AAMC/Hartford Geriatrics Education Grant



Texas Tech University Health Sciences Center

School of Medicine

AAMC/Hartford Geriatrics Curriculum

MS I: Case #2

Robert and Maria Johnson are both 70. They live on the family cattle ranch near Ropesville. The ranch has been in the Johnson family for over a 100 years. Maria grew up nearby on her family’s ranch from a Spanish land grant. They have two married sons who live on the ranch with their families.

Robert has been less active for the past 5 years following a hip fracture when his jeep rolled during a snowstorm. He rarely rides now and relies more and more on reports from his sons on ranch activities. Maria has been cooking his favorite dishes but his appetitie is falling off and he has been losing weight. She says he has been less humorous and affectionate lately.

Last week his two sons offered to take over running the ranch and suggested he and Maria move into Lubbock to a senior living compound to be closer to medical care. Robert and Maria have been talking about this and don’t want to move. Maria would like her brother and his family to help run the ranch.

Medications: Atenolol 50mg qid started last month. Allergies: None. Smoking: 2 packs per day for 40 years. Etoh: 1-2 beers each night.

PAST MEDICAL HISTORY: Usual childhood illnesses. Medical: Hypertension X 4 years. Bronchitis each of the last 4 winters. Arthritis in hands. Surgical: Right hip pinned 1997. Spiral fracture left tibia age 40. Psychiatric: None.

FAMILY HISTORY: Father died age 80 of MI; mother died age 85 “of old age”. Brother 65 with hypertension; sister 68 with degenerative arthritis – hands, hips, knees. Two sons 45 and 50 in good health.

PERSONAL/SOCIAL HISTORY: Born in Ropesville at home. Education through 11th grade. Two years in U.S. Army in the Philippines. Married age 22. Enjoys hunting, fishing, taxidermy. Many hunting trophies displayed at home. Likes teaching his grandchildren how to rope. Attends the local Catholic church on rare occasions.

REVIEW OF SYSTEMS: Unremarkable except as above.

PHYSICAL EXAMINATION: Pleasant older man, appears fit but underweight. Occasional jokes, somewhat distracted. Height 6’ 2”; weight 170 lbs. Vital Signs: BP 160/95, heart rate 96 and regular, afebrile. Skin: Well-tanned. Scattered macular nevi, none suspicious. Nails with cigarette stains. HEENT: Thinning hair. Scalp normocephalic/atraumatic. Pupils constrict 2mm to 1mm, equally round and reactive to light and accommodation. Discs flat, without hemorrhages/exudates. TMs clear. Pharynx with mild erythema, no exudates. Neck: Supple, without thyromegaly. LN: No lymphadenopathy. Lungs: Hyperresonant. Distant breath sounds. Scattered wheezes on forced expiration. CV: JVP 6 cm above right atrium; carotid upstrokes brisk, no bruits. PMI slightly sustained, 5th intercostal space, 8 cm lateral to midsternal line. Distant S1/S2. No murmurs or extra sounds. Abd: Active bowel sounds. Soft, non-tender. No hepatosplenomegaly. No masses. No femoral or abdominal bruits. Rectal: Rectal vault without masses. Stool brown and guaiac negative. Exts: no edema. Neuro: Oriented x3. Cranial Nerves II-XII intact. Motor: strength 5/5 throughout. Gait antalgic with limp on the right. Sensory: pinprick intact. Reflexes: 2+ and symmetrical with toes downgoing.

Texas Tech University Health Sciences Center

School of Medicine

AAMC/Hartford Geriatrics Curriculum

MS I: Case #3

Mrs. Connolly is a 72-year-old retired teacher and lives alone in a three-bedroom two-story home that she has occupied for the past 40 years. Her husband of 45 years died approximately 5 years ago. They had no children. This is her first visit to a physician in several years and she is here on the advice of a friend. She explains that she no longer has any energy. Although active in several church and civic groups in the past, she no longer participates in these activities. She complains that food no longer tastes good and that she has frequent episodes of constipation. She has not had general blood work for several years. She has had cholesterol, blood pressure, and blood sugar screenings at the mall, which were all normal. She had a mammogram at age 45, which was normal. She states that she has not had a reason to have one again-she has never felt a lump in her breast, and they are too expensive.

Medications: Premarin 0.65mg was discontinued three years ago, over the counter antihistamines, Ginseng/gingko herbal supplement. Allergies: Sulfa causes rash. Smoking: 1 ppd x 30 years. Etoh: 1-2 cocktails each evening since her husband died.

PAST MEDICAL HISTORY: Childhood – Usual childhood illnesses. Medical: Frequent bronchitis. Surgical: Hysterectomy age 48; appendectomy at age 40. NO history of fractures. Psychiatric: Depression when her husband died.

FAMILY HISTORY: Father died age 55, cause unknown. Mother died age 68 from pneumonia. One sister died age 42 from breast cancer, one brother is in good general health.

PERSONAL AND SOCIAL HISTORY: Born and has always lived in Lubbock. College graduate. Shops and cooks for herself. Drives a car. Fixed income—primary source is social security and limited savings. Enjoys reading to her two grandchildren and painting ceramics. Attends church on occasion.

REVIEW OF SYSTEMS: Unremarkable except for HPI.

PHYSICAL EXAMINATION: Pleasant, well-groomed, thin; appears fatigued. Eye contact limited. Anthropometrics: Ht: 5’6”. Current wt: 110 lbs. Wt 6 months ago: 125 lbs. Usual wt: 140 lbs.

Vital signs: BP 150/80. HR 82, regular. RR 18. Afebrile. Skin: Cool to touch, scattered bruises on arms and legs. Skull normocephalic/atraumatic. Temporal muscle wasting. Pupils constrict 3 mm to 2mm, ERRLA. Tympanic membranes clear. Pharynx with mild erythema. No sores on oral mucosa, some tenderness over bridgework. Several loose teeth. Neck: Supple, without thyromegaly. LN: No lymphadenopathy. Lungs: Resonant and clear. CV: JVP 6 cm above right atrium; carotid upstrokes brisk, no bruits. PMI tapping, non-displaced. Good S1/S2. No murmurs, S3; S4 present. Abdomen: Well healed surgical scars. Bowel sounds active. Abdomen soft, nontender, no hepatosplenomegaly. No masses. Extremities: Muscle wasting, bruising on arms and legs. No lesions or sores. No edema. Rectal: Rectal vault without masses. Stool brown, hard; guaiac negative. Neurologic: Mental status: Oriented to person, place, time. Recalls 3/3 objects after 5 minutes. Counts backward by seven without error. Motor: Strength 5/5. Decreased muscle bulk. Sensory: Pinprick intact to toes. Reflexes: 2+ and symmetrical, toes downgoing (Babinski-negative).

Case 3, page 2

Diet History:

At physician’s request, Mrs. Connolly reported the following 24-hour recall of food intake. She reports that this is a very typical day for her.

|Time |Location |Food |Quantity |

|9:00 a.m, |Home |White toast |2 slices |

| | |Jelly |2 tbsp. |

| | |Hot tea |2 cups, plain |

|11:00 a.m. |Home |Glazed doughnut |1 whole |

| | | | |

|1:00 p.m. |Home |Campbell’s chicken and rice soup|1 cup |

| | |Saltine crackers |6 |

| | |Hot tea |1 cup, plain |

| | |Butter cookies |2 |

| | | | |

|3:30 p.m. |Home |Pound cake |1 slice |

| | | | |

|6:00 p.m. |Home |White bread |1 slice |

| | |Peanut butter |2 tbsp. |

| | |Jelly |2 tbsp. |

| | |Butter cookies |2 |

INITIAL DISCUSSION QUESTIONS

1. What additional clinical history would be helpful?

2. What are your initial impressions?

3. What further evaluation might be helpful?

4. What is this patient’s Body Mass Index (BMI)? Is it adequate?

|Developing Focused Questions: End of Session I |

| |

|• Each student should develop one focused question at the end of Session I. |

|• Focused questions should include both basic science and clinical issues. |

|• Should entail 1-3 hours of searching relevant evidence - medical librarians |

|available to help. |

|• Results of your search should be orally presented to group during Session II. |

|Maximum length for your presentation - 3-4 minutes. |

Case 3, page 3

For Small Group Leaders Only: Each student should identify a focused question by

the end of Session I. Your primary role will be in ensure that the question is narrow

enough to be answered within a one to three hour literature search. Below are some

suggested questions in case the students have trouble identifying questions they want to

answer.

POSSIBLE STUDENT FOCUSED QUESTIONS:

Basic Science

• What is the biochemical link between albumin and nutritional status?

• What is the biochemical link between Hg and Hct and nutritional status?

• What are the links between nutrition and depression?

• What immune functions are linked to nutrition that affect wound healing? Explain

their biochemistry.

• What nutritional factors affect dentition?

• What biochemical changes affect clotting factors and bruising?

• What are the biochemical effects of vitamin A; D; C; E; calcium; magnesium, etc. Pick

one and describe in detail.

Clinical Medicine

• What factors or conditions could explain her poor appetite? Pick one to investigate.

• What clinical findings reflect poor nutrition?

• How does the patient’s diet compare to recommendations for her age? What

is deficient or limited? What needs to be added or replaced?

• What are fluid needs in 24 hours? How does the body metabolize fluid intake?

• What are the links between diet and constipation? Colon cancer?

• What are the risk factors for poor nutrition in the elderly?

• What nutrition services are available in Lubbock?

• What are recommended guidelines for physicians giving nutrition education?

What educational follow-up is needed?

• Risk factors for breast cancer?

• Indications for mammograms, including sensitivity and specificity?

N:\Case Module 6:GA 2/6/01

Texas Tech University Health Sciences Center

School of Medicine

AAMC/Hartford Geriatrics Curriculum

MS II: Case #4 *

Diane Linton is a 62 year old real estate agent who comes to your office for her annual physical examination. She is in excellent health except for fibrocystic breast disease and one prior breast biopsy at age 45 which was benign. She has found a small lump near the left axilla. She drinks decaffeinated coffee and soft drinks. She exercises sporadically and eats out frequently. She often has fast foods for lunch. Her last mammogram was two years ago. She checks her breasts on occasion.

Medications: Vitamins, Tylenol and Motrin prn headaches. Allergies: None. Smoking: In college, also tried marijuana. Etoh: 1-2 glasses of wine and a martini in the evening.

PAST MEDICAL HISTORY: Childhood: Tonsillectomy age 9. Medical: As above. Seasonal allergies. Surgical: Breast biopsy age 45 following abnormal mammogram -- showed fibrocystic breast disease. OB/GYN: G0P0. Infertility work-up at age 38 unremarkable except husband had low sperm count. Has never taken birth control pills or hormone replacement therapy. Psychiatric: None.

FAMILY HISTORY: Mother had breast cancer age 42, died age 45. Father in good health. Brother 40 in good health. Sister 55 with fibrocystic breast disease. Maternal aunt died of breast cancer at age 49. Grandparents died of old age.

PERSONAL/SOCIAL HISTORY: Born in Galveston. College graduate – degree in business. Husband also in real estate. She enjoys fishing and hiking.

REVIEW OF SYSTEMS: Unremarkable except as above.

PHYSICAL EXAMINATION: Pleasant older woman, appears healthy. Neatly groomed. Seems sad and worried. Vital Signs: 120/80, HR 80 and regular, RR 16, Temp. 98.6. Skin: No suspicious nevi. HEENT: Normocephalic/atraumatic. Pupils constrict from 3 mm to 2 mm, equally round and reactive to light and accommodation. Discs flat, without hemorrhages/exudates. TMs clear. Pharynx negative. Neck: Supple, no thyromegaly. No lymphadenopathy. Breasts: Symmetric, no nipple discharge. 1-2 cm firm nodule left breast at 2 o’clock, movable. Minor fibrocystic changes bilaterally. Lungs: Clear. CV: JVP 6 cm above right atrium; carotid upstrokes brisk, no bruits. PMI tapping, non-displaced. Good S1/S2. No murmurs or S3. Abd: Active bowel sounds. Soft, non tender. No hepatosplenomegaly. No masses. Pelvic: Deferred. Peripheral vascular: Pulses 2+ throughout. Extremities: warm and without edema. Neuro: Oriented x3. CrN II – XII intact. Motor: strength 5/5. Sensory: pinprick intact to toes. Reflexes: 2+ and symmetric, toes downgoing.

*Adapted from CATCHUM Project, National Cancer Institute see http:// catchum.utmb.edu

Case # 4 Page 2

INITIAL DISCUSSION QUESTIONS

1. What additional clinical history would be helpful?

2. What are your initial impressions?

3. What lab studies might be helpful?

|Developing Focused Questions: End of Session I |

| |

|Each student should develop one focused question at the end of Session I. |

|Focused questions should include both basic science and clinical issues. |

|Should entail 1-3 hours of searching relevant evidence - medical librarians available to help. |

|Results of your search should be orally presented to group during Session II. Maximum length for your presentation - 3-4 |

|minutes. |

Resources:

1. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services,

2nd ed. Baltimore, Md.: Williams & Wilkins, 1996.



2. Bickley L, Hoekelman R, eds. Bates’ Guide to Physical Examination and History

Taking, 7th ed. Philadelphia, Pa.: Lippincott, 1999.

3. Woolf S, Jonas S, Lawrence R. Healthy Promotion and Disease Prevention in

Clinical Practice. Baltimore, Md.: Williams and Wilkins, 1996.

4. Murphy G, Lawrence W Jr., Lenhard RE Jr. American Cancer Society Textbook

of Clinical Oncology, 2nd ed. Atlanta, Ga.: American Cancer Society, 1995.

5. Physicians Oncology Education Program. Cancer Resources for Education

(CARE) Box. Austin, Tx.: Texas Medical Association.

6. Boyer K, Ford M, Judkurs A, Levin B. Primary Care Oncology. Philadelphia, Pa.:

Saunders. 1999.

Case #4 Page 3

For Small Group Leaders Only: Each student should identify a focused question by

the end of Session I. Your primary role will be in ensure that the question is narrow

enough to be answered within a one to three hour literature search. Below are some

suggested questions in case the students have trouble identifying questions they want to

answer.

POSSIBLE STUDENT FOCUSED QUESTIONS:

Basic Science

1. At the cellular level, is breast cancer one disease or several diseases?

2. What molecular factors turn on breast cancer cell proliferation?

3. At the molecular and cellular levels, what are the actions of tamoxiphen?

4. What pathologic features distinguish fibrocystic changes from malignancy? Are there other grades of biopsy findings that would be worrisome?

Clinical

1. What are the risk factors for breast cancer? Which are the most worrisome?

2. What are the guidelines for frequency of mammograms? What is the sensitivity and specificity of mammograms for detecting breast cancer?

3. How useful is the self-breast exam (SBE)? How should you instruct patients to do this exam?

4. What about the clinical breast exam (CBE)?

5. What are the effects of alcohol and caffeine on breast disease?

6. What findings on mammogram are suspicious? What findings are diagnostic?

7. Treatment and its effectiveness for:

i. Ductal carcinoma in situ

ii. Local invasive disease

iii. Invasive disease with lymph node involvement

iv. Invasive disease with metastatic involvement

8. Ethics: ordering BRAC I or BRAC 2 testing; insurance company confidentiality.

9. Emotional support measures; effect of depression on treatment outcome.

N:\Case Module 4:GA 1/8/01

Texas Tech University Health Sciences Center

School of Medicine

AAMC/Hartford Geriatrics Curriculum

MS II: Case #5*

Mrs. Maria Garcia is a 64 year old teacher referred to your office by the Emergency Room for evaluation and treatment of anemia. In the Emergency Room she had presented with a 4 day history of fever, productive cough, sinus congestion, and malaise, and was given an antibiotic. Her HCT was 22 (normal 36-45) with an MCV of 71 (normal 80-98 fL) and RDW of 20 (normal 11-14).

She has been well until 2 to 3 months ago when she began to feel tired. Even light housework makes her short of breath, light-headed, with pounding of her heart. Her appetite has been good but she has lost a few pounds. Her diet is mainly hamburgers, beef, and pork. She eats cooked vegetables on occasion, but does not like fresh vegetables. She denies any nausea, vomiting, abdominal pain, or change in bowel habits or urination.

Medications: None. Allergies: None. Smoking: None. Etoh: Beer on occasion.

PAST MEDICAL HISTORY: Medical: See HPI. Also had iron deficiency anemia 1987 attributed to heavy menses. Surgical: Hysterectomy 1987 for fibroid uterus; required transfusion. Discharged on iron pills. Ob/Gyn: G3P2 Menarche age 12. Psychiatric: None.

FAMILY HISTORY: Father 85 with hypertension x 20 years; had surgery for colon cancer age 52. Mother 84 and healthy. One brother with hypertension.

PERSONAL/SOCIAL HISTORY: Born in Laredo, Texas. BA in Education. Married age 24. Husband is retired policeman. Enjoys home crafts and travel. Children all in the Lubbock are.

REVIEW OF SYSTEMS: Unremarkable except as above.

PHYSICAL EXAMINATION: Pleasant older Hispanic woman, appears slightly overweight at 163 lbs. Height 5’5”. Vital Signs: 110/70, heart rate 86 and regular, afebrile. Skin: No suspicious nevi. Nails without clubbing, cyanosis. HEENT: Normocephalic/atraumatic. Pupils constrict 4 mm to 2 mm, equally round and reactive to light and accommodation. Discs flat, without hemorrhages/exudates. TMs clear. Pharynx negative. Neck: Supple, without thyromegaly. LN: No lymphadenopathy. Breasts: Fibrocystic changes, no masses. Lungs: Resonant and clear. CV: JVP 6 cm above right atrium; carotid upstrokes brisk, no bruits. PMI tapping, 5th intercostal space, 8 cm lateral to midsternal line. I/VI systolic ejection murmur at LLSB. No S3/S4. Abd: Active bowel sounds. Soft, non tender. No hepatosplenomegaly. No masses. Pelvic: Vaginal mucosa pink. Absent uterus and adnexa. Rectal: Rectal vault without masses. Stool brown, 2+ guaiac positive. Exts: no edema. Neuro: intact.

*Adapted from CATCHUM Project, National Cancer Institute see http:// catchum.utmb.edu

Case # 5 Page 2

INITIAL DISCUSSION QUESTIONS

1. What additional clinical history would be helpful?

2. What are your initial impressions?

3. What further evaluation might be helpful?

|Developing Focused Questions: End of Session I |

| |

|Each student should develop one focused question at the end of Session I. |

|Focused questions should include both basic science and clinical issues. |

|Should entail 1-3 hours of searching relevant evidence - medical librarians available to help. |

|Results of your search should be orally presented to group during Session II. Maximum length for your presentation - 3-4 |

|minutes. |

Resources:

1. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services,

2nd ed. Baltimore, Md.: Williams & Wilkins, 1996.



2. Bickley L, Hoekelman R, eds. Bates’ Guide to Physical Examination and History

Taking, 7th ed. Philadelphia, Pa.: Lippincott, 1999.

3. Woolf S, Jonas S, Lawrence R. Healthy Promotion and Disease Prevention in

Clinical Practice. Baltimore, Md.: Williams and Wilkins, 1996.

4. Murphy G, Lawrence W Jr., Lenhard RE Jr. American Cancer Society Textbook

of Clinical Oncology, 2nd ed. Atlanta, Ga.: American Cancer Society, 1995.

5. National Cancer Institute Web site:

6. American Cancer Society Web site:

Case # 5 Page 3

For Small Group Leaders Only: Each student should identify a focused question by

the end of Session I. Your primary role will be in ensure that the question is narrow

enough to be answered within a one to three hour literature search. Below are some

suggested questions in case the students have trouble identifying questions they want to

answer.

POSSIBLE STUDENT FOCUSED QUESTIONS:

Basic Science

1. What are the genetics of colon cancer?

2. What molecular mechanisms lead to colon cancer cell proliferation?

3. What bone marrow signals allow response to anemia? What membrane signals change red cell width and distribution? How is iron incorporated into the heme molecule?

4. What postulated cellular mechanisms linked to increased fat and folate intake reduce risk of colorectal cancer?

Clinical

1. Identify the patient’s risk factors for colorectal cancer. Pick one and assess the strength of the evidence supporting this characteristic as a risk factor.

2. The prevalence of iron deficiency anemia in pre and postmenopausal women.

3. Sensitivity/specificity of stool guaiacs; of flexible sigmoidoscopy.

4. Colonoscopy vs barium enema.

5. Location, staging of colorectal cancer; role of CT scan.

6. Treatments for colorectal cancer; risks/benefits.

7. Significance of colonic polyps.

8. Ethics of genetic testing and disclosure.

9. Ethics of clinical trials for radiation/chemo.

N:\Case Module 5:GA 1/8/01

Texas Tech University Health Sciences Center

School of Medicine

AAMC/Hartford Geriatrics Curriculum

MS II: Case #6*

Pastor Blackburn is a 60 year old minister who comes to your office for routine follow-up for hypertension, diabetes, and coronary artery disease. He has followed advice about diet and medications and states he is feeling well except for recent problems with frequent urination. He is urinating almost hourly during the day, and up to four times during the night. He has no fever and no burning with urination. He has no difficulties with sexual activity. Bowel movements are regular.

Medications: NPH Insulin 20 units and Regular 10 units before breakfast and before dinner, ASA 325mg qd, Altace 10mg qd, Saw Palmetto one tablet three times a day, Vitamin E. Allergies: None. Smoking: None. Etoh: 1-2 cans of beer a day; occasional glass of wine with dinner.

PAST MEDICAL HISTORY: Childhood – No scarlet fever or rheumatic fever. Medical: Hypertension for 14 yrs. Diabetes for 6 yrs. Surgical: Angina then coronary bypass x 1 vessel age 52. Psychiatric: Depression following bypass surgery for 6 months.

FAMILY HISTORY: Father died age 68 of MI. Mother died age 55 due to gangrene from diabetes. Brother age 68 with prostate surgery.

PERSONAL/SOCIAL HISTORY: Born in Waco, Texas. Degree from SMU. Married for 31 years; 3 grown children. Maintains active schedule. Enjoys golf and Western history. Walks 1 mile a day.

REVIEW OF SYSTEMS: Unremarkable.

PHYSICAL EXAMINATION: Rev. Blackburn is a pleasant moderately obese older black male, who appears relatively fit. Vital signs: BP 155/92, HR 78 with occasional skipped beats, afebrile. Skin: No suspicious nevi. HEENT: Normocephalic/atraumatic: Pupils constrict 4 mm to 2 mm, equally round and reactive to light and accommodation. Optic discs with sharp margins; 1+ arteriolar narrowing. TMs clear. Pharynx without exudates. Neck: Supple, no thyromegaly. LN: No lymphadenopathy. Lungs: Resonant and clear. CV: JVP 6 cm above right atrium; carotid upstrokes brisk, without bruits. PMI slightly sustained in 5th intercostal space, 10 cm lateral to midsternal line. Good S1/S2. S4 present. No murmurs or S3. Abdomen: Obese. Active bowel sounds. Soft, non-tender. No hepatosplenomegaly. No masses. Genitourinary: Testes descended bilaterally; no penile lesions or discharge. Rectal: Rectal vault without masses; stool brown and guaiac negative. Prostate nontender; right and left lobes moderately enlarged. One centimeter nodule on right lobe, no palpable direct or indirect inguinal hernia. Extremities: warm and without edema. Peripheral Vascular: No femoral/abdominal/inguinal bruits. Pedal pulses 1+ and symmetrical. Neurologic: Oriented x3. Motor: Strength 5/5. Good bulk and tone. Sensory: Pinprick intact to toes. Reflexes: 2+ and symmetrical, toes downgoing.

*Adapted from CATCHUM Project: National Cancer Institute see http:// catchum.utmb.edu

Case# 6 Page 2

INITIAL DISCUSSION QUESTIONS

1. What additional clinical history would be helpful?

2. What are your initial impressions?

3. What further evaluation might be helpful?

|Developing Focused Questions: End of Session I |

| |

|Each student should develop one focused question at the end of Session I. |

|Focused questions should include both basic science and clinical issues. |

|Should entail 1-3 hours of searching relevant evidence - medical librarians available to help. |

|Results of your search should be orally presented to group during Session II. Maximum length for your presentation - 3- 4 |

|minutes. |

Resources:

1. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2nd

ed. Baltimore, Md.: Williams & Wilkins, 1996.



2. Bickley L, Hoekelman R, eds. Bates’ Guide to Physical Examination and History

Taking, 7th ed. Philadelphia, Pa.: Lippincott, 1999.

3. Woolf S, Jonas S, Lawrence R. Healthy Promotion and Disease Prevention in

Clinical Practice. Baltimore, Md.: Williams and Wilkins, 1996.

4. Murphy G, Lawrence W Jr., Lenhard RE Jr. American Cancer Society Textbook

of Clinical Oncology, 2nd ed. Atlanta, Ga.: American Cancer Society, 1995.

Case # 6 Page 3

For Small Group Leaders Only: Each student should identify a focused question by

the end of Session I. Your primary role will be in ensure that the question is narrow

enough to be answered within a one to three hour literature search. Below are some

suggested questions in case the students have trouble identifying questions they want to

answer.

POSSIBLE STUDENT FOCUSED QUESTIONS:

Basic Science

What is the neuroanatomy of bladder function? Of male sexual function?

What cellular changes occur in benign prostatic hyperplasia (BPH)?

What are the genetics of prostate cancer?

What is the neurochemistry of autonomic dysfunction in diabetic neuropathy?

What molecular signals control prostate cancer cell proliferation? Why is proliferation so slow compared to other malignancies?

Clinical Medicine

What is the differential diagnosis of urinary frequency? Pick one and

describe in detail.

How effective are screening questions for BPH? For prostate cancer?

What are the risk factors for prostate cancer? Pick one and describe its sensitivity, specificity, prevalence, and other characteristics.

How useful is the prostate specific antigen (PSA)?

How useful are alternative therapies?

How sensitive is the digital exam of the prostate for prostate CA? the prostate ultrasound?

What are the indications for prostate biopsy?

What are the risks for recurrence of depression?

What are the risks and benefits of prostate surgery?

N:\Case Module 6:GA 1/8/01

8/13/01

TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER

School of Medicine

AAMC/Hartford Geriatrics Curriculum

MSIII: Case #7

HISTORY OF PRESENT ILLNESS: RG is a 74 year-old widowed cotton farmer who comes to your office because he recently had a free prostate-specific antigen (PSA) blood test performed at a community hospital during Prostate Cancer Awareness Week on the advice of his daughter. His PSA test result is 3.7 ng/ml (normal ................
................

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