Nerden baslasam acaba??? Bu arada iki saattir yaziyordum biseyler oldu silindi, cildirmak uzereyim hepsini silbastan yazmam lazim umarim o kadar guzel olur yine..

Ben son iki hafta kalana kadar cok konsantre olamadim. Son iki hafta gunde 4-5 saat calistim bence yeterli ama benim ingilizcem cok iyidir ona gore biraz daha uzun olabilir kisiye gore. Kaplan ve First aid kullandim. Son derece iyi kaynaklardi bircok yerde usmleworldunde cok iyi oldugunu duydum. Kurslari ise bilmiyorum gitmedigim icin ama sahsi kanaatimce cok sart, olmazsa olmaz degiller hele kaplan gibi 2500 dolar vermeye hic degmezler, az parami ya!!!

Simdi, ilk genel seylerden bahsetmiycem, el yikamak, kapi calmak gibi zaten her kitapta yaziyor ve en temel sart seyler.

Ben hikaye ile baslayim. Ben sorulacak sorulari standart hale getirdim ve birazda calisirken kendi sistemini gelistiriyorsun, bu herkeste farkli olacaktir. Benim taktigim bu listeyi sekillendirdikten sonra her vaka orneginde sikayetine bakip ona gore kagida sorulmasi gereken sorulari yazip sonra hikayenin geri kalanina kitapta goz atip nereye gittigini anlayip ek sorularimi yazdim kagida. Sonra onlarin verdigi checkliste bakip kontrol ettim atladigim birsey varmi diye. Sonra FM’ye gectim onuda standard yaptim tabi her hastaya gore modifiye edilecek sekilde. FM’de yapilmasi gerekenleri ve yazilmasi gerekenleri kagida doktum ve onlarida kontrol ettim. En sonunda ayirici tanilarimi yazip tetkikleri istedim.

HIKAYE:

LIQOR AAA: location, intensity, quantitiy, onset, radiation, alleviating, aggravating, associated

When did it start

Where did it start

What kind of a pain is it (sharp-dull, burning-aching-cramping-pressure like)

How intese is it on a scale from 0 to 10

Sudden-gradual

Constant-intermittent

Progression (worse-better)

Previous episodes

Allev-aggr: food, position, exertion, time of day, breating, medication)

Does it move anywhere

Associated: iste bu kisimda ben biraz taktik farki yaptim ve bence cok ise yaradi hikayede birsey atlamamak icin burda genel sistem sorgulamasi yaptim daha sonra yapmak yerine ve tabiki oncelikle sikayetle alakali olanlari sordum. Sistem sorgulamasinda bazi maddeler genel her hastaya sorulurken karin agrisiyla gelene norolojik sorular sormadim, zaten soylemeye gerek yok. Listem:

1- fever-chills, night sweats, weight-appetite change, sleep problems

2- chest pain, palpitations, sweating

3- shortness of breath, cough

4- bowel habit change, constipation-diarrhea, blood in stool, nausea-vomiting

5- difficulty urinating, frequency, nocturia(how many times do you wake up at night to urinate), burning on urination

6- dizziness, loss of consciousness, numbness-tingling, weakness, headaches, loss of bowel-bladder control, head trauma, shaking movements, seizures, visual changes, speech difficulty, gait problems

7- joint pain, skin complaints

Sira geldi hikayenin geri kalanina, liste gozunuzu korkutmasin, bir zaten o heycanla ve o ortamda unutuluyor bircok sey sadece yarisini sorabiliyorsunuz bide hastaya gore zaten bircok madde elimine edilir. Hastalarda cok kisa ve hizli evet hayirli cevaplar veriyor panik olup sonra ne sorcagini unutuyo insan.

PMH: related diseases, other diseases (DM, HTN, CAD)

Allergey:

Medications: over the counter, prescribed

Hospitalization-trauma-surgery

Family History: related or other significant diseases?

OB&GYN: LMP(regular? Amount? Duration?), abortions?, children #,

Sexual: active?/# of partners/male-female-both/condoms/STD history

Social: Tobacco use-Alcohol use-Drugs-occupation, sick contacts, travel history, diet, exercising habits,

Bu kisimda unutmadan once bi sorun varsa hemen consulting yapilmali benden soylemesi. Alkol kullanimi haftada 2’den fazlaysa CAGE sorularina geciniz:

Have you tried to Cut down your drinking?

Are you Annoyed when others comment on your drinking?

Have you felt Guilty because of your drinking?

Are you and Eye opener/ do you drink the first thing in the morning

Bide ozel durumlar icin hikaye listem var

OB:

Have you ever been pregnant?/how many times?

How many children do you have?

Any miscarriages abortions?

GYN:

First menstural period

Last menstural period

Frequency/duration/regularity/how heavy are they(#of pads or tampons)

Do you get cramps

Change in cycles

Spotting/breakthrough bleeding

Pain during intercourse

Vaginal discharge(blood, amount, color, odor, consistency, constant-intermittent)

Urinary problems-bladder control

Pap smear before?

MENOPAUSE:

Hot flushes

Mood changes

Sleep disturbances

Urinary problems

Vaginal dryness

MENSTURAL IRREGULARITY:

LMP

Regular before?

Sexually active/contraception?

Exercise/stress level/nutritional level (hypothalamic)

Discharge from breast/headaches/double vision (prolactinoma)

Cold-heat intolerence/diarrhea-constipation/weight gain-loss/hair falling/skin changes/palpitations (thyroid scanning)

Excessive hair/obesity/infertility (PCOS, CAH, testicular feminization=PRL, LH-FSH, testosteron, DHEA istenir)

Medication effect??

Breast tenderness, nausea, urinary frequency, LMP-contraception method (pregnancy)

D&C/tbc history: Asherman’s

Hypovolemic shock: Sheehan’s

reha