HO 1: Case presentation

● Read: case presentation

● Define unknown terms
● Define Symptoms
○ (eg. Grading of fever? What layer must be involved to be considered an ulcer?)
● Identify Pertinent information and explain why they are important
● Ask: Pertinent questions to ask about the history which may lead us to a diagnosis, explain the reason for asking. Start with:
○ HPI: OLD CARTS
○ General information
○ Past medical history
○ Personal social history
○ Family history
● Hypotheses: impression/ organ system that might be primarily involved: CNS, CVS, muscular, infectious, trauma, etc
● Pathophysio of primary sx
○ If you can explain with concept map, please do; makes the discussion easier to follow (eg. Fever in general + possible causes)
○ Doctors would appreciate it

HO 2: History/ Patient Profile

● Read: History
● Define unknown terms
● Pertinent info (+,-) in order, explain why it is pertinent
○ Positive: important in ruling in a ddx
○ Negative: important in ruling out a ddx
● Ask: other pertinent questions not answered which may lead us to a diagnosis, explain the reason for asking
You can opt to do this per paragraph or as one whole lump of history

HO 2: History of Present Illness

● Read: HPI
● Define unknown terms
● Pertinent info (+,-) in order, explain why it is pertinent
○ Positive: important in ruling in a ddx
○ Negative: important in ruling out a ddx
● Ask: other pertinent questions not answered
○ OLD CARTS
○ And other impt questions

● Hypothesis: give working diagnosis and at least 2 differentials (rank in order)

○ Reasons based on hx, ssx, incidence in Cebu
○ What other hx questions to ask to cinch the diagnosis
○ Give possible PE findings for each ddx

HO 3: PE

● Read: PE
● Define unknown terms
○ Describe special maneuvers
○ What is positive for that test
● Pertinent info (+,-) in order, explain why it is pertinent
○ To rule in or rule out ddx
● Ask: other pertinent PE not done
● Hypothesis: rerank working diagnosis based on new information
○ Make table to compare ssx for each ddx
■ Makes it cleaner and easier to understand similarities and differences bw differentials
■ Doctors also like it when we make tables
○ Cross out unlikely dx
■ Some doctors wouldn’t want us to cross them out completely but just put them lower in the ranking
○ Give possible LAB work up
■ How would said labs help in ruling in or out certain dxx
■ Anticipated findings for each ddx
■ Definitive and supportive labs
■ Specificity and accuracy
■ Cost-benefit: if px doesn't have enough funds for all requested labs, which ones would be the most important to get?

HO 4: LabsHO 4: Labs

● Read and interpret labs

○ Describe any new lab test mentioned
○ Describe how they are obtained/ any special methods to take note
■ (eg. Blood culture - at 2 separate sites, taken simultaneously, before any antibiotic intake)
○ Always describe normal values
● Pertinent info (+,-) in order, explain why it is pertinent
● Ask: other labs not done
○ Sometimes they leave out some labs for discussion

KJTG, JQSM 2022

 ● Hypothesis: as a grp decide on PRIMARY IMPRESSION
○ Don’t give the answer right away
○ Debate which dx should be the primary impression
■ Based on hx, PE, labs
■ Give reasons that makes the differentials more or least likely
■ Doctors like it when we debate this part out because it shows them our critical thinking skills
● EXPLAIN the dx
○ Review: normal anatomy/physiology of organ related to dx
○ Pathophysio of dx
■ Some doctors may ask the group to explain how the Dx brings about each pertinent symptom in the PE and how it
causes each abnormal lab result
● Eg. How does typhoid fever lead to increased ALT/AST?
■ reference: Harrison’s & Robbins
○ Microbiological agent
■ Reference: Jawetz
● What will be your MANAGEMENT?
○ Pharmacologic treatment
■ Start with first line drugs
■ MOA, contraindications, when to use
○ Non-pharmacologic treatment
○ Monitoring and follow-up
○ Prevention
○ Patient Education

HO 5: Patient Outcome

● Discuss management
● Would you agree with how the patient was managed?
○ If not, give alternative mgt
● Discuss: other management not mentioned
○ Follow up labs, consult
● Summarize case

HO 6: Mini Cases

● Pertinent info (+,-) in order, explain why it is pertinent

○ Positive: important in ruling in a ddx
○ Negative: important in ruling out a ddx
● Ddx and primary impression
● Labs usually given
● Management
● Answer other questions, if present

KJTG, JQSM 2022