FM-tute 5

Topics
1. Health promotion and disease prevention
2. Approach to pregnancy and sexual health
3. Approach to a patient presenting with common menstrual problems and vaginal

discharge
4. Approach to a patient presenting with fatigue
Questions
1.
1.1. List key action areas in health promotion according to Ottawa Charter.
1.2. Briefly describe each of the above-mentioned action areas using an example action
concerning NCD prevention.
1.3. List 4 levels of prevention.
1.4. Briefly describe each of the above-mentioned levels using an example action
concerning the prevention of alcohol-related health issues.
2.
A 37-year-old man presents to his general practitioner (GP) with a 5-day history of urinary
frequency, dysuria and urethral discharge. In the previous 24h, he had become unwell,
feeling feverish and with a painful right knee. He works in an international bank and
frequently travels to Asia and Australia, from where he had last returned 2 weeks ago. There
is no relevant past or family history and he takes no medication. He looks unwell and has a
temperature of 38.1°C. His heart rate is 90/min, blood pressure is 124/82 mmHg. Otherwise,
examination of the cardiovascular, respiratory, abdominal and nervous systems is normal.
His right knee is swollen, and slightly tender, and there is a small effusion with a slight
limitation of flexion. There is no skin rash and no oral mucosal abnormality. He has a cream-
coloured urethral discharge.

Investigations
Normal
Haemoglobin 17.1 g/dL 13.3-17.7 g/dL
White cell count 16.9 × 109/L 3.9-10.6 x 109/L
Platelets 222 X 109/L 150-440 x 109/L
Blood film: neutrophil leukocytosis

2.1. What are the other investigations you need to evaluate this patient
2.2. What are the differential diagnoses?
2.3. What are the risk factors of this patient for the most probable diagnosis?
3.
A 51 years old female patient is coming to your family practice complaining of increased
menstrual flow for 2 weeks. She wets about 3-4 pads per day. Her previous menstrual cycles
were regular and for the last 2 months, she had episodes of increased menstrual flow. She
complains of headache, faintishness, weakness and dyspnea during her regular activities.
3.1. What are your differential diagnoses?
3.2. How do you investigate this patient and what are the goals of each step?
3.3. Outline the management plan for this patient.
4.
A 36 years old unmarried lady comes to your clinic with a history of smelly vaginal discharge
for 3 days.
4.1. What is the important information about the patient’s history you would inquire about
to arrive at a differential diagnosis?
4.2. What are the possible differential diagnoses?
4.3. What are the important investigations to be done at the primary care setting?
4.4. What is your treatment plan?
5.
A 55-year-old man presents to his general practitioner (GP), complaining of a lack of energy.
He has become increasingly tired over the past 18 months. He works as a solicitor and
describes episodes where he has fallen asleep in his office. He is unable to stay awake after
9.30 pm and sleeps through until 7.30 am. He finds it difficult to concentrate at work and
has stopped playing his weekly game of tennis. He had an episode of depression 10 years
ago related to the break-up of his first marriage. He has no current personal problems. He
has had no other major illnesses. His brother developed type 1 diabetes mellitus at the age
of 13. On direct questioning, he has noticed that he has become more constipated but
denies any abdominal pain or rectal bleeding. He has put on 8 kg in weight over the past
year. On examination he is overweight. His facial skin is dry and scaly. His pulse is 56/min,
regular and his blood pressure is 146/88 mmHg. Examination of his cardiovascular,
respiratory and abdominal systems is unremarkable. A neurological examination was not
performed.
Investigations

Normal
Haemoglobin 10.3 g/dl. 13.3-17.7 g/dL
Mean corpuscular volume (MCV) 92 fL 80-99 fL
White cell count 4.3 x 10 /L 9
3.9-10.6 x 109/L
Platelets 154 x 109/L 150-440 x 109/L
Sodium 140 mmol/L 135-145 mmol/L
Potassium 4.4 mmol/L 3.5-5.0 mmol/L
Urea 6.4 mmol/L 2.5-6.7 mmol
Creatinine 125 μmol/L 70-120 μmol/L
Glucose 4.7 mmol/L 4.0-6.0 mmol/L

Calcium 2.48 mmol/L 2.12-2.65 mmol/L
Phosphate 1.20 mmol/L 0.8-1.45 mmol/L
Cholesterol 6.4 mmol/L 3.9-6.0 mmol/L
Triglycerides 1.4 mmol/L 0.55-1.90 mmol/L
Urinalysis: nothing abnormal detected (NAD)

5.1. What are the likely diagnoses?
5.2. How would you further examine this patient
5.3. How are the other investigations?
5.4. What is your management plan for this patient?

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Topics

1. Health promotion and disease prevention

2. Approach to pregnancy and sexual health

3. Approach to a patient presenting with common menstrual problems and vaginal

4. Approach to a patient presenting with fatigue

1.3. List 4 levels of prevention.

2.2. What are the differential diagnoses?

3.1. What are your differential diagnoses?

3.3. Outline the management plan for this patient.

4.2. What are the possible differential diagnoses?

Glucose 4.7 mmol/L 4.0-6.0 mmol/L

5.2. How would you further examine this patient

5.3. How are the other investigations?

5.4. What is your management plan for this patient?

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