SSP:Portal-ENG

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This chapter provides a set of generic situations which cover the common circumstances, symptoms, complaints and findings which the physician should be able to manage on day one of his residency. In other words, she or he should be able to assess a patient presenting with any of these situations in a well-structured way, establish a differential diagnosis and propose diagnostic, therapeutic, social and preventive/counselling measures.

The list encompasses most of the typical situations a young resident may face. The situations are listed under several subtitles to make their use easier, but in some instances the classification is arbitrary. Items listed as “symptoms” may also be defined as “findings”, and vice-versa. A set of pre-defined criteria was used to design the list. The situations were selected:

• if they occur frequently,
• if rapid and appropriate intervention may be crucial or even life-saving,
• if they are a recognized cause of important emotional distress for the patient.

The situations are presented in a very generic way, which means that they can be used and applied to all gender identities and ages (children, adults, and the elderly) unless otherwise specified. They cover acute, subacute and chronic problems (e.g. fever, pain, fatigue), which further increases the range of potential pathologies. For instance, the situation “jaundice” may be a starting point for numerous situations such as neonatal jaundice, hepatitis, pancreatic cancer or cirrhosis.

As entry points, the situations mostly constitute a broad range of diagnostic pathways involving different disciplines. For instance, a situation such as “chest pain” can be a starting point for discussion of several pathologies such as cardiac, pleural and parietal problems, disorders of the spine, stress and anxiety and so on. As mentioned above, the situation will have different implications according to the sex, gender and age of the patient and whether the problem is acute or chronic. The use of these situations should assist students to develop their skills in clinical reasoning, to increase their ability to integrate various options into their differential diagnosis, and to maintain an interdisciplinary perspective.

The situations are intended to be used by faculties and teachers to illustrate lectures, to engage in problem-based learning sessions and to facilitate teaching in a clinical environment. They will also be used as a basis for the development of the Federal Licensing Examination.

Situations as starting points encompass not only health problems and symptoms but also normal or current health issues, e.g. the birth of a baby or injury prevention among elderly people.

General complaints and symptoms (G)

 G1 – Abnormal perspiration

 G2 – Swelling, tumor, included enlarged lymph nodes (lymphadenopathy)

 G3 – Excessive thirst, excessive fluid intake (polydipsia)

 G4 – Fatigue, tiredness

 G5 – Feeling of illness

 G6 – Fever, chills, hyperthermia

 G7 – Flushing

 G8 – Hypothermia

 G9 – Itching

 G10 – Pain of all types

 G11 – Sleep problems (insomnias, hyper-somnias/sleepiness, parasomnias)

 G12 – Oedema (diffuse or local)

 G13 – Unnatural death

 G14 – Unexpected or sudden death

 G15 – Weight gain, obesity

 G16 – Weight loss, loss of appetite

System-related or specific complaints and symptoms (S)

Head and neck

 S1.1 – Diplopia, ptosis, abnormal eye movements

 S1.2 – Acute and gradual loss of vision (acute, slow, temporary, partial)

 S1.3 – Alteration of voice (hoarseness, aphonia, dysphonia)

 S1.4 – Asymmetric face, deformation

 S1.5 – Bleeding nose

 S1.6 – Blepharospasm

 S1.7 – Difficulty in swallowing, choking

 S1.8 – Discharge from ear

 S1.9 – Dryness, pain, mass in mouth or throat, oral lesions

 S1.10 – Earache

 S1.11 – Facial, jaw or tooth pain, trismus

 S1.12 – Hearing impairment: hyper- and hypoacusis, deafness, whistling, tinnitus

 S1.13 – Micro- and macrocephaly

 S1.14 – Nasal discharge

 S1.15 – Nasal obstruction

 S1.16 – Neck stiffness and pain

 S1.17 – Painful, red, itchy eyes; eye discharge

 S1.18 – Snoring

 S1.19 – Sore throat

 S1.20 – Squint (strabismus)

 S1.21 – Swelling of face, lips, neck

 S1.22 – Swelling of the eyelid

 S1.23 – Visual disturbances, photophobia, light flashes, floating objects, diplopia, color blindness, blurred vision

Chest

 S2.1 – Apnea, apnea with arousal

 S2.2 – Change of respiratory pattern

 S2.3 – changes of breast size, breast lump, breast discharge

 S2.4 – Chest discomfort

 S2.5 – Chest pain

 S2.6 – Cough, expectoration, hemoptysis

 S2.7 – Dyspnea VZOROVÉ SSP

 S2.8 – Heartburn (pyrosis)

 S2.9 – Impaired or painful passage of food, dysphagia, regurgitation

 S2.10 – Painful respiration, wheezing, stridor

 S2.11 – Palpitations

 S2.12 – Parietal chest pain

Abdomen

 S3.1 – Abdominal pain

 S3.2 – Abdominal distension

 S3.3 – Abdominal mass

 S3.4 – Altered defecation pattern, incontinence, pain

 S3.5 – Anal itching, anal pain, anal protrusion

 S3.6 – Hematemesis

 S3.7 – Constipation

 S3.8 – Diarrhea

 S3.9 – Anal bleeding, melena, fresh blood, mucus, pus in feces

 S3.10 – Nausea, vomiting

Pelvis, urogenital system

 S4.1 – Variations in sexual development

 S4.2 – Anuria, pollakiuria, oliguria, polyuria

 S4.3 – Dysuria, pyuria, hematuria

 S4.4 – Issues related to conception, e.g. infertility and sterilization

 S4.5 – Menstrual symptoms: disorders of menstruation, painful menstruation, premenstrual symptoms

 S4.6 – Pelvic mass

 S4.7 – Pelvic pain

 S4.8 – Request for contraception, emergency contraception

 S4.9 – Scrotal pain, swelling, mass

 S4.10 – Sexual complaints and dysfunction

 S4.11 – Swelling, pain in groin

 S4.12 – Symptoms related to menopause

 S4.13 – Urethral discharge

 S4.14 – Urinary incontinence and enuresis

 S4.15 – Urinary retention

 S4.16 – Uterine prolapse, pelvic relaxation

 S4.17 – Vaginal bleeding

 S4.18 – Vaginal discharge

Back and extremities

 S5.1 – Abnormal posture and back deformities

 S5.2 – Back pain

 S5.3 – Deformities of skeleton and joints

 S5.4 – Myalgia

 S5.5 – Pain, burning, cramp, numbness in the extremities

 S5.6 – Swollen or painful joints, morning stiffness, reduction of joint motility

Skin

 S6.1 – Changes in oral, genital or perianal mucosa

 S6.2 – Ecchymosis, hematoma, purpura

 S6.3 – Hyper- or hypopigmentation

 S6.4 – Infected wound, delayed wound healing, skin ulcers

 S6.5 – Jaundice (icterus)

 S6.6 – Lack or loss of hair, excess hair

 S6.7 – Macules, papules, pustules, blisters, ulcers and abscess, bullae, thickening, necrosis, tumors

 S6.8 – Nail complaints

 S6.9 – Redness of the skin (localized or diffuse) and/or mucosa

Nervous system

 S7.1 – Abnormal sense of balance, falls

 S7.2 – Abnormal gait

 S7.3 – Abnormal involuntary movements, tremor, tic, lack of coordination

 S7.4 – Disorders of speech or language

 S7.5 – Dizziness, vertigo

 S7.6 – Headache

 S7.7 – Cognitive impairment, including loss of concentration, memory disturbance, and trouble in understanding

 S7.8 – Paresis, paralysis

 S7.9 – Disturbances of sensation (hyper- or hypo-esthesias, paresthesias, pain)

 S7.10 – Twitches, convulsion, fasciculations, seizure and epileptic status

Injuries and trauma

 S8.1 – Abdominal injuries

 S8.2 – Burn, cold injury

 S8.3 – Contusion, soft tissue bruising

 S8.4 – Dislocation of joint

 S8.5 – Drowning or near drowning

 S8.6 – Foreign body

 S8.7 – Head and brain injuries and trauma

 S8.8 – Injuries of the extremities

 S8.9 – Laceration, closed or open wound, blood loss

 S8.10 – Spine injuries

 S8.11 – Thoracic injuries

 S8.12 – Vascular injuries

Emotional and behavioral symptoms

 S9.1 – Anxiety and panic

 S9.2 – Attention deficit

 S9.3 – Change in behavior

 S9.4 – Change in eating behavior

 S9.5 – Change in mood

 S9.6 – Hyperactivity

 S9.7 – Irrational fear, fear of illness

 S9.8 – Irritability, aggressive and violent behavior

 S9.9 – Changes in mental status such as confusion, delirium, (auto-)aggressive behavior

 S9.10 – Obsessive and/or compulsive behavior

 S9.11 – Reactions to major stressful events

 S9.12 – Self-harm, including suicide

 S9.13 – Non-medical substance use (“misuse”), addiction e.g. tobacco, alcohol, illegal substances

Findings (F)

Findings upon physical examination

 F1.1 – Abnormal blood pressure

 F1.2 – Physiological, post-surgical or after mutilation, hormonal, and pathological variations in external genitalia (female, male, including intersex and transgender individuals) abnormal findings upon auscultation

 F1.3

 F1.4 – Abnormal findings upon inspection

 F1.5 – Abnormal findings upon palpation

 F1.6 – Abnormal findings upon percussion

 F1.7 – Bradycardia, tachycardia, irregular pulse

 F1.8 – Cachexia and malnutrition

 F1.9 – Cognitive impairment

 F1.10 – Cyanosis

 F1.11 – Disorganized speech

 F1.12 – Exophthalmos (proptosis), myosis or mydriasis

 F1.13 – Halitosis (fetor oris)

 F1.14 – Gangrene

 F1.15 – Impairment or loss of consciousness, coma

 F1.16 – Oedema

 F1.17 – Pallor

 F1.18 – Pulseless patient, cardiorespiratory disturbances and arrest

 F1.19 – Transient loss of consciousness, syncope

Findings upon additional examination

 F2.1 – Abnormal blood gas values

 F2.2 – Abnormal cardiac enzymes

 F2.3 – Abnormal coagulation profile

 F2.4 – Abnormal X-rays of abdomen, chest and skeleton

 F2.5 – Abnormal leukocyte count

 F2.6 – Abnormal ECG

 F2.7 – Abnormal electrolytes

 F2.8 – Abnormal fecal analyses, occult blood, parasites

 F2.9 – Abnormal glycaemia and markers of glycaemia homeostasis

 F2.10 – Abnormal histology, cytology and molecular genetic test

 F2.11 – Abnormal liver enzymes

 F2.12 – Abnormal markers of kidney function

 F2.13 – Abnormal serum lipids

 F2.14 – Abnormal thyroid hormones

 F2.15 – Abnormal urine sediment

 F2.16 – Anemia

 F2.17 – Blood group incompatibility

 F2.18 – Effusion detected by ultrasound (abdomen, pleura

 F2.19 – Elevated biomarkers of inflammation

 F2.20 – Low bone density

 F2.21 – Nutritional deficiencies

 F2.22 – Polycythemia

 F2.23 – Proteinemia, albuminemia

 F2.24 – Proteinuria

 F2.25 – Thrombopenia, thrombocytosis

Other situations (O)

Situations related to pregnancy and motherhood

 O1.1 – Abnormal birth weight and prematurity

 O1.2 – Basic care in normal delivery and childbed

 O1.3 – Basic pre- and post-conception screening for genetic disease and malformation

 O1.4 – Maternal problems during pregnancy, fever, oedema, hypertension, premature labour

 O1.5 – Problems related to delivery

 O1.6 – Problems related to lactation

 O1.7 – Process and basic care of pregnancy

 O1.8 – Request for abortion

 O1.9 – Suspicion of pregnancy, unplanned pregnancy

Situations related to childhood

 O2.1 – Abnormal growth and puberty (slowing or acceleration), failure to thrive

 O2.2 – Behavioral issues in childhood and adolescence

 O2.3 – Child abuse and neglect

 O2.4 – Child immunization

 O2.5 – Developmental delay

 O2.6 – Feeding and eating issues during infancy, childhood and adolescence

 O2.7 – Fetal problems during pregnancy

 O2.8 – Infant death (Live threatening issues and inborn deseases)

 O2.9 – Irritable, crying infant

 O2.10 – Learning and school problems in childhood and adolescence

 O2.11 – Low muscle tone and hypotonia

 O2.12 – Well-baby, well-child visit, and well-adolescent visit

Situations related to old age

 O3.1 – Elder abuse and neglect

 O3.2 – Functional impairment (cognition, sensory and motor)

 O3.3 – Malnutrition and sarcopenia

 O3.4 – Polymorbid, polymedicated patient

 O3.5 – Pressure ulcers

 O3.6 – Progressively dependent patient

 O3.7 – Urinary and fecal incontinence

Akutní stavy - příznaky, nálezy

 203 – Akutní bolest břicha, bolest v epigastriu

 204 – Akutní bolest na hrudi, bolest v epigastriu, bolest paže, čelisti, zubu

 205 – Akutní neurologický deficit

 206 – Akutní těžká dušnost

 207 – Akutní těžká bolest hlavy, meningeální syndrom

 208 – Popáleniny

 209 – Kolika

 210 – Hemateméza

 211 – Otrava, intoxikace

 212 – Mydriáza, mióza

 213 – Sebepoškozování a pokus o sebevraždu

 214 – Těžká hypertenze, těžká hypotenze

 215 – Těžká akutní ztráta krve

 216 – Náhlé změny duševního stavu – zmatenost, bludy, (auto)agresivní chování

 217 – Synkopa, ztráta vědomí

 218 – Kardiorespirační poruchy a zástava

 219 – Křeče

 220 – Běžná nekomplikovaná traumata

Issues linked with prevention and health promotion

 O4.1 – Consultation before engaging in sports activities or after a sport injury

 O4.2 – Immunization plan

 O4.3 – Promotion of healthy life style

 O4.4 – Request for check-up, health examination, radiologic and laboratory procedures

 O4.5 – Promotion of sexual health and fertility

 O4.6 – Shared assessment of risks and benefits of screening and treating asymptomatic conditions

 O4.7 – Shared assessment of risks and protective factors for frequent life-compromising diseases, such as cardiovascular, metabolic, oncological, and neurological diseases

Palliative care

 O5.1 – Caregivers’ fatigue, loss of energy

 O5.2 – Change in treatment goals and end-of-life decisions

 O5.3 – Holistic care of the dying patient

 O5.4 – Management of refractory symptoms (pain, nausea)

 O5.5 – Need for psychosocial or other kind of support (e.g. spiritual)

Psychosocial issues

 O6.1 – Absenteeism (school, work)

 O6.2 – Concern about appearance, body image

 O6.3 – Domestic violence, sexual abuse, rape

 O6.4 – Harassing, bullying, mobbing

 O6.5 – Issues regarding diversity of affective and sexual orientation and gender identity

 O6.6 – Issues related to family life such as divorce, single parent and reconstructed family

 O6.7 – Loss, death, grieving process, illness of someone close

 O6.8 – Mental or spiritual suffering

 O6.9 – Problems related to work conditions, burnout, unemployment, financial problems

Various health care issues

 O7.1 – Consultation before or after trip to foreign (tropical) country

 O7.2 – Determination of work or school incapacity

 O7.3 – Dietary counselling including a healthy and sustainable nutrition

 O7.4 – Environmental and psychosocial aspects of chronic condition

 O7.5 – Errors or misconduct of a co-worker or other healthcare professional

 O7.6 – Immunocompromised patient

 O7.7 – Issues linked with food tolerance

 O7.8 – Medically unexplained symptoms

 O7.9 – Nosocomial infection

 O7.10 – Request for informed consent for a procedure

 O7.11 – Patient refusing treatment

 O7.12 – Patient with sexually transmitted infection

 O7.13 – Patient with other cultural background, migration

 O7.14 – Physical and psychosocial inpatient and outpatient rehabilitation

 O7.15 – Poor adherence to treatment

 O7.16 – Pre-intervention and pre-operative assessment

 O7.17 – Request for certificate, attestation or expertise by patients and insurers

 O7.18 – Request for unnecessary investigations and treatment

 O7.19 – Request for information about gene therapy

 O7.20 – Request for information related to organ donation, transplantation

 O7.21 – Benefits and risks of complementary and integrative medicine

 O7.22 – Suspicion of drug intolerance or interaction (including herbal medicine and dietary supplements)

 O7.23 – suspicion of rare disease

 O7.24 – vulnerable patient

 O7.25 – request for genetic counselling

 O7.26 – intoxication, poisoning

Zdroje

• Situations as Starting Points