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贾马尔·华盛顿,男,69岁,突发胸部中央疼痛。
Jamal Washington
History of Presenting Complaint
5- Asks about onset and duration of chest pain (establishes acute onset 45 minutes ago at rest) +1
- Asks about radiation of chest pain to the left arm or jaw +1
- Asks Jamal to rate his pain on a 0–10 scale (he reports 8/10) +1
- Asks about associated symptoms — shortness of breath, nausea, and diaphoresis +1
- Asks whether anything makes the pain better or worse (Jamal reports no relief from rest or position change) +1
Past Medical History and Risk Factors
5- Asks about known cardiovascular conditions — hypertension, diabetes, and hyperlipidaemia +1
- Asks about smoking history, diet, and exercise (Jamal: 20 pack-year history, quit 10 years ago; poor diet; minimal exercise) +1
+ 28 more criteria across 7 domains
Which of the following is the most appropriate next step?
- A 格雷夫斯病
- B 桥本氏甲状腺炎
- C Commence amiodarone 200 mg TDS for atrial fibrillation rate control
- D 甲状腺癌
- E 病态甲状腺功能正常综合征
这些症状与甲状腺毒症相符,而眼球突出(和胫前粘液性水肿)则更特异于格雷夫斯病。 甲状腺功能检查结果提示原发性甲状腺功能亢进(病变位于甲状腺,而非垂体等其他部位)。抗甲状腺过氧化物酶抗体升高提示自身免疫性甲状腺疾病,例如格雷夫斯病或桥本氏甲状腺炎。桥本氏甲状腺炎通常会导致甲状腺功能减退。
Explain your differential, investigations, and management under examiner prompts.
- Prioritise the dangerous diagnoses. Lead with time-critical conditions before broadening the list.
- Justify investigations. Explain how each result would change your next step.
- Close with management. Show escalation, safety-netting, and patient-centred communication.
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- Reveal the findings. Check your reasoning against the model answer.
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Adelaide · Sydney | Australia
The team
-
Raymond
GP, Adelaide, SA
FRACGP, M.D. (Griffith University)
-
George
Ophthalmology Registrar, Sydney, NSW
M.D. (University of Melbourne)
-
Marie
ENT Registrar, Adelaide, SA
M.D. (Griffith University)
-
Tasneem
GP, Adelaide, SA
FRACGP, M.D. (Griffith University)
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