Clinical Skills Case



good morning mr. Soto morning my name is dr. Hawking belladonna I'm the physician physical examination is that okay fine okay perfect so how can I help you today well I have a pain on my belly okay I'm so sorry to hear that we're getting more best if I try to find what's causing the pain now well we'll see from there okay okay let's talk a little bit about this abdominal pain we did you start off feeling I felt it over the last month usually when I eat spicy food there is too much food oh I see I see okay so it's been long and then when you eat a spicy food okay now how would you describe the pain for me I want to describe it as the dull aching okay keeping okay now is kept on one to ten ten being the worst pain in your life how's your greatest thing about five bye okay now what is it located show me we won't be helpful around this area okay okay now as if this pain is travelling somewhere else no just stays here maybe a little bit sometimes a little bit okay okay No is there something that you need is being better um well not that I think maybe you wanna eat pink milk sometimes I okay have you tried any anti-acids um I've tried one but I don't I don't have many okay is there something that can make this pain worse um yeah when I eat happy meal okay okay that seems important let me write it this sometime at night bye you too much and go to sleep it that feels like going back okay have you ever had a pain like this before um I had it once but then I went away okay what's the same like this one it was it was similar it was similar the same location yeah it wasn't that bad yeah I wasn't so bad this time it got worse okay have you had any nausea um I felt a little bit you can't have you ever mom in it no no bum okay um let's say have you had any diarrhea lately no okay constipation okay how's your how's your appetite um it's it's it's not a good appetite okay the appetite is good did you have any fevers no favor no favors are you feeling any tired lately no okay now have you noticed any changing your weight no it's been stable just instinct okay I see okay normally to ask you a couple of questions about your past medical history is that okay definitely any important medical condition that I should know no I don't have any problem okay your high blood pressure cholesterol okay okay what about allergies you have the allergies now Americ not really okay do you take any medications um I've been taking a little bit of Advil for the pain of some ibuprofen okay they did work that helps a little bit because some okay but sometimes I mean I feel like to make it worse to take it I understand I understand okay we're going to try to do we're going to try to find out what's causing the pain and it will give you the proper medication for the pain no have you ever been hospitalized no after no surgeries I'm not having an internal pain person you know I'm going to ask you a couple of questions about your family histories okay that's fine are your parents alive yes Sarila are being good help for the most part okay do they have any important medical condition you think my dad does high blood pressure here okay you're then full type of pressure nothing what about your mom not she's helping I understand that you're in a lot of pain I want to help you just bear with me a couple of minutes and then okay we'll give you the medication so you're being having a pain right here it's been bugging you for the past for the past month yeah okay so it's been a ball Anke pain that is not going away and is not responding to medication would you like to add something so far sometimes I might feel like go up a little bit the pain Brady did you feel any 30 yeah a little bit of burning okay any sour of like taste of sorrow in your mouth well now that you mention it sometimes I have a little bit of coffee on that night the copies of like okay okay that seems important or let's keep that in mind okay the next step would be to a physical examination verification by making them go wash my hands so tell me mr. Soto why are you buddy um I'm sitting right now there's a lot of your study about your major um studying general it's great to hear that you're in college okay before you start the examination do you have any concerns okay first time we like to check on your chest man and tie your gown yes okay just hold it place here thank you you can fold this down a little bit I'm gonna hear your chest okay thank you very much and they put this back now I'm going to here on your back okay okay would you take a deep breath for me please okay thank you so much lemon today's okay now I want to ask you to lay down for me please okay I have to check out your hand okay cover this part let me know if you feel anything at any time okay now I have to plan a little bit of pressure if you feel any pain just let me know here you have the big okay I'm so sorry I won't do it again so the pain is located right there okay now I'm going to tap on your app and okay now I'm going to apply a little bit of pressure here and they want you to take a deep breath did you feel any pain okay perfect so let me cover you back I'm just going to check on your legs okay and the swelling okay perfect let me tell you sit up okay mr. solo after all the questions on the physical examination your condition may be due to a medical condition called gastritis or it could be emulsion for that we're going to have to run some blood tests and try to check out your blog and maybe do an endoscopy what's an endoscopy it's putting a team together camera to check on the inside okay we have to check if you have any alters and inflammation in the meantime I can write you a prescription for pain medication maybe some anti-acids to help you with a pain in the meantime you get the results okay okay do you have any questions for me um no okay perfect so as soon as we have the results then we'll be calling you on contact you to give you the proper medication another unique diagnosis well I just have one question how are my blood pressure are your blood pressure seems within the normal limits it means that it is normal the numbers are normal and then we have to keep on looking at your blood pressure every three months like you have to come Logan recheck okay okay thank you did I answer your question yes to do okay perfect do you have any other questions Matt this moment perfect great pleased to meet you I will talk to you okay thank you you and you you

30 comments

  1. Its OK … – only adding our thoughts.
    He is a student. We are NOT criticizing him but what about the Directors from UCLA, who produced this?

    1. Is he left handed?
    Standing on right makes the exam easy… most of are right handed. …. palpation etc.. try it your self… even helping the patient
    get up & adjust posture too.
    2. Patient volunteered about NSAID – Ibuprofen. . He did not ask for/ pay attention to/advise against.
    3. Does the positioning make the pain worse ? — he should talk & advise about.
    4. Social history?
    5. Listening to the heart / examining on the clothing? not ideal…
    6. Life style changes …
    Don't lie down immediately after a meal- No tight clothing- avoid foods/ drinks that aggravate- take smaller meals- healthy weight- Avoid Ibuprofen etc to avoid acid reflux …. etc….
    Make a better video — Directors….

  2. this is the UCLA program for IMGs however they require a SSN in order to accept you into the program…

  3. It's so easy to see the mistakes and omissions when u are watching someone else do it, but when you are the in front of the patient and nervous it's a whole different story. But yes, smoking and alcohol history in a pt with epigastric pain is very important.

  4. -Should always do vital signs at the beginning!
    -You should palpate the carotid to confirm S1/S2
    -You should make sure the patient breathes through his mouth when checking vesicular breath sounds
    -Drape the patients leg for abdominal exam
    -GERD has to be the first differential

    Please correct me if I'm wrong, just sharing what I learned! Great video, well done and thanks for putting yourself under scrutiny, its the best way to get better!

  5. the background music feels like the 80's (we are the doctors , we are the healers) . just pay for your goddamn health insurance OK.but of course, respect .useful video

  6. Muy buen video pero debajo de la bata el paciente tiene su camisa me da la impresion que era muy tímido el paciente

  7. Legs should be folded during examination of the abdomen. It relaxes the abdominal muscles, and allows for deep palpation. He's on the wrong side of the patient, also. Always stand on the right side of the patient. 

  8. tough crowd. how would you like it if someone blasted your performance like you've done? He's a student! he's there for constructive criticism not crucification by other students. I can pick out several things lacking but come on. bunch of self-important cruel jerks. not MD material if this is how you treat others. just because you can pass a USMLE exam doesn't mean you have any bedside manner. Check yourselves.

  9. Fool palates over skin
    Gerd is not exacerbated by palpating
    Hand washing not 15 seconds
    Gerd first line is lifestyle modification followed by PPI

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