11/05/2006

Group 8 Room 397

Read and interpret history: Matthew

Read and interpret Physical exam: Austine

Read and interpret Lab: Franki

Summarize the case: Linda

1. Define the following terms:  (Angina, Radiation, Apical Heart rate, S2, S4, R2ICS, Apex, Indirect Hernia)   Sara

2. Cite the primary clinical problem (not the diagnosis)  Jennifer

3. Develop a general differential diagnosis of this clinical problem using categories of disease. Cite examples from each:  Mariana

4. In general, what factors (data) would you take into consideration in determining a differential diagnosis of specific diagnosis:  Kevin

5. Develop a specific differential diagnosis (higher probability causes of chest pain in this patient).  Justin

6. What is your diagnosis: Why?  Michael

7. Describe the Coronary arterial system.  Justin

8. How is blood flow (oxygen supply) to myocardium  regulated and accomplished?  Matthew

 9. What is the patho-physiology of Myocardial ischemia?  Austine

10. What are the risk factors for this disease in this patient?  Franki

11.What is the significance of determining levels of low density (LDL) and high density (HDL)  lipoproteins in a patient with increased cholesterol ?  Linda            

We are now ready for a diagnostic strategy

The development of a diagnostic strategy depends on the characteristics of the diagnostic tools that are used and the characteristics of the patient. The history, physical, laboratory studies, and supplemental tests all provide information that may enable the physician to reach a diagnosis. The operating characteristics of historical data, data from the physical exam, and further testing are described by the terms sensitivity, specificity, probability (pre and post) and positive and negative likelihood ratio.

12. Define these terms  Sara

13. In considering Mr. Solomon’s presentation with "pain on my chest" what are the key parts of the history and physical that influence how you develop a differential diagnosis? Qualitatively, what is your impression of the sensitivity and specificity of the historical and physical exam findings?  Calculate the post test probability of Angina for this patient. Jennifer

14  What are the options available for us to confirm a diagnosis of Angina?  Mariana

15. What supplemental testing, if any, would you want in addition to the history, physical, and laboratory studies that are listed? Kevin

16. What are the pathological conditions that can give rise to angina? Nathaniel

17. The characteristics of a patient determine how one interprets data obtained from that person. For example, a positive HIV test on a cloistered nun who has never had any sexual contact, blood exposure or other risk is almost certainly a false positive. In Mr. Solomon’s case, what characteristics, or risk factors, make you think it is likely that he has the diagnosis you consider most likely.  Given these characteristics, is there any point in supplemental diagnostic testing for Mr. Solomon? Would you believe a negative or positive test? Should be proceed directly to the "gold standard"?.  Michael

18. What drug therapy would you consider prescribing to control his symptoms?  Nathaniel

19. What would you consider to modify Mr. Solomon’s risk factors ?  Matthew

20. What drug therapy would you consider to prevent further progression of obstruction to Coronary arteries ?  Austine

21. What options do we have to relieve mechanical obstruction of Coronary arteries ? Franki