Hanoi Medical University

Author: Nguyen Kim Thu

Case outline

At the clinic

The 46-year-old male patient, who regularly drank alcohol and used drugs, had a history of hepatitis B 10 years ago but did not receive any treatment and the patient was HBsAg positive for this visit. In this 7 days event, patients appear tired, anorexia, dark urine, accompanied by patients without fever. The patient has been examined at Hospital A and have an AST/ALT of 150/230 U/L. The patient’s father was diagnosed with liver cancer died 2 years ago. You are the doctor who examines this patient and decide to test the hepatitis virus marker for the patient.

Choice 1: Patient outpatient follow up, make some hepatitis virus evaluation and make another appointment after 6 months returning to the clinic for re-evaluation and screening for liver cancer.

Choice 2: Patient outpatient follow up, make some hepatitis virus evaluation and screening for liver cancer

Choice 3: Provide the patient with liver function drugs and make re-appointment after 6 months

Learning objectives

• Viral hepatitis causal agents and transmission routes
• Clinical manifestation of acute viral hepatitis
• Laboratory tests for acute viral hepatitis: diagnostic test, hepatic function test, Viral hepatitis B markers
• Acute viral hepatitis treatment principle and consultancy
• Viral hepatitis prevention

Medical errors

• Playing the odds
• Miss triage
• Fixation
• Ignorance

Author: Nguyen Van Duyet

Case outline

At the clinic, a 56-year-old male patient, a history of disk herniation, sometimes has a back pain, restricts movements, but only takes a few days to recover. Patients are brought to the clinic because many people complain, restrict travel, eating difficult. No symptoms: 36oC, pulse: 80 times/minute, blood pressure: 120/80 mmHg. You are a physician treating patients at the Central Hospital for Tropical Disease, you are giving the patient blood tests and X-ray of the vertebrae of the straight waist-tilt, magnetic resonance imaging of the lumbar spine. Test results:

CTM: BC: 98 G/L, TT: 75%, lym: 8%, momo: 7%, HC: 4.5 T/l, Hct: 0.42 l/l, Hgb: 134 g/l. TC: 215 G/l.

HSM: ure: 7.5 mmol/l, creatinine: 78 umol/l, CK: 1245 UI/l

Spine X-ray straight tilt image degeneration lumbar spine

MRI scan of patients with spinal disc herniation in lumbar vertebra 3-4, L 4-5.

Choice 1: Transfer the patient to the outpatient department, review the spine surgery for the spinal cord to relieve the spinal cord for patients

Choice 2: Transfer the patient to the rehabilitation department to stretch the spine and wear the spine to the patient

Choice 3: Ask the patient to take the pain relief medication and follow up the appointment after 5 days

Learning objectives

• Epidemiological characteristics: causal agent, transmission route
• Clinical manifestation
• Complication
• Laboratory test
• Treatment and prevention

Medical errors

• Bravado
• Fixation
• Ignorance
• Insufficient skills
• Miss triadge

Author: Le Thi Hoa

Case outline

The 21-year-old male patient was taken to a clinic for stimulation, speech impotence. After asking to know that this patient as a builder, a history of aneurysm node was 6 years ago, did not inject, drank much and the night before drank a lot of alcohol. Parents do not know if they have had diarrhea or recently taken any medication. From early morning appear chattering, stimulating, hugging head but no convulsions, family hospitalized. Mucosal abscess: 120/80 mmHg, M: 80 times/min, T: 38.6 degrees, Glassgow 14 points, no skin lesions, no localized lesions, dirty tongue, stiff neck, unknown kernig. What will you do next?

Choice 1: Hospitalization in the Department of Neurology

Choice 2: Hospitalization in the Department of Poison Control

Choice 3: Hospitalization in the Department of Infectious Diseases

Learning objectives

• Epidemiological characteristics: causal agent, transmission route
• Clinical manifestation
• Confirmative and differential diagnosis
• Treatment for meningitis and sepsis cases
• Prevention

Medical errors

• Insufficient skills
• Ignorance
• Miss Triadge
• Poor communication

Author: Nguyen Manh Truong

Case outline

You are a resident physician in the hospital's clinic. On a night at the clinic, you received a 28-year-old female patient who had a fever on day 4th. Exploring a healthy patient population living in an epidemic area with many patients. Diagnosing dengue hemorrhagic fever. 4-day course of patients develops high fever of 39-40 degrees, accompanied by headache, fatigue, sore eyes, since yesterday patients presented menstruation earlier than the usual cycle number little, today found menstruation more than normal, feeling nausea but no vomiting, no cough, no sore throat, no shortness of breath,

Examination patients, the patient is tired, high 160cm, weight 55kg, fever 38.50C, Pulse rate 100l/min, HA: 100/60mmHg, pulse rate 18l/min, pink mucosa, congestion, moderate amount of dermal hemorrhage, softening of the lungs, cardiopulmonary hearing loss, Soft belly, not liver spleen.

You think most people with dengue hemorrhagic fever, you give the patient test results:

NS1 positive, Red blood cell: 4.5T/l, HCT 40%, BC: 1.3G / l, TC: 55G / l, AB blood group, AST: 123U / l, ALT: 250U / l, ultrasound with little abdominal cavity, pleural membrane, sacral lung pulmonary heart lung, less bilateral pleural fluid. You diagnose a patient with dengue hemorrhagic fever, the direction of treatment for this patient:

Choice 1: Hospitalization in the Emergency Department

Choice 2: Hospitalization in the Department of Infectious Diseases

Choice 3: The patient can go home, take the prescription, ask for the re-appointment if the patient has serious symptoms as heavy blood, shock, rebension.

Learning objectives

• Epidemiological characteristics: causal agent, transmission route
• Clinical manifestation and laboratory test
• Confirmative and differential diagnosis
• Treatment and prevention

Medical errors

• Bravado
• Fixation
• Ignorance
• Insufficient skills
• Miss triadge
• Poor communication
• Playing the odds

Author: Nguyen Thi Lien Ha

Case outline

You are a general practitioner. On a tour of the Emergency Clinic at the National Tropical Hospital, you can see the following case:

Male patient, 40 years old. No history of hypertension and no previous disease. A history of allergy to penicillin antibiotics. Patients in the hospital on day 4 of the disease because of high fever continuously and away from loose stool 3-4 days. Patient at hospital, very sick, fever 39.5 degrees, pink, mucosa, HA: 140 / 80mmHg, pulse 60 times / minute, breath 30 times / minute, dry lips, dirty tongue, lung abscess, soft bloating, moderate abdominal distension, pressure ulceration, no response to suspected abdominal cavity in the pelvic cavity, 4 cm thick ribs below the ribs, soft, light, spleen 2cm below From the morning till the urine is 100ml / 14 hours.

Your action?

Choice 1: Give the patient a special examination to exclude appendicitis

Choice 2: Provide the patient the antipyretics and diagnostic tests at the clinic, if necessary, the patient will have outpatient treatment

Choice 3: The patient need to hospitalize

Learning objectives

• Epidemiological characteristics: causal agent, transmission route
• Clinical manifestation
• Complication
• Laboratory test
• Treatment and prevention

Medical errors

• Team-working
• Ignorance
• Miss triadge
• Insufficient skills
• Poor communication