Case 32: Veronica Richards

INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a focused history from Veronica. Then ask the facilitator for the results of a relevant clinical examination and initial investigations.

Outline the diagnosis and your management plan to Veronica.

The following information is on her summary sheet:

• Past medical history

• Two normal deliveries

• Medication

• Nil

• Allergies

• Nil

• Immunisations

• Up-to-date

• Social history

• Housewife, trained as a teacher

• Non-smoker, no alcohol.

INSTRUCTIONS FOR THE PATIENT, VERONICA RICHARDS

You are 49 years old. You grew up in the Philippines and trained as a teacher. You have been in Australia for the past 30 years. You have two teenage children and are happily married. You are not depressed.

You saw your doctor four weeks ago complaining of tiredness, at which time your doctor suggested making some changes to diet and regular exercise. They suggested coming back for review if the tiredness continued, hence why you are here today—‘I’m still tired, Doc’. You sleep well but don’t have the energy you used to have. You have noticed the tiredness for about three months and it is getting worse.

Your periods are regular, not particularly heavy and you have no menopausal symptoms.

You eat a balanced diet, including red meat two or three times a week, and take your dog for a walk every day after the advice given last visit. You have put on a few kilos in the past year, including a further kilo since your last visit (despite eating healthier and exercising regularly). You have no night sweats or changes to your thirst, urine or bowel symptoms. If asked, you have noticed feeling the cold a little more than you usually would at this time of year.

The following information is on your summary sheet:

• Past medical history

• Two normal deliveries

• Medication

• Nil

• Allergies

• Nil

• Immunisations

• Up-to-date

• Social history

• Housewife, trained as a teacher

• Non-smoker, no alcohol.

INSTRUCTIONS FOR THE FACILITATOR

Please give to the doctor on specific request.

Examination

Hydration good, no cyanosis, anaemia or jaundice

Weight 70.8 kg

Height 1.62 m

BMI 27 kg/m²

Pulse 66 reg

BP 130/82 mmHg

No thyroid enlargement

No thyroid eye signs

Chest clear

Heart sounds normal