Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice. The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
- Demonstrate competence in the evaluation and management of common respiratory problems (WO 2.1) (CO,2,3,4,5)
- Distinguish between obstructive and restrictive lung disease (CO 2, 4) Develop a management plan for the case study patient based on identified primary, secondary and differential diagnoses. (WO 2.2) (CO 2,4)
- Interpret pulmonary function test results. (WO 2.3) (CO 2, 4)
Student enters initial post to part one by 11:59 p.m. MT on Tuesday; responds substantively to at least one topic-related post of a peer including evidence from appropriate sources AND all direct faculty questions in parts one by Sunday, 11:59 p.m. MT.
A 10% late penalty will be imposed for discussions posted after the deadline on Tuesday 11:59pm MT, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).
Total Points Possible: 50
Case Study – Part 1
Date of visit: November 20,2019
A 62 year-old Caucasian male presents to the office with persistent cough and recent onset of shortness of breath. Upon further questioning you discover the following subjective information regarding the chief complaint.
|History of Present Illness Onset 6 months Location Chest Duration Cough is intermittent but frequent, worse in the AM Characteristics Productive; whitish-yellow phlegm Aggravating factors Activity Relieving factors Rest Treatments Tried Robitussin DM without relief of symptoms Severity Unable to walk > 20ft without stopping to catch his breath. Last year at this time he routinely walked 1 mile per day without difficulty Review of Systems (ROS) Constitutional Denies fever, chills, or weight loss Ears Denies otalgia and otorrhea Nose Denies rhinorrhea, nasal congestion, sneezing or post nasal drip. Throat Denies ST and redness Neck Denies lymph node tenderness or swelling Chest Describes a persistent productive cough upon wakening for the last 6 months. Color of phlegm is usually white-yellowish. Shortness of breath with activity. Cardiovascular Denies chest pain and lower extremity edema|
|History Medications Metoprolol succinate ER (Toprol-XL) 50mg daily for hypertension; Multivitamin daily PMH Primary hypertension PSH Cholecystectomy, appendectomy Allergies Penicillin (hives) Social Married, 3 children Senior accountant at a risk management firm Habits Former smoker (20 pack-year), quit “cold turkey” when father died; Denies alcohol or illicit drug use. FH Father died of MI & CHF at age 59 years (diabetes, hypertension, smoker) Mother is alive (osteoporosis) Healthy siblings|
Physical exam reveals the following:
|Physical Exam Constitutional Adult male in NAD, alert and oriented, able to speak in full sentences VS Temp-98.1, P-66, RR-20, BP 156/94, Height 68.9in, Weight 258 pounds, O2sat 94% on RA Head Normocephalic Ears Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender. Nose Nares patent. Nasal turbinates clear without redness or edema. Nasal drainage is clear. Throat Oropharynx moist, no lesions or exudate. Tonsils ¼ bilaterally. Teeth in good repair, no cavities noted. Neck Neck supple. No lymphadenopathy. Thyroid midline, small and firm without palpable masses. No JVD Cardiopulmonary Heart S1 and S2 with no murmurs, noted. Lungs clear to auscultation bilaterally with faint forced expiratory wheezes in bilateral bases. Respirations unlabored. Legs without edema. Abdomen Soft, non-tender. No organomegaly|
- Briefly and concisely summarize the history and physical (H&P) findings as if you were presenting it to your preceptor using the pertinent facts from the case. May use approved medical abbreviations. Avoid redundancy and irrelevant information.
- Provide a differential diagnosis (minimum of 3) which might explain the patient’s chief complaint along with a brief statement (2-3 sentences) of pathophysiology for each.
- Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis.
- Rank the differential in order of most likely to least likely.
- Identify any additional tests and/or procedures that you feel is necessary or needed to help you narrow your differential. All testing decisions must be supported with an evidence-based practice (EBP) argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBP evidence.
|DISCUSSION CONTENT Category Points % Description Application of Course Knowledge 15 30% A brief AND concise summary of the history and physical (H&P) findings is presented without redundancy or irrelevant information; AND Three (3) appropriate diagnoses in the differential are presented which can explain the patient’s chief complaint; AND A brief statement of pathophysiology is included for each diagnosis; AND Each diagnosis in the differential is analyzed using pertinent positive and negative subjective and objective findings as support; AND The differential is ranked in order from most likely to least likely; AND Clinical reasoning skills are demonstrated by linking testing to diagnoses as applicable; AND Testing decisions are well supported with EBP arguments that are in-line with the clinical scenario and appropriate for the primary care setting (7 critical elements) Support from Evidence-Based Practice (EBP) 15 30% Discussion post is supported with appropriate, scholarly sources; AND Sources are published within the last 5 years (unless it is the most current CPG); AND Reference list is provided and in-text citations match; AND All testing decisions are fully supported with an appropriate EBP argument (4 critical elements) Interactive Dialogue 10 20% Student provides a substantive* response to at least one topic-related post of a peer; AND Evidence from appropriate scholarly sources are included; AND Reference list is provided and in-text citations match; AND Student responds to all direct faculty questions (*) A substantive post adds new content or insights to the discussion thread and information from student’s original post is not reused in peer or faculty response (4 critical elements) Total CONTENT Points= 40 pts DISCUSSION FORMAT Category Points % Description Organization 5 10% Case study response is presented in a logical format, AND Responses are in sequence with the numbered questions AND The case study response is understandable and easy to follow AND All responses are relevant to the case topic (4 critical elements) Grammar, Syntax, Spelling & Punctuation 5 10% Discussion post has minimal grammar, syntax, spelling, punctuation, or APA format errors* Total FORMAT Points= 10 pts DISCUSSION TOTAL= 50 pts|