Exam (elaborations)
Praktijktoets casuïstiek persisterend wk 3-6
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Alle casussen van de persisterend weken 3-6 uitgebreid uitgewerkt.
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InhoudsopgaveCasus: Romeo (enkel persisterend) ............................................................................................................................................................................................................. 4
Anamnese: ..................................................................................................................................................................................................................................................... 5
Hypothesen: .................................................................................................................................................................................................................................................. 8
Onderzoeksplan: ............................................................................................................................................................................................................................................ 9
Behandelplan: .............................................................................................................................................................................................................................................. 14
Casus: Sebastiaan (lies persisterend)......................................................................................................................................................................................................... 21
Anamnese: ................................................................................................................................................................................................................................................... 22
Hypothesen: ................................................................................................................................................................................................................................................ 25
Onderzoeksplan: .......................................................................................................................................................................................................................................... 26
Behandelplan: .............................................................................................................................................................................................................................................. 34
Casus: mw. Jongerius (nek persisterend)................................................................................................................................................................................................... 42
Anamnese: ................................................................................................................................................................................................................................................... 43
Hypothesen: ................................................................................................................................................................................................................................................ 45
Onderzoeksplan: .......................................................................................................................................................................................................................................... 46
Behandelplan: .............................................................................................................................................................................................................................................. 61
Casus: Gijs (lwk persisterend).................................................................................................................................................................................................................... 66
Anamnese: ................................................................................................................................................................................................................................................... 67
Hypothesen: ................................................................................................................................................................................................................................................ 69
Onderzoeksplan: .......................................................................................................................................................................................................................................... 70
Behandelplan: .............................................................................................................................................................................................................................................. 86
Casus: Demi (heup en lage rug persisterend) ............................................................................................................................................................................................ 92
Anamnese: ................................................................................................................................................................................................................................................... 93
Hypothesen: ................................................................................................................................................................................................................................................ 95
Onderzoeksplan: .......................................................................................................................................................................................................................................... 96
Behandelplan: ............................................................................................................................................................................................................................................ 109
Casus: Mariska (knie persisterend) .......................................................................................................................................................................................................... 117
Anamnese: ................................................................................................................................................................................................................................................. 118
Hypothesen: .............................................................................................................................................................................................................................................. 120
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IBS-Curriculumcommissie maart 2020
, Onderzoeksplan: ........................................................................................................................................................................................................................................ 121
Behandelplan: ............................................................................................................................................................................................................................................ 127
Casus: Marianne (schouder persisterend) ............................................................................................................................................................................................... 133
Anamnese: ................................................................................................................................................................................................................................................. 134
Hypothesen: .............................................................................................................................................................................................................................................. 136
Onderzoeksplan: ........................................................................................................................................................................................................................................ 137
Behandelplan: ............................................................................................................................................................................................................................................ 146
Casus: Iddo (LSRS persisterend)............................................................................................................................................................................................................... 157
Anamnese: ................................................................................................................................................................................................................................................. 158
Hypothesen: .............................................................................................................................................................................................................................................. 160
Onderzoeksplan: ........................................................................................................................................................................................................................................ 161
Behandelplan: ............................................................................................................................................................................................................................................ 169
Casus: Sjoerd (TOS) ................................................................................................................................................................................................................................. 174
Anamnese .................................................................................................................................................................................................................................................. 175
Hypothesen: .............................................................................................................................................................................................................................................. 177
Onderzoeksplan: ........................................................................................................................................................................................................................................ 178
Behandelplan: ............................................................................................................................................................................................................................................ 186
Casus: Dhr. van Son (rugklachten persisterend) ...................................................................................................................................................................................... 189
Anamnese: ................................................................................................................................................................................................................................................. 190
Hypothesen: .............................................................................................................................................................................................................................................. 192
Onderzoeksplan: ........................................................................................................................................................................................................................................ 193
Behandelplan: ............................................................................................................................................................................................................................................ 200
Casus: Mw. Jongerius (nek persisterend) ................................................................................................................................................................................................ 203
Anamnese: ................................................................................................................................................................................................................................................. 204
Hypothesen: .............................................................................................................................................................................................................................................. 206
Onderzoeksplan: ........................................................................................................................................................................................................................................ 207
Behandelplan: ............................................................................................................................................................................................................................................ 215
Casus: Demi (heup en lage rugklachten persisterend) ............................................................................................................................................................................. 222
Anamnese: ................................................................................................................................................................................................................................................. 223
Hypothesen: .............................................................................................................................................................................................................................................. 225
Onderzoeksplan: ........................................................................................................................................................................................................................................ 226
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IBS-Curriculumcommissie maart 2020
, Behandelplan: ............................................................................................................................................................................................................................................ 232
Casus: pols persisterend .......................................................................................................................................................................................................................... 236
Anamnese: ................................................................................................................................................................................................................................................. 237
Hypothesen: .............................................................................................................................................................................................................................................. 238
Onderzoeksplan: ........................................................................................................................................................................................................................................ 239
Behandelplan: ............................................................................................................................................................................................................................................ 244
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IBS-Curriculumcommissie maart 2020
, Casus: Romeo (enkel persisterend)
Romeo is een Surinaamse man van 48 jaar werkzaam als kraanmachinist in de haven van Rotterdam:
“prachtig uitzicht vanuit mijn kraantje, en geen dag is hetzelfde”! Zijn huisarts heeft hem geadviseerd
om veel meer te gaan bewegen, vanwege zijn ongezonde leefstijl en zijn zittende beroep wat zich uit
in overgewicht (BMI 29) en verhoogde bloedglucose. Ook bij zijn collega’s is de betekenis van een
gezonde leefstijl niet echt bekend. Hij is opgegroeid in een Surinaamse omgeving, en daar hoort
lekker eten nou eenmaal bij! Hij heeft vaker geprobeerd om te gaan fitnessen, maar daarvoor kan hij
zich niet goed motiveren. 5 maanden geleden is hij daarom gestart met hardlopen, dit bevalt hem
zeer goed. “Ik ben al 6 kilo afgevallen en voel me fitter dan ooit!” Hij heeft zich zelfs samen met zijn
zoon ingeschreven voor de kwart marathon van Rotterdam. Hij is vaker bij de marathon gaan kijken
en hij had nooit gedacht dat hij daar zelf ook ooit een keer tussen zou lopen. “Mijn vrouw en
kinderen zullen echt super trots op mij zijn als ik daar loop!”.
Sinds 4 weken ervaart hij steeds meer pijnklachten rond zijn rechter achillespees tijdens het
hardlopen en hij is bang dat het ervoor gaat zorgen dat hij moeten stoppen met lopen. Hij zoekt
contact met de fysiotherapeut om ervoor te zorgen dat hij over 3 maanden de kwart marathon goed
kan uitlopen. Ondertussen heeft hij wel gewoon doorgetraind, want “ik wil niet alles weer
kwijtraken…het is bij mij een beetje alles of niets”. Hij heeft van een vriend gehoord dat een
fysiotherapeut hem goed had geholpen met een speciaal soort massage techniek: “diepe dwarse
fricties”. “Hij vertelde dat het erg pijnlijk was, maar dat hij na een paar behandelingen weer zonder
klachten kon hardlopen.”
Bij navraag vertelt Romeo dat hij al langere tijd stijfheid ervaart rond zijn achillespees de dag na het
hardlopen: “dat hoort er natuurlijk bij, ik ben ook de jongste niet meer”. Tijdens het hardlopen ging
het altijd heel goed, behalve in het begin deed het eventjes pijn. Maar de laatste tijd blijft die pijn dus
ook tijdens het hardlopen aanhouden en de dag erna heeft hij ook pijn tijdens bijvoorbeeld het lopen
van de trap.
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IBS-Curriculumcommissie maart 2020
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