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Instructions for Completing Case Study Reports

Purpose of the Case Studies • Case Study Notebook • Ground Rules • Plagiarism
Step 1: Introducing the Patient • Step 2: The Patient Interview
Step 3: The Physical Examination • Step 4: Laboratory Tests

Purpose of the Case Studies

The case studies have been designed to provide a real world approach to studying pathophysiology. Instead of memorizing long lists of signs and symptoms associated with each disorder, the cases present you with patients who have come to the clinic because they aren't feeling well. Your job is to use what you are learning in class to solve the case.

Each case contains four steps: (1) an introduction to the patient and his/her symptoms, (2) an interview with the patient, (3) information from a physical examination, and (4) data from laboratory tests. Each step includes a series of follow-up questions that may be answered from information found in the case or in your lecture notes. The multiple-choice questions provide immediate feedback upon clicking on the answers. Some multiple-choice questions are linked to online tutorials where you can go for additional help. Answers to the open-ended questions can be emailed directly to me, or you may jot them down on a piece of paper to turn in with your case notebook.

Step 1: Introducing the Patient

The first step introduces you to the patient and provides a general description of his or her problem. You will be asked to use this basic information to formulate a hypothesis, or an educated guess about his or her condition. For example, imagine that Joe Blow has come to see you about his headaches. Remember, our bodies have only a limited response to disease, so the symptoms could match a variety of disorders. Mr. Blow's headaches could have several causes!

Each introduction includes some questions that ask you to think about what the patient has told you and come up with a list of possible causes for his or her problem. It's OK to guess here, just provide a rationale for what you are thinking.

Here are some sample follow-up questions and answers:

1. What could be causing Mr. Blow's headaches?
   "Mr. Blow's headaches could be caused by a variety of things, such as sinus pain, muscular tension, or stress. They could also be caused by something more serious, such as a tumor."
2. What kinds of questions would you ask Mr. Blow to get more information that would rule out some causes and support other ones?
   "I would rule out sinus headaches by asking Mr. Blow if his headaches occur over the sinuses and if they respond to sinus medicine. I could rule out stress by asking him if his headaches are related to job stress or other lifestyle problems such as alcohol consumption, caffeine, or food."

Step 2: The Patient Interview

The patient interview page gives you a chance to get the answers to some of the questions you developed. On this page, the questions have been organized into such categories as Pain, Lifestyle, or Sleep. Choose a category and then go on to the next box to choose a more specific question. For Joe Blow's headaches, you could choose Pain and then ask him more about his headaches, such as where does his head hurt and do the headaches respond to Tylenol or other painkillers. Once you have chosen your category and question, click on "Ask Joe" to get an answer.

There are many questions available for you to chose from, however, not all of them are appropriate for every case. You could spend a lot of time looking over all the questions and answers, but it would be much faster if you thought about Joe's symptoms and choose questions that are most likely to provided meaningful information.

After you have finished your interview, you will be asked to summarize the information you gathered and to predict what might be discovered during the upcoming physical examination.

Examples of follow-up questions:

1. Was Mr. Blow able to give you any helpful information? What was it?
   "Yes - Mr. Blow told me that these headaches always come with a change in the weather. His forehead hurts and sometimes Sine-Off helps."
2. What do you think is his problem? What information supports your answer?
   "I think Mr. Blow may have sinus headaches. His pain is located over the frontal sinus and a nasal decongestant seems to help. Changes in atmospheric pressure tend to make sinus headaches worse."

Step 3: The Physical Examination

The physical examination page presents the patient's vital signs and other information. Some of the measurements or results are linked to reference sites on the World Wide Web so that you can compare these values to the normal range. Other observations may be linked to a photograph on the Web so you can see what it looks like. Hopefully, your preliminary opinion is supported by the data on this page.

The Physical Examination questions ask you to relate these signs and symptoms to what you know about the pathogenesis of the disorder. Some of these questions may require you to refer to your notes.

Examples of follow-up questions for Mr. Blow:

1. Are any of Mr. Blow's vital signs outside the normal range? If so, what are they and what do they indicate? Do his vital signs rule out any causes of headache?
   "All of Mr. Blow's vital signs are within normal limits. His normal blood pressure rules out a dehydration headache."
2. Why was a neurological examination done on Mr. Blow? Are the results normal? What causes might or might not be ruled out?
   "A neurological examination was done to rule out a brain tumor. The results were normal, which rules out a tumor or other brain disorder."
3. Does the physical examination support or refute your opinion? Explain how.
   "I still think Mr. Blow is suffering from sinus headaches. The nasal congestion noted on the physical exam supports my opinion."
4. What laboratory tests might you request to support your opinion? Remember, laboratory testing is expensive, so please provide a rationale for your tests and predict the results.
   "An X-ray of Mr. Blow's sinuses would show if they were full.
   I would like to run a CBC (complete blood count) on Mr. Blow to see if his sinus headache is caused by an infection, which would be indicated by increased white cells. I could also culture some of his nasal secretions, but it would be cheaper just to count the white cells."

Step 4: Laboratory Tests

Laboratory tests are used to confirm a diagnosis. Hopefully, the results of the lab tests will match your request and follow your predictions. The questions on this page will ask you to interpret the lab values, decided upon a final answer and suggest treatment options. See Step 3 for examples. See Diagnostic and Laboratory Tests page for further information on specific tests.

Case Study Notebook -- 50 points

Throughout the quarter, we will practice using lecture material in a series of 5 real-world case studies. The case studies are presented on the World Wide Web and you will have time in class to work on them. Your progress though each case will be recorded in your case study notebook.

Each case study is worth 10 points and will be graded according to the following scale:

Ground Rules

1. Write your answers so that your grandmother can understand them. 1 point will be deducted from your final score for answers that are not written clearly for a lay audience.
2. Case notebooks are due one week after the case is assigned. Late case study notebooks are subject to a deduction of 1 pt for each week you are late.
3. Poor mechanics, such as grammar, spelling, and typos/illegible handwriting are subject to a 1 pt. deduction.
4. Uncited references (maximum 1 point). Here are some sample citations for your textbook and course notes, as well as a sample Internet citation:
   • Bullock, B. (1996). Pathophysiology: Adaptations and Alterations in Function. Philadelphia: Lippencott-Raven Publishers.
   • Titterington, L. C. (1999). Pathophysiology course notes. Columbus, OH: Columbus State Community College.
   • Miracle, Vickie A., Sims, Jennifer M. (1999). "Easy ECG series, part I: Making Sense of the 12-lead ECG." Nursing99 (July issue). Available online [http://www.springnet.com/ce/p907b.htm]. Accessed June 25, 2000.

100% will be deducted for plagiarism. This means that if you are caught copying from my notes, the textbook, or any other resource, then you will get a ZERO.