You are a physician associate working in GP and you have been asked to see a 52 year old Johnathan Mayor who has noticed a recent change in himself.
Take a focused history
Discuss the appropriate investigation and possible diagnosis with the patient
Name: Johnathan Mayor
You’ve noticed that you have been feeling more tired than usual in the last three months. Although you work night shifts and have been for the last 25 years, you haven’t been as tired as this ever. You have taken two weeks of work as you feel that you need some rest, but you haven’t felt any better. You have also noticed red marks on your test and have gained some weight around the abdomen in the last six months despite keeping the same diet for the last 40 years. You deny any cough or chest pain but feel short of breath when you walk up the stairs. When asked if there has been a change in skin pallor you deny, only mention a yellow tinge in your skin if asked directly. You recently noticed both your hands have been shaking quite a lot. Your wife also reports that you have been more confused lately and that has been frustrating as you feel fine. Deny any changes to your urine and stool and deny any weight loss or itchy skin.
You have no idea what is going on, but you are slightly concerned you might have cancer like your grandfather because he was tired a lot before he was diagnosed with bowel cancer. You expect to have a blood test soon to see why you are feeling like this.
Past Medical history
High blood pressure – you take Ramipril 2.5mg
Past Surgical history
Appendicectomy – aged 11
A pint of vodka daily for around 25 years – be reluctant to reveal this information
Current smoker, a pack a day for 40 years
Lost both parents aged 4, unaware of family history
Grandfather died of bowel cancer aged 74
History of presenting complaint
Explore Liver pathology
Past Medical History