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INSTRUCTIONS FOR THE DOCTOR

This is a long case.

Please take a history and conduct an appropriate physical examination. The facilitator will give you the results of initial tests on request. Outline the most likely and differential diagnoses to Mohammed and negotiate a management plan with him.

Scenario

Mohammed Noor is a 23-year-old student studying business at university. He presents today complaining of epigastric burning.

The following information is on his summary sheet:

  • Past medical history

  • Nil recorded

  • Medication

  • Nil recorded

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Social history

  • Lives with mother and five younger siblings

  • Studying business

  • Rohingya refugee born in Burma, spent two years in refugee camp in Bangladesh, arrived in Australia 10 years ago

  • Alcohol—nil

  • Non-smoker

  • Family history

  • Mother—migraines

  • Father killed in Burma prior to rest of family fleeing to Bangladesh.

INSTRUCTIONS FOR THE PATIENT, MOHAMMED NOOR

You are 23 years old and are studying a business degree at university. You are a Rohingya refugee and arrived in Australia 10 years ago. You speak English very well. You completed high school here, achieving good marks, and have almost finished your university studies. Over the past month or so, you have noticed some indigestion after meals. Particularly after spicy foods, you notice burning pain in your upper abdomen. It seems to be worse on university days when you drink three cups of coffee and feel more stressed. Indigestion tablets that you bought from the pharmacy have helped a little to relieve the symptoms. You have felt a little nausea but have not vomited. You have noticed a need to burp associated with times you are feeling pain, which is embarrassing when in a group.

Your bowels are unchanged and there is no rectal bleeding or black motions. You have no trouble swallowing and no sensation of reflux or bitter taste in your mouth. You have not lost any weight (and in fact have probably gained a few kilos over the last couple of years due to eating at the university cafeteria). You do not take any over-the-counter medications other than the indigestion tablets (including no anti-inflammatories).

You are fit and active, playing soccer twice per week with no shortness of breath or chest pain. Your diet consists of traditional food at home (often heavy on the chilli which you grow in your garden) and fast food from the university cafeteria.

You are worried as a friend’s mother just passed away from stomach cancer, which has shocked your small community as she was relatively young. You remember her always complaining of symptoms after eating spicy foods, like yourself. You have no personal family history of gastric cancer.

The following information is on your medical record:

  • Past medical history

  • Nil recorded

  • Medication

  • Nil recorded

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Social ...

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