This handout is available in Word and PDF formats.
After reviewing the handout, please read the following case and answer the questions below:
Case 1: Mr. Robert Durrett (first presentation)
Summary: 85 yo with joint pain everywhere
Mr. Durrett is a Korean War veteran who is underwent aortic valve replacement for critical aortic stenosis three days ago. Yesterday, he was extubated and transferred to the inpatient ward unit, having done well in the immediate postoperative period. He is on morphine for post operative pain. This morning, he was noted to have a fever of 101 degrees and he complained of terrible joint pain in his wrists and knees as well as bilateral foot pain. He denies other complaints.
PMHx: Hypertension, Diabetes, chronic renal insufficiency, dyslipidemia
SHx: Korean war veteran, lives with his wife of 60 years
Outpatient Medications: Insulin, Zestril, Aspirin, simvastatin
Inpatient medications: heparin, post operative antibiotic prophylaxis
ROS: otherwise negative
PE: Uncomfortable African American man with new mid sternal scar, mildly diaphoretic
BP: 170/110
HR: 112, regular
T: 100.9 F
Alert and oriented to person, place and situation. Does not recall the date
Lungs: faint bibasilar crackles
Cor: JVP is flat, PMI is laterally displaced S1 and S2 are soft. No murmur is audible
Abdomen: obese and non tender with no organomegaly
Extremities: bilateral wrists, knees are warm, tender, boggy and have limited range of motion due to pain. They appear slightly erythematous. Across both insteps, redness, warmth and tender spots are present.
Neurologic exam is limited because of the pain in the joints but it appears to be grossly intact.
Simple Problem List
Write a simple problem list for Mr. Durrett. This list should include at least 10 items.
0
points:
No answer
5
points: Fewer than 10 items included OR at least 10 items included, but some or all do not accurately
describe Mr. Durrett's case
10
points: At least 10 items included that accurately describe Mr. Durrett's case
Processed Problem List
Write a Processed Problem List for Mr. Durrett, making sure to include Epidemiology, Time Course, Syndrome Description, and Other PMHx.
0
points:
No answer
4
points:
Epidemiology, Time Course, Syndrome Description and Other PMHx are all included.
8
points:
Epidemiology, Time Course, Syndrome Description and Other PMHx are all included AND at
least two of these four are consistent with the answers provided.
10
points:
Epidemiology, Time Course, Syndrome Description and Other PMHx are all included AND all
four are consistent with the answers provided.
Case Summary
Summarize this case in one sentence.
0
points:
No answer or answer that does not reflect the case
5
points: One sentence description of the case, which uses the details included above and is consistent
with the example given.
Tiered Differential Diagnoses
Five possible diagnoses for Mr. Durrett might be:
- Septic arthritis
- Rheumatoid arthritis
- Gout
- Pseudogout
- Endocarditis
Applying the concept of tiered differential diagnoses, classify these five diagnoses as being in Tier I, Tier Ie, Tier II, or Tier III. It is possible that a tier may include none of these diagnoses.
0
points:
None of the five diseases are in the correct tier
1
point: One of the five diseases is in the correct tier
2
points:
Two of the five diseases are in the correct tier
3
points:
Three of the five diseases are in the correct tier
4
points:
Four of the five diseases are in the correct tier
5
points:
All five of the five diseases are in the correct tier
Illness Script: Epidemiology
From the question on Tiered Differential Diagnoses, select one Tier I diagnosis, one Tier II diagnosis, and one Tier III diagnosis. Then, write the Epidemiology for each of these three diseases.
0
points:
No submission
1
point: Epidemiology is included for only one of the three diseases
2
points:
Epidemiology is included for only two of the three diseases
3
points:
Epidemiology is included for all three of the three diseases
4
points:
Epidemiology is included for all three diseases AND one out of three is consistent with the correct answers
provided
5
points:
Epidemiology is included for all three diseases AND two or three are consistent with the correct answers
provided
Illness Script: Time Course
From the question on Tiered Differential Diagnoses, select one Tier I diagnosis, one Tier II diagnosis, and one Tier III diagnosis. Then, write the Time Course for each of these three diseases.
0
points:
No submission
1
point: Time Course is included for only one of the three diseases
2
points:
Time Course is included for only two of the three diseases
3
points:
Time Course is included for all three of the three diseases
4
points:
Time Course is included for all three diseases AND one out of three is consistent with the correct answers
provided
5
points:
Time Course is included for all three diseases AND two or three are consistent with the correct answers
provided
Illness Script: Syndrome Statement
From the question on Tiered Differential Diagnoses, select one Tier I diagnosis, one Tier II diagnosis, and one Tier III diagnosis. Then, write the Syndrome Statement for each of these three diseases.
0
points:
No submission
1
point: Syndrome Statement is included for only one of the three diseases
2
points:
Syndrome Statement is included for only two of the three diseases
3
points:
Syndrome Statement is included for all three of the three diseases
4
points:
Syndrome Statement is included for all three diseases AND one out of three is consistent with the correct
answers provided
5
points:
Syndrome Statement is included for all three diseases AND two or three are consistent with the correct
answers provided
Illness Script: Mechanisms of Disease
From the question on Tiered Differential Diagnoses, select one Tier I diagnosis, one Tier II diagnosis, and one Tier III diagnosis. Then, write the Mechanisms of Disease for each of these three diseases.
0
points:
No submission
1
point: Mechanisms of Disease is included for only one of the three diseases
2
points:
Mechanisms of Disease is included for only two of the three diseases
3
points:
Mechanisms of Disease is included for all three of the three diseases
4
points:
Mechanisms of Disease is included for all three diseases AND one out of three is consistent with the
correct answers provided
5
points:
Mechanisms of Disease is included for all three diseases AND two or three are consistent with the correct
answers provided
