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贾马尔·华盛顿,男,69岁,突发胸部中央疼痛。
Study Chat
How can heart failure occur with a normal ejection fraction?
In HFpEF, impaired relaxation and increased ventricular stiffness raise filling pressures. Congestion can occur even when the proportion of blood ejected is preserved.
Ejection fraction describes emptying, not filling. A preserved EF does not exclude heart failure.
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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Follow the same case as a structured reasoning walkthrough.
- Characterise the complaint. SOCRATES separates dangerous causes from benign ones.
- Screen red flags and risks. They shift your differential and your urgency.
- 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)