ever tried to give up or quit?
 Do you drink?
 How old were you when you started drinking?
 What sort of house do you live in?
 What seems to be the provlem at the moment or today?
 What do you mean by that?
 How long has this been going on?
 And were yhere any other symtoms before then or did this condition start quite suddently?
 So you havent experienced this symtom before?
 Was there anythin that seemed to cause this?
 Do you feel any pain?
 Could you show me where it hurts? Can you point out the painful area?
 Is it always just in the spot?
 What kind of pain is it? Can you describe the pain?
 Does it come and go or do you have it all the time?
 Does it start suddently or build up slowly?
 Does the pain move, radiate to other areas as well?
 What do you do when you get the pain?
 And does anything in particular seem to bring the pain on or make it worse?
 How long does the pain last when you get it or when it comes?
 Does the headache ever upset your eyes, for example, does your vision get blurred?
 Have you found any tablets or medication that seems to have helped?
 Does anybody else in your family have this type of pain?
 Can you describe the character of your pain?
 How would you describe the dizziness?
 What does a dizzy spell consist of for you?’
 In what body position do you feel dizzy?
 Do you ever suffer from diziness or get dizzy?´
 Does the dizziness feel like spinning or is it just a kind of unsteadiness?
 Do you fell as if you are falling in a certain direction?
 Do you have any other problems such as ringing in the ears perhaps?
 Have you seen a consultant or specialist about it?
 Do you gave any associated symtoms like blurred vision?
 Have you got a tempeture or had any fever recently?
 Is your temperture high all the time, constantly high, or does it go up and down?
 What is the highest and the lowest it has been in the past few days?
 And where did you take your temperature?
 Do you also have shivers, chills?
 Do your teeth rattle or are the shivers milder than that?
 Have you been abroad?
 Do you perspire more than usual?
 Do you just feel sick, nauseous, or have you actually vomited or thrown up?
 Does it get better or worse if you eat something?
 When you vomit, do you bring up digested food, undigested food or bile?
 What colour is it?
 Does it ever have blood on it, or look like ground coffee?
 Do you belch ,burp a lot?
 How long have you had difficulty breathing?
 Are you short of breath when you are resting or only when you are doing something
physical?
 Are you short of breath all the time, or is it just when you walk up the stairs , exert yourself?
 Can you lie flat in bed?
 Do you ever wake up at night feeling short of breath?
 What do you do when this happens? I mean, do you sit or stand up, does some movement
help, you breathe easier?
 Do you have a cough?
 Is this a recent symtom, or have you had it for some time now?
 Do you suffer from coughing fits
 Do you bring up phlem or is it a dry cough?
 What is the phlegm like? Is it foamy or thick and sticky?
 Do you ever feel sick or sweaty when this happens?
 Do you ever feel that you heart beats unusually fast or slow?
 Have you had any swelling in your ankles?
 Does it go down overnight or are they still swollen in the morning?

Appetite

 Tell me, whats your appetite like? Hows your appetite?

 How do you feel about your eating habits? Describe your eating habits to me.
 Have you lost or put on, gained any weight recently or does your weight stay the same?
 How many kilos have you gained, do you think?
 Over how long a, what period of, time has this happened?
 Are you trying to do anything to control your weight, for example, are you on a diet?
 Are there any foods that you dislike or is there anything that you particularly like to eat?
 Do your eating habits change for any reason?

Bowel

 Do you have regular bowel movements?

 When you say you have diarrhoea, do you mean the stool is very loose, or that you
have to go the toilet ,bathroom frequently?
 When you have to go, do you have to go quickly?
 Can you describer your stool?
 Do you have any problems flushing it down at all?
 Has there benn any blood or mucus in the stool?
 Is it mixed in the stool or is it just there on the paper when you wipe yourself?
 And when you are constipated, do you take laxatives, or do you give yourself use an
enema?
 Do you feel bloated, have any bloating, when you are constipated?
 Do you have any problems with excessive flatulence or belching gas or burping?

Obstetrics

 Could you tell me when your last period was?

 Do you have a regular cycle?
 And how long do your period last for?
 Would you say that they were painful?
 Would you say that your periods are quite light, average or heavy?
 Do you find you using a lot of pads?
 Now, have you had a smear done within the last 3 years?
 Do you remember the results of it?
 Do you know how often you ought to be coming for smear test?
 Yes, thats right, although if there are any abnormalities on any of the smear tests you
must come back more regularly than that. Do you have any pain or swelling youve
noticed in your breasts?
 Have you been passing any clots in them?
 Do you ever find it uncomfortable to have sex?
 Is the discharge foul smeeling at all?
 Do you have any burning or stinging when you got to the toilet?
 Is your vagina itchy or sore?
 Is that after you ve been to pass urine or after you have a bowel motion?
 Are you able to push this lump back up?
 Are you sexually active?
 Have you ever gone this long before without having a period?
 Are you using any kind of contraception?
 Have you ever had any accidents or perhaps forgotten to use a condom? Do you thin you
might be pregnant?
 Is this your first pregnancy?


Examination

 Let´s take a look. I´ll listen to your heart and lungs to begin with.
 Let me listen to your chest
 I would like to examine you. I just want to check one or two things: your heart and lungs
and abdomen. Would you just take off clothes down to your underwear and put on this
gown with the opening at the back.
 Hop on, please get on the table for me. Can you manage or shall I give you a hand?
 I m going yo take your pulse, your blood pressure. Will you straighten your arm for
me,please.
 Look up for me.
 Let me check the reflexes in your arms and legs. Relax.
 Turn your head to the right to look at the wall. I want to check the pulse in the neck.
 Now let me feel your windpipe, your glands?
 Stick your tongue out for me. Open your mouth and say..
 Just breathe out quietly.
 Now sit forward while I listen to the back. Hold your breath. Take deep breaths through
your mouth. In, out.... keep going.
 I would like to feel your abdomen. Put your arms down by your sides and let you
tummy,stomach relax. Are there any places that are tender or painful? Now I want to
check your liver and spleen so take a deep breath in, hold it, fine.
 Id just like to examine your prostate and rectum. Now this will be slightly uncomfortable,
but it shouldnt hurt. Lie down on you left side and bend your knees right up to your
chest. Im going to insert a finger in your rectum, dont worry, you wont lose any control.

Treatment

 You seem to have a localised skin rash caused by a bacterial infection. This means that you
will have to take some antibiotics. Are you allergic to any medicine?
 Ok! Ill prescribe an antibiotic. You lll have to take one tablet three times a day, preferably
immediately after eating?
 I can prescribe an anti-inflammatory ointment or some talcum [Link] should help
reduce the burning and itching sensation. I recomment ointment, but I ll prescribe whichever
you prefer. Which would you rather use?
 You should apply it whenever you need to. Do you feel that you need some pain killers?
 Well, that should clear it up. If everything looks good you wont have to come back again.
However, if the symtomss dont go away after a week, make sure you come back and see me
again.
 Aspirinn sometimes affects the stomach. I think you should take paracetamol instead, it
doesnț cause stomach problems.
 Your pressure has come down a little low and thats causing the diziness, so we ll adjust the
dosage of your tablet.
 We will have to change the tablets to put a stop to the nausea.

 I´m stoked—about a song—to be  excited and very happy about something

 To be anal about something
 The poet embodied her ideas in words.
 There were many things that I was taking on with my role
 Hands down= without much effort—easily
 I never sung publicly
 I´m gonna toss it up och you r gonna try to catch it
 You have a lot of faith in how dexterous I am
 In line with... this is....
 The little ones are pack with flavour.. are most flavourful
 They are my all time favourits
 Aim at my hand
 Selena is brushing off bodyshaming comments about her weight
 She has dropped out of American Idol for personal reasons.

Vilka är topp 3 specialiteter som anses vara mest stressande?