Purpose

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:

1. Synthesize clinical knowledge, didactic learning and research findings to provide appropriate primary care to patients with common acute and stable chronic conditions. (WO3.2) (CO 1, 2, 4 & 5) 

Due Date:  

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). Week 8 discussion closes on Saturday at 11:59pm MT. 

Total Points Possible:  50 

Requirements: 

1. 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. Use shorthand where possible and approved medical abbreviations. Avoid redundancy and irrelevant information.
2. Provide a differential diagnosis (minimum of 3) which might explain the patient’s chief complaint along with a brief statement of pathophysiology for each.
3. Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis.
4. Rank the differential in order of most likely to least likely.
5. 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 medicine (EBM) 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 EBM evidence.

Case Study

Date of visit: October 20, 2017

A 19-year-old male freshman college student presents to the student health center today with complaints of bilateral eye discomfort. Upon further questioning you discover the following subjective information regarding the chief complaint.

Physical exam reveals the following.

 

**To see view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric.

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 EBM 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 EBM 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

SOLUTION

A 19-year-old male freshman college student presents to the student health center today with complaints of bilateral eye discomfort. Upon further questioning you discover the following subjective information regarding the chief complaint.

History of Present Illness
Onset	2-3 days ago
Location	Both eyes
Duration	Constant
Characteristics	Both eyes feel “gritty” with mild to moderate amount of discomfort. Further describes the gritty sensation “like sand caught in your eye”
Aggravating factors	None identified
Relieving factors	None identified
Treatments	Tried OTC visine drops once yesterday which temporarily improved the redness but the gritty sensation, tearing and itching remained.
Severity	Level of discomfort is 2/10 on pain scale
Review of Systems (ROS)
Constitutional	Denies fever, chills, or recent illnesses
Eyes	Denies contact lenses or glasses, has never experienced these symptoms previously. Last eye exam was “a few years ago”. Denies eye injury, trauma, visual changes or dryness. Denies crusting of lids or mucoid or purulent drainage. Bilateral symptoms of +redness, +itching, +tearing + FB sensation.
Ears	-otalgia, -otorrhea
Nose	+occasional runny nose with intermittent nasal congestion, denies sneezing. History of seasonal nasal allergies which is aggravated in the spring but is well controlled on loratadine and fluticasone nasal spray taken during peak season (he is not taking either right now).
Throat	Denies ST and redness
Neck	Denies lymph node tenderness or swelling
Chest	Denies cough, SOB and wheezing
Heart	Denies chest pain
History
Medications	Loratadine 10mg daily and fluticasone nasal spray daily (only takes during the spring months when nasal allergies flare)
PMH	Seasonal allergic rhinitis with springtime triggers
PSH	None
Allergies	None
Social	Freshman student at the University of Awesome located in central Illinois. Home is in Phoenix.
Habits	Denies cigarettes +recreational marijuana use +drinks 3-6 beers per weekend
FH	Adopted, does not know biological parents history
Physical Exam
Constitutional	Young adult male in NAD, alert and oriented, cooperative
VS	Temp-97.9, P-68, R-16, BP 120/75, Height 6’0, Weight 195 pounds
Head	Normocephalic
Eyes	Visual Acuity 20/20 (uncorrected) OU. PERRL with white sclera bilaterally. Slight light sensitivity noted bilaterally. No crusting, lesions or masses on lids noted. Bilateral conjunctiva with diffuse redness and tearing but no mucoid or purulent drainage noted.e No visible FBs under lids or on cornea to gross examination. Fundiscopic examination: Discs flat with sharp margins. Vessels present in all quadrants without crossing defects. Retinal background has even color, no hemorrhages noted. Macula has even color.
Ears	Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender.
Nose	Nares patent. Nasal turbinates are pale and boggy with mild to moderate swelling. 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.
Cardiopulmonary	Heart S1 and S2 noted, no murmurs, noted. Lungs clear to auscultation bilaterally. Respirations unlabored.

 

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. Use shorthand where possible and approved medical abbreviations. Avoid redundancy and irrelevant information.

M.J is a nineteen yo male with a CC of each eye discomfort x two to three times. He identifies the discomfort of his as international body feeling in the eyes of his. PLEASE CLICK THE PURCHASE BUTTON TO ACCESS THE ENTIRE COPY AT $10

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